The NREMT Exam for EMTs

The National Registry of Emergency Medical Technicians certifies EMS clinicians at more than one level, and each level has its own exam. This page is about the EMT exam. The Registry's exams for other levels, such as AEMT and Paramedic, have their own specifications and are not described here.

The exam on this page is the cognitive exam: the computer-based test of knowledge and judgment. National Registry certification as an EMT also requires a BLS skills competency verification approved by your State EMS Office, which is arranged separately.

You must have completed a state-approved EMT course that meets or exceeds the National EMS Education Standards, and you must have completed it within the past two years. Your program director verifies the completion; you cannot self-certify it.

States can add requirements of their own, and the handbook pages we read did not state a minimum age or a CPR credential. Check both with the National Registry and with your state EMS office before you apply.

The exam is a computerized adaptive test. Instead of giving every candidate the same fixed set, it chooses questions as you go and keeps going until it is 95% confident that you are above or below the passing standard. That can happen after 70 questions, or it can take all 120.

Two things follow. First, the number of questions you get tells you nothing reliable about the result: the exam can reach its decision early in either direction, and a long exam only means the decision took longer. Second, there is no "number correct" to aim for. The decision rests on where your performance sits against a fixed standard, not on a count.

Whatever its length, your exam includes 10 unscored pilot questions that the Registry is trying out. The time limit is 2 hours.

The standard question is multiple choice with four options. The exam also uses technology-enhanced questions: multiple response, where you select two or three of five or six options; options tables; build lists, where you put options in order; and drag-and-drop.

Every question, whatever its type, is scored right or wrong. There is no partial credit, so a multiple-response question with one wrong selection earns the same as one left blank.

An on-screen calculator is available. Hand-held calculators are prohibited.

Five domains that follow the order of a call: Scene Size-up and Safety, Primary Assessment, Secondary Assessment, Patient Treatment and Transport, and Operations.

The National Registry publishes a range for each domain rather than a single figure: 15 to 19% for Scene Size-up and Safety, 39 to 43% for Primary Assessment, 5 to 9% for Secondary Assessment, 20 to 24% for Patient Treatment and Transport, and 10 to 14% for Operations. The table further down this page shows the midpoints of those ranges, scaled to total 100, because a table needs one number per row. How to divide your preparation across the domains is the subject of the separate study guide, linked at the end of this page.

$104 for each attempt, paid as the application fee. Your EMT course and the skills verification are separate costs. The National Registry's site is the authority on the current fee.

The outcome is pass or fail against a fixed passing standard, decided by the adaptive algorithm once it reaches 95% confidence. Results are reported on a scale of 100 to 1500, and 950 is the passing point.

The scale is not a percentage. A 950 does not mean 950 of 1500 of anything, and it cannot be converted into a number of questions answered correctly.

Pearson VUE delivers the exam in two ways: at a Pearson VUE test center, or online through Pearson's OnVUE remote proctoring. Read Pearson VUE's requirements for the online option before you choose it, since a remote sitting depends on your own computer, connection and room.

You have six attempts in total. After an unsuccessful attempt you must wait 15 days before testing again, and every attempt requires the $104 application fee again.

After three unsuccessful attempts, remedial education is required before you can use attempts four to six. The Registry's handbook sets out what that education must consist of; confirm the details there.