Expert Guide to EMT & Paramedic Certification Exams Preparing for the Exams

The most important first step to becoming an EMT or paramedic is earning a certificate by passing the exams. This requires a lot of preparation and situational field knowledge. On this page, find details about each section of the exam, necessary subject knowledge, study tips and strategies for crushing the exams.

EMS & Paramedic Testing and Certification

The EMS and paramedic certification process consists of two exams; one, called a cognitive exam, is computer based and multiple choice, and the other is psychomotor, which is a hands-on testing of emergency medical responses. The National Registry of Emergency Medical Technicians (NREMT) coordinates the national cognitive exam and provides a psychomotor local test locator on its website.

While only four states do not require the NREMT certification and having the certification is not a guarantee of a job, the national designation provides a bar of proficiency and performance. This provides better job mobility if moving from state to state and indicates basic necessary skills to a candidate’s future employers. The four states that do not participate in the requirement conduct their certification process in state, and their tests will vary.

In her experience, “CPR, ACLS and PALS must be maintained in order to be a paramedic,” said Kourtney Hartford, a firefighter paramedic with South Metro Fire Rescue in Colorado. “The Colorado paramedic certification is the one that is mostly used, but if you plan on testing in any other state, make sure to keep your national registry certification current. It will make the transfer from state to state much easier.”

After certification, EMT and paramedic candidates can go on to earn their licensure and then have the ability to apply for related jobs.

What are the NREMT exams?

The National Registry of Emergency Medical Technicians provides computer based cognitive testing for certifications as EMR, EMT, AEMT and paramedic. Each is slightly different in delivery method, cost, length, number of questions and subject matter, as detailed below.

The Emergency Medical Responder cognitive exam consists of 90–110 questions, and the time limit is one hour and 45 minutes. The exam is a computer adaptive test, or CAT, during which the computer constantly assesses the ability level of the candidate with question content increasing in difficulty. 60 to 80 of the questions are live and will count toward the scoring, with 30 pilot questions that don’t affect final scoring. The computer stops when it is 95 percent confident either that the candidate is above or below the required level of competency or if time has run out. The cognitive exam fee is $75 per attempt with a renewal fee of $10. The EMR psychomotor exam portion, administered by the state EMS office or approved training center, requires skill verification in areas such as trauma and medical patient assessments, BVM ventilation of an apneic adult, oxygen administration by non-rebreather mask and cardiac arrest management/AED. Certification candidates of any age may take the EMR exams, but they must have completed a state approved EMR course at National Emergency Medical Services education standards in the past two years and have a current or equivalent CPR BLS for a healthcare provider.

The Emergency Medical Technician cognitive exam, also a computer adaptive test, consists of 70 to 120 questions and must be finished within two hours. The cognitive test fee is $80 per attempt with a renewal fee of $15. The psychomotor exam, administered by either the State EMS Office or at the state EMS approved training institution, requires that candidates demonstrate skills in areas such as trauma and medical patient assessments, BVM ventilation of an apneic adult, oxygen administration by a non-rebreather mask, spinal immobilization of seated and supine patients, bleeding control, shock management, cardiac arrest management, AED, joint immobilization and long bone immobilization. Certification candidates must be at least 18 years old, have completed a state approved EMT course at National Emergency Medical Services education standards in the past two years and have a current or equivalent CPR BLS for healthcare provider.

The Advanced Emergency Medical Technician cognitive computer based linear exam consists of 135 questions, with 100 that will be scored and 35 that don’t affect the final scoring. Computer based linear exams mean there is a fixed length to the test, and test takers can skip questions and reverse to correct previous questions until time runs out. Unanswered questions are marked incorrect, but there is no penalty for guessing. Candidates can take up to two hours and 15 minutes on the exam, which costs $115 per attempt with a renewal fee of $15. The psychomotor exam demands that candidates pass 10 hands on scenarios involving trauma and medical patient assessments, ventilatory management, cardiac arrest management/AED, IV and medication skills, pediatric intraosseous infusion skills, spinal immobilization and randomized EMT skills. Certification candidates must be at least 18 years old, have completed the AEMT course at National Emergency Medical Services education standards within the past two years and have a current or equivalent CPR BLS for healthcare provider.

The paramedic cognitive exam, administered in the computer adaptive test format, contains anywhere from 80 to 150 questions, including 60 to 130 live scored items and 20 pilot questions that don’t affect the scoring. The exam must be completed in two and a half hours and covers topics like airway, respiration and ventilation, cardiology and resuscitation, obstetrics and gynecology, trauma and EMS operations. The fee for the exam is $125 per attempt with a $20 renewal fee. The psychomotor exam tests candidates on six skills: patient assessment of trauma, dynamic cardiology, static cardiology, oral station case A, oral station case B and an integrated out of hospital scenario. Certification candidates must be at least 18 years old, have a current national EMT certification or state EMT or higher-level license, must have completed a CAAHEP accredited paramedic program within the past two years, a completed psychomotor competency portfolio, and a current or equivalent CPR BLS for healthcare provider.

“In order to renew your paramedic certification, you must have a certain number of continuing education hours in each subject,” Hartford said. “You get these hours through seminars, conferences, training and classes. If you are hired as a paramedic or an EMT, your employer should provide opportunities to get these hours. If not, hospitals and community colleges around the state offer CE’s through seminars and trainings.”

The Ins and Outs of EMS Exams & Certifications

EMRs, EMTs, AEMTs and paramedics each must complete the two-part examination, which includes a cognitive and psychomotor test, to qualify for certification at the national level. Continue reading for specifics about the tests, subject matter and how to prep for them.

Cognitive

The cognitive tests, as described above, are computer-based exams administered by the National Registry of Emergency Medical Technicians. NREMT goes into great detail on test format and scoring, which differs among certification type. Each test has a time limit, but less than one percent of testers cannot finish within the established parameters. Candidates can sign up on the NREMT website and then apply for cognitive testing. To prep for the cognitive test, NREMT suggests that test takers review their textbooks and workbooks; find an applicable study guide, as there is no official study guide; and review “American Heart Association’s Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.”

Psychomotor

Candidates can get a good idea of what to expect on their psychomotor exams through NREMT’s step by step PDF checklists and videos listed under each certification category. The test is a hands-on demonstration of skills the candidates have learned through their programs. Skills that test takers need to know may include trauma and medical patient assessments, BVM ventilation of an apneic adult, oxygen administration by a non-rebreather mask, spinal immobilization of seated and supine patients, bleeding control, shock management, cardiac arrest management, AED, joint immobilization, long bone immobilization, dynamic cardiology, static cardiology, oral station case A, oral station case B and an integrated out of hospital scenario. The skills tested will vary by certification level. The psychomotor exam is administered by a state EMS office or an approved training center, which can be located on NREMT’s website.

NREMT vs State Exams

Wyoming, North Carolina, Illinois and New York do not require NREMT certification for initial state licensure. These four exceptions use state exams to qualify certifications. All other states use the NREMT certification process for their emergency personnel.

Certification Reciprocity by State

All categories of NREMT certifications are good for two years after the initial expiration date. If a certification lapses, a late fee is usually assessed. The EMR renewal fee is $10 and late fee is $50; EMT and AEMT renewal is $15 and late fee is $50 plus renewal; paramedic renewal is $20, and the late fee is $50 plus renewal. If it has been less than two years since the certification lapsed, personnel can retake the NREMT exams after proving education requirements have been met. If the certificate has been expired for more than two years, a number of extra qualifications may need to be satisfied, depending on the certification level.

In states that do not require NREMT certification, current and prospective emergency personnel should contact their state EMS to get specific requirements for certification, licensure and renewals.

Expert Study Tips & Strategies to Pass EMS Exams

Preparation is key to passing the EMS exams. With the help of an expert, five to six tips for both the cognitive and psychomotor tests have been outlined and explained below.

Kourtney Hartford spent four years as a volunteer firefighter, 10 years with South Metro Fire Rescue as a firefighter and three years so far as a firefighter paramedic in fire-based EMS, in which paramedics are cross trained as firefighters. She worked as a paramedic recruiter for several years, traveling to firefighter and EMS conferences in other states, including Louisiana, Indiana and Florida.

Cognitive Exam

  1. “Know your protocols and medication dosages,” Hartford said. Emergency personnel need to make decisions on the fly regarding necessary emergency medications for patients in distress. Memorizing medications, dosages and knowing when to administer them is not only part of the test but also part of the job.
  2. Remember that although the computer-based tests may offer up correct information in several of the provided multiple choice answers, only one answer will be the best when applied to the given situation. “While taking the NREMT certification exam, the correct answer will strictly pertain to the question. Sometimes there will be one answer that is correct but mixed with vital signs or additional information that does not pertain to the question at hand; therefore, there may be a more correct answer,” she said.
  3. “Know your cardiology, especially deadly rhythms, myocardial infarction and heart blocks,” Hartford said. NREMT lists cardiac arrest management and AED within each certification category’s skills that necessitate demonstrated proficiency. As heart disease is the leading cause of death in the U.S., it makes sense that emergency personnel be well versed in cardiology and appropriate responses to cardiac emergencies.
  4. For the certification categories that use the computer adaptive test format, it may help to mentally prepare for this type of testing, as it’s different from the usual linear type of multiple choice exams. “The National Registry test is designed to test the limits of your knowledge on the different aspects of paramedicine. This means that the questions will get increasingly more difficult for every right answer you get. If you miss an answer, you may get an easier question,” Hartford said. The computer will also decide when to end the exam based on the test taker’s proficiency.
  5. “Take your time on your answers, no need to rush,” Hartford said. Only less than one percent of candidates who take the test are unable to finish within the given time. With the linear test for AEMTs, test takers can skip questions they are unsure of and come back to them later. It is better to guess on these than to leave them blank. On the CAT format exams, slow, considerate answers may be in the candidate’s best interest, as the more correct answers are chosen, the quicker the exam will be ended by the computer, anyway.

Psychomotor Exam

  1. “Know your protocols,” Hartford said. EMS protocols are developed to provide a standard of care and procedures to follow in each situation. Only in a rare circumstance could emergency personnel deviate from protocol, and even then, there should be a demonstrated reason backed by documented clinical reasoning. Any alteration in protocol is usually required to be documented and reviewed. Memorizing protocols sets candidates up for success and therefore provides the best care to patients and the best performance on the exam. “I was first an EMT, and I highly recommend getting experience as an EMT before going to paramedic school,” Hartford said. “The exams will follow your reading material, so read.”
  2. Ability to concentrate on the task at hand and control emotion are desirable traits in paramedics and will serve candidates well to practice during their psychomotor exam. “Stay calm and be methodical,” Hartford said.
  3. In regard to prioritization, “During scenarios, there could be multiple medical complaints. Treat the medical complaint that could be the most life threatening first,” Hartford said. If test takers are presented with a scenario like she mentioned, the ability to think quickly to correctly prioritize will serve a paramedic candidate well.
  4. Recognize and resolve mistakes quickly. “If you realize that you have missed a step, are on the wrong path or did something you weren’t supposed to, address the issue, fix it and move forward,” she said.
  5. “Stick to the basics,” Hartford said. “If there is an airway issue, fix it. If there is a circulation issue, fix it. Basic life support first.” The ability to assess an emergency situation and break it down into basics will help candidates simplify a problem and stay on task.
  6. “Study and practice your critical skills before the test,” she said, listing chest decompression, intubation, drip rates and medication mixes, cricothyrotomy and heart pacing as important techniques to know with proficiency.

Additional Resources to Help Pass the Exam

EMT and paramedic job seekers will find a plethora of information in the resources, including extensive certification exam information and tips, practice exams, study guides and individual states’ certification requirements.