The National Registry of Emergency Medical Technicians is an organization created in 1970 by recommendation of President Lyndon Johnson.  NREMT serves as the certification verifying agency to ensure all levels of EMS personnel are trained to meet all standardized training curriculum.  NREMT certifies the Emergency Medical Technician levels of: Emergency Medical Responder (EMR), Emergency Medical Technician (formally EMT-Basic), Advance Emergency Medical Technician (AEMT), and Paramedic (NRP; formally EMT-Paramedic).  All programs are required to meet NREMT’s standards to be allowed to teach EMT students.

Nearly every state requires NREMT certification for your initial license; however, they do not require the provider to maintain NREMT certification throughout their career.  In the event that the provider would like to leave their state, most states require an active NREMT certification to apply for reciprocity.  Reciprocity is the ability to move from state to state while maintaining your level of certifications.  Some states only require proof of NREMT certification to approve the provider’s request, while other states may require a written and/or practical exam to achieve a state license.  This is completely at the decision of the state EMS office.  In the event that you do not have an active NREMT certification, there is a chance that you will be denied reciprocity and would be required to retake any EMT classes you have taken in the past.  I personally have seen this happen to several coworkers who have moved from/to the states of New York, California, and Florida, to name a few.  Florida will accept NREMT certifications to obtain reciprocity, however, the state of Florida is not a NREMT state.  This means that their EMS providers are not eligible for NREMT certification, and will lose their EMS certification in the event they leave the state.  For these reasons, it is HIGHLY recommended that you obtain your NREMT certification and maintain it throughout your EMS career. 

Following successful completion of your program/class, you will be given the opportunity to challenge NREMT’s exams.  These exams come in the forms of the Psychomotor Examination and Computerized Written Examination.  These exams can be completed in either order; however a passing grade must be achieved to obtain your certification.  Each level has different psychomotor skills that are tested.  In the event that you do not pass a skill station, you will be given another opportunity to retake that station.  Depending on your testing facility, you may be able to retake this skill station on the same day with another preceptor, or you may be required to schedule another day to test. In the event that you fail more than three skill stations, you will need to reschedule another test on a later date.  Once you have successfully passed all of your required skill stations, your NREMT representative will send the required documentation to NREMT for their approval.

All that’s left is the computerized written examination.  I am not going to lie, this is the worst part of becoming an EMT/Paramedic.  The written exam is taken at a NREMT approved facility, typically a Pearson-Vue testing site.  The test is “self-adaptive”, meaning that the number of questions you will have to answer, the category of question, and the level of difficulty are all dependent upon how you are doing.  The written exam can be separated into the following five categories:  Respiratory (Airway, Respiration, & Ventilation, Cardiology (& Resuscitation), Trauma, Medical (Medical, Obstetrics, & Gynecology), and EMS Operations.  Each of these categories will be tested and in the event that the test feels that you are not performing well in a certain category(ies), it will begin to give you multiple questions in that specific category.  So for example, if you are not doing great in cardiac, you may begin to see a ton of cardiac questions.  Fire Department personnel have a habit of performing quite well in the EMS Operations category, due to many of the questions being in their level of expertise (i.e. hazmat, landing zones, & scene safety to name a few), whereas an EMT might perform poorly in EMS Operations, but quite well in the other categories.  It has been said that if you know you do well in a certain category, to purposely fail questions in that category to get an “easier test”.  Trust me, this is not a good idea. 

I am not ashamed to admit that I have taken the NREMT exam multiple times to achieve my Paramedic certification.  For me, it isn’t a bad thing.  The struggle I endured to pass the NREMT exam pushed me to study over and over again, which made me into the medic that I am today.  For those that care to know, it took me eight attempts at this exam to become a Paramedic.  NREMT allows you to take the test three times before having to take a 24-hour refresher class to be able to take the exam an additional three attempts.  After your sixth attempt, you have to retake the class.  So that’s exactly what I did.  Don’t get me wrong, I thought I was beyond ready to become a medic, and felt that the test was just “unfair”.  That couldn’t have been any further from the truth.  I passed all my classes and even all of my psychomotor skills, but my head wasn’t in the right place.  I have no doubt that I didn’t know what I was doing, but I was too afraid of actually becoming a medic.  Taking the class over gave me the confidence I needed and the drive to better myself as a medic.  While I still am not a fan of NREMT, I do believe that the test did exactly as it was created to do.

In the event that you fail the NREMT written exam, you will be given a readout of what categories you need to work on.  If you’re like me, those results will be all over the place.  I highly recommend taking pre-test questions from any of the great sites out there.  Most offer a free month’s subscription in the event that you don’t pass the exam.  I found a lot of use from emt-national-training.com, due to the fact that their pretests not only tell you if you got the question right or wrong, but also why the wrong answers are wrong.  This feedback was extremely beneficial for me, but that might not be the case for everyone.  I would recommend you avoid any site that claims they have “retired NREMT questions”, due to the fact that NREMT does not release their questions to the public.  NREMT does not tell anyone what is and isn’t on their examination.  NREMT approved schools are informed of the areas of study and minimal requirements that are expected of the student, however, no one actually knows what is on the test.

The last thing I want to discuss today is the security of test taking at a Pearson-Vue testing facility.  If you take your exam at another location, you may only have to show proof of ID to take the test.  However Pearson-Vue has a whole series of security protocols in place, which can be extremely nerve-racking if you have anxiety, or aren’t prepared for it.  When you arrive at the testing facility, you will need to show two forms of federally approved ID.  They will take a picture of your face as well as a palm scan. This palm scan reads the layout of the arteries/veins in your hand, to verify that you are the same person who checked in, as well as the same person who takes the exam.  You will then be asked to take a seat in the waiting room until you are called for your exam.  You are to place all of your personal belongings into a locker that is provided, including your phone, car keys, jacket, or anything else on your person.  Once called, you will need to show your ID again and a secondary palm scan.  You will be given a lithograph paper (dry erase paper) and a pen.  You now enter the testing area.  The test is timed and you have two hours to finish the exam of anywhere from 70 to 120 questions.  Your last question is in no way an indication of your pass or fail results.  Upon completion, you will leave the room by showing your ID again, as well as another palm scan.  After that you are free to go, and may collect your belongings.  Typically, if you take your exam before noon Monday-Thursday, you receive your results that afternoon, or at the latest, the next morning.  

Like I said, NREMT testing is probably the worst part of the entire EMT training, but I promise it’s worth it in the end.  With hard work and determination, you will become a great NREMT EMR, EMT, AEMT, or NRP.  Good luck, and give em’ hell!