EMT Training - Become an Emergency Medical Technician


National Registry of EMT Exam – EMT Training

Towards the end of EMT training a candidate will need to begin preparing for the National Registry of EMT (NREMT) Examinations. These exams are required for emergency medical technician (EMT) certifications of all levels. (For more information about certification see our page EMT Certification). With some knowledge and preparation the NREMT Exam can be passed the first time.


This page will give an explanation of the National Registry of EMT exams and explore the content of each exam. This page will also help  to clarify the requirements, types of content for both the Basic EMT and Advanced EMT, and even give tips for passing the NREMT exam.


Once a candidate passes their National Registry of EMT exams they become certified as an Emergency Medical Technician and become eligible to qualify for a license in their state. Anyone interested in Paramedic testing can find information on the new National Registry Paramedic Exam here.



Requirements for all levels: (EMT-B, AEMT, EMTP)


1. EMT test applicant must be 18 years of age or older.


2. Applicant for EMT test must have a High School Diploma, GED, or equivalent.


3. EMT test candidate must have a current CPR-BLS (Cardiopulmonary – Basic Life Support) for “Healthcare Provider.”


4. National Registry of EMT applicant must complete a state approved course for the EMT training level being tested. (EMT-B, AEMT, EMTP)

Components of NREMT Exam


The National Registry of EMT Exam is divided into two components: The Cognitive Exam and the Psychomotor Exam. The Cognitive Exam is a knowledge based written exam and the Psychomotor Exam is a skills based exam. The National Registry of EMT test for each one will be administered at a different location.


The content for the Cognitive National Registry of EMT Exam is determined by a Board approved test plan which will be discussed in-depth below.


All levels of EMT training (Basic EMT, Advanced EMT, EMT Paramedic) will be tested and must meet a minimum level of competency by providing safe and effective emergency medical care.


Throughout the NREMT Cognitive Exam applicants will be tested on patient care with 85% of testing focused on elderly and adult patients and 15% focused on pediatric patients.


This means the EMT test will cover different areas of content, but through out each type of content, all patient care questions will be 15% pediatric and 85% elderly or adult.


National Registry of EMT Exam


The National Registry of EMT exam for the Basic Emergency Medical Technician is a written EMT test and will have from 70 to 120 questions.


NREMT exam studying at desk


Candidates must pay $80 for each National Registry of EMT exam attempt and they have up to 2 hours to complete the exam. The National Registry of EMT cognitive exam for a Basic EMT is a written test, but it is administered via computer using computer adaptive testing (CAT).

Computer Adaptive Testing


Computer adaptive testing is a very specific type of testing and being familiar with it can give you an advantage when taking the NREMT exam. The directions for the EMT test are simple and you do not need to be familiar with computers to do well on this test.


However, understanding CAT and getting comfortable with it can help a candidate pass the National Registry of EMT exam and further your goal to become an EMT. Computer adaptive testing is different from the computer based linear tests candidates are probably used to.


These linear tests are a similar experience to taking a test with pencil and paper. Linear tests have a set number of questions and they allow candidates to skip questions, go back and change answers, mark questions for review. Also, there is no penalty for guessing with a linear test.


Computer adaptive testing however does not have a fixed number of questions, there is no skipping questions or going back to change answers, and there is a penalty for guessing. Now that you know the differences lets talk about how CAT works on the EMT test.


The computer adaptive test algorithm used for the NREMT exam is a variable length (70-120 questions) Basic EMT test during which questions are delivered in a specific logical manner.


The EMT test algorithm begins by presenting a medium or medium-easy item as the first question. The next EMT test question is chosen based on whether the candidate gets the first question correct or wrong.


Question Answered Correctly – If the candidate answers the EMT test question correctly, they will be given a question on the same topic that is a higher difficulty level. This higher difficulty question may not be asked immediately because the algorithm may test you on other medium and medium-easy topics before moving to medium hard difficulty level topics.


If the candidate continues to get answers correct on a topic, the difficulty level will increase until they either reach maximum ability level and begin to get the questions wrong or they reach the level of competency needed to pass that topic.


Question Answered Wrong – If the candidate answers the first EMT test question incorrectly, the algorithm will at some point offer an easier question on that topic. If they answer incorrectly again they will be given an even easier question. If they answer this question correctly the algorithm will increase the difficulty level again and give the candidate another chance at that level of difficulty.


If the candidate gets it right the difficulty gets harder until they reach their maximum ability level and consistently answer wrong on the same difficulty level, or they show the required level of competency needed to pass that topic.



Reasons EMT Test Will End – The algorithm continues to assess the test takers knowledge with every question and will end the EMT test when:


It is 95% confident the test-taker is competent in each area of content, or it is 95% confident that the test-taker can not reach the level of competency needed to pass the NREMT exam.


The NREMT Exam will also end when the 2 hour time limit is up or you have answered the maximum allowed 120 questions.


NREMT Exam Computer Adaptive Testing


Advantages Of Computer Adaptive Testing

1. The EMT test can be shortened by fifty percent while remaining more precise than a linear test. The adaptive algorithm doesn’t waste time presenting questions that are too hard or too easy for the test-taker. This shortens the amount of questions and time required for the test.


2. Can show results quickly after testing is completed. In the case of the NREMT exam, test results will be posted within two business days on the candidate’s National Registry of EMT account. This requires log in with password at the National Registry of EMT website.


Disadvantages Of Computer Adaptive Testing

1. Candidate can not skip a question, go back and change answers, mark a question to review later, or review their answers. Each question on the EMT test needs to be taken seriously and answered well at the time it is given.


2. Candidates are not able to accurately judge or budget the time allowed for each question. Since the EMT test is adaptive and the number of questions will vary based on performance, a candidate can’t judge whether their test will have closer to 70 or 120 questions. This means candidates need to remain flexible and focus on answering questions correctly rather than rapidly.


Don’t Panic – If you begin the NREMT exam for an EMT-B and the questions become difficult very quickly, it may be a good thing. Some individuals begin to panic because the NREMT exam starts ok and suddenly seems very hard after a few questions.


They feel like the EMT test is hard questions with a few easier questions sprinkled in here or there. (This was my experience when I took the NCLEX for Nursing, which is also CAT.) If this happens to you during the test don’t panic, it might be a sign you are doing well on the test.


After all, if you answer a question correctly the EMT test administers more difficult questions until you show competency. This means if you are answering the lower level questions correctly, the test may begin administering harder and harder questions on each area of content.


More correct answers means more difficult questions.


Obviously if the candidate isn’t familiar with the material and is unprepared for the EMT-B Cognitive Exam, the questions may seem very difficult. So they can also seem difficult for candidates who are getting them mostly wrong.


Another reason test-takers panic is because their test ends at 70 questions (60 test and 10 pilot questions). Once again this can be very good or very bad.


This means that within 60 questions the EMT test was able to determine with 95% confidence that the candidate is competent in ALL content areas, or that the candidate will not be able to reach the minimum level of competency under any test circumstances.


Ten questions in each NREMT exam for the Basic EMT are “Pilot Questions” being tested for future candidates and do not count toward your test score.


When an EMT test stops after administering the minimum required items it usually means the candidate did very well or very poorly.


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