With tens of thousands of people watching our TikTok live videos every week on our EMS Bros account, we get the same questions over and over. How do I pass my NREMT test, what’s on the NREMT test, and the worst one we see so often, “I keep failing the test, what do I do?”

In 2015, I finished my EMT classes and registered to take the National Registry exam. I was nervous, scared, but excited. Being nationally registered is the highest achievement as an EMT because you can go to almost any state, get reciprocity, and go to work. You can even pick up travel EMT jobs that pay over $60 an hour, so it’s a certification worth obtaining.

Unfortunately, the National Registry Exam has a bad name for itself due to how challenging it is. In 2019, only 69% of EMTs passed the exam on their first try. Since 2014, the pass rate has stayed around 70% or lower.

These numbers may not seem too terrible, but put them into perspective. According to a study by California Emergency Medical Services in 2019, 77,938 people in the US tested for National Registry, only 54,164 passed. Sadly, almost 24,000 people received the dreaded “With regret, we must report that you have failed the cognitive examination.”

First, what is the National Registry Exam?

The NREMT Exam is between 75 to 140 questions long that will randomly end whenever the test thinks you have correctly answered enough questions. The screen goes blank, and that’s it. Then you have to wait up to a week to know if you passed.

If you know what you’re doing, you can pass with only answering 75 questions; however, if you don’t know what you’re doing, you may have to answer the maximum 140 questions. You only get three attempts at passing or else you have to take your EMT class once again.

The exam has multiple topics such as anatomy, cardiology, trauma, OB, respiratory, poisoning, and others.

5 Tips & tricks to pass

1. Pocket Prep

I recommend Pocket Prep to everyone in my classes as well as people that watch our TikTok live videos. I have tried other apps, but they did not compare to PocketPrep. PocketPrep has a very detailed explanation with every answer, whereas the other apps mainly just list the correct answer without any kind of explanation.

2. Do not procrastinate

If you procrastinate and wait until the last minute to study, you probably will fail. If you do happen to skim by and pass, that doesn’t really help you in the long term. Remember that you are literally holding people’s lives in your hands with this job. Know your stuff and do not be lazy.

3. Learn to dissect each question

It’s important to break down each question logically and analyze the components. Here are two examples:

 An accumulation of air or gas in the pleural space, resulting from a penetrating wound of the chest wall, is termed:

    1. Hemothorax
    2. Open pneumothorax
    3. Tension Pneumothorax
    4. Pulmonary Embolism

We can quickly eliminate D because air in your chest cavity is not going to be a blood clot. It couldn’t be A because the question is talking about air or gas, not blood. So we are left with B and C. Since the question stated “Penetrating wound,” we know it can’t be a Tension Pneumo because they are caused by blunt trauma. The answer would be B, Open Pneumothorax.

Let’s try one more.

The most important step when caring for any emergency care patient is to:

    1. Ascertain the chief complaint
    2. Obtain and maintain a patent airway
    3. Maintain body temperature
    4. Identify the patient

Always remember ABC, Airway, Breathing, Circulation. The answer is B, obtain and maintain a patent airway. If the patient can’t breathe, the body temperature and the chief complaint no longer matter. D is pretty important but read the question again. At this point you are already caring for and have identified the patient so that eliminates D.

4. Group study

Get some classmates together and study. Each person will be able to bring something to the table to help remember things.

For example, I remembered Epinephrine dosages by making the rhyme “Green is teen” because EpiPen Junior is for small children and has a green lid and a dosage of 0.15mg. For the adult dosage, I know that doubles, so 0.3mg.

Finding simple things like that to help you remember drug dosages will make a huge difference.

5. Most importantly, relax!

The National Registry exam is challenging, but don’t overthink it. Overthinking things in this field can be the difference between life and death. The same thing applies to second guessing yourself on the exam. Your gut instinct is almost always right, so the more you think about it and second guess yourself, the more likely you are to make an error.

What to do on test day

1. Once again, relax.

It’s just a test. If you fail, do it again. If you give up, I promise you will never pass. Take a deep breath and go in with nothing else on your mind except passing.

2. KISS… Keep It Simple Stupid.

Read the question, think of the answer in your head, and then pick the most appropriate answer on the list. If you start by looking at the answers first before thinking of the correct answer in your head, you’ll start second guessing yourself and set yourself up for failure.

Keep it simple, read the question, say the answer, pick the closest one to your answer.

3. Stay confident.

If you go into the testing site scared and worried, you will not do well. Go in with a positive mindset and focus on the task at hand. Remember, it’s just a test. You’ve taken dozens of tests before; this is no different.

Congratulations, you passed – now what?  

Your hard work has finally paid off. You received the email from the National Registry with that beautiful blue and white card. All that’s left now is to apply for a job you want and start working.

A lot of states still do not require you to have the National Registry certification. If you are in one of these states, having your National Registry will be a good negotiating point for your salary. It means you have taken another step further in your career and not only know your state’s protocols, but you can also work on the national level.

In 2019, only 69% of EMTs passed the exam on their first try.

Being an EMT is one of the most underrated jobs out there. You will be referred to as an “ambulance driver,” and a lot of people may think you have very limited knowledge or skills.

Even in the hospital setting, some nurses will think all you do is drive, even though you are adept at adjusting the tidal volume, PEEP, and all of the other settings on a ventilator so that you and your paramedic partner can transfer the patient to a higher level.

The important thing is to just let it go. No one will understand your job until they do it. People like you and I are a special breed who can consistently see things and do things on a daily basis without it really bothering us.

This is where your career begins. A lot of EMT’s go on to become paramedics, then enroll in a bridge class to become an RN. Some even go further and go from RN’s to Physician Assistants.

I have one friend who went from being an EMT to a doctor. He started as an EMT years ago and then made the decision to further himself. Today, he’s working in one of the busiest emergency rooms on the east coast as a doctor.

Always keep learning and always further yourself. This is just the beginning of your career.