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Executive Summary

This report analyzes first-attempt pass rates on the National Registry of Emergency Medical Technicians (NREMT) certification examinations for Florida's approved EMT and paramedic training programs across the 2023 through 2025 graduating cohorts, using certification data provided by the Florida Department of Health. Results are examined statewide, by Bureau of Emergency Medical Oversight (BEMO) region, and at the program level. The report concludes with evidence-based recommendations on initial training and continuing education.

Florida's EMT programs are performing at the national standard. In 2025, the state's 5,873 EMT candidates passed on their first attempt at 74.1%, statistically indistinguishable from the national average of 73.2%, and the statewide rate rose a significant 5.5 percentage points from 2023. The EMT level warrants continued monitoring rather than intervention.

The paramedic level is the report's central concern. Florida's 1,869 paramedic candidates passed at 63.4% in 2025, 9.5 percentage points below the national average of 72.9%. The shortfall is longstanding. Florida has trailed the rest of the nation in every comparable cohort since the state began requiring the National Registry examination in 2018 and pooled across those cohorts a Florida candidate had roughly half the odds of first-attempt success of a candidate trained elsewhere. Program retention is within one point of the national rate, so the deficit arises at the certification examination rather than in program completion. The 3.5-point gain recorded in 2025 is real, but a decade of stability in the high fifties and low sixties defines the problem as structural.

The shortfall is concentrated rather than diffuse. The Southeast region posts the lowest first-attempt rate at both certification levels while enrolling the largest candidate volume of any region. Three paramedic programs have passed fewer than half of their first-attempt candidates in every year with available data and together account for a disproportionate share of the state's first-attempt failures. Commercial ownership is independently associated with lower paramedic first-attempt success after adjustment for program size, and about 6% of eligible paramedic graduates never attempt the examination at all. This concentration is a policy asset: targeted effort directed at a small number of programs and one region can move the statewide figure more efficiently than uniform statewide effort. Improvement is demonstrably achievable within the existing program population, as several Florida programs posted statistically significant paramedic gains of roughly 29 to 32 percentage points over the study period under the same statutes, examination, and labor market as the programs that did not improve.

The report makes seven recommendations, framed to operate within the Department's existing program approval authority under Chapter 401, Florida Statutes. The Department should continue rolling multi-year, volume-aware performance metrics as the trigger for structured review and should establish a graduated performance-review process for approved programs. This is modeled on the state's own nursing precedent in § 464.019, Florida Statutes, attached to the existing biennial renewal cycle and sequenced from technical assistance through improvement planning to probationary status and, for sustained failure, non-renewal. Structured improvement planning should begin with the programs of sustained concern and address curricular alignment with the NREMT examination's clinical judgment framework, live clinical experience, examination readiness, and admission and progression standards. A regional improvement collaborative should pair the Southeast's low-performing programs with the state's documented improvers. Programs should be expected to track every graduate to a first examination attempt and support unsuccessful candidates through the retest window. Continuing education should be aligned with the clinical judgment model now governing initial certification. Finally, program-level results should continue to be published annually, programs under review should disclose that status to applicants, and this analysis should be repeated annually on the same rolling cohort basis.

First-attempt pass rate measures one dimension of program quality at one point in a graduate's career, and the associations reported here are descriptive rather than causal. The recommendations are accordingly sequenced to lead with measurement, support, and discipline to reserve consequences for sustained and well-measured failure.

Publication Date

9-1-2026

Comments

This report is the intellectual property of the Florida Center for Emergency Medical Services (FL-CEMS) at the University of South Florida. It may be shared freely for non-commercial use with proper attribution. No part of this publication may be reproduced for sale or profit without express permission.

Florida's Lifeline in Focus: NREMT Performance Review 2025

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