The National Registry of Emergency Medical Technicians (NREMT) plays an important role in ensuring emergency medical services (EMS) providers are competent to practice. Here are answers to some frequently asked questions about the NREMT.
What is the National Registry of Emergency Medical Technicians?
Founded in 1970, the National Registry of Emergency Medical Technicians (NREMT) is the nation’s emergency medical services certification organization. The certifications it provides attest that EMS providers have the skills and knowledge required to deliver care safely.
The NREMT provides national certifications and recertifications at the levels of emergency medical responder (EMR), emergency medical technician (EMT), advanced emergency medical technician (AEMT) and paramedic. Each of the NREMT’s programs is accredited by the Institute for Credentialing Excellence’s National Commission for Certifying Agencies. The NREMT is governed by a board of directors that consists of prominent leaders from the EMS community and public.
Since its inception, the NREMT has certified almost two million EMS providers. Today more than 400,000 providers are nationally certified across the National Registry’s four levels. NREMT certifications are recognized in every state, and 46 states use them as a basis for licensure.
How hard are NREMT exams?
The National Registry of EMTs’ certification examinations are intended to be rigorous to ensure providers have sufficient knowledge and skills to practice safely. At all four levels, NREMT exams feature both cognitive (knowledge-based) and psychomotor (skills-based) components. For test takers, extensive preparation and familiarity with the material help ensure success.
The National Registry’s EMT and paramedic cognitive exams are computer-adaptive, meaning their difficulty adjusts automatically based on test takers’ responses. A correct answer means the next question becomes harder; an incorrect answer means it will be easier. This enables an accurate assessment of the candidate’s level of understanding. Areas covered include anatomy and physiology, medical emergencies, trauma, patient assessment and EMS operations.
NREMT psychomotor exams gauge the ability to perform key skills and procedures (e.g., patient assessment, trauma management, cardiac life support) in a simulated environment.
Candidates for the National Registry are advised to review the National Emergency Medical Services Education Standards and any relevant study guides, practice exams and educational materials provided through their programs before undertaking any NREMT exam.
What are NREMT exam questions?
NREMT cognitive exams are computer-based and multiple-choice.
The National Registry’s Emergency Medical Technician exam covers five primary content areas:
- Airway, respiration and ventilation (accounting for 18%–22% of the final grade)
- Cardiology and resuscitation (18%–22%)
- Trauma (14%–18%)
- Medical and obstetrics/gynecology (27%–31%)
- EMS operations (10%–14%)
Some sample questions similar to those on the NREMT EMT exam (with correct answers bolded) include:
1. A 65-year-old male is experiencing severe respiratory distress. He has a history of chronic obstructive pulmonary disease (COPD) and is on home oxygen. He is using accessory muscles and has diminished breath sounds. What is the most appropriate initial intervention?
A. Apply a nonrebreather mask at 15 L/min.
B. Assist ventilations with a bag-valve mask (BVM).
C. Place the patient in the supine position and prepare for intubation.
D. Administer albuterol via nebulizer and encourage deep breathing.
2. You arrive at a scene where a 52-year-old male is unresponsive, pulseless and apneic. A bystander is performing CPR. What is your next step?
A. Apply the AED and follow its prompts.
B. Continue CPR for two more minutes before applying the AED.
C. Administer epinephrine immediately.
D. Check for a pulse before applying the AED.
3. A 24-year-old male was involved in a motorcycle crash. He is conscious but confused, has pale, cool and clammy skin, and a blood pressure of 90/60 mmHg. What type of shock is he most likely experiencing?
A. Anaphylactic
B. Neurogenic
C. Hypovolemic
D. Cardiogenic
4. A 30-year-old pregnant woman is complaining of severe headaches, visual disturbances and swelling in her hands and feet. Her BP is 170/100 mmHg. What is the most likely condition?
A. Eclampsia
B. Placenta previa
C. Preeclampsia
D. Braxton Hicks contractions
5. You arrive at the scene of a multivehicle crash with multiple patients. According to the START triage system, which patient should be tagged red (immediate priority)?
A. A 25-year-old female with a femur fracture, alert and breathing normally.
B. A 40-year-old male who is unresponsive, has a weak radial pulse and breathes 30 times per minute.
C. A 60-year-old female with a head laceration, oriented and respiratory rate of 18.
D. A 10-year-old child who is not breathing after repositioning the airway.
The National Registry’s paramedic exam covers more advanced topics, with greater emphasis on critical thinking and decision-making. Its content areas include:
- Airway, respiration and ventilation (18%–22%)
- Cardiology and resuscitation (22%–26%)
- Trauma (13%–17%)
- Medical and obstetrics/gynecology (27%–31%)
- EMS operations (10%–14%)
Some sample questions similar to those on the NREMT paramedic exam (with correct answers bolded) include:
1. A 45-year-old male is unconscious following a heroin overdose. He has snoring respirations and a respiratory rate of 6 breaths per minute. His oxygen saturation is 82%. What is the most appropriate intervention?
A. Administer naloxone 0.4 mg IM and place the patient in the recovery position.
B. Apply a nonrebreather mask at 15 L/min and reassess his breathing.
C. Assist ventilations with a bag-valve mask (BVM) and prepare for intubation.
D. Insert a supraglottic airway and provide continuous oxygen therapy.
2. A 58-year-old male presents with chest pain, diaphoresis and nausea. His ECG shows ST elevation in leads II, III and aVF. Which artery is most likely occluded?
A. Left anterior descending (LAD)
B. Right coronary artery (RCA)
C. Left circumflex artery
D. Posterior descending artery
3. A 35-year-old male was involved in a motorcycle crash. He is hypotensive, tachycardic and has jugular vein distension (JVD). Breath sounds are absent on the left side. What is the most immediate intervention?
A. Place the patient in Trendelenburg position.
B. Perform needle decompression at the second intercostal space.
C. Administer a one-liter bolus of normal saline.
D. Apply a bulky dressing to the chest wound.
4. A 22-year-old female is experiencing a seizure lasting more than five minutes. Her vital signs are BP 142/88, HR 110, RR 20, SpO₂ 94%. What is the first-line medication for this condition?
A. Midazolam 10 mg IM
B. Diazepam 2 mg IV
C. Lorazepam 1 mg IV
D. Magnesium sulfate 2 g IV
5. During a hazardous-materials incident, you are treating a patient exposed to an organophosphate pesticide. He presents with salivation, lacrimation, urination, defecation and bradycardia. What is the most appropriate treatment?
A. Atropine and pralidoxime (2-PAM)
B. Sodium bicarbonate IV
C. Epinephrine IM
D. Activated charcoal PO
NREMT psychomotor exams test EMTs’ basic skills (for example, splinting, CPR, airway management) and paramedics’ advanced skills (e.g., IV access, medication administration, advanced airways).
How many questions are on the NREMT tests?
The number of questions on the National Registry’s cognitive exams may vary by level and because some of the exams are computer adaptive.
- Emergency medical responder exams contain 90–110 questions and are not computer adaptive. They must be completed within 90 minutes.
- Emergency medical technician exams contain 70–120 questions and are computer adaptive. They must be completed within two hours.
- Advanced EMT exams contain 135 questions and are not computer adaptive. They must be completed within two hours and 15 minutes.
- Paramedic exams contain 80–150 questions and are computer adaptive. They must be completed within 2½ hours.
The National Registry’s EMT and paramedic exams stop once the system has determined with 95% confidence whether the candidate has passed or failed.
Check current requirements on the NREMT’s website when preparing for any test.
Where can I find NREMT practice tests?
Many sources offer practice exams and study materials to help prepare candidates for National Registry exams. Here are some:
- BoostPrep
- Career Employer
- CPR Select
- EMT National Training
- EMT Training Station
- Kaplan Test Prep
- NREMT Practice Test
- ·Pocket Prep
- Practice Test Geeks
- Quizlet
- Test-Guide.com
- Union Test Prep
Find additional NREMT exam resources and practice tests here.
Where can I find an NREMT study guide?
Quality study materials can be a great asset when preparing for National Registry examinations. Find study guides and materials for NREMT exams from these popular sources:
- Amazon
- EMT National Training
- EMTprep
- Examzify
- Limmer Education
- NREMT Practice Test
- Pocket Prep
- Practice Test Geeks
- Quizlet
- The Paramedic Coach
- Union Test Prep
Ensure any study guide aligns with the latest content and formats for the exam you’re taking.
How do I recertify my NREMT?
The National Registry of Emergency Medical Technicians has recertification information for its four provider levels on its website.
Emergency medical responder (EMR) – Nationally registered EMRs are required to renew every two years. This is done by completing either continuing education or a cognitive exam. The CE route requires 16 credits, with national, local/state and individual components. These can be obtained through online or in-person courses. For the process for cognitive recertification, see the NREMT’s EMR recertification page.
Emergency medical technician (EMT) – Nationally registered EMTs must renew their certifications every two years. They also have the option of continuing education or a cognitive exam. CE recertification requires 40 credits, with national, local/state and individual components. These can also be online or in person. For the process for cognitive recertification, see the NREMT’s EMT recertification page.
Advanced EMT (AEMT) – Nationally registered AEMTs must renew every two years. This can be done through CE or by taking the AEMT certification exam. CE recertification requires 50 credits, with national, local/state and individual components. These can also be online or in person. For the process for cognitive recertification, see the NREMT’s AEMT recertification page.
Paramedic – Nationally registered paramedics must renew every two years. This can be done through CE or by taking the paramedic certification exam. CE recertification requires 60 credits, with national, local/state and individual components. These can also be online or in person. For the process for cognitive recertification, see the NREMT’s paramedic recertification page.
For more on the National Registry of Emergency Medical Technicians’ recertification processes, see its website.
