EMT Training - Become an Emergency Medical Technician

NREMT Exam

 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.

 NREMT Exam 

 

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.

 

If you did well through EMT school and studied well, you should have an idea which group you fall into. Candidates who fail may have done well on most of the EMT-B exam, but have done very poorly on a specific area or areas of content.

 

 

If the algorithm determines early a candidate can not pass a required area of content it may end the test around 70 questions. The good news is if a candidate fails, the National Registry of EMT will indicate how well they did on the various content areas.

 EMT-B Cognitive Exam Content 

 

The cognitive portion of the NREMT exam for the EMT-B is constructed to administer test questions from 5 areas of content. These content categories are EMS Operations, Trauma, Cardiology and Resuscitation, Airway; Respiration and Ventilation, and Medical/ Obstetrics/ Gynecology.

 

For all of these areas of content, any patient care questions will be 85% elderly and adult and 15% pediatric. 

 

Infographic NREMT Exam Content

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The goal of the National Registry of EMT exam is to determine if candidates can apply their book learning and course knowledge to real life field experience and patient care. The EMT test is designed to create situations and tasks that an entry-level EMS professional will need to respond to.

 

Wrong answers on the EMT test may reflect wrong choices in the field that lead to incorrect assessment or treatments of patients in the field.

 

The EMT-B Cognitive Exam content is organized using a test plan which is approved by the National Registry of EMT Board.

 

The test plan is basically a blue-print that communicates with the computer testing software and tells it how to build each candidate’s exam.

 

According to the test plan each Basic EMT test will focus:

 

 10% – 14% of the NREMT exam is EMS Operations.

 

 Trauma will be the focus of 14% – 18% of the EMT test.

 

 20% – 24% of the EMT test is Cardiology and Resuscitation.

 

 Airway; Respiration & Ventilation is 18% – 22% of the NREMT exam.

 

 Medical: Obstetrics & Gynecology is 27% – 31% of the NREMT exam.

 

These areas of content cover Emergency Medical Services (EMS) care and the standard for passing is to provide safe and effective entry-level emergency medical care.

 

Before taking the NREMT exam follow this link to 10 Expert Tips for passing the National Registry of EMT cognitive exam. Follow the guide to be better prepared on your test day.

 NREMT Psychomotor Exam 

 

The National Registry of EMT Psychomotor Exam for the EMT-B demonstrates that a candidate is competent in a range of emergency medical skills. The candidate should speak to their instructor in EMT school about this portion of the NREMT exam because it can be completed during the final stages of an EMT course.

 

If the EMT test for psychomotor skills is not done at the educational institution of the EMT school, the instructor should be able to inform the candidate of where to go for testing.

 

The NREMT psychomotor exam is not administered by the National Registry of EMT. If an EMT school doesn’t give a candidate information about testing, they can always contact their state’s Local EMS office for testing information.

 

Unlike the cognitive EMT test which is written, the psychomotor NREMT exam is a hands on exam with stations the candidate will visit and perform at. Each skill is timed and during the psychomotor EMT test the candidate must verbalize what they are doing and the instructor may ask questions that will require a verbal answer or action. 

 

To get better prepared check out these 7 Expert Tips for passing the psychomotor exam.

NREMT Exam CPR Certification

The best way to study for the psychomotor EMT test is with hands on practice using the National Registry of EMT skill sheets.

 

These NREMT skill sheets are similar to the skill sheets used in EMT school and should be familiar to candidates. Here are 10 examples of skills that candidates will need to become competent in for the EMT-B NREMT psychomotor exam. (These skills are from the 2016 NREMT skill sheets):

 

1. Long Bone Immobilization: Candidate needs to:

A. Verbalize or actually use Personal Protective Equipment (PPE)
B. Direct application of manual stabilization of the injury
C. Assess distal Motor, Sensory, and Circulatory functions in the injured extremity and the examiner should verbalize that they are present and normal
D. Measure and Apply the splint
E. Immobilize the joint above and the joint below the injury site.
F. Secure the entire injured extremity and immobilize the hand/foot in the position of function.
G. Reassess distal Motor, Sensory, and Circulatory functions in the injured extremity and the examiner will verbalize that they are present and normal.

2. Joint Immobilization: Candidate should:

A. Use or verbalize the use of Personal Protective Equipment (PPE)
B. Direct application of manual stabilization of the injury
C. Assess distal Circulatory, Motor, and Sensory functions in the injured extremity and the examiner should state that they are present and normal.
D. Select the correct splinting material and immobilize the site of the injury.
E. Immobilize the bone above and the bone below the injury site.
F. Secure the entire injured extremity.
G. Reassess distal Circulatory, Motor, and Sensory functions in the injured extremity.  (Examiner will most likely state that these functions are present and normal.)

3. Bleeding Control/ Shock Management:

A. Verbalize or take the appropriate PPE precautions
B. Apply direct pressure to the wound (the examiner will verbalize that the patient continues bleeding)
C. Apply tourniquet (Examiner will notify the candidate that the patient is showing signs and symptoms of hypo-perfusion)
D. Properly position the patient
E. Administer high concentration oxygen
F. Begin steps to prevent heat loss in patient
G. Indicate the need for immediate transport.

4. Oxygen Administration by Non-Rebreather Mask:

A. Verbalize or take the appropriate PPE precautions
B. Get the appropriate equipment needed
C. Crack the oxygen tank valve and assemble the regulator to the oxygen tank
D. Open the oxygen tank valve and check the oxygen tank pressure
E. Check for leaks and attach the non-rebreather mask to the correct port of the regulator
F. Turn on the oxygen flow in order to fill the reservoir bag and adjust the regulator to oxygen flow rate of at least 10L/ Minute
G. Adjust mask to patient’s face and adjust so that it fits snugly.

5. Cardiac Arrest Management / AED:

A. Verbalize or take the appropriate PPE precautions
B. Determine the scene and situation is safe
C. Check patient responsiveness and direct assistant to get the automated external defibrillator (AED)
D. Request additional EMS assistance
E. Check pulse and breathing simultaneously (Examiner will indicate the patient is unresponsive, apneic and pulseless)
F. Begin immediate chest compressions with adequate depth and rate (Allow the chest to recoil completely)
G. Perform high-quality 1 Rescuer Adult CPR for 2 minutes:
   a. Correct depth and rate
   b. Compression to ventilation ratio is correct
   c. Allow chest to recoil completely
   d. Adequate volume for each breath
   e. Minimal interruptions of no more than 10 seconds throughout CPR.
NOTE: After 2 minutes or around 5 cycles of CPR the candidate should assess the patient and a second rescuer will resume compressions while the candidate operates the AED.
H. Turn power on to AED
I. Follow AED prompts and correctly attach the AED to the patients
J. Stop CPR and make sure all rescuers are clear of the patient during rhythm analysis
K. Ensure everyone is clear of patient and deliver shock from AED
L. Immediately direct rescuer to resume chest compressions.

6. Spinal Immobilization (Seated Patient):

A. Take or verbalize appropriate PPE precautions
B. Instruct assistant to place and maintain head in the neutral, in-line position
C. Instruct assistant to maintain manually stabilizing the head
D. Reassess circulatory, motor, and sensory functions in each extremity
E. Apply appropriate size extrication collar
F. Position the immobilization device behind the patient and secure the device to the patient’s torso
G. Evaluate torso fixation and adjust as needed
H. Evaluate and pad behind the patient’s head as needed and secure the patient’s head to the device
I. Verbalize moving the patient to a long backboard and reassess circulatory, motor, and sensory functions in each extremity.

7. Spinal Immobilization (Supine Patient):

A. Use or verbalize the use of Personal Protective Equipment (PPE)
B. Instruct assistant to place and maintain head in the neutral, in-line position
C. Instruct assistant to maintain manually stabilizing the head and reassess circulatory, motor, and sensory functions in each extremity
D. Apply appropriate size extrication collar and position the immobilization device correctly
E. Direct the movement of patient onto the device without compromising the integrity of the spine
F. Apply padding to void between patient torso and device as needed
G. Immobilize the patient’s torso to the device
H. Evaluate the pads behind the patient’s head as needed and immobilize the patient’s head to the device
I. Secure the patient’s legs to the device and then secure the patient’s arms to the device
J. Reassess circulatory, motor, and sensory functions in each extremity.

8. BVM Ventilation of an Apneic Adult Patient:

A. Take or verbalize appropriate PPE precautions
B. Check responsiveness of patient and request additional EMS assistance
C. Check pulse and respirations simultaneously (The examiner will inform the candidate that patient is unresponsive, apneic, and has a weak pulse of 60)
D. Open airway properly (Examiner will verbalize the patient’s mouth is full of secretions and vomitus)
E. Prepare rigid suction catheter
F. Turn power on to suction device OR retrieve a manual suction device
G. Insert rigid suction catheter without applying any suction
H. Suction the mouth and oropharynx (Examiner will inform the candidate the mouth and oropharynx are clear)
I. Open the airway manually and insert the oropharyngeal airway (Examiner will verbalize that no gag reflex is present and the patient accepts the airway adjunct)
J. Immediately ventilate the patient Bag Valve Mask (BVM) device not attached to oxygen (Examiner will verbalize that ventilation is being given properly without difficulty)
K. Recheck the patient’s pulse for 10 seconds or less
L. Attach the bag valve mask (BVM) assembly [Bag, Mask, and Reservoir] to oxygen at 15L/minute
M. Ventilate the patient adequately with correct volume to cause a visible chest rise and the proper rate of 10 – 12 breaths per minute, around 1 ventilation every 5-6 seconds. (Examiner will ask candidate how will you know if you are delivering the correct volume with each ventilation and candidate will need to answer out loud.)

9. Patient Assessment / Management – Trauma:

A. Take or verbalize appropriate PPE precautions
SCENE SIZE UP
B. Determine that the scene and situation is safe
C. Determine the mechanism of injury or nature of illness
D. Determine the number of patients
E. Request additional EMS assistance if needed
F. Consider stabilizing the spine
PRIMARY SURVEY/RESUSCITATION
G. Verbalize general impression of the patient
H. Determine responsiveness / level of consciousness (LOC) of the patient
I. Determine apparent life-threats / chief complaint
J. Airway: Open and assess airway and insert adjuncts as needed
K. Breathing:
   a. Assess breathing and assure adequate ventilation
   b. Initiate oxygen therapy as needed and manage any injury which compromises airway/ventilation.
L. Circulation:
   a. Check pulse and assess skin for color, temperature or condition
   b. Assess for major bleeding and control if found
   c. Initiate shock management [position patient, conserve body heat]
M. Identify patient priority and make treatment/transport decision based on calculated Glasgow Coma Scale (GCS)
N. Obtain Baseline vital signs – Blood pressure, pulse and respirations
O. Attempt to get a SAMPLE history.
SECONDARY ASSESSMENT
P. Head – a. Inspect and palpate the patient’s scalp and ears b. Assess eyes c. Inspect mouth, nose and facial area
Q. Neck – Check position of trachea, check jugular veins and palpate the cervical spine
R. Chest – Inspect, palpate and auscultate chest
S. Abdomen/Pelvis:
   a. Inspect and palpate the abdomen
   b. Assess pelvis and verbalize assessment of genitalia/perineum as needed
T. Lower Extremities – Inspect, palpate and assess motor, sensory and distal circulatory functions
U. Upper Extremities – Inspect, palpate and assess motor, sensory and distal circulatory functions
V. Posterior thorax, lumbar and buttocks:
   a. Inspect and palpate posterior thorax
   b. Inspect and palpate lumbar and buttocks areas
W. Manage secondary injuries and wounds as needed
X. Demonstrate how and when to reassess the patient.

10. Patient Assessment/ Management – Medical:

A. Take or verbalize appropriate PPE precautions
SCENE SIZE UP
B. Determine that scene and situation is safe
C. Determine mechanism of injury or nature of illness
D. Determine number of patients
E. Request additional EMS assistance if appropriate
F. Consider stabilization of the spine
PRIMARY SURVEY / RESUSCITATION
G. Verbalize general impression of the patient
H. Determine responsiveness/level of consciousness (AVPU)
I. Determine apparent life-threats/chief complaint
J. Assess Airway and Breathing:
   a. Assessment
   b. Assure adequate ventilation
   c. Initiate oxygen therapy as appropriate
K. Assess Circulation:
   a. Assess and control any major bleeding
   b. Check pulse
   c. Assess skin for color, temperature or condition
L. Identify patient priority and make treatment/transport decision.
HISTORY TAKING
M. Taking History of present illness:
   a. Onset, Provocation, Quality, Radiation, Severity, Time
   b. Clarify questions of signs and symptoms associated with OPQRST.
N. Past Medical History – Allergies, Medications, Past pertinent history, Last oral intake, and events leading up to present illness
SECONDARY ASSESSMENT
O. Assess affected body part/systems – Cardiovascular, Pulmonary, Neurological, Musculoskeletal, Integumentary, GI/GU, Reproductive and Pyschological/Social.
VITAL SIGNS
P. Blood Pressure, Pulse, and Respiratory Rate and quality
Q. State field impression of the patient
R. Interventions [verbalize the proper treatments and interventions for the patient]
S. Demonstrate how and when to reassess the patient to determine any changes in condition
T. Provide an accurate verbal report to the arriving EMS unit.

EMT Training Ambulance Side View

 NREMT Exam Critical Criteria 

 

Each psychomotor skill test has a set of “Critical Criteria” which can be found listed at the bottom of the National Registry of EMT skill sheet. These NREMT skill sheets can be found by going to the National Registry of EMT website and clicking EMT, then under the heading EMS Certification click EMT again. From there, the NREMT skill sheets can be found under the psychomotor Exam tab.

 

The critical criteria must be done correctly to pass the skill. If a candidate fails to do any of these criteria they will fail the skill station, regardless of how well they do completing the rest of the skill.

 

Basically, these are actions the candidate takes that have the potential to cause the patient injury or puts the patient’s life at risk.

Here are some examples of common Critical Criteria:

 

Failure to take or verbalize PPE precautions.
Failure to make establish scene safety.
Failure to manage the patient as a competent EMT.
Exhibits unacceptable affect with patient or other personnel.
Uses or orders a dangerous or inappropriate intervention.
Failure to suction airway before ventilating the patient.
Failure to assess/provide adequate ventilation.
Failure to initiate or call for transport in expected time limit.

(Cont. next page for Advanced EMT)

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