Navigating Changes to the New NREMT BLS Exam

A new NREMT exam has been announced for EMTs and EMRs beginning on April 7, 2025. What does this mean for educators and students? This series of posts will explore the changes and provide solutions to make sure you and your students are ready.

NREMT BLS Exam Changes: What is the short version educators need to know now? 

The new BLS exam blueprint released by the NREMT is weighted more heavily on assessment than the current exam. EMT educators should continue to teach all content in the education standards, and the actual questions the NREMT has used in the past are still in play. However, it’s prudent to add additional assessment content to our entire course in our presentations, lab time, quizzes and exams, and clinicals.

It is important to take a moment and embrace this change. Change can be difficult–and we don’t have a lot of notice on this one. It is difficult to argue that patient assessment is a bad thing or that additional concentration on assessment will be anything other than positive for an EMR or EMT. Focusing on key things (that we likely agree we need to cover more anyway), like identifying criticality and changes in a patient’s condition, will only help build better clinicians–and help exam success rates.

New NREMT BLS Quick Reference

Why is the NREMT focusing on patient assessment?

When Joe Mistovich, Twink Dalton, Howie Werman, and I planned and wrote the first edition of the Advanced Medical Life Support (AMLS) book, we planned on about 80% of the book highlighting assessment and differential diagnosis. Only 20% was about treatment. Why is that? Because protocols tell us what to do. The challenge is getting to the correct protocol. That is where assessment comes in. Most errors in EMS are cognitive. We don’t give the wrong medication because we pulled the wrong drug out of the box as much as we give the wrong medication because of a cognitive or diagnostic error. We get the diagnosis wrong and apply the wrong medication or modality. Better assessment builds better clinicians.

Most errors in EMS are cognitive... Better assessment builds better clinicians.

This applies more at the EMT level than ever. The toolbox of the BLS provider is larger than ever with meds and modalities. We’ve heard horror stories about providers giving repeated doses of naloxone to a patient who isn’t experiencing an opioid overdose–and wondering why the patient doesn’t wake up. Or a provider fails to do a blood glucose measurement, believing the patient is having a stroke and misses a treatable condition. These are ultimately assessment errors.

Let’s not forget that solid assessment and thinking skills will create better candidates for AEMT or paramedic students.

What do my EMT students need to know about the new BLS exam?

Students taking the exam won’t know it's new. It is simply the exam they must take. The educator feels the newness. We must be careful not to share any anxiety with our students.

The proper messaging involves telling your students that they have been prepared properly, that they have been given an excellent education that focused on patient assessment throughout the course (using Limmer Education resources), and that they must still do their part for preparation by focusing in class, doing well on class exams, and studying outside of class.

Remind students that the exam will have many of the same questions they would see on the older exam; they have just been sorted into different categories. Students have the potential to create barriers or blocks in their heads that don’t exist. Be careful not to fuel this and make the new exam that monster to overcome.

All of the preparation advice Limmer Education offers is still valid. NREMT questions and question styles haven’t changed–and our apps will all be updated to reflect the new exam structure in plenty of time for the new exam.

Limmer Education products for the new NREMT BLS exam

Limmer Education will update all of our EMT products to meet the new exam criteria–and to meet the needs of you and your students in this transitional time. We will help you make sense of the changes and give you actions you can take immediately to help prepare your students for the new exam. Use this New NREMT BLS Quick Reference to learn more about the exam, the tasks the exam was built around, and match areas of the National EMS Education Standards to the new tasks.

This three-part series will integrate how to include more assessment in your class through presentations, lab and clinical experience, and testing.