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“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.

Recommended Resources


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 PASS practice exams, you can succeed on the NREMT. Check out the PASS apps.

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. Membership includes weekly live NREMT review sessions. Get a membership.

NREMT Review Streaming Video

In two hours, learn how to analyze NREMT test questions. This video walks you through practice NREMT questions (including TEIs) and teaches you how to approach challenging questions. There’s nothing else like it! Stream from LC-Ready.com.

EMT Remedial Training Icon: Green and yellow arrows encircling blue star of life; word "Remediation" in white on yellow arrowLimmer Education Remediation for EMT

If you’ve failed the NREMT 3 times, the National Registry requires you to take a 24-hour remedial course before your next attempt. This program is the most comprehensive course there is. Bonus: It’s not just a bunch of boring slides. Sign up for EMT remedial training.

Join the discussion 9 Comments

  • B. Gonzales says:

    As a medic of the early 2000s and doing EMS for 26 year I could not pass this test now to save my life. It seems unfair that we got a 300 question test that really covered just the basics of doing the job and then had a chance to grow into the job. Now students are working longer and with classes that are so out of touch with what a street level medic do and need to learn to get there feet wet it is crazy to me and many others. To bed thinking at a level of a doctor dose your patient no good if you have no working knowledge of the basics of care at a real level. Seems like the new grads can talk like doctor but can’t think basic to upper level care. What happened to the idea of be a EMT for a year or so then Paramedic. Should be a happy medium. I know some grate people that give the old test would pass hands down and grow into a great Medic but because of the new system will never get a chance. 2 test with 300 questions was the old way now they have the possibility of 15000 ( APROX )different questions per test NERMT . How fair is that, in this area we know trauma Docs that can’t pass practice test. We do need a change in the test. This is not a thing that can be pushed through in 16 months if nurses get more time and Docs get 4 years if they tests are going to be like this. Or go back to test the basics of care and give the crews a chance to help people grow into the job or figure out this is not for them. Only thought from a Medic that got 1 in a lifetime opportunity and got to make a difference in many live and change mine.

  • Nicole Lindquist says:

    The NR test is absolutely ridiculous! I took the whole emt class and passed every single exam with a 100. Got to the NR test and failed. It is a unnecessary test! That’s why emts are hard to come by now because they added that test to trick people

  • Clinton Harris says:

    I have failed the paramedic exam twice. I feel like I know the information, and besides a few questions I felt like I knew most the information cold. Obviously there were some terms I never heard of or learned about in the classroom/clinics/ or exams. I have received below passing twice and I am just so confused on how??? Any recommendations. I want to pass extremely bad. I am a honor roll study 4.0 . But this is exam is throwing me off. I felt like I passed both times

    • Dan Limmer says:

      Thanks for writing. As you can see from several posts here you aren’t alone.

      Without more information, I can’t say for sure but I have seen many people in your position (high-performing student who is unsuccessful). I think there are a couple of reasons for that. The first is that many classroom exams are memory-based, not decision making and interpretation like the NREMT. They are easier and of a different style. The NREMT is a shock.

      The other things I have observed in top performers are that they often agonize over questions and read into them too much. They may miss very subtle facts in the question or stress over the fact that the answer they want isn’t there and have to choose from the 4 responses given. Finally, the amount of reading and attention to detail (proper detail without overthinking) required for the NREMT surprises and challenges students.

      I recommend looking over our YouTube videos on digesting questions. This will give you another (free) resource and help you determine if that is the issue. I also do live weekly sessions through ParamedicReview.com where we go over questions. There are additional resources on that site as well.

      Most importantly I hope you continue and pass the exam. Go on and do good things as a paramedic. My best to you.

  • Brian says:

    I’ve been doing this a long time, 26+ years. I started out as an Army medic, had to do basic and just completed AEMT course last December. I just today failed my second attempt at the NREMT. I had a good feeling. Knew the material, studied hard, had great seasoned instructors. Now I’m left reevaluating my choice to stay in this field. I honestly think and believe in my heart of hearts that NREMT is a big crock of baloney and a waste of time. I know my stuff, I’ve proven it through the years. Now I’ve got this bunch saying, “No you don’t know your stuff.” And don’t even get me started on the scoring…. Below Passing, Near Passing, and Above Passing…… but at no time on their website or any other can you find out what PASSING IS. And since they don’t score you on a point system anymore, you don’t know. It’s a bunch of bullsh%T.

    • Daniel Limmer says:

      Hi Brian–I won’t repeat what I said in the blog post above. There are benefits to the NREMT and things about the test that are valid. Unfortunately, many classes don’t prepare students either in content or exam style for the exam. AEMT has been a low-scoring exam for a while. Some of this is left over from the many varied definitions of EMT-I over the years. The exam is tougher and deeper than many realize. I don’t know anything about your class or educators. I just know it is an issue everywhere.

      I’m going to offer this suggestion tailored directly to you. Many get hung up in anger over the exam–often fed by people they work with–and this drags you and your chances of passing down. Remember your time in the Army? Remember how there were so many things that made no sense but you had to do them because you were a soldier? Look at the NREMT that way. Stop fighting it. Stop being angry. Just like the Army, it doesn’t have to make sense, but if you do it you will be successful. Can you take that approach?

      I think you need to reframe it. It’s like boot camp. You hate it but are proud when you finish and succeed. I hope you look to Limmer Education for any help you need to get over this hurdle. Please let me know if you have any specific questions and I send my personal best to you.

  • Michael Cornett says:

    I have to agree with the other medics.. I do not see the point in why the nremt is the way it is??!! Know your stuff sound like a doctor and can’t preform in the field? I feel it’s just a money scam in a dying profession with 100s of schools letting kids leave their schools with no shot of passing nremt well then you pay more for online education with 100s more of medics teaching you all over again! All to turn around and make 15 dollars an hr

  • Monica gamble says:

    My questions were out of my scope of practice both times. As an EMT all we can do is air way load and go. Period. It’s expencive, I know my stuff,, I have read my entire book 3x, the questions are nothing to what we learn in class. I think of you ass your schooling you pass, or call is in as groups ask us questions, them computer questions are nothing as of what we do actually on the job

  • Roxana Safipour says:

    Well I heard you out and I couldn’t disagree with you more! As someone with many certifications in various fields from past careers, I have a lot of experience taking standardized tests. I can honestly say the NREMT is the worst, most poorly designed test I have ever encountered. The people who wrote these questions may be EMS experts, but they clearly know nothing about how to design good test questions. A good test is one that accurately assesses a person’s knowledge about the subject; many of the NEEMT questions are so poorly written that one can get the question wrong even when they knew the information it was trying to test. Many of the questions involve scenarios that are oversimplified or omit crucial pieces of information; others have multiple answers where experienced providers will disagree over which answer is “best”. It truly is a horrible and poorly designed exam which reflects the writers’ lack of knowledge of good test design practices as much as it fails to accurately reflect the knowledge of the students being subjected to it.

    And by the way, I passed on my first attempt, so I’m not “angry” or “bitter”. I’m just pointing out that everyone’s frustration with this test is 100% valid and frankly your blog post is way off the mark. The NREMT absolutely needs to be overhauled.

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