The National Registry of Emergency Medical Technicians Exam (NREMT)

When a medical emergency occurs — a traffic accident with injuries, a heart attack, a baby being born before the mother can reach the proper medical facilities — the first people to arrive on the scene to provide medical assistance usually aren’t doctors. They’re emergency medical technicians, or EMTs. EMTs don’t have medical degrees and aren’t qualified to perform all of the lifesaving tasks that many hospital personnel are, but they have enough medical knowledge to stabilize a patient, perform basic lifesaving tasks and transport them safely to a hospital where more advanced equipment and qualified doctors and nurses can do the rest. When you call for an ambulance, EMTs are the people who are going to get out when it arrives.

Perhaps you’re looking for a career in the medical field that doesn’t require the time and expense of medical school or that won’t tie you down to a hospital or doctor’s office. If so, an emergency medical technician may be precisely what you want to be. It’s an exciting field and an emotionally rewarding one.

How do you get to be an EMT? You’ll need to take one or more certification exams to qualify. The precise sequence of exams varies according to local state law, but in many localities the most basic of EMT certifications is that of First Responder. Holding a First Responder certification would not give you all of the privileges and responsibilities of an emergency medical technician. However, the holder of a First Responder certification is qualified to perform a number of medical tasks, including advanced first aid and cardio-pulmonary resuscitation (CPR). A First Responder’s job is to stabilize a patient’s condition until more advanced EMT help arrives and can even include delivering a baby if the situation warrants. In many cases, First Responders work full time at locations where rapid medical assistance may be needed on a regular basis, such as constructions sites and on fire-fighting teams. Or they can work as part of an ambulance crew for deployment to any location where a medical emergency occurs.

Not all states have a First Responder certification. Some require the EMT Basic certification, which is slightly more advanced than First Responder certification, as the entry-level position for emergency medical technicians. Other EMT certifications, in order of the difficulty of certification, are Intermediate/85, Intermediate/99 and Paramedic. Although ultimately it is the individual states that set requirements for EMTs, including for First Responders (in states where the First Responder certification is recognized), but the basic standards for EMT skills are created on a national level by the National Highway Traffic Safety Administration (NHTSA). And a nationwide certification agency, the National Registry of Emergency Medical Technicians (NREMT), administers a series of certification exams that correspond to the NHTSA standards. Individual states may add additional qualifications to the NHTSA standards if they so desire, but the majority of states recognize NREMT certification for EMT positions.

To qualify for NREMT national First Responder certification, you must first take a state-approved course at some time in the two years before you take the exam. Then, once you’ve taken any state-required exams, you must go to the NREMT’s Web site athttps://www.nremt.org/nremt/about/reg_1st_history.asp#Entry_Requirements and register. There you can submit an application along with a fee of $75.00 to take the NREMT test. You’ll receive a letter with an ATT (Authorization to Test) advising you how to schedule your appointment and what types of identification you’ll need to bring. The exam itself will consist of two parts: a cognitive examination and a psychomotor examination. The cognitive examination tests your knowledge of emergency medical procedures while the psychomotor examination tests your physical skills at emergency medical tasks that you have otherwise only been tested for on paper.

Once you’ve passed both tests, the duration of your certification will depend on the half of the year during which you completed the tests, but will be between two and three years. You may then recertify.

First Responder Exam Contents

It helps to know in advance what will be on the cognitive portion of the examination for certification for an Emergency Medical Technician (EMT) First Responder, offered by the Registry of Emergency Medical Technicians (NREMT). Unfortunately, there’s no way to know exactly what the questions will be. It would be unfair to other applicants if you knew those questions in advance. However, the NREMT makes available a list of the subject areas that need to be studied for continued certification and we can assume that these subjects will be covered by the exam. You can get a look at their own list on their Web site:https://www.nremt.org/. However, we’ll give you a rough idea of what it contains:

There are six types of topics that are covered in the First Responder certification exam. They are Preparatory, Airway, Patient Assessment, Circulation, Illness & Injury, and Children & Childbirth. Here are what those topics include:

  • Preparatory: This is about the most basic knowledge that is expected of a First Responder. What sort of responsibilities will you have? What will be your role on an EMT team? How can you protect yourself at the emergency scene and make things safe for others? You’ll also need to know something about human anatomy, the medical and legal ramifications of emergency response, and how to lift and move a victim.
  • Patient Assessment: One of the most important roles of the First Responder is to assess the patient at the scene. It may be necessary to do this before other EMTs arrive or while they are still setting up their equipment, so you need to know how to make the initial assessment, taking vital signs and patient history, assess trauma victims and other medical patients, perform ongoing assessment during preparation and transport, communicate with the patient and document the patient’s condition.
  • Circulation: You’ll need to know how to manage shock, how to treat cardiac emergencies, how to treat bleeding and wounds, and how to perform cardiopulmonary resuscitation (CPR).
  • Illness and Injury: You’ll need knowledge of general pharmacology, breathing emergencies and problems with the respiratory system, environmental energies, acute abdominal emergencies, how to deal with diabetic conditions, allergic reactions to drugs and other substances, how to treat poisoning and drug overdose, how to handle behavioral emergencies, how to treat injuries to soft tissue, how to treat injuries to the muscles and skeleton and injuries to the head and spine.
  • Childbirth & Children: You’ll need to know how to deal with obstetrical and gynecological emergencies, childbirth and its possible complicates, how to care for a newborn infant, and how to assess pediatric conditions. You’ll need an understanding of medical emergencies in very young children and of managing infants’ airways, as well as how to treat trauma emergencies in children.

If you study all of these subjects (which, admittedly, constitute a pretty long list), you’ll do well on your First Responder certification cognitive exam. However, the cognitive exam is not the only requirement that must be met in order to get a First Responder certification. Assume that any part of the above list of subjects that requires you to perform physical actions — lifting and moving a patient, performing CPR, delivering a child — is likely to be simulated during the psychomotor examination and you should practice or simulate those tasks to the extent possible before the exam takes place. (Obviously practicing delivering a baby in advance of the test is going to be a bit tricky and, at any rate, isn’t advised prior to taking a training class.) So taking a state-approved training class (which is a requirement for certification) is essential.

And remember that the individual states may have their own requirements separate from those specified by the NREMR and may expect to test you separately.

First Responder Exam Study Guide

First Responder Exam Study GuideThere are up to five different levels of EMT, depending on what state you practice in. The levels, in order of degree of expertise required for the job, are:

  • First Responder
  • EMT Basic
  • Intermediate/85
  • Intermediate/99
  • Paramedic

First Responder if effectively the entry level position for EMTs. It’s the position that requires all the basic lifesaving skills and is a good place to start if you want to begin working up to a role as a paramedic. To become a First Responder you need to be certified, not only at the national level but at the state level. The National Highway Transportation Safety Administration (NHTSA) has devised a series of standards for the knowledge and skills that EMTs require. The National Registry of Emergency Medical Technicians (NREMT) offers tests designed around the NHTSA qualifications that you can take to acquire a certification at each of the EMT skill levels. These certifications are accepted by most states, but because individual states may have requirements in addition to those established by NHTSA, the states may require additional certification exams of their own. You can sign up for the NREMT exams at the NREMT Web site: https://www.nremt.org/.

How do you prepare for these exams and become a First Responder? We recommend that you acquire a study guide expressly created not only to review the skills needed of a First Responder but to prepare you for the test itself. A good study guide would contain sample questions and a subject-by-subject breakdown of the information that will be covered on the certification exam. Where do you get such a study guide? They’re widely available in book stores and on the Internet. They come in many forms: flash cards, books, DVDs, CDs, software. They may cost a little more than a standard paperback book but probably not a lot more and the information that they contain is well worth any extra cost, especially if you’d decided that being an EMT is the career that you want.

The First Responder certification exam is divided into two sections: a cognitive exam and a psychomotor exam. The first is what study guides are best prepared to teach you. The cognitive exam will ask you questions to test your knowledge of the information, skills and techniques that you will need as a First Responder. These skills include basic airway management, cardiopulmonary resuscitation (CPR) techniques and even childbirth techniques, in the event that you find yourself called to the scene of a pregnant mother who is unable to reach full medical care in time.

The psychomotor exam, however, will test your physical abilities with these skills. While a study guide cannot impart these abilities to you directly, it can suggest drills by which you can practice lifesaving techniques and develop the automatic physical reactions that help you do your job correctly. If used in conjunction with a course on EMT techniques (which will be required in most states before you can receive EMT certification on the state level), the study guide can help you acquire all the skills that you will need to get a passing grade on the First Responder exam and begin your career as an emergency medical technician.

Why Become a First Responder?

A First Responder is one of the most important individuals on any medical team, in some ways more important than doctors, nurses and laboratory technicians. A First Responder is, as the term implies, the first person on the scene in a medical emergency, such as a car crash, a life-threatening illness or the unexpected birth of a baby. It is the First Responder who has the first opportunity to intervene in what may be a life-or-death crisis. This is why the job of First Responder is vitally important in the medical hierarchy.

Why should you want to be a first responder? We’ll list some reasons.

What you do will matter. When the work that you perform makes the difference between life and death, treatable injury and permanent disfigurement, a healthy child or an unhealthy child, you are doing an incalculable service for the human race. Of course, so are doctors and nurses, but the First Responder is there before they are and can make a difference when they cannot. A First Responder may not have the necessary skills to perform surgery or operate an MRI machine, but a First Responder has a full set of basic emergency medical skills that can be used to intervene long enough for a patient to reach a hospital. In other words, as a First Responder, what you can do save lives.

What you do will be exciting. First Responder is not your typical desk job or clerk position. It is not the type of job that will be the same day after day after day. It’s true that when no medical emergencies are happening, you may find yourself sitting around for long hours reading books or playing cards with your teammates, but when there’s an accident on the freeway or a man goes into cardiac arrest, you will find yourself in the middle of the kind of pulse-pounding action that you see on the most exciting TV shows. Yes, some of your job will be boring, but much of it will be as exciting as any adventure you’ve ever imagined being part of.

You will work with a team. As a First Responder, you will work with a team of Emergency Medical Technicians, or EMTs. Not all members of the team will be First Responders themselves. Some may hold certifications for jobs as sophisticated as paramedic, a position you may work up to one day yourself. As part of the team, you will make friends who may become such a close part of your life that you’ll stay in touch and do things together until you die. You may come to know these people better than you know your own family. You will form relationships as you fight to keep people alive and bring children into the world. At the very least, you will remember this team for the rest of your life.

Being a First Responder will allow you to call yourself a hero. As corny as it sounds, a First Responder can legitimately think of him- or herself as performing an heroic act, one that puts you in the way of danger on a regular basis for the most important cause there is: making people’s lives better. Remember how firefighters and policeman were proclaimed heroes after the attacks of September 11, 2001? First Responders were there too and what they did was every bit as heroic as the acts of the police and firefighters. As a First Responder, you will have that same opportunity to perform heroic acts.

The requirements for becoming certified as a First Responder differ from one state to another. (In some states, First Responder certification does not exist.) You’ll have to check with your state to find out what the local requirements are. Also, go to the National Registry of Emergency Medical Technicians (NREMT) Web site athttps://www.nremt.org/nremt/about/reg_1st_history.asp#Entry_Requirements to find out what how to gain national certification as a First Responder.

What Does a First Responder Need to Know?

An Emergency Medical Technician (EMT) is the first person on the scene of an accident or medical emergency when fast medical intervention is required and (usually) someone needs to be taken to the hospital. Often, the first EMT at the scene is the aptly named First Responder, the person who must make the first assessment of the patient and make the first intervention in an emergency that may cost someone their life or their continued health if action is not taken within minutes or even seconds.

What Does a First Responder Need to Know?A First Responder doesn’t need to know all the things a doctor or a registered nurse needs to know, but they still have to know enough about medicine and the things that can go wrong with the human body to make split-second decisions as to how to save someone’s life. This is the body of knowledge that will win you your First Responder certification when you take your EMT certification exam. What are some of the things that you’ll need to know.

How the human body works. You’ll need to know some basic things about human anatomy and how it works. Much of this may seem obvious to you — after all, you’ve had a body all your life and you know how to make it work — but there’s a great deal going on inside you that you’re not necessarily aware of and when things start to go wrong, you’ll begin to realize just how much you don’t know. As a First Responder, you will often need to deal with people whose bodies have begun to malfunction in often deadly ways — cardiac arrest, for instance, or arterial bleeding. You’ll need to make a rapid diagnosis of these things and apply enough treatment to keep the patient alive and stable until they can reach a hospital.

How breathing works. One of the most common of medical emergencies is choking. The airways that lead to the lungs can become blocked by foreign objects, such as food or small objects that are inadvertently swallowed. You’ll need to know how to clear these objects out of the way. Then, if the patient has stopped breathing, you may need to perform artificial respiration techniques until more sophisticated medical equipment arrives.

How the human circulatory system works. Other common emergencies involve bleeding or cardiac arrest. If blood is spurting from someone’s arm or leg, especially if the blood is coming from an artery, you’ll need to know how to stop the bleeding while the victim still has enough blood left in their body to be saved by a transfusion. And if someone’s heart is malfunctioning or has stopped beating altogether, you’ll need to know how to apply emergency medication or cardio-pulmonary resuscitation (CPR) to keep them alive until they can reach the hospital or specialized equipment can arrive.

The proper use of pharmacological drugs. As an EMT, there will be drugs that you will be required to administer. You will need to be trained in their proper use, dosage, delivery, and how to be sure that you are not giving the wrong drug to the wrong patient. There are techniques for all these things and, as a First Responder, you will learn them.

How to deliver a baby. This may be the most surprising and exciting part of a First Responder’s life: The possibility that you will be called on to deliver a baby when no other doctors, midwives or EMTs are present. The nice thing about this aspect of your job is that you rarely have to worry about anyone dying or becoming seriously injured. Chances are, mother and baby will come through just fine. And — who knows? — the parents may just end up naming the baby after you.

Recertifying as a First Responder

If you’ve obtained your certification as an EMT (Emergency Medical Technician) First Responder, congratulations! Getting that certification requires a great deal of knowledge and the job of the First Responder is difficult, if exciting and satisfying, work. You get to be the first on the scene at medical emergencies and the opportunity to save (or at least vastly improve) the lives of people at serious medical risk. This is one of the most rewarding jobs any person can take on and you should congratulate yourself for becoming successfully qualified for it.

But the National First Responder certification given out by the National Registry of Emergency Medical Technicians (NREMT) doesn’t last forever. In fact, it expires after either two or three years, according to the following formula:

If you receive your certification between the dates of January 1 and June 30, it will have an expiration date of September 30 two years in the future. If you receive your certification between the dates of July 1 and December 31, it will have an expiration date of September 30 three years in the future. Whichever is the case for you, there will come a time when your certification expires and you need to become recertified.

How do you go about doing this?

If it has been two years or less since your certification expired, then you can recertify simply by taking a state-approved refresher course. This will serve to help you remember everything you learned for your first certification exam and acquire any new information and techniques that have come along in the previous two to three years.

If it has been more than two years since your certification expired, getting recertified isn’t quite that easy. In effect, you’ll have to go back to square one and take both a state-approved cognitive exam (the exam where you demonstrate that you know the things that a First Responder needs to know) and a state-approved psychomotor exam (the exam where you demonstrate that you are physically capable of performing the tasks that you wrote about in the cognitive exam)).

You can also take 12 hours of continuing education credits while holding your certification instead of taking the state-approved refresher course mentioned above. The education credits in this course should be on the following subjects:

  • Preparatory: 1 hour
  • Airway: 2 hours
  • Patient Assessment: 2 hours
  • Circulation: 3 hours
  • Illness & Injury: 3 hours
  • Childbirth & Children: 1 hour
  • Total: 12 hours

For recertification, you must have been actively working within the field of emergency medical service or at a patient-care facility for your skills to be considered current. Your training directory will give you more information on how to keep your skills up to date. Note that not all classes or forms of activity are considered relevant as continuing education experience for First Responder certification. A partial list can be found on the NREMT Web page at https://www.nremt.org/nremt/about/reg_1st_history.asp. In addition, this Web page will give you more details about exactly what subtopics of each area of continuing education you should concentrate on when keeping your skills current.

Note that when applying for recertification, a $10 processing fee must be included. The application for recertification is available at the NREMT Web site. If you need to recertify by exam, there will be an examination fee of $75.

You must keep the NREMT apprised of any changes of mailing address during the period of your certification or when applying for recertification.

We suspect that you will find it worthwhile to keep your First Responder certification current, especially if you plan to make a lifetime career as an emergency medical technician. Allowing the certification to lapse will render you unable to engage in this exciting and emotionally rewarding field, and that’s certainly something that you do not want to happen.

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