EMT Training - Become an Emergency Medical Technician

EMT Certification

 EMT Certification – EMT Training 

Becoming an EMT is a process with many steps that each emergency medical responder must follow in order to get certified. It may sound complicated, but going over each step will help guide you on your way to EMT certification. Emergency medical professionals must apply for certification through the National Registry of Emergency Medical Technicians (NREMT) before they can become licensed in their state.


To clarify, National Registry of EMT certification is a national standard and licensure is dictated by each individual state.


The NREMT is a private certifying organization that maintains consistent standards throughout the United States. Getting EMT certification through the National Registry indicates a candidate has successfully demonstrated knowledge and skills in mandated examinations.


Getting certified shows the state that an individual has shown a certain level of competency. However, EMT certification does not authorize you to work. Candidates must get licensed in their state before they can begin working as an EMT in the field.


Each state handles licensing through their State EMS Offices or an equivalent building, but the process of licensure is much easier than the EMT certification process.

EMT Certification Emergency Room

Once a candidate completes Emergency Medical Technician school training they gain eligibility to become EMT certified. However, before being awarded certification, candidates must pass two National Registry exams: the Cognitive Exam and Psychomotor Exam.

National Registry of EMT Exams


Applying for the Cognitive Exam is done at the NREMT website. This can be done by first going to the National Registry of EMT site and creating an account, then creating a new application, and finally paying the $80 cognitive exam fee. The last step will be to set up a time and location for the written test.


This is a written exam but it’s administered via computer using a computer adaptive test (CAT) algorithm. This means the length of your test will vary depending on how well you answer the test questions.


The minimum questions asked will be 70 and the maximum will be 120. No matter how many questions a candidate is asked, they will have 2 hours to complete the Cognitive portion of the exam.


The cognitive exam splits content up into five major areas:


• Trauma
• EMS Operations
• Cardiology and Resuscitation
• Airway, Respiration and Ventilation
• Medical; Obstetrics and Gynecology


 The Psychomotor Exam tests an individuals competency in emergency care skills and demonstrates a readiness for field duty. The candidate must be able to show competency in many skill areas including patient assessment, managing cardiac arrest, spinal immobilization, bleeding control, and shock management.


The Psychomotor Exam is not given by the NREMT, so the EMT-B is responsible for setting up their exam times. EMT course instructors should give students information on where to take the Psychomotor Exam because these tests are coordinated by educational institutions or the State EMS Office.


Advanced emergency medical personnel can find information on how to locate a psychomotor exam site for their certifications on the NREMT site. For information on Paramedic exams check out Paramedic Testing page.

 EMT Certification Requirements 


Before applying for the National Registry of EMT Certification there are a few requirements. They are:

• Applicant should be 18 years of age or older (there are a few states that allow younger).


• Candidate must have completed a state approved EMT course within the past two years.


• Applicant must have a current “Healthcare Provider” CPR-BLS (Cardiopulmonary Resuscitation – Basic Life Support).


• Candidate needs to successfully pass both sections of the NREMT Exams. Both the Cognitive and Psychomotor portions need to be completed within the last 12 months.


 EMS Responsibilities 


After getting certified as an Emergency Medical Services Personnel a candidate has certain responsibilities. The NREMT expects certified EMTs to be responsible for their own certification and notify the National Registry in regards to any of the following:


• A change in mailing address, which can be done on your user profile page.
• Any criminal conviction
• Disciplinary action in any state that causes interruption of licensure or right to practice.

 How To Become EMT Certified


How to get an EMT certification may vary from state to state, but there are some guidelines set by the National Registry of Emergency Medical Technicians (NREMT). Along with those set standards, there are some other things an individual can do to increase their ability to successfully get certified on the first attempt.


This 13 Steps to EMT Certification infographic lists out recommendations to follow both before and after getting EMT certified. Each step is explained in more detail below.  


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Below are 13 steps for getting and keeping EMT certification.


1. CPR CertificationBLS-CPR for “Healthcare Providers” (Basic Life Support – Cardiopulmonary Resuscitation) is a pre-requisite for EMT courses. It will need to be taken before a candidate can apply to some EMT classes.


This CPR class is a good introduction into emergency response scenarios and can be taken in one afternoon. In California these BLS-CPR classes are about 4 hours long, can be taken through the local American Red Cross for $85, and the certification lasts for two years.


Topics covered in this course include learning how to perform CPR, using an Automated External Defibrillator (AED), and treatments for obstructed airways.


2. Check Local Ambulances For Ride Alongs: Going on an ambulance ride along as a civilian is not guaranteed, but many private Ambulance companies do allow citizen ride alongs – especially to future EMTs.


If you have never been exposed to emergency medicine, this might be a good time to do an ambulance ride along. Experiencing what it’s like to respond to emergency scenes and provide patient care can be motivating before committing to an EMT school.


Many facilities allow prospective students to ride along as an observer. Call local ambulance companies and let them know you want to start a career as an emergency medical responder and would like to know if they allow civilian ride alongs. Tell them you have already taken your BLS-CPR Healthcare provider class so they know you are serious about becoming a Basic EMT.


Some companies only allow students affiliated with a school to ride along so don’t take it personal if they won’t allow a civilian ride along. If they approve you, make sure you ask if there is a required dress (usually a polo shirt and navy blue or black pants) and try to maintain a friendly but professional attitude.


3. Meet State Requirements: Meeting state requirements will be important in order to get admitted into state approved EMT training courses. Each state may have it’s own age requirements but the majority require a candidate to be 18 years or older. Other requirements may be having a High School Diploma, GED or Equivalent.


There is more information about this on our EMT Programs page under the heading “Requirements For EMT Program.”


4. Enroll In EMT School: Once you have met state requirements you are ready to enroll in an EMT training program. Before enrollment candidates must decide which training program they are most interested in (Basic EMT, Advanced EMT, Paramedic).


After choosing a program the candidate will need to decide what type of EMT course they prefer (Online/hybrid, Accelerated, Standard). For information about EMT training classes and programs check out our EMT Courses page. There are many programs and courses available at a wide range of costs to help students achieve their goals.


5. Join EMS Forums: Go online and find forums or chat rooms for Emergency Medical Service (EMS) personnel, or more specifically EMT’s and become a member of the online EMT community. Joining EMS forums also allow you the freedom to ask questions and get a variety of opinions from medical professionals.


Being a member of an online EMS community can also be helpful later when you are taking classes and need information from experienced emergency medical responders who know what to do during a medical crisis.


6. Attend EMT Classes And Do The Work: An important part of EMT training is to keep up with the assigned reading material. Plan on attending every class and study your skill sheets. EMS is literally life and death students often don’t recognize how a patient experiences each interaction. Practice patient assessment over and over until you are comfortable, it’s a skill you will use constantly.


EMT assessing patient white background

Don’t be afraid to mess up – this may seem counterintuitive, but EMT school is the best time to learn and sometimes that means messing up. As long as you are doing the work, no instructor will blame you for making mistakes.


Don’t be afraid to ask for help. Instructors, preceptors, and healthcare professionals are happy to help students. Remember they don’t mind helping, but they don’t want to feel like they are babysitting.


Quick Tip: The first day of class can be very overwhelming. Instructors go over the syllabus, guidelines, requirements, and then tell you how easy it is to fail the course. Don’t get discourage and quit! This is your first chance to face fear and move forward anyway. EMS professionals become experts at overcoming fear, showing up for your second day of class is good practice at this. P.S. It gets easier. 


7. Learn From The Professionals: Once EMT training begins you will have opportunities to learn from professional emergency medical responders. Instructors for EMT classes are usually experienced Medical Technicians with extensive knowledge on EMS techniques.


Also once field training begins, candidates will be surrounded by professionals during ambulance ride alongs and hospital clinicals.


These are great opportunities to learn from on the job experience while observing Basic EMTs, Paramedics, and Nurses responding to medical trauma and treating patients. This is the time to watch how an EMT-B in the field does a patient assessment and learn techniques to provide good patient care.


Don’t just show up to field training and sit through it to get required hours. Stay engaged and mentally ask questions during ride alongs and hospital clinical.


For example, during an ambulance ride along if the patient complains of difficulty breathing during the patient assessment. Ask yourself:

Would I do an intervention? Would I apply Oxygen? Would I apply a mask or nasal cannula?


Next watch what the professional EMT does to intervene. If the experienced EMT intervenes differently than what you chose, wait until after the call is over and ask why they did that intervention. This is a great way to learn critical thinking skills.


8. Practice Assessment Skills: After EMT training starts, students will be given skill sheets that have very specific requirements. Some of these skill sheets will pertain to patient assessment skills like the primary and secondary assessments.


The primary assessment helps emergency responders get an overall impression of a patients status and detect immediate threats to a patients life. The secondary assessment is longer with a focused history and head to toe examination of the patient.


Know these patient assessment skills and practice them using the sheets until you don’t need the skill sheet anymore. Every patient you approach will undergo some type of assessment so these are good skill to be comfortable with.

EMT Certification Practical Skills

It’s also important to be able to complete the patient assessments in the expected time periods and to know what conditions indicate immediate transport of the patient. Assessment skills are a must for emergency medical responders and will be tested for during EMT certification.


9. Apply For Cognitive Exam On NREMT Site: After successful completion of EMT training, students will need to get their EMT certification through the National Registry of Emergency Medical Technicians (NREMT). In order to get an EMT certification the student must pass two exams.


The Cognitive Exam is a written exam and you can apply for it on the NREMT website. After going to their website you will be asked to create an account and will then create a new application. After filling out the forms you will pay the $80 testing fee.


Next you will get instructions to set up an account with Pearson VUE in order to find a testing center date, time, and location of your choice.


10. Pass NREMT Cognitive And Psychomotor Exams: The psychomotor portion will often be completed by practical exams during the final stages of an EMT course. If it’s not done at your educational institution, they will give you information on where to go for the exam.


The NREMT does not administer the psychomotor portion of the exam, it is coordinated by each State’s Local EMS Office or at educational institutions.


The Cognitive Exam will cover all major content, but according to the National Registry they break the content up into five sections and give each section a percentage of points.


The five content sections are EMS Operations, Trauma, Airway; Respiration and Ventilation, Cardiology and Resuscitation, and Medical; Obstetrics and Gynecology. For more information on these exams, check out our National Registry of EMT testing page.


If you don’t pass the cognitive portion of the National Registry Exam, it can be taken a total of three times before you have to retake your EMT training.


However, if you fail the first attempt it’s important to take time to restudy the material before retaking the exam. Candidates should also get more familiar with the computer adaptive testing (CAT) format used to administer the test if they fail.


Before attempting the NREMT Cognitive exam make sure to check out our guide with 10 Expert Tips for Passing.


11. Get EMT Certification And License: After passing both portions of the NREMT Exam, candidates will be mailed a letter congratulating them on passing both these examinations. The letter will also indicate the candidate has been awarded their National EMS Certification at the Emergency Medical Technician Level.


Enclosed with the letter will be the EMT certificate, EMT certification card, and an embroidered emblem (a patch). Once a candidate has a National EMT certification, they need to contact their state EMS office for instructions on how to obtain a state license/certification.


All EMT’s must have a state license card issued before they are allowed practice EMS in the field. After contacting (going to their website is a good way to contact) the State EMS Office to apply for a state EMT certification/license, the candidate may have to get fingerprints for a background check, pay a fee, or meet other requirements.


Each state has its own standards so they vary. After all the requirements are met the candidate will be assigned an EMT number from the State Central Registry and an Emergency Medical Technician Card will be issued. At this point the candidate is employable and can begin working as an emergency responder.

EMT gurney in ambulance


Check out our page about types of jobs available to licensed Emergency Medical Technicians. There is also good information about how much money an EMT earns on our EMT Salary page.


12. Stay Updated On Emergency Medicine: Once licensed and working as an emergency medical responder it is important to stay update in your field. The healthcare field and specifically emergency medicine are always evolving and to be a great EMT it’s important to stay updated on new information.


For example, in California beginning 7/01/2019 any EMT that is renewing certification for the first time will need to submit documentation of EMT training for administration of Naloxone, administration of epinephrine, and use of glucometers due to an expanding scope of practice.


A good way to keep up with the latest medical trends is to subscribe to magazines and local newsletters related to emergency medicine. JEMS (Journal of Emergency Medical Services) magazine has been around a long time and has stayed popular with emergency responders.


EMS World magazine is heavily focused on reporting future changes in EMS and the magazine is only a small part of their organization.


Taking classes offered by your employer is another way to stay up to date on evolving technologies and equipment changes. It’s difficult to stay for a class after working a 12 or 24 hour shift, but in the long run these classes will increase your knowledge and skills as an Emergency Medical Technician.


13. Maintain License With CEU Requirements: Currently EMT’s have three recertification models available to get CEU’s (continuing education unit) and refresher courses. They are: 


– National Continued Competency Program (NCCP) Model
Traditional Model
– Recertify by Exam


After March of 2019 all EMT-B, AEMT, and EMTP will be required to use the NCCP Model to obtain their CUE units and recertify, but for now the three choices make the process a bit confusing. There is more in-depth information about each method of renewal below.


It is the responsibility of the licensed EMT to properly take the correct CEU’s and maintain documentation as proof, in case they are audited later. It’s a good idea to take CEU’s which add to skills and enhance knowledge related to your field, rather than taking quick online courses just to get credit requirements met.


EMT Training Certification

 EMT Recertification 


Guidelines for all levels of EMT Recertification can be found on the National Registry of Emergency Medical Technicians (NAEMT) website. EMT recertification has requirements that all candidates must meet. They are:


• The candidate must be actively using EMT skills within a patient care setting. (If you don’t meet this requirement you can meet all other requirements and file for inactive status).


• A supervisor or training officer will need to validate that the candidate has maintained skill competency by signing (or electronically signing) the recertification application.


• A candidate will demonstrate cognitive competency by either A) Recertification by exam or B) Documenting Continuing education units.


• The candidate may need to pay an application fee and other fees depending on what process is chosen for renewal.


• The candidate must submit the certificate renewal application with all the requirements met (recertification report) before March 31. This can be done with the online or paper based recertification tools. (Online recertification has a 24 hour processing time and the paper based has a 6 week processing time.)


 EMT Certification Renewal 


EMT’s need to be recertified every two years to keep up with evolving standards and any changes made to the EMT scope of practice. An 
EMT needs to stay up to date with the latest medical information and skills and abilities must be evaluated occasionally to prove competency.


As of now all levels of EMT’s have three EMT recertification options to choose from when obtaining CEU’s (Continuing Education Units). They include:


1. Recertify by Exam – This option allows the emergency medical responder to show cognitive competency without documenting any CEU’s. Recertification by exam is the same process whether you are a Basic EMT, Advanced EMT, or Paramedic.


The first step is to complete a recertification by examination application and pay the exam fee. Wait 24-48 hours and then log in to your National Registry of EMT account and print the ATT (Authority To Test) letter. Next read the ATT letter and follow the directions to schedule the exam.


Applicants may only make ONE attempt to take and pass the exam starting one year prior to your expiration date (April 1). Applicants who pass the recertification exam will find a Cognitive Competancy form in their National Registry of EMT account.


The applicant must fill out the form and get any signatures and documentation required before returning the form prior to March 31. All other standard recertification requirements still need to be met and verified like normal.


2. Traditional Model – This model is what has commonly been used up until now, but by March of 2019 it will be phased out and replaced by the NCCP model.


Every level of emergency responder who recertifies using the traditional method are required to get 72 hours of continuing education using an EMT refresher course and CEU’s.


Paramedic EKG logo white background

The Emt must show proof that their current BLS-CPR is valid past the NREMT expiration date (March 31) when using the traditional EMT recertification model.


The EMT refresher course requirements can vary by state but some states allow two options to complete the refresher course requirements. The first option is completion of a traditional state approved 24 hour EMT refresher course.


The second EMT refresher option is to complete 24 hours of Continuing Education Topic hours. These are mandatory Core Content hours on specific topics, and a maximum of ten hours can be online type of EMT training courses.


All other courses must involve the student and educator to interact in real-time. These are the standards for all levels of emergency medical responder: EMT-B, AEMT, and EMTP.


3. The NCCP Model (National Continued Competency Program) – Beginning in March of 2019 all Emergency Medical Technicians, this includes EMT-B, AEMT, and EMTP, will be required to use the NCCP model for EMT certification renewal. (Verify which options are currently available in your state by contacting the state EMS office).


The NCCP model offers improvements that allows evidenced-based medicine to reach EMS professionals all over the United States. A couple of benefits of the NCCP model are reduced CEU hours needed and increased local control, which can translate into more relevant continuing education topics for the EMT.


The NCCP model separates the recertification process into three continuing education components: national, local, and individual, which allows state and local agencies the freedom to determine a quarter of the requirements for recertification.


The NCCP model for EMT recertification requires a total of 40 continuing education hours to recertify an EMT-B, 50 hours for an AEMT, and 60 hours for a Paramedic. Those hours are divided among the three components with 50% consisting of the National Component, 25% the Local Component, and 25% the Individual Component.


Certification Hours For Each Component
NationalLocalIndependentTotal Hours


The National Component refresher topics are updated every 4 years by the NREMT. The topics reflect current trends in evidenced based medicine and changes in EMT scope of practice.


Quick Tip: The National Component portion replaces the traditional DOT Refresher Course (Department of Transportation).


The Local component is decided by local entities such as state agents or regencies. This means 25% of recertification learning will include items such as local protocols that come from a local level.


The Individual Component is the simplest because it leaves the candidate free to use 25% of recertification education on any EMS related education.


This model hasn’t been implemented in all states yet, so check your state EMS office to see if they are participating yet.


→ Don’t forget to check out our Medical Abbreviations, EMT mnemonics and Basic EMT terminology pages if you are interested in medical terminology EMS uses in the field.

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