NREMT EMR Exam Prep
The National Registry Emergency Medical Responder (EMR) exam uses five task-based domains, with Primary Assessment accounting for 37–41%. Start with the priority map below, then work through the call example, the 16 original practice questions, and the 14-day plan.
Exam format, domains, fees, and testing policies last verified October 19, 2026.
Your EMR priority map: the five exam domains
| Exam domain | Share of the exam | What it means for an EMR | What to drill |
|---|---|---|---|
| Primary Assessment | 37–41% | Build rapport, form a general impression, and check responsiveness, airway, breathing, and circulation. Find the chief complaint and life threats, get baseline vital signs, and decide whether the patient needs rapid treatment, rapid transport, or more help. | Say the assessment sequence out loud until it's automatic. Know which findings mean "fix it now." |
| Patient Treatment and Transport | 20–24% | Manage the airway, ventilation, and oxygen. Control bleeding and support circulation. Restrict movement of injuries, give medications within your scope, and adapt care for children, older adults, and pregnant patients. Support transport and pass on what matters. | For every intervention, know three things: why you'd do it, what you'd do, and what you'd recheck afterward. |
| Scene Size-Up and Safety | 19–23% | Plan from dispatch information, protect yourself and others from hazards, and choose PPE. Find every patient, triage, and request the right resources. | Hazard, then resource, then ask: "What has to change before I approach?" |
| Operations | 10–14% | Keep equipment working and supplies stocked, document accurately, and look after your own well-being and your crew's. | Readiness checks, accurate records, and exposure response. |
| Secondary Assessment | 4–8% | Do a focused physical exam and history. Reassess to catch changes in the patient's condition. | Ask: what changed since your last check, and what does that send you back to do? |
Source: NREMT EMR Examination Specifications, pp. 2–4.
The table is sorted largest share first. The official domain list is Scene Size-Up and Safety, Primary Assessment, Secondary Assessment, Patient Treatment and Transport, and Operations. Questions about children are mixed into every domain (NREMT).
The percentages describe the share of examination content assigned to each domain. They don't tell you how hard an area is or how many hours you need.
Exam at a glance
| Row label | Row label |
|---|---|
| Format | Computerized adaptive test (CAT) |
| Length | 90–110 questions; 30 are unscored pilot questions you can't identify |
| Time limit | 1 hour 45 minutes |
| Question types | Multiple choice, multiple response, build list, drag-and-drop, options table |
| Where | Pearson VUE test center, or online at home or work through Pearson's OnVUE |
| Fee | $88 per attempt |
| Results | Generally posted to your National Registry account within 2 business days |
| Skills | Separate requirement: a BLS skills competency approved by your State EMS Office |
Sources: EMR Examination Specifications, pp. 5–6; EMR Candidate Handbook: About the Examination; EMR Candidate Handbook: Certification Process.
One call, five domains: a worked example
The five domains connect to tasks performed across a call. Here is one original scenario traced through all five domains.
Dispatch: You're an EMR on an engine company. You're sent to a "worker down" at a construction site.
- Scene Size-Up and Safety. On the way, plan from what dispatch told you: a construction site may mean heavy equipment, falls, or electrical hazards. On arrival, look before you walk in. Is equipment still running? Are there overhead lines? Put on gloves and eye protection. Ask the foreman how many people were hurt. One worker is down, and a second is sitting nearby holding his arm. That's two patients, so you request a second unit now, not later.
- Primary Assessment. The worker who is down groans when you speak to him, and blood is spurting from a deep gash in his thigh. That bleeding is a life threat you treat the moment you find it, before you count his breaths. Apply firm direct pressure. Check airway, breathing, and circulation while your crew continues bleeding control; get baseline vital signs without delaying treatment. Decide whether he needs rapid transport.
- Patient Treatment and Transport. Pressure isn't stopping the bleeding, so you apply a tourniquet above the wound, avoiding a joint, tighten it until the bleeding stops, and note the time. Then you position him and keep him warm, and give the care your protocols allow at the EMR level. When the ambulance arrives, you help load him. You give the receiving crew a clear handoff, including the tourniquet time.
- Secondary Assessment. Once the immediate threats are handled, you do a focused exam and get a short history. On reassessment you notice he's harder to wake than he was five minutes ago. That change sends you straight back to his airway and breathing.
- Operations. Afterward you document what you saw and what you did. You follow your agency's process for promptly removing and handling the blood-contaminated clothing, wash any affected skin with soap and water, and restock the bleeding-control kit.
When a practice question confuses you, ask what task it is testing and what the patient needs now. Many "what do you do first?" questions become clearer once you place them.
Sources: EMR Examination Specifications, pp. 2–4; 2024 AHA/Red Cross First Aid Guidelines, §9.1; LAFD tourniquet steps; OSHA bloodborne pathogens standard, §1910.1030(d)(2)(vi), (d)(3)(vi)–(viii), and (d)(4)(iv).
16 practice questions (original, unofficial)
These questions were written for this page. They are not official NREMT items. They use all five official question formats and spread across the domains in rough proportion to the exam. Choose the best answer from the facts given, and read the explanation even when you get it right.
| Domain | Questions | Count |
|---|---|---|
| Scene Size-Up and Safety | EMR-01 to EMR-03 | 3 |
| Primary Assessment | EMR-04 to EMR-09 | 6 |
| Secondary Assessment | EMR-10 | 1 |
| Patient Treatment and Transport | EMR-11 to EMR-14 | 4 |
| Operations | EMR-15 to EMR-16 | 2 |
| Total | Blank | 16 |
Scoring: For this practice set, each question counts as one point, and you must get the whole question right. There is no partial credit on multiple-response, build-list, drag-and-drop, or options-table questions. A score on 16 questions shows patterns in your thinking. It does not predict your official result.
EMR-01 · Scene Size-Up and Safety · Multiple choice
You are the first EMR to arrive at a van rollover on a rural road. Traffic has been stopped and the scene is safe. About 12 adults are scattered around the van. The patient closest to you is unresponsive and not breathing. Patient needs exceed the responders immediately available. Using your agency's START mass-casualty protocol, what is your best next action?
- A. Begin CPR on the closest patient.
- B. Request additional resources and begin rapid triage of all patients.
- C. Do a complete head-to-toe exam on the patient who looks worst.
- D. Have a bystander drive the most injured patient to the hospital.
Show answer and explanation, question EMR-01 (question 1 of 16)
Answer: B.
Why: There are far more patients than responders. Your first job is to get enough help coming and sort everyone quickly so the people who can be saved get care first. In START triage, you reposition the airway of a patient who isn't breathing. If they still don't breathe, they are tagged expectant/deceased. You don't do prolonged CPR while everyone else waits.
Why not the others:
- A ties up the only responder on one patient while the others go unassessed.
- C is a detailed exam that belongs much later.
- D loses track of a patient and skips EMS care during transport.
Sources: EMR Examination Specifications, p. 2 (Scene Size-up tasks: triage, request resources); HHS CHEMM: START Adult Triage Algorithm. Your local mass-casualty protocol may use a different triage system, such as SALT.
EMR-02 · Scene Size-Up and Safety · Drag-and-drop
During initial START triage at an adult mass-casualty incident, sort each patient into a category: Minor, Delayed, Immediate, or Expectant/deceased. Patients B–E cannot walk. Use the radial pulse to assess perfusion. Categories may be used more than once.
| Patient | Your category |
|---|---|
| A. Walks to the collection area when you ask everyone who can walk to move there | ___ |
| B. Not breathing; starts breathing after you reposition the airway | ___ |
| C. 24 breaths per minute, radial pulse present, follows commands, but can't walk because of a leg injury | ___ |
| D. 20 breaths per minute, radial pulse absent | ___ |
| E. Not breathing, even after the airway is repositioned | ___ |
Show answer and explanation, question EMR-02 (question 2 of 16)
Answer:
| Patient | Category | Why |
|---|---|---|
| A | Minor | Able to walk |
| B | Immediate | Breathing returned only after you repositioned the airway |
| C | Delayed | Passes all three checks: under 30 breaths, radial pulse present, follows commands |
| D | Immediate | No radial pulse means poor perfusion |
| E | Expectant/deceased | No breathing after airway repositioning |
Why: START checks walking first. Then it checks three things in order: respirations, perfusion, and mental status (RPM). A patient who remains apneic after airway repositioning is tagged Expectant/deceased. For the other nonwalking patients here, breathing that returns after airway repositioning or an absent radial pulse leads to Immediate; patient C passes the breathing, perfusion, and command-following checks and is Delayed.
Source: HHS CHEMM: START Adult Triage Algorithm. Use the pediatric triage system specified by your local protocol.
EMR-03 · Scene Size-Up and Safety · Multiple choice
After a storm, you see a person lying beside a fallen overhead power line. The line is not sparking or humming. You are standing well away from it. Which action is best?
- A. Approach the person, because a line that isn't sparking has no power.
- B. Push the line away with a dry wooden branch, then check the person.
- C. Keep yourself and bystanders away and request the utility company and fire/rescue resources.
- D. Put on exam gloves and pull the person away from the line.
Show answer and explanation, question EMR-03 (question 3 of 16)
Answer: C.
Why: Treat every downed line as energized. Lines can stay live without sparking or humming. Current can also spread through the ground and into nearby objects. Your job is to keep everyone from becoming another patient and to get the people who can make the line safe.
Why not the others:
- A assumes something the scene doesn't show.
- B puts you in contact with a possible hazard.
- D treats exam gloves as electrical protection, which they are not.
Source: OSHA Fact Sheet: Working Safely Around Downed Electrical Wires (FS-3941), "Safety First" and "Rules to Live By."
EMR-04 · Primary Assessment · Build list
An adult collapses in front of you at a warehouse, and a bystander is available to help. When assessed, the adult is unresponsive, has no normal breathing or only gasps, and has no definite pulse within 10 seconds. Put these five listed actions in the order shown by the 2025 AHA healthcare-professional adult BLS algorithm.
| ID | Action |
|---|---|
| A | Check for breathing and a pulse at the same time, for no more than 10 seconds |
| B | Make sure the scene is safe |
| C | Begin CPR: cycles of 30 compressions and 2 breaths |
| D | Check for responsiveness |
| E | Shout for help, activate the emergency response system, and send someone for an AED |
Your order: ___ → ___ → ___ → ___ → ___
Show answer and explanation, question EMR-04 (question 4 of 16)
Answer: B → D → E → A → C.
Why:
- Scene safety comes first so you don't become a patient.
- Calling for help and an AED comes before your breathing and pulse check, so help is already on the way.
- The breathing and pulse check is short so compressions aren't delayed. If you find no breathing or only gasping, and no definite pulse, start CPR.
- When the AED arrives, use it right away.
Source: AHA 2025 Adult BLS Algorithm for Healthcare Professionals. Only the complete correct order earns the point.
EMR-05 · Primary Assessment · Multiple choice
A 54-year-old man collapses at a gym. He is unresponsive and takes an occasional deep, gasping breath. You can't feel a definite pulse within 10 seconds. A coworker is bringing the AED. What should you do now?
- A. Give 2 rescue breaths, then recheck the pulse.
- B. Place him in the recovery position because he is breathing.
- C. Begin CPR, starting with chest compressions.
- D. Wait for the AED before starting care.
Show answer and explanation, question EMR-05 (question 5 of 16)
Answer: C.
Why: Gasping is not normal breathing. An unresponsive adult with only gasping and no definite pulse within 10 seconds should be treated as being in cardiac arrest. If you aren't sure you feel a pulse, treat that as no pulse.
Why not the others:
- A delays compressions.
- B mistakes gasping for breathing, which is one of the most common errors in recognizing cardiac arrest.
- D wastes time. CPR is recommended until the AED is applied.
Source: AHA 2025 Part 7: Adult Basic Life Support, §6.1 (Recognition of Cardiac Arrest, recommendation 2 and supporting text), §6.2, §9.2.
EMR-06 · Primary Assessment · Multiple choice
A woman in her 30s is found unresponsive in a restroom with a syringe nearby. She is taking about 4 shallow breaths a minute, her lips are blue, and you feel a definite carotid pulse. You have a bag-valve mask and intranasal naloxone. What should you do?
- A. Begin chest compressions.
- B. Ventilate with the bag-valve mask at 1 breath every 6 seconds and give naloxone per your protocol.
- C. Give naloxone, then wait a few minutes to see whether she starts breathing before ventilating.
- D. Place her in the recovery position and monitor her breathing.
Show answer and explanation, question EMR-06 (question 6 of 16)
Answer: B.
Why: She has a pulse but isn't breathing adequately. This is severe respiratory depression with inadequate breathing. She needs ventilation now, at 1 breath every 6 seconds, with naloxone given for the suspected opioid overdose. Do not delay ventilation to give naloxone. Check her pulse every 2 minutes. If it disappears, start CPR.
Why not the others:
- A does not fit this adult with a definite pulse.
- C leaves her without enough oxygen while you wait. Naloxone doesn't replace breathing for her.
- D doesn't fix breathing that is already inadequate.
Sources: AHA 2025 Adult BLS Algorithm for Healthcare Professionals ("Abnormal breathing, pulse felt"); AHA 2025 Part 7, §8.3; AHA 2025 Part 10: Opioid Overdose, §21.11 (recommendations 1 and 4). Bag-valve-mask ventilation and premeasured intranasal opioid antagonists are EMR-level skills in the National EMS Scope of Practice Model 2019, August 2021 edition, pp. 25 and 28–29. Your state and medical director set your actual protocol.
EMR-07 · Primary Assessment · Multiple choice
A construction worker is alert after a saw injury. Bright red blood is spurting from a deep wound in the middle of his thigh. A coworker has been pressing a towel firmly on it, but blood keeps soaking through. You have a commercial tourniquet. What should you do first?
- A. Take a full set of baseline vital signs.
- B. Apply the tourniquet about 2–3 inches above the wound, avoiding a joint, and tighten it until the bleeding stops.
- C. Ask SAMPLE history questions.
- D. Splint the leg in the position you found it.
Show answer and explanation, question EMR-07 (question 7 of 16)
Answer: B.
Why: Life-threatening bleeding gets treated the moment you find it. When firm direct pressure isn't controlling bleeding on an arm or leg, apply a tourniquet. Place it 2–3 inches above the wound, never over a joint, and tighten it until the bleeding stops. Note the time you applied it and give that time to the arriving crew.
Why not the others: A and C must not delay hemorrhage control. D is appropriate only if the injury calls for splinting and must not delay bleeding control.
Sources: 2024 AHA and American Red Cross Guidelines for First Aid, §9.1 (life-threatening extremity bleeding not controlled by direct pressure); LAFD: Stop the Bleed, tourniquet steps. Tourniquets are within the EMR level in the National EMS Scope of Practice Model 2019, p. 27.
EMR-08 · Primary Assessment · Multiple response (select 3)
Which three findings are immediate life threats you must act on during the primary assessment?
- An adult who cannot speak or cough after choking on food
- An unresponsive patient taking only occasional gasps
- Bright red blood spurting from an upper-arm wound
- A swollen, deformed wrist with a strong radial pulse
- Scraped knees on both legs
- A blood pressure that hasn't been measured yet
Show answer and explanation, question EMR-08 (question 8 of 16)
Answer: 1, 2, and 3.
Why:
- Option 1 is a severe airway obstruction.
- Option 2 is abnormal breathing in an unresponsive patient. It requires immediate assessment and support and may indicate cardiac arrest.
- Option 3 is life-threatening bleeding.
All three need action now. A deformity with good circulation, minor scrapes, and a pending blood pressure can wait. On the real exam, multiple-response questions give no credit unless every choice is right.
Sources: EMR Examination Specifications, pp. 2–3 and 5–6; AHA 2025 Part 7, §6.1 and §10.1; 2024 AHA/Red Cross First Aid Guidelines, §4.2.
EMR-09 · Primary Assessment · Multiple choice
A 4-year-old with a hand injury is alert, breathing comfortably, and has no uncontrolled bleeding. The child is clinging to a calm parent. Which approach best supports your assessment?
- A. Talk only to the parent and avoid addressing the child.
- B. Separate the child from the parent so the child cooperates better.
- C. Get down to the child's eye level, use simple words, and include the parent when it helps.
- D. Promise that nothing you do will hurt.
Show answer and explanation, question EMR-09 (question 9 of 16)
Answer: C.
Why: Building rapport is a primary assessment task. With a young child, that means a calm approach, simple language, and help from a supportive caregiver.
Why not the others:
- A leaves out your patient.
- B removes the child's support for no reason the scenario gives.
- D is a promise you can't keep, and breaking it costs trust.
Sources: EMR Examination Specifications, p. 2 (establish rapport); 2024 AHA/Red Cross First Aid Guidelines, §4.2 and §4.6 (children: calm them and consider engaging their caregiver). This scenario describes a helpful parent. It doesn't address suspected abuse or an unsafe caregiver.
EMR-10 · Secondary Assessment · Multiple choice
You are reassessing a 70-year-old woman who fell. On your first check she was alert and talking. Now she only moans when you apply a painful stimulus, and her breathing has slowed. What should you do?
- A. Finish the head-to-toe exam where you left off.
- B. Return to the primary assessment, manage her airway and breathing, and update the incoming EMS unit.
- C. Repeat the SAMPLE history.
- D. Recheck her vital signs at the next scheduled interval.
Show answer and explanation, question EMR-10 (question 10 of 16)
Answer: B.
Why: Reassessment exists to catch changes like this one. A drop in responsiveness with slowing breathing means your earlier findings are out of date. Go back to the life-threat checks, act on what you find, and pass the change on.
Why not the others:
- A delays the urgent recheck.
- C asks history questions she can no longer answer.
- D waits on a schedule when the patient is getting worse now.
Sources: EMR Examination Specifications, p. 3 (reassessment to determine changes; communicate pertinent information); 2024 AHA/Red Cross First Aid Guidelines, §4.2 (new confusion and abnormal breathing are emergency signs) and §5.1 (stay with the person and monitor for changes).
EMR-11 · Patient Treatment and Transport · Multiple choice
A conscious adult at a restaurant clutches her throat. She cannot speak or cough. Following the 2025 AHA guidelines, what should you do?
- A. Give abdominal thrusts only until the object comes out.
- B. Give repeated cycles of 5 back blows followed by 5 abdominal thrusts.
- C. Do a blind finger sweep of her mouth.
- D. Have her drink water to wash the object down.
Show answer and explanation, question EMR-11 (question 11 of 16)
Answer: B.
Why: Not being able to speak or cough means a severe obstruction. The 2025 guidelines call for repeated cycles of 5 back blows followed by 5 abdominal thrusts, until the object comes out or she becomes unresponsive. If she becomes unresponsive, start CPR, beginning with compressions.
Why not the others:
- A is how many people learned it. Under 2025 guidance, the cycle starts with back blows.
- C is listed as harmful because a blind sweep can push the object deeper.
- D is unsafe with a blocked airway.
Source: AHA 2025 Part 7: Adult Basic Life Support, §10.1 and §10.2. For an adult in late pregnancy, or one whose abdomen you can't wrap your arms around, give repeated cycles of 5 back blows followed by 5 chest thrusts (§10.3).
EMR-12 · Patient Treatment and Transport · Options table
Mark each statement about infant CPR (under 1 year old, not a newborn) as Recommended or Not recommended under the 2025 AHA guidelines.
| Statement | Your choice |
|---|---|
| A. Compress with the heel of one hand | ___ |
| B. Use the 2 thumb–encircling hands technique | ___ |
| C. Compress with two fingers on the breastbone | ___ |
| D. Compress at least one-third the depth of the chest, about 1½ inches | ___ |
| E. With two rescuers and no advanced airway, give 15 compressions to 2 breaths | ___ |
Show answer and explanation, question EMR-12 (question 12 of 16)
Answer:
| Statement | Key |
|---|---|
| A | Recommended |
| B | Recommended |
| C | Not recommended |
| D | Recommended |
| E | Recommended |
Why: The 2025 guidelines dropped the two-finger technique because it often fails to reach the right depth. Use one hand, or the 2 thumb–encircling hands technique. If you can't fit your hands around the infant's chest, use one hand. Without an advanced airway, a single rescuer uses 30:2. Two rescuers use 15:2.
Source: AHA 2025 Part 6: Pediatric Basic Life Support, §7.2 (recommendations 5, 6, and 9) and §7.3 (recommendation 1). You need every row right for the point.
EMR-13 · Patient Treatment and Transport · Multiple choice
An adult is having a convulsive seizure on the floor of a break room. Help has been called. Chairs and a metal table are within reach of the person's jerking arms. What should you do?
- A. Hold the person's arms and legs down until the jerking stops.
- B. Move the hard objects away and stay with the person.
- C. Put a spoon between the person's teeth to protect the tongue.
- D. Give the person water once the shaking slows.
Show answer and explanation, question EMR-13 (question 13 of 16)
Answer: B.
Why: Protecting the person from injury and staying with them are the core seizure care steps. When it's possible, placing them on their side helps protect the airway.
Why not the others:
- A can injure the person or you.
- C can break teeth or injure your fingers. People can't swallow their tongue.
- D risks choking, because a person who is having a seizure or is drowsy afterward can't swallow safely.
Source: 2024 AHA/Red Cross First Aid Guidelines, §6.6 (Seizures, recommendations 2, 3, 5, and 6).
EMR-14 · Patient Treatment and Transport · Multiple choice
Under the 2019 National EMS Scope of Practice Model, which intervention is within the EMR level?
- A. Oral aspirin for chest pain
- B. Oral glucose for suspected low blood sugar
- C. Premeasured intranasal naloxone for a suspected opioid overdose
- D. A traction splint for a suspected thigh-bone (femur) fracture
Show answer and explanation, question EMR-14 (question 14 of 16)
Answer: C.
Why: The national model places opioid antagonists at every level, including EMR. It lists aspirin, oral glucose, and traction splints at the EMT level and above. Exam questions are written for the entry-level EMR role, so watch for answer choices that belong to a higher level.
Source: National EMS Scope of Practice Model 2019, pp. 28–29. Your state and medical director set your actual scope, and some states add skills.
EMR-15 · Operations · Multiple choice
While you control bleeding, blood splashes into your eye. Another responder takes over patient care. What should you do?
- A. Wipe the eye with gauze and report the exposure at the end of your shift.
- B. Rinse the eye right away with clean water or saline, then report the exposure to your supervisor immediately.
- C. Wait to see whether symptoms develop before reporting.
- D. Wash the eye with soap.
Show answer and explanation, question EMR-15 (question 15 of 16)
Answer: B.
Why: First aid for the exposure comes first, followed by immediate reporting and medical evaluation under your agency's exposure plan. Looking after your own well-being is part of the Operations domain.
Why not the others:
- A and C delay reporting and medical evaluation.
- D is not how you rinse an eye. Use clean water, saline, or a sterile eye rinse.
Sources: CDC/NIOSH: How to Prevent Needlestick and Sharps Injuries (2012-123); MedlinePlus: After an exposure to sharps or body fluids. Follow your agency's exposure plan for the next steps.
EMR-16 · Operations · Multiple choice
During a routine AED check, you notice that the sealed pad package is past its expiration date. Unexpired replacement pads are on the shelf. There is no emergency in progress. What should you do?
- A. Replace the expired pads following the manufacturer's instructions, then finish the check.
- B. Keep the old pads because the package is still sealed.
- C. Ignore the date as long as the AED turns on.
- D. Note the date on the checklist and replace the pads at next month's check.
Show answer and explanation, question EMR-16 (question 16 of 16)
Answer: A.
Why: Expired pads shouldn't be used, and a routine check is exactly when you fix problems like this. Your job in Operations is to have equipment ready before the next call, not just present.
Why not the others:
- B and C leave an expired part in service.
- D knowingly leaves the AED unready for a month.
Sources: EMR Examination Specifications, p. 3 (equipment in working order); one manufacturer's instructions as an example: Defibtech DDU-100 Series User Manual, §5.2.4–5.2.5. Always follow the manual for the AED you actually use.
Your 14-day EMR study plan
Assumptions: You have finished or nearly finished an approved EMR course and have your course notes. You can study about 45 minutes a day for 14 days. That works out to 630 minutes, or 10.5 hours (14 × 45 = 630 minutes ÷ 60 = 10.5 hours). That number is our planning budget, not an official requirement, and not a guarantee of anything.
Each session:
- 5 minutes recalling the topic without notes
- 20 minutes of focused review
- 15 minutes applying it to questions or cases
- 5 minutes updating your mistake log
| Day | Focus | Do this | Keep this |
|---|---|---|---|
| 1 | Baseline | Read the five domain descriptions in the priority map. Answer all 16 questions before reading explanations. Log every miss and every lucky guess. | Two topics to prioritize |
| 2 | The assessment sequence | Walk through the one-call example out loud. Redo EMR-04 until the order is automatic. | A one-line sequence you can say from memory |
| 3 | Scene Size-Up and Safety | Review hazards, PPE, patient count, resource requests, and triage. Redo EMR-01 to EMR-03. Apply the same thinking to a traffic scene and an unsafe building from your course. | Hazard, resource needed, and what must change before you approach |
| 4 | Primary: first impression and rapport | Review responsiveness and general impression. Redo EMR-09, then compare an adult case and a child case from your course. | What you'd say to the patient in the first 30 seconds |
| 5 | Primary: airway and breathing | Sort normal breathing, inadequate breathing, respiratory arrest, and cardiac arrest. Redo EMR-05 and EMR-06. Note one pediatric difference from your course. | The finding that separates "ventilate" from "start CPR" |
| 6 | Primary: circulation and life threats | Review severe bleeding and signs of poor circulation. Redo EMR-07 and EMR-08. | One case written as finding → action → recheck |
| 7 | Primary: put it together | Run two full course scenarios from scene to handoff. Include one older adult or child. Say when you'd call for more help. | Two short case summaries |
| 8 | Secondary assessment and reassessment | Review the focused exam, history, and reassessment. Redo EMR-10 and retake your two hardest misses from Day 1. | When your earlier findings stop being good enough |
| 9 | Treatment: BLS and AED | Review the current adult and pediatric BLS sections and the 2025 changes. Redo EMR-11 and EMR-12. Practice on a manikin and AED trainer if your program offers one. | The 2025 choking cycle and infant compression techniques, from memory |
| 10 | Treatment: medical emergencies | Review your course chapters on seizures, stroke recognition, breathing problems, and altered mental status. Redo EMR-13 and EMR-14. | The EMR-level action for each, and what's outside your scope |
| 11 | Treatment and transport: trauma and special patients | Review trauma priorities, restricting movement, moving patients, childbirth and newborn care, and older adults. Practice a spoken handoff that separates what the patient told you, what you saw, and what you did. | A handoff outline |
| 12 | Operations | Review equipment and supply checks, documentation, infection control, and responder well-being. Redo EMR-15 and EMR-16. | One corrected readiness problem and one sample documentation entry |
| 13 | Question formats | Try NREMT's interactive EMR sample items on a desktop or laptop, or read the EMR sample packet. Retake all 16 questions. Mark which misses came from format confusion and which from knowledge. | Instructions that change how you answer, such as "select 3" |
| 14 | Consolidate and check logistics | Review only your mistake log, out loud and without notes. Confirm your ATT deadline, that your ID matches your ATT name, and your test-center route or OnVUE system check. | A short list to keep reviewing after the exam date is set |
Got more time? Run the cycle again with new cases from your course. Spend the extra days on the gaps your log shows. Got less time? Do Days 1, 2, 5, 6, 9, and 13, then work straight from your mistake log. Shortening the plan doesn't show you're ready. It just puts the highest-value review first.
If you're retesting
NREMT counts the 15-day wait from the day your results post. That posting day counts as Day 1, so an otherwise eligible candidate with attempts remaining can schedule a retest for Day 15. (Examination Retesting Policy 62.10, version 4.) If you start on the results-posting day, the 14-day plan fits inside that wait.
Start from your score report. A failing report shows your score on a 100–1500 scale, with 950 as the passing point. That tells you how far away you were, though not which topics you missed (EMR Candidate Handbook). Weight the plan toward the domains your mistake log and instructor feedback point to.
Turn a missed question into your next study session
A missed question is useful when you can name why you missed it. Memorizing the right letter doesn't help on a question you've never seen.
| Question / topic | What I chose and the fact I missed | Correction (with source) | Next review |
|---|---|---|---|
| Example: EMR-06, breathing support | I chose compressions, but the stem said she had a definite pulse. | For an unresponsive adult with absent or inadequate breathing and a definite pulse, ventilate at 1 breath every 6 seconds. Give naloxone per protocol if opioid overdose is suspected, without delaying ventilation. (AHA 2025 adult BLS algorithm; AHA 2025 Part 10, §21.11) | Tomorrow: explain the pulse/no-pulse split without notes |
| Your next miss | Blank | Blank | Blank |
Tag each miss with one label:
- Knowledge gap: you didn't know the fact.
- Missed scenario detail: a fact in the stem changed the answer and you skimmed past it.
- Wrong sequence: you knew the actions but not the order.
- Instruction slip: for example, you selected 2 when the question said select 3.
These labels are just a way to organize your review, not a measure of readiness.
How the EMR exam works
It adapts to you. After a starting set of questions, the computer gives you questions at or above its estimate of your ability. Once the minimum number of questions has been answered, the exam can end when it is 95% confident of a pass or fail decision. It can also end at the maximum number of questions or the time limit (EMR Examination Specifications, p. 5).
What the question count tells you. Stopping at 90 questions or going to 110 tells you nothing by itself about passing. The passing standard is the same for everyone (EMR Candidate Handbook). Thirty questions don't count, and you can't tell which ones, so treat every question as scored.
Five question formats, all or nothing.
| Format | What you do | How to practice |
|---|---|---|
| Multiple choice | Pick one of four options | Say why the answer fits the facts given |
| Multiple response | Pick 2 or 3 correct answers from 5 or 6 options | Check how many to select; judge each option on its own |
| Build list | Put options in the stated order | Start from the exact point the question names |
| Drag-and-drop | Sort options into categories | Read every category definition first |
| Options table | Classify each row of a table | Apply the same rule to every row |
You receive full credit only for a completely correct response. Partly right earns nothing (EMR Examination Specifications, pp. 5–6). An untimed tutorial at the start of the exam shows how each format works, and the Help function stays available during the exam (NREMT).
Results. Results post to your National Registry account, generally within 2 business days. If you pass, you get no score details. If you don't pass, you see your score on the 100–1500 scale, with 950 as the passing point (EMR Candidate Handbook).
What changed in April 2025, and how to spot outdated prep
The current EMR exam launched April 7, 2025. The last day to take the previous version was April 4, 2025 (NREMT). NREMT changed the domain labels and organized the exam around tasks you perform on a call.
| Old domain (before April 7, 2025) | Examples of related current tasks |
|---|---|
| Airway, Respirations, and Ventilation | Primary Assessment (assessing airway and breathing) and Patient Treatment and Transport (managing them) |
| Cardiology and Resuscitation | Primary Assessment (recognizing arrest) and Patient Treatment and Transport (CPR, AED, circulation) |
| Trauma | Primary Assessment (life threats such as bleeding) and Patient Treatment and Transport (bleeding control, restricting movement) |
| Medical, Obstetrics, and Gynecology | Secondary Assessment, Primary Assessment, and Patient Treatment and Transport (including special populations) |
| Operations | Operations and Scene Size-Up and Safety |
This mapping is our reading of how familiar topics connect to the current task list (NREMT).
Red flags in prep material:
- Old domain list. A guide or app that lists the old five domains as the current exam outline is out of date, whatever year is on its cover.
- "Actual exam questions." Avoid anything that advertises real or recalled exam questions. Sharing or reconstructing exam content breaks NREMT's rules for candidates (EMR Candidate Handbook: Candidate Responsibilities).
- Endorsement claims. NREMT does not recommend any particular prep materials (EMR Candidate Handbook).
Studying during the 2025 AHA guideline update
Two separate updates are easy to confuse:
- The exam blueprint changed in April 2025.
- The American Heart Association (AHA) CPR guidelines were updated in October 2025.
The EMR handbook tells you to review the current AHA guidelines (EMR Candidate Handbook). On October 27, 2025, NREMT said it was reviewing live exam questions and removing any that conflict with the 2025 guidelines. It expected new questions based on those guidelines to become operational within 12 to 15 months (NREMT news). By that estimate, the window runs from roughly late October 2026 to late January 2027. That is NREMT's projection, not a fixed date.
The practical answer: learn the 2025 versions, especially if your course used older materials.
| Topic | 2025 AHA guidance | Why it trips people up |
|---|---|---|
| Severe choking, responsive adults and children | Repeated cycles of 5 back blows, then 5 abdominal thrusts | Many people learned abdominal thrusts first |
| Infant compressions | Heel of one hand, or the 2 thumb–encircling hands technique. The two-finger technique was eliminated. | The two-finger technique was taught for years |
| Severe choking, responsive infants | Repeated cycles of 5 back blows, then 5 chest thrusts; no abdominal thrusts | Mixing up the infant and child sequences |
| Unresponsive adult with absent or inadequate breathing and a definite pulse | 1 breath every 6 seconds; check the pulse every 2 minutes; give naloxone per protocol if opioid overdose is suspected, without delaying ventilation | Starting compressions on this adult despite a definite pulse |
| Blind finger sweeps | Should not be done | An old habit that can push the object deeper |
If a patient with severe choking becomes unresponsive, begin CPR with chest compressions. For the adult chest-thrust exceptions, see EMR-11 above.
Sources: AHA 2025 Part 7: Adult BLS, §8.3 and §10.1–10.3; AHA 2025 Part 6: Pediatric BLS, §6.3 and §7.3; AHA 2025 Adult BLS Algorithm for Healthcare Professionals; AHA 2025 Part 10, §21.11.
EMR scope traps: what the national model includes
Many wrong answer choices describe a real skill that belongs to a higher certification level. The exam measures what an entry-level EMR is expected to do. The National EMS Scope of Practice Model 2019, including Change Notices 1.0 and 2.0 (August 2021 edition) (pp. 25–31) draws these lines:
| Within the EMR level | Listed at EMT level and above |
|---|---|
| Oral airways, bag-valve mask, upper-airway suction | Nasal airways, supraglottic airways (AEMT and above), CPAP |
| Oxygen by nasal cannula or non-rebreather mask | Pulse oximetry |
| CPR and AED | Mechanical CPR devices |
| Direct pressure, tourniquets, wound packing | Traction splints, long spine boards |
| Manual stabilization of the head and neck, cervical collars, extremity splinting | Seated spinal motion restriction devices |
| Premeasured intranasal naloxone and auto-injector opioid antagonists | Aspirin for chest pain, oral glucose, epinephrine auto-injectors supplied by the agency |
| Helping deliver a baby; manual blood pressure | Helping with a complicated delivery; automated blood pressure |
The model also says an EMR may assist during ambulance transport but should not be the highest-level person caring for the patient (National EMS Scope of Practice Model 2019, p. 18). Your state sets your actual scope, and some states go beyond this list.
Before exam day: requirements that affect your plan
- Eligibility. For the recent-education route, you need a state-approved EMR course—or a qualifying higher-level EMS course—that meets or exceeds the EMR education standards, completed within the past 2 years. Your program director verifies it. Certification also requires a State EMS Office–approved BLS skills competency. Exam results and skills results each stay valid for 24 months. (Certification Scheme: EMR, Policy 81.10, revision 07.)
- Application and scheduling. The fee is $88 per attempt. Your Authorization to Test (ATT) is valid for up to 90 calendar days from issuance, or less if your course eligibility ends sooner (ATT Expiration Policy 82.14). Online rescheduling or canceling costs $30; doing it by phone adds a fee. Changes must happen at least one business day (24 hours) ahead (EMR Candidate Handbook: Scheduling). Our step-by-step guide covers the rest: NREMT exam registration: apply, get your ATT, and book.
- Accommodations. NREMT asks that requests arrive at least 45 days before your desired test date, and earlier is better (Accommodations for Examinations, Policy 62.02). Use the current ADA accommodations instructions before you pay or schedule.
- Retakes. You get three attempts. After three unsuccessful attempts, you must repeat a state-approved EMR education program and get a new course completion before testing again. The 15-day wait counts the results-posting day as Day 1. (Examination Retesting Policy 62.10.)
- Working as an EMR. National certification is not a license to practice. Your state decides that, so check with your State EMS Office (NREMT: Certification vs. Licensure). EMR recertification follows a two-year cycle; your initial expiration date depends on when you complete all certification requirements (Certification Scheme: EMR).
Free official resources worth using
- EMR Examination Specifications (test plan PDF): the exact job tasks behind each domain. Read them once at the start of your prep.
- Interactive EMR sample items: practice the real question formats. NREMT recommends a desktop or laptop.
- EMR sample packet: the same formats in a readable document.
- EMR Candidate Handbook: rules for scheduling, test day, results, and retesting.
- AHA 2025 CPR and ECC Guidelines: the source for current CPR, choking, and AED guidance.
Sources
National Registry of Emergency Medical Technicians
- EMR Examination Specifications (test plan)
- The Updated EMR and EMT Certification Examinations
- EMR Candidate Handbook: About the Examination
- EMR Candidate Handbook: Certification Process
- EMR Candidate Handbook: Candidate Responsibilities
- Certification Scheme: Emergency Medical Responder (Policy 81.10)
- Examination Retesting Policy 62.10
- ATT Expiration Policy 82.14
- Accommodations for Examinations Policy 62.02
- How the 2025 AHA Guidelines Impact National Registry Certification Examinations
- Certification vs. Licensure
Clinical and safety references
- AHA 2025 Part 7: Adult Basic Life Support
- AHA 2025 Part 6: Pediatric Basic Life Support
- AHA 2025 Part 10: Adult and Pediatric Special Circumstances of Resuscitation
- AHA 2025 Adult BLS Algorithm for Healthcare Professionals (PDF)
- 2024 AHA and American Red Cross Guidelines for First Aid
- National EMS Scope of Practice Model 2019, including Change Notices 1.0 and 2.0, August 2021 edition (NHTSA)
- HHS CHEMM: START Adult Triage Algorithm
- OSHA: Working Safely Around Downed Electrical Wires
- OSHA: Bloodborne pathogens, 29 CFR 1910.1030
- LAFD: Stop the Bleed, tourniquet
- CDC/NIOSH: Needlestick and sharps injuries (2012-123)
- MedlinePlus: After an exposure to sharps or body fluids
- Defibtech DDU-100 Series AED User Manual (FDA)
Last verified: October 19, 2026. We checked these items against the official NREMT sources above:
- EMR exam format, domains and weights, question types, fee, eligibility, results, retesting, and accommodations rules
- NREMT's notice on the 2025 AHA guidelines
We checked the teaching points in the practice questions against the AHA 2025 guidelines, the 2024 AHA/Red Cross First Aid Guidelines, the National EMS Scope of Practice Model, and the other references linked with each question.
Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the National Registry of Emergency Medical Technicians or Pearson. Exam and credential names are used only to identify the subject of this page, and trademarks belong to their respective owners. The practice questions are original and unofficial. This page supports your study. It does not replace approved EMR training, your state's scope of practice, or your medical director's protocols.
By the Castleport Test Prep Editorial Team. This page was researched and drafted with AI assistance, and the facts and teaching points above were checked against the linked sources on October 19, 2026. No clinician has professionally reviewed it. See our methodology and editorial standards.