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By Dan Limmer

Students and educators alike are looking for a magic recipe for what is on the NREMT exam. I’ll tell you two answers. They may not make you feel any better, but here goes.

What’s on the NREMT? You already have most of it in front of you with your textbook.

I’ll admit that I have a horse in the textbook race. I am an author of the Emergency Care EMT textbook. That being said, I feel confident that the book we put together covers the material you need for the NREMT. While I would prefer you to use my book, the other books on the market can certainly make the same claim—and will likely be right.

Books are written based on the National EMS Education Standards. Each book’s authors or contributors interpret the standards and present them in the book. They combine the standards with current science, guidelines, position papers, and current practice.

How does the NREMT determine content for the exam? Members of item writing panels prepare new questions. These members review all of the submitted questions. They come from all over the country, so regional practices, issues, and terms are avoided. After questions meet the muster of the panel members and NREMT item writing experts, they are entered into the database as “pilot” items. Depending on the exam you take, at least ten questions are pilot items and don’t count toward your score.) Questions must be proven valid before they become official and counted on the test. This process prevents outlying topics or obscure items from dominating the exam.

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Let’s take a common topic – shock – and look at different depths of information for the EMT level of certification. This isn’t a complete presentation of shock. It provides examples.

Basic InformationDetailed Information You Need to Know. (Pathophysiology) Information You Likely Don’t Need for the NREMT
In shock, the pulse increases The pulse increases to maintain cardiac output
(HR x SV = CO)
Matching pulse rates to various stages of hemorrhage. This is minutiae, and patients respond differently to shock.
The pulse pressure narrows in shock. The minimum pulse pressure is 25% of the systolic BP
The pulse pressure narrows because of decreased cardiac output lowering the systolic pressure and increased vascular resistance raising the diastolic pressure.
Mean arterial pressure (MAP) is less important at the EMT level because they don’t have a cardiac monitor that presents it; calculating it manually has no benefit. They don’t provide treatments designed to elevate blood pressure.
The BP drops in shock.
Hypotension indicates decompensated shock

Don’t chase your tail looking for the magic recipe.

Why? Because the possibility of finding one nook and cranny isn’t worth losing time studying important concepts like pathophysiology and shock, resuscitation, decision-making, and more. People don’t fail the NREMT because they haven’t heard of Prinzmetal’s angina, they fail because they don’t study and pay attention in class, they rush and don’t read the questions, or maybe they don’t test well. Prinzmetal’s angina (or cystic fibrosis or myxedema coma) has never failed anyone.

Keep your focus. Study efficiently and study what’s important. Don’t search for the magic recipe when you have the recipe in front of you.


As always, if you need high-quality exam prep for yourself or for a classroom, Limmer Education has a variety of solutions for all different types of learners at all different levels of EMS and allied health.  

Join the discussion One Comment

  • Gerry says:

    Overall, I agree: Focus on the important stuff, ignore the minutiae. That said, any advice for a retread? I was trained a lifetime ago, let EMT and Medic lapse when my medical research career resulted in learning things in hospital I could never incorporate on the street, and now in retirement I want to get ’em back. My CME reading/participation is extensive but not really geared to prehospital. Once I get the Medic, I intend to find an ER job rather than get on a truck again. Looking for suggestions.

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