“That’s absolutely ridiculous. You would never do that on a real call.”
“The NREMT gives you trick questions.”
“Some of the questions really don’t give you enough info to make a good choice.”
“They didn’t teach us any of this in class.”
“I have tons of knowledge but I get every single practice question wrong.”
“If this were my patient, I would…”

These are just a handful of the comments we’ve seen on forums, in YouTube comments or in our own inboxes from frustrated students practicing for the National Registry exam. As far as these passionate test-takers are concerned, the NREMT is composed of random and poorly-planned questions that don’t align with a new provider’s education or field experience.

Why does the NREMT seem so ridiculous to so many people? We can think of a few reasons, below. We ask that you put your frustration aside and hear us out. 

The NREMT is a Difficult Test

The average first-time pass rate in 2020 was 67% for EMTs and 70% for paramedics. [Source] People who have passed it love to say that it was easy, but except for a handful of geniuses out there, most of those people had really good instructors, were really dedicated students, and/or figured out a really good test prep plan early on. Their own preparedness made a difficult exam seem not so difficult. And good for them! 

The NREMT should be difficult. You shouldn’t certify someone as an emergency medical professional unless they can prove they can handle the job. The NREMT tests entry level competency. The concept of “handling the job” means the test-taker has a good knowledge base, but it also means s/he can process multiple information points and make a sound treatment decision. And those decisions sometimes need to be made in seconds! 

For some people, the test is made more difficult because their instructor didn’t do a good job presenting the necessary clinical material. Or because the test-taker didn’t invest in studying the material presented in class. Or some combination of both.

The NREMT isn’t Always in the Class Curriculum

Most classes will touch on NREMT prep at some point. But it may be at the very end of the semester, and the approach is often over-simplified. It takes more than basic multiple choice questions and skill sheets to prepare someone for an exam like the NREMT.

It’s no wonder, then, that many people leave EMS classes and feel confused – even outraged – when they experience the NREMT or NREMT-style practice questions. If they succeeded in class by relying on step-by-step thinking, it’s a rude awakening to suddenly be expected to draw a highly specific conclusion from the often-limited information of an NREMT question.

A big part of NREMT prep is learning how to read NREMT questions. They aren’t structured the same way as most class exam questions. Test-takers need to be able to recognize small clues in the question stems, and then apply vast clinical knowledge to each scenario. Ideally, this process is taught and practiced in class. In reality, some classes don’t bother or don’t spend enough time on it.

It’s the difference between “If A happens, then do B” and “If A happens alongside C, then do E before you do B.” One mirrors the textbook. The other mirrors real life. One is a lot easier. The other builds a competent and confident provider.

The NREMT Doesn’t Feel like the Street

Many people see NREMT answer choices and feel frustrated if the choice they want isn’t there. They think, “But if this were my patient, I would…” That type of thinking is more likely to lead them away from the correct answer than to it. There is always a correct answer. Keep in mind, NREMT questions are written by EMS experts, reviewed by EMS experts and pilot tested on thousands of people before they can be scored as part of the exam. It’s extremely unlikely that you have a better answer than the choices you’re provided.

Also keep in mind, the NREMT is a national organization that can’t tailor its exams to every region, station or municipality. It doesn’t know what your local protocols are, so don’t distract yourself trying to match your specific protocols with the answer choices on the screen.

The only notable way the NREMT differs from the street is that it gives you four choices for each scenario, while the street offers you unlimited choices. You need to be able to handle those four choices before you can handle the unlimited choices. The NREMT is, in fact, good preparation for the street because of the type of thinking it requires.

Change Your Approach to the NREMT

EDUCATORS: It’s important to start teaching critical thinking early. Throughout your course, exam items and class discussions should challenge students to combine information points from multiple topics. On exams, all the answer choices should be “choosable” – but only one correct. (For more about this, check out our Exam Item Creation Guide and our Multiple Response Item Writing Guide.) Weave NREMT-style questions and preparation into every class section. Your students won’t be surprised by the NREMT style questions and It should improve first-time pass rates. It also develops stronger providers.

STUDENTS: What can you do if your class doesn’t require the kind of thinking needed for the NREMT? Find the highest-quality NREMT prep you can and start using it early. High-quality test prep will challenge your knowledge and challenge your ability to assess a test question. Look at test prep as an opportunity to keep learning. Don’t study just to pass. Study to understand.

This is the purpose of our NREMT prep apps: They train students to think more critically than the average class exam requires. They train them how to read and analyze NREMT-style questions. And they train them to be more thoughtful and effective providers.


Our 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 the PASS practice exams, you can succeed on the National Registry. Check out the PASS apps.

Our subscription site is the most complete, most affordable NREMT prep program there is. High quality questions closely resemble those found on the NREMT. It’s especially good for people who may have struggled in class. Get a Premium membership.

NREMT Review Streaming Video
In two hours, learn how to analyze NREMT test questions. This video walks you through practice NREMT questions (including samples of TEIs) and teaches you how to approach challenging questions for the best chance of success. Stream from LC-Ready.com.

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