If you are reading this article because you are already in the process of training to become and EMT or if you are just thinking about becoming an EMT: Congratulations! You are on your way to joining a profession that has proven to be a vital, time-honored part of public safety in the United States. EMTs are the backbone of emergency medicine. Without their help and intervention, millions of Americans would not live to be treated by an emergency physician. Being passing the NREMT- EM-B cogitive exam is an indispensable step in becoming a certified EMT. This article presents background information and pointers that will help you get ready for this career defining examination.

What Is the NREMT?

The National Registry of Emergency Medical Technicians or NREMT is the nationally recognized organization that establishes the standards of competence for Emergency Medical Technicians. Created by the National Transportation and Safety Administration or NTSA, the NREMT develops the tests designed to evaluate competence in all the areas covered by the national EMT training curriculum created by the NTSA. Evaluation of EMT competence for the sake of public safety is the main objective of the examination. The EMT standards of the NTSA apply to all states in the United States, because a uniform standard of quality care is essential for implementation of best practices to secure public safety.

What Is the NREMT EM-B Cognitive Exam?

According to the NREMT, the NREMT EM-B Cognitive Exam is a computer based test that evaluates your ability to execute an appropriate emergency scenarios in six basic areas: Airway & Breathing, Cardiology, Medical, Trauma, OB/Gyn/Peds, and Operations. The content of the NREMT EM-B Cognitive Exam is developed using multiple levels of input and feedback from EMT experts and practicing EMTs. There are separate cognitive exams for EMT-Advanced and Paramedic levels.

The test is designed such that there is only one correct answer. Every word is carefully evaluated, so that the test content is free of racial, cultural, language and gender bias. The answers are based on knowledge that is broadly available and found in commonly used EMT texts.

What to Expect on the NREMT EMT-B Cognitive Exam

The NREMT EMT-B Cognitive test is a Computer Adapted Test or CAT. This means that the test uses computer algorithms that present you with questions based on the answers you give. The computer selects questions that challenge you progressively to solve problems and demonstrate knowledge appropriate for your EMT level and training. There is a single pass score. The pass score identifies that you have obtained the level of competence required by the NREMT. Scores below the pass level are failures. It is important that you answer every question to the best of your ability. Questions vary for each candidate, and you cannot go back and change answers.

Each item on the exam is carefully calibrated to measure a level of ability. Questions can start as a series of short questions based on important skills in the topics of airway, cardiology, medicine, trauma, OB/Peds, or Operations. If you are able to answer most of these questions correctly, then the next items will test a higher level of ability. The number of questions you may be asked varies from 70 to 120. When the computer has a 95 percent certainty that your level of competence has been measured, the test will end. You are allowed a maximum of 2 hours to complete the test. Results are usually available within 24 to 48 hours, and are posted on the NREMT website. Access to results is password protected.

The exam uses definitions and scenarios of medical and trauma situations that EMTs commonly have to respond to. 85 percent of clinical questions address adult problems, and 15 percent address problems seen in children.

Strategies for Preparing for a Computer-Based Exam:

An excellent strategy for passing the NREMT EM-B Cognitive Examination involves combining what you learn in class with actual experience. The test measures how you will respond or act within a given emergency situation. According to J. Scriven, a EMT student from Virginia, volunteering to work with other EMS workers such as the fire department, helps you to see text materials in action. Don’t expect to pass by cramming book material several days before the test.

The responses and actions of EMTs are based on the type of situation encountered. The two general emergency categories are trauma and medical emergencies. Trauma applies to injuries sustained during accidents or use of weapons. Examples of medical emergencies include heart attacks, strokes, medication reactions and overdoses. EMT text books use memory devices or mnemonics to help you recall what to do when responding to trauma or medical emergencies. Use of these mnemonics can help orient you in evaluating the situations presented in the NREMT EM-B Cognitive Examination.

One general mnemonic is “SAMPLE.” SAMPLE stands for:

Signs and symptoms
Past medical history
Last oral intake
Events leading up to the present illness.

The SAMPLE can be obtained in medical and trauma cases where the person is able to talk to you, or there is someone with the person who has knowledge about their medical history and the events preceding the emergency.

Another mnemonic is OPQRST, which stands for:


The OPQRST mnemonic gives you a step-wise way of collecting information about pain that will shed light on what is going on. Once you have identified what is going on, you can then take the next step that is appropriate for your level of training. Knowing the OPQRST can help you to respond correctly to the scenarios in the cognitive exam.

DCAT is an mnemonic that will help make clear what is going on in trauma scenarios. DCAT stands for:


The mnemonic BTLS also helps with trauma assessment. It stands for


By studying the course material in a timely manner, gaining practical experience through volunteering, and skillful use of on-site evaluation reminders such as the mnemonics listed above, you will be prepared make accurate assessments.

How to Relax and Deal with Stress Examination Day

The following steps will help you to avoid stress on examination day:

  • Get adequate sleep the night before. Avoid cramming, which increases anxiety.
  • Know exactly how you will get to your test center ahead of time.
  • Plan your transportation so that you arrive on time.
  • Don’t forget you will need 2 forms of ID. At least one of your IDs must have your picture on it. You will not be able to take the exam without proper ID.
  • Eat a protein rich breakfast. This can help you to stay alert and avoid being distracted by hunger.

The NREMT suggests that:

  • You should take your time and read each question carefully. Less than 1 percent of candidates do not finish the test, so there is plenty of time for you to read the question thoroughly. Knowing precisely what the question is asking improves your chances of performing to the best of your ability.
  • Stay calm. The CAT algorithm is designed to test your level of ability, so you may be tempted to feel that the test is hard.
  • Focus your attention on each question, one by one, then move on.


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