NREMT FAQs & Cognitive Tips

What is an EMT?

“Emergency Medical Technicians provide out of hospital emergency medical care and transportation for critical and emergent patients who access the emergency medical services (EMS) system. EMTs have the basic knowledge and skills necessary to stabilize and safely transport patients ranging from non-emergency and routine medical transports to life threatening emergencies. Emergency Medical Technicians function as part of a comprehensive EMS response system, under medical oversight. Emergency Medical Technicians perform interventions with the basic equipment typically found on an ambulance. Emergency Medical Technicians are a critical link between the scene of an emergency and the health care system.” [Source: National EMS Scope of Practice Model]

What are the different EMS training levels?

  • Emergency Medical Responder (EMR) – the lowest level of responder, the EMR possesses simple skills to provide immediate life-saving care for critical patients. The EMR can render on-scene interventions while awaiting additional resources and may serve as part of a transport crew, but generally will not be the primary caregiver. State licensure as an EMR requires completion of a state-accredited training program.
  • Emergency Medical Technician (EMT) – The EMT conducts basic, noninvasive interventions to reduce the morbidity and mortality of acute out-of-hospital emergencies. They have all the EMR’s capabilities, plus additional skills associated with patient transport. In many places EMTs provide the majority of out-of-hospital care, and in some places the highest level. State licensure as an EMT requires completion of a state-accredited program.
  • Advanced Emergency Medical Technician (AEMT) – The AEMT has all the skills of the EMR and EMT, and can also conduct limited advanced and pharmacological interventions. This level allows provision of high-benefit, lower-risk advanced skills by systems that can’t support Paramedic-level care. In some jurisdictions, AEMTs may represent the highest level of out-of-hospital care. State licensure requires completion of a state-accredited program.
  • Paramedic – The Paramedic is an allied health professional who can conduct invasive and pharmacological interventions. Possessing all the skills of the lower-level providers, Paramedics can also conduct a broader range of interventions based on skills that are harder to maintain and pose greater risk to patients if done incorrectly. Paramedic care is based on advanced assessment and formulating a field impression. State licensure requires successful completion of an accredited Paramedic program at the certificate or associate’s degree level. [Source:]

What is the NREMT certification process?

Note: The following is from from July 10, 2020 and may have changed, please check on under the Important Links tab for most updated information.

Individuals applying for the Emergency Medical Technician national certification must meet the following requirements:

  1. Successful completion of a state-approved Emergency Medical Technician (EMT) course that meets or exceeds the National Emergency Medical Services Education Standards for the Emergency Medical Technician.
    • Candidates must have completed the course within the past two years and the course Program Director must verify successful course completion on the National Registry website.
  2. Have a current CPR-BLS for “Healthcare Provider” or equivalent credential.
  3. Successful completion of the National Registry cognitive (knowledge) and a state approved psychomotor (skills) exams.
    • Passed portions of the cognitive and psychomotor exam remain valid for 24 months. For candidates with a course completion date prior to November 1, 2018, passed portions of each examination are valid for 12 months. Provided all other entry requirements are met.

Note 1: If the initial Emergency Medical Technician (EMT) educational program was completed more than two years ago, and the candidate is currently state licensed at the EMT level, the candidate must document successful completion of a state-approved EMT refresher course or 24 hours of equivalent continuing education topic hours within the past two years.

Note 2: If the candidate is not currently state licensed as an EMT and it has been more than two years from the completion of an approved EMT course, the candidate must complete a new state-approved EMT course prior to applying for National Certification.

What is the NREMT Cognitive Retest Policy?

Note: The following is from from July 14, 2020 and may have changed, please check on under the Important Links tab for most updated information.

After successful completion of an approved EMS education program, candidates are initially given three attempts to pass the cognitive examination (provided all other requirements for National EMS Certification are met). If a candidate is unsuccessful on an exam attempt, they may apply to retest 15 days after the last examination. After three unsuccessful examination attempts, EMT candidates must submit official documentation verifying the completion of a remedial training program.

Remedial Training Requirement: Remedial training is designed to provide candidates additional education and to improve their performance on subsequent examination attempts. After a remedial training program is complete, the candidate is given additional attempts to pass the examination (provided all other requirements for National EMS Certification are met). Candidates who fail to pass the cognitive exam after a total of six attempts attempts are required to complete an entire state approved education program. EMT’s require 24 hours.


Cognitive Tips 

All of the following is from – 

All exam items evaluate your ability to apply knowledge from your course and textbook to the types of tasks and situations that are expected of entry-level EMS professionals. Questions that are answered incorrectly on the exam mean you could choose the wrong assessment or treatment in the field. There are some general concepts to remember about the cognitive exam:

  • There is only one best answer. The items are written to determine how you would respond when providing patient care. Incorrect responses may be misunderstandings, common mistakes or inefficient approaches that represent less-than-optimal care.
  • Examination content reflects the National EMS Educational Standards, not local or state protocols. The National Registry avoids questions on specific details that have regional differences. Some topics in EMS are controversial, and experts disagree on the single best approach to some situations. The National Registry avoids testing over controversial areas.
  • National Registry exams focus on what providers should do in the field. The exam is not taken from any single textbook or source. The exams are intended to reflect the current accepted practices of EMS. Fortunately, most textbooks are up-to-date and written to a similar standard; however, no single source thoroughly prepares you for the exam. You are encouraged to consult multiple references, especially in areas in which you are having difficulty.
  • You do not need to be an experienced computer user or be able to type to take the computer based exam. The computer testing system has been designed so that it can be used by those with even minimal computer experience and typing skills. A tutorial is available to each candidate at the testing center prior to taking the examination.


Preparing for the exam:

Here are a few simple suggestions that will help you to perform to the best of your ability on the examination:

  • Study your textbook thoroughly and consider using the accompanying workbooks to help you master the material.
  • Thoroughly review the current American Heart Association’s Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. You will be tested on this material at the level of the exam you are taking.
  • The National Registry does not recommend a particular study guide but recognizes that they can be useful. Study guides may help you identify your weaknesses, but should be used carefully. Some study guides have many easy questions leading some candidates to believe that they are prepared for the exam when more study is warranted. If you choose to use a study guide, we suggest that you do so a few weeks before your actual exam. You can obtain these from your local bookstore or library. Use the score to identify your areas of strength and weakness. Re-read and study your notes and materials for the areas you did not do well in.
  • The National Registry is not able to provide candidates information about their specific deficiencies.

The Night Before The Exam

  • Do not try to study the night before the exam. If you come across a topic you do not think you know well, there will not be enough time to study. This will only create a stressful situation.
  • Get a good night’s sleep

The Day of the Exam

  • Eat a well-balanced meal.
  • Arrive at the test center at least 30 minutes before the scheduled testing time. The identification and examination preparation process takes time. You may also need this time to review the tutorial on taking a computer based test. Arriving early will reduce stress.
  • Be sure to have the proper identification as outlined in your confirmation materials before you head to the test center
  • You will not be able to take the exam if you do not have the proper form of identification.
  • Relax, thorough preparation and confidence are the best ways to reduce test anxiety

During the Exam

  • Take your time and read each question carefully. The exam is constructed so most people will have plenty of time to finish. Most successful candidates spend about 30 – 60 seconds per item reading each question carefully and thinking it through.
  • Less than 1% of the candidates are unable to finish the exam. Your risk of misreading a question is far greater than your risk of running out of time.
  • Don’t get frustrated. Because of the adaptive nature of the exam, everyone will think their exam is difficult. The CAT algorithm is adjusting the exam to your maximum ability level, so you may feel that all the items are difficult. Focus on one question at a time, do your best on that question and move on.

After The Exam

  • Examination results are not released at the test center or over the telephone.
  • Your examination results will be posted to your National Registry account usually within 2 business days following the completion of the examination provided you have met all other requirements of registration.
  • Log into your account and click on “Dashboard” or “My Application -> Application Status” to view your exam results.


Example Items

To help you understand what to expect from exam questions, we have provided examples of the types of questions entry level providers are expected to answer on the exam. These three questions range in difficulty but are all either at the passing standard or above the passing standard.

  1. Your patient fell while skateboarding and has a painful, swollen, deformed lower arm. You are unable to palpate the radial pulse. You should immediately
    1. apply cold packs.
    2. align the arm with gentle traction.
    3. splint the arm in the position found. 
    4. ask the patient to try moving the arm.
  2. Your patient is a disoriented 86 year old male who has a history of terminal brain cancer. He fell out of bed and complains of severe right hip pain. His wife called 9-1-1 for assistance in putting him back to bed. She tells you that he has DNR orders and that she does not want him transported. You should initially
    1. explain why he needs to be transported. 
    2. ask to see the DNR orders
    3. have her sign a refusal form.
    4. call for law enforcement back-up.
  3. You are called to a scene where law enforcement officers have detained a man who they thought was drunk. They called you because he has a history of diabetes. You administer oral glucose and within a minute the patient becomes unresponsive. You should
    1. remain at the scene under law enforcement authority and request ALS back-up. 
    2. leave the glucose in place, complete a primary survey and transport.
    3. open his airway with an oropharyngeal airway and ventilate him.
    4. suction his mouth and begin transport.