The founding of the NREMT in 1970 came as a result of recommendations made by President Lyndon Johnson’s
Committee on Highway Traffic Safety. The committee proposed the establishment of uniform standards for training
and examination of personnel active in the delivery of emergency ambulance service. Since then, uniform standards
have been established for training and examination of the people who provide out-of-hospital emergency medical
care. As a non-profit, non-governmental, independent certification agency, the NREMT provides four distinct
areas of service:
Entry level competency assessment
A Registry of nationally certified EMS professionals
Re-registration certification process
Research that benefits the EMS community
The NREMT is governed by a Board of Directors representing the broad EMS community. The Board consists
of twenty-one individuals—including physicians, state EMS office officials, EMS professionals, educators, and members
of the public—highly regarded in their respective areas of practice. We encourage you to review the biographical
outlines that cover the accomplishments of the distinguished members of our Board of Directors.
Accreditation by the National Commission For Certifying Agencies (NCCA) is the highest assurance that the health,
welfare and safety of the public is being met through a credible exam and certification process. Accreditation also
ensures that the NREMT complies with the standards outlined in the “Standards for Education and Psychological Testing”,
developed jointly by the American Psychological Association (APA), American Educational Research Association (AERA)
and National Council on Measurement in Education (NCME).
Individuals applying for NREMT-Intermediate/99
registration must meet the following requirements to be eligible
for National Registration:
Applicant must be 18 years of age or
older.
Possess current National Registration at the EMT-Basic or Intermediate/85 level or current state certification at the EMT-Basic or Intermediate/85 level or higher.
Successful completion of a
state-approved EMT-Intermediate/99 educational program, within the past
two (2) years, that equals or exceeds the behavioral objectives
of the 1999 EMT-Intermediate National Standard Curriculum as
promulgated by the U.S. Department of Transportation. Candidates
in EMT-Paramedic education programs may be eligible to take the NREMT-Intermediate/99 examination provided they supply a
course completion certificate from an approved program, which verifies they have successfully completed a course, which equals or exceeds the
education objectives of the US DOT EMT-Intermediate/99 National Standard Curriculum.
If the candidate's initial Intermediate/99 education
or equivalent (as determined by the state EMS office) is beyond two years and the candidate has maintained
state licensure at the EMT-Intermediate/99 level or equivalent, the candidate must submit
official documentation verifying successful completion of current refresher
education that meets or exceeds the requirements as stated in the re-registration brochure.
If the initial training is beyond two (2) years
and state licensure at the EMT-Intermediate/99
level or equivalent has not been maintained, the candidate must successfully complete a
new, state-approved EMT-Intermediate/99
education program prior to application.
Truthfully complete the Licensing Action and Felony Statements on the application and supply the documentation if necessary.
Possess current CPR credential at the healthcare provider or equivalent level.
Successful completion of the National Registry EMT-Intermediate/99 cognitive and practical
examinations.
A non-refundable/non-transferable application fee of $100.00 payable to the National Registry of Emergency Medical Technicians must
be submitted to cover the cost of processing the application. Authorization to test will not be issued until all entry
requirements are verified and the application fee is received by the NREMT.
Note - Each examination attempt will require an additional application and an
additional application fee.
Initial expiration dates are established in
reference to the date of successful completion of the
examination. Individuals initially registered during the first
six months of the year will revert to the beginning of that year
for an anniversary date. Those initially registered during the
last six months of the year will begin their biennium the first
day of the following year. All subsequent registration periods
will be for the full two-year period running from April 1 through March 31.
For example:
Individuals successfully completing the
examination between the dates of January 1, 2007, and June 30, 2007, will receive an expiration date of March 31,
2009.
Individuals successfully completing the
examination between the dates of July 1, 2007, and December 31, 2007, will receive an expiration date of March 31,
2010.
To be reinstated once NREMT-Intermediate/99
Registration has lapsed, the candidate must:
If lapsed within a two-year period,
document successful completion of a state-approved Intermediate/99 refresher
education course adhering to the topical content outlined in the re-registration brochure; submit a new application and fee; and successfully
complete the NREMT-Intermediate/99 cognitive and practical
examinations.
If lapsed beyond a two-year period, and still
currently state certified at the EMT-Intermediate/99 level or equivalent, document successful
completion of a state-approved Intermediate/99 refresher education course
adhering to the topical content outlined in the re-registration brochure; submit a new application and fee; and successfully complete the NREMT-Intermediate/99
cognitive and practical examinations.
If lapsed beyond a two-year period, and state
licensure at the EMT-Intermediate/99 level has not been maintained, complete a
new, state approved National Standard EMT-Intermediate/99 education
program; submit a new application and fee; and successfully complete the NREMT-Intermediate/99
cognitive and practical examinations.
The National Registry EMT-Intermediate/99 cognitive examination consists of 150 multiple-choice items contained in six (6)
topical areas based on the 1999 EMT-Intermediate National Standard Curriculum, and the tasks in the 1999 NREMT
Practice Analysis, and current American Heart Association guidelines. The NREMT-Intermediate/99 cognitive examination
is based upon the EMT-Intermediate level practice as identified in the 1993 EMS Education and Practice Blueprint.
Two hours and 30 minutes are allowed for completion of the examination.
The National EMS Certification for the
NREMT-Intermediate/99 has a test plan that is based upon research findings of
the practice of EMT-Intermediates and the above listed information. The percentage of the test plan for each area is as follows:
Test Plan Topics
Percent of overall test
Airway and Breathing
18.0%
Cardiology
17.3%
Trauma
16.7%
Medical
15.3%
Obstetrics and Pediatrics
16.0%
Operations
16.7%
TOTAL
100%
If you want further information on the specifics of how the examination was constructed you should review,
About the Cognitive Examination
Please note the NREMT-Intermediate/99 examination items were constructed via the same process,
however this examination is a computer based examination. The cut score has been established via the
Gross modification of the Nedelsky formula. The cut score represents entry-level competency.
Candidates are given three opportunities to pass the cognitive examination provided all other requirements for National EMS
Certification are met. After three attempts candidates must submit official documentation verifying completion of
36 hours of remedial training.
Remedial training is designed to provide further education to change the performance of the candidate taking subsequent
examination attempts. It is suggested that this education be over areas within the test plan where the candidate has
been identified on their result letters to be near or below the passing standard. Following remedial training the candidate is
given three more attempts to pass the examination, provided all other requirements for National
EMS Certification are met. Candidates who fail to
pass after a total of six attempts are required to complete an entire state approved EMT-Intermediate/99 education program.
If you want to watch a video of what will occur at a Pearson
Professional Center you can see this by referring to Tour a Pearson VUE Testing Center
If you have any questions regarding your application status
you should log-into the NREMT website (www.nremt.org)
and check your application status.
Candidates who pass the examination will be sent National EMS Certification materials. Candidates who fail the examination will be sent a
results letter from the NREMT which will identify by test plan the areas on the examination where the candidate performance was near or below
the passing standard. Candidates should tailor their studying and any remedial training necessary toward the tasks that make up the areas
where they were near or below the standard. Because each examination experience is completely different it is important for candidates to change
their ability level by studying further for the examination. If the candidate’s ability is not improved the likely outcome on the examination will
be consistent.
The National Registry reserves the right to investigate any irregularities that occur in conjunction with the application process, course
completion verification and/or in conjunction with any test experience. The NREMT has disciplinary actions that may be taken in these cases.
Rights of appeal of NREMT decisions are outlined in the NREMT Disciplinary Policy.
Practical Examination
The practical section of the
examination process consists of eleven (11) separate skills presented in a
scenario-type format to approximate the abilities of the EMT-Intermediate/99 to
function in the out-of-hospital setting. All skills have been developed in
accordance with the National Standard EMT-Basic Curriculum, the behavioral and
skill objectives of the National Standard EMT-Intermediate/99 Training
Curriculum, A.H.A. guidelines, and the 1993 EMS Education and Practice
Blueprint's EMT-Intermediate. The process is a formal verification of the
candidate's "hands-on" abilities and knowledge, rather than a teaching, coaching
or remedial training session. The NREMT will not explain any specific
errors in any performance. Candidates are permitted to bring their own
equipment for the examination, provided it is approved for testing by the
National Registry Representative in attendance at the examination. All
candidates are urged to review all practical examination criteria in the
supplemental brochure "Performance Standards for Advanced Level Practical
Examination Candidates" before attempting the examination.
All candidates must complete the practical
examination in a standardized format. The candidate must demonstrate an
acceptable level of competency in each of the following skills:
Patient Assessment-Trauma
All candidates will be required to
perform a "hands-on," head-to-toe, physical assessment
and voice treatment of a moulaged simulated patient for a given scenario.
This skill includes:
Scene Size-Up
Initial Assessment/Resuscitation
Focused History and Physical Examination - Rapid Trauma Assessment
Detailed Physical Examination
Patient Assessment-Medical
All candidates will be required to
perform a "hands-on," head-to-toe, physical assessment
and voice treatment of a moulaged simulated patient for a given scenario.
This skill includes:
Scene Size-Up
Initial Assessment/Resuscitation
Focused History and Physical Examination - Rapid Trauma Assessment
On-Going Assessment
Ventilatory Management
The candidate will be evaluated over the following two (2) ventilatory
management scenarios:
Each candidate's ability to manage cardiac
arrhythmias and interpret ECGs will be verified in two portions:
Dynamic Cardiology
Each candidate will be evaluated in his/her
ability to manage a cardiac arrest situation, including actual delivery of
electrical therapy and "voicing" all interpretations and treatments given a
scenario. The presentation of this portion will be similar to a "megacode."
Static Cardiology
Given four (4) prepared ECG tracings with
associated patient information, the candidate must verbalize the interpretation
of each rhythm and voice all associated treatments.
IV and Medication Skills
Intravenous Therapy
All candidates will be required to establish a
patent IV in a mannequin arm in accordance with a given scenario.
Intravenous Bolus Medications
After establishing a patient IV line, the
candidate will be required to administer an IV bolus of medication in accordance
with a given scenario.
Pediatric Skills
Candidates will be evaluated over the following
two (2) pediatric skills:
Pediatric Ventilatory Management
Given a scenario of having just found an apneic
infant with a palpable brachial pulse, the candidate must demonstrate immediate
management of the patient using simple airway maneuvers and adjuncts,
bag-valve-mask device, and supplemental oxygen. The candidate will then be
required to place an endotracheal tube (ET).
Pediatric Intraosseous Infusion
The candidate will be required to establish an
intraosseous line in a pediatric IO mannequin.
Random Basic Skills
All candidates will be evaluated over one
(1) of the following EMT-Basic skills tested at random. All instruments
for these skills will adhere to the
National Registry EMT-Basic Practical Examination material:
Spinal Immobilization (Seated Patient)
Spinal Immobilization (Supine Patient)
Bleeding Control/Shock Management
NREMT-Intermediate/99 candidates are required
to complete eleven (11) skills as listed when taking the entire practical examination.
Grading of the practical examination is on a Pass/Fail basis. Failure of
five (5) or less skills (when taking the entire NREMT-Intermediate/99 practical)
entitles the candidate to two (2) retesting opportunities of just the skill(s)
failed. If a same-day retest is offered at the examination site, only one
(1) retest attempt may be completed at that test. Retests must be
completed in an all-or-none fashion. The NREMT cannot score or report
incomplete practical attempts. Candidates are not permitted to complete
only a portion of the skills that need to be retested. The NREMT does not
mandate or guarantee same-day retest opportunities at any National Registry
Advanced level practical examination site.
Failure of any portion of the second retest attempt
constitutes failure of the entire practical examination. The candidate is
then required to officially document remedial training over all skills before
starting the next full attempt of the practical examination and re-examining
over all eleven (11) skills on another date, provided all other requirements for
National Registration are fulfilled.
Failure of six (6) or more skills
constitutes failure of the entire practical examination. The
candidate is then required to officially document remedial
training over all skills before starting the next full attempt of
the practical examination and re-examining over all eleven (11) skills on another
date, provided all other requirements for National Registration are fulfilled.
The passed portion of the examination,
either the cognitive or practical, will remain valid for a twelve (12) month
period from the date of the examination. Candidates not
completing the failed portion of the examination within that twelve (12)
month period will be required to repeat the invalid portion.
Candidates are allowed three (3) full attempts
to pass the practical examination (one "full attempt"
is defined as completing all skills and two retesting opportunities if
so entitled). Candidates who fail a full attempt or any portion
of a second retest must submit official documentation of remedial
training over all skills before starting the next full attempt of
the practical examination and re-examining over all eleven (11) skills, provided
all other requirements for National Registration are fulfilled. This official documentation must be signed by the EMT Training Program Director or Physician
Medical Director of
training/operations that verifies remedial training over all
skills has occurred since the last unsuccessful attempt and the
candidate has demonstrated competence in all skills. Should a
candidate fail the third full and final attempt of the practical
examination, the candidate must complete a new, state-approved EMT-Intermediate/99 Training Program.
An inactive status is designed for Nationally Registered EMTs who are not actively
engaged in the EMT-Intermediate/88 service at the time of re-registration.
Educators, administrators or regulators who are not actively treating patients should consider this status. Inactive status will be
awarded only to those who have fulfilled all refresher, CPR, and continuing education
requirements. A registrant may not request inactive status in his/her initial
registration period if he/she has never been affiliated with an ALS EMS service
or functioned in a patient health care setting as an NREMT-Intermediate/99 for a
period of at least six (6) months.
A request to return to active status must be accompanied by a completed
Inactive to Active Registration form which may be download here, or
obtained by calling the NREMT Re-registration Department.
It is the policy of the National Registry of Emergency Medical Technicians to administer its certification examinations
in a manner that does not discriminate against an otherwise qualified applicant. An applicant with a disability, who is
otherwise eligible to take the certification examination may file a request for reasonable testing accommodations if, by
virtue of a disability, the applicant cannot demonstrate under standard testing conditions that he/she possesses the
knowledge and skills to be certified as an EMS provider at the level of certification requested. The NREMT will make
reasonable accommodations to individuals with documented disabilities unless such an accommodation fundamentally alters
the measurement of the examination or the established eligibility requirements for gaining National
Registration.
The National Registry of Emergency Medical Technicians offers reasonable and appropriate accommodations for the written
and practical components of the registration examination for those persons with documented disabilities,
as required by the Americans with Disabilities Act (ADA). At a minimum, all requests for accommodations must be received
by the NREMT no less than three (3) weeks before the scheduled test date. The NREMT urges candidates requesting any
accommodation to submit such requests as early as possible to provide adequate time to resolve any documentation issues
that may arise. The NREMT will review each request on an individual basis and make decisions relative to appropriate
accommodations based on the following general guidelines:
In order to be considered for accommodations under the ADA, an individual
must present documentation indicating that his/her disability substantially limits some major life activity.
Only individuals with disabilities who, with or without reasonable
accommodations, meet the eligibility requirements for certification at the
level of the requested examination are eligible for accommodations.
Accommodations being requested must be reasonable and appropriate for the documented
disability and must not fundamentally alter the examination’s
ability to assess the essential functions of pre-hospital care, which the
test is designed to measure.
Documents relative to current functioning of a candidate must be no older than three
(3) years to help ensure accommodations are based on assessment of the
current impact of the candidate’s disability on the examination activity.
Professionals conducting assessments, rendering diagnoses of specific disabilities
and/or making recommendations for appropriate accommodations must be
credentialed to do so.
The NREMT realizes that each candidate’s circumstances are unique and a case
by case approach to review the documentation is required.
Candidates requesting accommodations for the cognitive component of the examination should go to our
Examination Accommodations Policy for further details.
NREMT has disciplinary procedures, rights of appeals and due process within its policies. Individuals
applying for registration or re-registration, who wish to exercise these rights should read our
Disciplinary Policy. Requests to appeal must be submitted within
thirty (30) days of receipt of notice of determination.
