While institutional and program accreditation has long been required for physician and nursing education, paramedic program accreditation was largely voluntary in the US until recently. Our objective was to assess whether program accreditation is associated with higher pass rates and cognitive ability performance. This was a cross-sectional evaluation of the National Registry of Emergency Medical Technicians' (NREMT) Paramedic Certification cognitive examination results for graduates of US paramedic pro¬grams. Individual first-attempt and cumulative third-attempt pass rates along with first-attempt cognitive mean ability estimates (MAE) for each content area were analyzed. In 2012, 8,404 paramedic program graduates attempted the cognitive examination. The first-attempt pass rate for accredited program graduates was higher than that of their non-accredited counterparts (75.6% vs. 67.3, p<0.001). The cumulative pass rate after three attempts also was higher for accredited program graduates than for non-accredited graduates (88.9% vs 81.9%, p<0.001). Paramedic students from accredited programs demonstrated higher cognitive ability in all clinical content areas (p<0.001). Accredited program graduates had greater success on the National Paramedic Certification examination with 51% greater odds of first-time success (OR 1.51, 95%CI 1.31-1.73, p<0.001). Collectively, these results support the need for universal paramedic program accreditation.