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Everyone practicing EMS has to pass the NREMT or a state EMS exam. Using a special episode of the podcast 7 Things EMS, we dissect the important things you should do – before and during the exam! – to be fully prepared . Listen to the whole episode below or keep reading to find out which secrets to success you’ve been missing.

1. Put in the Work.

A lot of people think they’re going to take an EMT class and be able to coast through class and certification. That is seldom the reality. The amount of work you put in throughout class makes a big difference.

You also have to remember that even if class doesn’t require a lot of hard work – the National Registry does. While in class, most people only think about what it takes to pass the class. By the time they start thinking seriously about the NREMT, they feel overwhelmed trying to prepare for it in a relatively short amount of time.

The amount of work you put in throughout class makes a big difference.

The NREMT is a hard test. The questions aren’t about memorization. They’re designed to make you think more like a provider than a student. As an EMT, you’re the person in charge in the back of an ambulance. It’s a big responsibility, it’s an important job, and it’s fair and good for the National Registry to require competency for that job. It shouldn’t be an easy test.

If a patient has broken bones, they don’t need someone showing up at their door reciting all the bones in the body. They need someone who understands how to manage broken bones, and how broken bones can cause shock, and how to manage a complex medical scenario. The NREMT tests to see if you learned the “between the lines” material and how to make clinical judgements.

2.) Prepare Properly for the NREMT.

The concept of studying is something a lot of people just don’t get. So many students finish class, decide it’s time to get ready for the NREMT, and then their whole approach is just going back and rereading sections of their textbook. The textbook is a valuable tool during class, but when class is over, it’s a reference book. When you get a flashcard or a practice question on an app that you don’t understand, that’s when you go back to the book. But by the end of class, you’ve already gotten all the lessons out of the book that you’re going to get. Now it’s time to start putting those lessons together and using them for critical thinking.

Spaced Repetition

Marathon study sessions don’t work, especially when you’re close to the exam. What works best is spaced repetition. This is where you study a topic, give it a break, then come back and study it again. For example, if you want to study cardiology, study it for a couple days, make flashcards and do practice questions, then put cardiology down while you move on to other subjects. Then after a few days, come back to cardiology. When you pick up those flash cards again, you’re probably going to find it easier. Dan Batsie, a state EMS chief and an educator, talks about how studying is like going through a jungle where you’re trying to slash through weeds with a machete. Spaced repetition creates a path for your knowledge to come out.

Practice Tests

If you have the knowledge from class, now it’s time to condition yourself to take a challenging exam. Find test prep that doesn’t give you simplistic, memorization-based questions. As you practice, take your time reading each question and then submit your answer. If you get it right, good for you. But if you get it wrong, make sure you learn from it! Stop and read the rationale. Go back to the question and identify where you went wrong:

  • Did you miss a piece of information in the question?
  • Did you read too fast?
  • Did you misunderstand the wording?
  • Did you just not know something?

Most NREMT prep products include sample or simulated exams. Take those sample exams in their entirety, doing each one in a single sitting. Before you walk into the testing center, you want to know what it’s like to sit there for two hours answering tough questions.

Recommended NREMT Prep

PASS Apps: The famous EMT, AEMT and Paramedic PASS apps are a little more challenging than the NREMT itself. We did that on purpose. If you can succeed on PASS practice exams, you can succeed on the NREMT. Check out the PASS apps.

EMT Review Plus logo/iconReview Plus Apps: Get a review of everything you learned in EMT, AEMT or paramedic class, while getting practice for the NREMT. Content is organized by subject so you can find and focus on your weakest areas. Start reviewing.

emtreview.com product logo is a staff of aesculapius inside a light blue star of life inside a hexagonEMTReview.com: The most affordable NREMT prep program there is! This site is especially good for people who struggled in class or who already failed the NREMT once. High quality questions closely resemble those found on the NREMT. Get a membership.


3. You May Never Feel “Ready.”

Let’s say you had a good class, you did well in class, and you’ve been studying well. Even so, you might not actually feel confident about the test. Not a lot of people go into the test saying, “I’m going to ace this thing.” Most people go in with some nervousness.

When Dan does NREMT prep sessions on EMTReview.com, he always says everybody needs three things to pass the NREMT: Knowledge, an understanding of how the exam works, and mojo.

Mojo is the hardest part because it’s an unknown. But you have to believe you can pass the test. If you look at some of the EMT and paramedic Facebook groups and Reddit posts, you see people say they put off taking the National Registry because they didn’t feel ready. The truth is, the longer you’re out of class, the more material you forget. Try to take the exam within a month of finishing class. Don’t hold yourself back because you’re not confident. Schedule your test and study the best you can.

The truth is, the longer you’re out of class, the more material you forget. Don’t hold yourself back because you’re not confident.

At the EMT level, about 70 percent of people pass on the first try. For paramedic, the first time NREMT pass rate is about 75 percent. The odds are on your side. Take the test!

4. Understand the NREMT.

There’s a lot of misunderstanding, misinformation and outdated information about the NREMT. Here are the most up-to-date details on four often-misunderstood parts of the exam:

Adaptive Exams

The EMT and paramedic tests are adaptive, meaning you start with easy questions and the exam gives you harder questions as you go along. And if you do well on the harder questions, you will continue to get increasingly difficult questions.

The computer keeps giving you questions until you reach a 950 score – that’s the passing score. Often, people who are doing really well on the exam freak out because they’re getting all these difficult, complicated questions. Just remember, that’s probably a good sign because it means you’ve proved mastery of the easier stuff and now the computer is giving you those hard questions. People who don’t do well on the easier questions won’t get the super hard questions.

Pilot Items

A few questions on every test are pilot items. Pilot items tend to mess with people’s heads because in the back of their mind they know some questions aren’t going to count – but they don’t know which ones.

Pilot questions might also feel confusing because maybe all your pilot questions are hard questions, or they’re all on one topic – so you see a bunch of questions about abdominal evisceration or placenta previa and then you wonder if you’re getting those questions because you answered other questions incorrectly.

If some of your questions feel weird or repetitive, don’t second-guess yourself. You’re probably having a normal exam experience and the best thing you can do is just focus on each question individually.

Remember pilot questions are important because they help the National Registry weed out questions that are confusing or poorly constructed. Pilot questions never count against you and they help make sure the questions that do count are fair and valid.

What the Question Is Asking

The NREMT asks a lot of “you should” questions (“you should first…” or “you should next…”) and a lot of diagnosis-type questions (“you should suspect…”). Those questions are asking for a decision or an action. For some people, this is very different from what they saw on class exams.

The Registry has stated that they do not do the “best answer” format anymore. For every question, there is always only one right answer. However, the questions are challenging because there’s not much “wiggle room” between the right answer and the wrong answers. There’s a “choosability” to the wrong answers and only careful reading and understanding of all the information stated in the question will help you eliminate those wrong answers. A lot of class tests and exam prep products have questions where the answer choice is more obvious or more memory-based than the NREMT. This is why a lot of students get thrown for a loop when they take the NREMT the first time.

This is why you need exam prep that’s really going to challenge the way you think and put your critical thinking skills to the test. Your exam prep should also include rationales for the questions that help you see the difference between the right and wrong choices and improve your knowledge and understanding as you study.

New Questions for 2024

The National Registry has added new styles of questions – specifically, the scenario style questions. AEMT and paramedic exams are using multi-part scenario questions that cover an entire all from start to finish. Each scenario may have 10 or 15 questions. The first question might be getting the call or arriving on scene, and with each successive question, you might get a little bit more information about the patient and the scene. These items are designed to test you in several different ways, like predicting if something might be a problem later, knowing what should be done on scene versus in the ambulance, etc.

There are other types of new questions: Drag and drops where you can rank issues in order of severity or arrange items in the order you would do them on scene. There are multiple response questions where you choose more than one answer. So the exam might say “choose two of these five items” or “select the three correct items out of these six.” The former executive director of the National Registry, Bill Brown, has advice for reading multiple response questions: Just treat each answer choice as a true/false question.

5. You Have Enough Time. Really!

A lot of people worry about running out of time on the NREMT, but you really do have plenty of time. You get about a minute per question. The average length of time a person takes according to the National Registry is 31-32 seconds per question. You’ll spend a lot less on some questions and a little longer on others. You have plenty of time! It’s rare for someone to time out.

You have plenty of time! It's rare to time out.

Our apps have a timer on the simulated exams. Pay attention to the timer. If you give yourself a minute per question and have a 100-question practice test, then you have 100 minutes to finish the test. In the overwhelming majority of cases, people finish with plenty of time to spare.

6. Read Carefully, but Don’t Read Into the Question.

This is exactly how it works in the field: Whether EMT, AEMT or paramedic, if you ignore a piece of information, or if you fixate on a single piece of information without considering the whole picture, you’re going to make mistakes.

Read Carefully

Read each question thoroughly – and preferably read it twice – and make note of each detail it provides. Identify words that make a difference: shallow, confused, pale, anxious, sleepy. If they’re sleepy and have shallow breathing, maybe they’re in respiratory failure. Every word means something, so identify all those pieces of information and interpret what it says about the patient.

Don’t Read Into It

Don’t assume information that isn’t there. There are no tricks in NREMT questions. If you’re answering an NREMT question about giving medication and the question itself doesn’t say or suggest there’s an allergy, then there’s no reason to worry about the patient having an allergy. Don’t let your mind insert “what ifs.” The NREMT gives you the information you need to answer the question. If information isn’t provided, then rest assured, it’s not relevant for that question.

Only after you’ve worked your way through all the details in the question, look at the answer choices. And if you’re still not sure which is the right answer, use process of elimination to rule out choices that don’t match the whole picture.

7. Answer Each Question to the Best of Your Ability, Then Move On.

What’s important about this point is the “move on” part. Of course you’re going to answer each question to the best of your ability, but there will be times where you didn’t know the meaning of a word in a question, or you felt torn between two answer choices, and it stays in your head and freaks you out. This is the hard part, but you have to mentally move on from those questions.

After you click the next button, don’t second-guess yourself. If your mind is still wondering whether you got a question wrong two questions ago, it’s going to mess with your ability to answer the new question. Now it’s time to fully focus on the question that’s on the screen right now.

After you click the next button, don’t second-guess yourself.

Bonus: What do you do if you already failed the NREMT?

First, do some honest reflection. Did you really prepare well enough and do what you needed to do for this test? The answer might be yes and it might be no. Either way, your ego will be bruised. It doesn’t feel good to be unsuccessful, but it doesn’t mean you won’t be successful later. Now you have to change the way you prepare. Do active preparation:

  • Make study cards.
  • Write out your responses to the critical thinking exercises at the end of each chapter in your textbook.
  • Form a study group with other people who you can trust to focus on studying.
  • Go back to your instructor and ask for advice.
  • Take some diagnostic exams to identify which topics you need to study most.
  • Look for practice tests that really challenge you and make you think. Read the rationales and take notes on what caused you to get questions wrong.

If you do fail, take a couple days to get over it, but then go sign up for your retest. Give yourself 30 days because if you wait too long, you’ll starrtr forgetting information. Give yourself a comfortable timeframe to do active test prep, and get back in there and take the next test. For most people, the second time is easier because now they understand what the exam is like and they’ve probably put in more work to pass this time.

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