Exam Format

You will take the cognitive exam on a computer. The cognitive exam consists primarily of multiple-choice items. The exam items are written by members of the EMS community, including educators, providers and medical directors. Each exam has questions that count toward your score and questions that do not. Your exam will have between 70–120 questions. Ten  of those questions do not affect your score.

The unscored questions are for testing new concepts to make sure that future questions are fair and appropriate. This is a standard part of making exams. You will not be able to tell which questions count toward your final score and which do not, so answer each one as if it counts.

The exam is a computerized adaptive test (CAT). This means the number and difficulty of test items will vary for each exam session, but the passing standard remains the same for all candidates. The decision regarding passing or failing the exam PART 4: COGNITIVE EXAM is based on the following question: “Has the candidate reached the level of entry-level competency (passed) or has the candidate not yet reached entry-level competency (failed)?”

A CAT exam is different from a traditional exam. The more questions you get right, the harder the CAT gets. The goal is to find out if you have enough knowledge compared to the passing standard. If the exam asks the nine hardest questions about, for example, Trauma, and you get them right, then it will not need to ask the easier questions. Instead, it can move on to other categories. All you need to do is demonstrate entry-level competency. As long as you demonstrate competency, you will pass. CAT testing is faster and more accurate than a traditional exam.

The EMT cognitive exam covers the following areas:
Content Area Percent of Exam Adult/Pediatric Mix
Airway, Respiration & Ventilation 18%–22% 85% Adult; 15% Pediatric
Cardiology & Resuscitation 20%–24% 85% Adult; 15% Pediatric
Trauma 14%–18% 85% Adult; 15% Pediatric
Medical; Obstetrics & Gynecology 27%–31% 85% Adult; 15% Pediatric
EMS Operations 10%–14% N/A

You can find more information on the format of the exam at:


The following suggestions may help you prepare for the cognitive exam:
  • Study your textbook and education materials
  • Review the current American Heart Association’s Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care and the National EMS Education Standards and Instructional Guidelines. Both resources are available at: nremt.org/Document/EMT-Full-Education-Program

More information that will help you prepare for the exam can be found on: nremt.org/document/cognitive-exams

The Registry does not recommend any particular exam preparation materials. If you have any additional questions after reviewing the previous information, ask someone in your education program for more information.
FAQ: Do I have to take my cognitive exam prior to my psychomotor exam?
The Registry does not have a set order for the exams. However, you need to check with your program director or state office for local requirements.

Authorization to Test (ATT)

To get an Authorization to Test (ATT), you need to have completed an application and paid the application fees. Your program director must verify your eligibility. When those steps are complete, our system will give you an ATT, usually within 1-2 business days, but the process may take longer during high volume times. The ATT will post to your account.

You can find and print your ATT from the “Application Status” page using these steps:

  1. Log into your Registry account.
  2. Select “Candidate”.
  3. Select “My Applications” on the left-hand side.
  4. Select “Application Status/ATTs”.
  5. Select the box “Current Applications”.
  6. Select the box labeled “Print/View Authorization to Test Letter” on the application.
  7. Follow the prompts to print or view the ATT.
The ATT tells you how to schedule your exam and gives you important information about testing requirements at Pearson VUE centers.

The ATT is only valid for 90 days from the day it posts to your account. We do not offer extensions for expired ATTs.

If your ATT expires, you must apply again and pay the fee again in order to get a new ATT.

You can find the ATT expiration date and refund policy at: https://content.nremt.org/static/documents/policy-ATT-refund.pdf

FAQ: What do I do with my ATT and what information do I need off it?
You will need to print/view your ATT since it contains key information to creating your Pearson VUE account and scheduling your exam. You need to view the Registry Candidate ID; it starts with the letters NR. You will also need to know your Deadline to Test; this tells you how long your ATT is valid. The ATT contains information on how to contact Pearson VUE to schedule your exam and what forms of ID are acceptable.


Print the ATT. Follow the instructions on the ATT to schedule your exam at: pearsonvue.com/nremt
The National Registry utilizes Pearson VUE as its exclusive test provider. You will have two options for taking your exam:
  • At a Pearson VUE Testing Center; or
  • From your home or office using Pearson VUE’s online proctoring platform, OnVUE

We post all information about your application to your Registry account. Pearson VUE is an independent testing vendor and has its own way of contacting you. They will send you an email about your exam. The email will confirm the day and time of your exam, the delivery method/testing location, and the testing rules.

If you do not receive an email confirming your exam appointment, your exam has not been successfully scheduled.

If the email has an error and you do not contact Pearson VUE to correct it, you will not be allowed to take the exam.

OnVUE Online Proctored Examinations

You will have the option to schedule your examination via OnVUE online proctoring. For more information on OnVUE requirements and procedures click here: https://home.pearsonvue.com/nremt/onvue Rescheduling/Cancellation

If you need to reschedule or cancel your exam, contact Pearson VUE at least one business day (24 hours) prior to your exam appointment. Call 866-673-6896 (M-F 7 a.m. to 7 p.m. CST) or log into your Pearson VUE account to make changes to your appointment.

The fee to reschedule or cancel your exam is $30. If you reschedule or cancel by telephone, Pearson VUE will charge an additional call center fee.

Important Note: If you fail to appear for your scheduled exam appointment, fail to cancel or reschedule within the required time, or are refused admission, you will forfeit your exam fee. You will have to complete a new application and submit the associated application fee to receive a new ATT. The Registry does not issue refunds for failure to appear for your scheduled exam appointment.

No-Show Policy

If you fail to notify Pearson VUE at least one business day (24 hours) before your scheduled exam, your account will be marked with a “no show” and you will forfeit your exam fee.

You can appeal the “no show” status if extenuating circumstances are involved. You will need to provide documentation of the circumstances if you want to try to reschedule the missed exam at no additional cost.

If you are denied a “no show” appeal, you will need to reapply. Use an Express Application and pay the application fee to receive a new ATT.

To learn more about “no show” policies and procedures, go to: nremt.org/Policies/Examination-Policies/Cognitive-Exam-Policies

Contacting the Registry vs. Pearson VUE

If you have questions about your eligibility for Registry certification, the application, your ATT, the exam format, exam results, retesting, Registry appeals and disciplinary processes, and maintenance of certification, please contact the Registry at 614-888-4484.

If you have questions concerning Pearson VUE test site rules and regulations, acceptable forms of identification, your Pearson VUE username and password, scheduling a cognitive exam appointment at a Pearson VUE Test Center, directions to the Pearson VUE Test Center, and/or your exam appointment, please contact Pearson VUE at 866-673-6896. Please note: Pearson VUE charges a fee for scheduling or canceling an appointment over the phone.

FAQ: What do I do if I do not have a valid ID?
You will need to obtain a valid ID before scheduling your exam.

Taking the Exam

Pearson VUE Test Center Protocols and Rules

Arrive at the test center at least 30 minutes before your scheduled testing time. You must bring two forms of acceptable identification with you on the day of your exam. Your ATT contains vital information about what documents to bring to the Pearson VUE Test Center. Review the information contained in your ATT carefully before arriving for your confirmed exam appointment.

You are not allowed to bring personal items, including but not limited to, mobile electronic devices, watches, wallets, purses, firearms or other weapons, hats (and other non-religious head coverings), bags, jackets, notes, pens or pencils into the testing room. There are no exceptions to this policy.

The test center will provide a small locker space to secure personal belongings. All electronic devices must be turned off before storing them in a locker. You are encouraged to leave as many of these as possible at home. Pearson VUE and the Registry are not responsible for lost, stolen, or misplaced personal items at any test center. If you refuse to store your personal items, you will not be permitted to test, and you will forfeit your testing fee.

Before you enter the testing area, the Pearson VUE Test Administrator is required to verify that you are not bringing any unauthorized materials or devices into the room. You may be asked to pull your hair back, pat yourself down, or roll up your sleeves during this process.

You will have 2 hours to complete the EMT exam.

Starting the Exam

The test center administrator will bring you to the computer you will use to take your exam. You will have a tutorial on how to take a computer based test. This tutorial is untimed.

Next, you will have to read and acknowledge a non-disclosure agreement about the exam. The non-disclosure agreement has a maximum time limit of five minutes, and if you do not complete the non-disclosure agreement in this time window, you will not be allowed to begin the exam. After the tutorial and non-disclosure agreement, you will then begin your exam.

Exam Security

We take exam security seriously. We put security policies and procedures in place to protect exam content and testing session data. These policies help make sure that the exam is given in the same way in every testing center, without inappropriate aid. They also make sure that the person who was given the ATT is the same one taking the exam. As a result, you may be required to:

  • Show identification as described in your ATT
  • Have your identity verified by a digital security device (infrared palm reader)
  • Provide a legal signature
  • Have your picture taken
  • Store all belongings prior to entry into the exam room
  • Be recorded (by audio and/or video) during the exam

All National Registry cognitive exam materials are copyrighted. You may not copy or record any material from the exam in any way. You are prohibited from the following:

  • Disclosing or discussing any information about the exam with anyone, including instructors
  • Posting or discussing questions on any internet or social media websites
  • Reconstructing exam content using your memory or the memory of others
  • Seeking help from anyone in answering exam questions
  • Removing exam materials or recorded information from the testing center

If you witness any of the above behavior, or any irregular behavior that may be in violation of the Registry Candidate Policies, report it to the Registry immediately by calling 614-888-4484. The Registry reserves the right to terminate a certification, invalidate the results of an exam, and take any other appropriate action against any candidate who violates copyright or performs any of the above behaviors.

Exam Results

Scoring and Accessing of Exam Results

Pearson VUE sends your cognitive exam to us. We score the exam electronically. The Pearson VUE staff does not have access to your results and cannot give you results.

Our system posts your exam results to your Registry account, generally within two business days after you complete your exam, provided all other requirements are met. Your results are only available to you on your Registry account. If your results have not posted after five business days, please contact the Registry.

To find your exam results, please follow the steps below:

  1. Log into your National Registry account.
  2. Click on “View All Certification Applications”.
  3. Click on “Results”.
  4. Click on “Print Exam Results”.

Report of Candidate’s Results

If you pass the cognitive exam, we do not send you specific details about your exam results.

If you do not pass the cognitive exam, we will post more information about your results to your account. Our system scores the exam as a whole. Your score will be presented on a scale from 100-1500. The passing point is indicated by a 950.  Your score will be shown as a number on this scale, as well as on a graphical depiction. This will allow you to see how far your attempt was from the passing standard. This difference will allow you to determine how much more preparation you need for your next attempt.


If you did not pass the exam, you may apply to retest 15 days after the last exam.

You have six chances to pass the Registry cognitive exam. If you fail three times, we require you to complete remedial education.In order to take the remaining attempts, you will have to send us documentation of your remedial education. Send the documentation to support@nremt.org. Once we receive the documentation and your new application, we will clear you to take the exam again.  The remedial education allows you to take the exam three more times. To receive a new attempt, you must submit a new application, pay a new fee, and get a new ATT each time.

State requirements for remedial training vary. You will need 20 hours for states using NCCP or 24 hours for states using traditional. Check with your state to make sure there are no other state specific requirements for remedial education.

For further information about the retest policy, visit:
FAQ: What education can I use for remedial training?
The remedial training requirement can be satisfied through three different options:
  1. NCCP 20 hours of continuing education: Completion of the EMT 20-hour National Competency Component from the NCCP model
  2. Traditional Refresher Course: Completion of a State or CAPCE (F1, F2, F5) approved 24-hour EMT refresher course
  3. Continuing education: The 20 or 24-hour requirements can be met with any state approved education program, including but not limited to community colleges, vocational schools, local EMS agencies, or online education providers. You can complete online education if it is CAPCE or state approved.

Note: Some states require the traditional refresher course and will not accept continuing education hours. Contact your State EMS Office if you have questions about the required training.

Exam Review

The National Registry is committed to a fair and unbiased testing process and follows industry best practices to ensure that all examinations are accurately scored. As a service to the community, the National Registry offers candidates the option to have their examinations rescored by a qualified staff member. Although it is extremely unlikely an examination was incorrectly scored, the rescoring process allows verification of a score.

If a candidate suspects that their score may have been negatively affected by a specific item, or items, delivered on their written examination, they may ask for a review of such item(s) as part of their rescoring request. Only items identified in the request will be reviewed. For example, if a candidate suspects that an item asking to interpret a 12-lead ECG was outside the scope of practice for the certification level at which they tested, they must indicate that in their rescoring request. If such items were present on their examination, they will be reviewed to ensure (1) their accuracy, (2) whether they were within the scope of practice for the relevant certification level, and (3) whether they had any impact on the test score.

The rescoring process is not:
  • A review of the content of all items administered during the examination
  • A reconsideration of the passing standard or the acceptability of the testing conditions
  • An opportunity for the candidate to review examination items

How to Request a Review of the Scoring Report

To request a review of the scoring report, please complete the Rescoring Request Form detailing the specific reason for the request. Requests must be submitted within 30 days of the official release of the cognitive examination score reports.

A $150.00 fee is due prior to the rescoring process. Once a rescore request is received, The National Registry of Emergency Medical Technicians will e-mail a payment request to the candidate that will include a link to make a payment via credit card.

Once payment is submitted and confirmed, the National Registry will rescore the examination and, if requested, conduct a review of items identified in the rescoring request. The review will take place within 30 days of receipt of payment.

Upon completion of the rescoring process, candidates will be provided with a Rescoring Report. If an irregularity is discovered during the review process, the review fee will be refunded, and we will work with the candidate on further accommodations and resolutions. a rescore request is received, The National Registry of Emergency Medical Technicians will e-mail a payment request to the candidate that will include a link to make a payment via credit card.

Part 5: Certification Policies