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Emergency Medical Responder (EMR)

    Entry Requirements
    Application Process
    Certification Process
    Cognitive Examination
    Cognitive Exam Retest Information
    Psychomotor Examination
    Expiration Date
    Lapsed Certification
    ADA Compliancy
    Disciplinary Policy and Rights of Appeal
    Responsibilities of Certified Emergency Medical Responder
    Emergency Medical Responder Recertification

Entry Requirements

Individuals applying for Emergency Medical Responder certification must meet the following requirements:

  • Successful completion of a state-approved Emergency Medical Responder (EMR) course that meets or exceeds the National Emergency Medical Services Education Standards for the Emergency Medical Responder. You must have completed the course within the past two years. Your Program Director must verify your successful completion of the course on the NREMT website.

    If your initial Emergency Medical Responder (EMR) educational program was completed more than two years ago and you are currently state licensed at the EMR level, you must document successful completion of a state-approved EMR refresher course or 12 hours of equivalent continuing education topic hours within the past two years. If you are not currently state licensed as an EMR and it has been more than two years from the completion of your EMR course, you must complete an entire state-approved EMR course prior to applying for National Certification.

  • Verification from the Program Director that you hold a current CPR-BLS for Healthcare Providers or equivalent credential and have demonstrated competence in Emergency Medical Responder (EMR) skills.

  • Successful completion of a state-approved Emergency Medical Responder (EMR) psychomotor exam.

Application Process

  • Create a login on this website.

  • Complete a National Registry online application, including truthfully completing the Licensing Action and criminal statements. click here for more information on the NREMT Criminal Policy. The NREMT may deny certification or take other appropriate actions in regards to applicants for certification or recertification when a criminal conviction has occurred.

  • Pay the application fee of $65.00 (US funds). The application fee is non-transferable and non-refundable. This fee is charged for each attempt of the cognitive examination.

  • You will receive an Authorization to Test (ATT) once you are eligible for the exam. The ATT letter contains scheduling instructions and important details concerning proper identification required at testing centers.

Certification Process

National Emergency Medical Responder (EMR) certification requires successful completion of both a cognitive and psychomotor exam. Passed portions of the exam (both cognitive and psychomotor) remain valid for a twelve (12) month period.

Cognitive Examination

The NREMT Emergency Medical Responder (EMR) cognitive exam is a computer adaptive test (CAT). The number of items a candidate can expect on the Emergency Medical Responder (EMR) exam will range from 80 to 110. The maximum amount of time given to complete the exam is 1 hour 45 minutes.

The exam will cover the entire spectrum of EMS care including: Airway, Respiration & Ventilation, Cardiology & Resuscitation; Trauma; Medical & Obstetrics/Gynecology; and EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). In order to pass the exam, you must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry level emergency medical care.

Cognitive Exam Retest Information

In the event you are unsuccessful passing the cognitive exam, the NREMT will provide feedback on your performance. You may apply to retest 15 days after your last examination.

Candidates are given three opportunities to pass the cognitive examination provided all other requirements for National EMS Certification are met. Candidates who fail the examination on the third attempt will be required to repeat the entire Emergency Medical Responder (EMR) program in order to apply for subsequent examination attempts.

Psychomotor Examination

The psychomotor exam provides a hands-on opportunity for you to demonstrate the skills you have learned. Speak with your instructor or state EMS Office about the format and logistics of completing a state-approved Emergency Medical Responder (EMR) psychomotor exam.

Expiration Date

Initial expiration dates are determined by the date of successful completion of the entire certification process. Individuals successfully completing the national certification process between the dates of January 1 - June 30 will receive an expiration date of September 30 two years in the future. Individuals successfully completing the national certification process between July 1 and December 31 will receive an expiration date of September 30 three years in the future.

For example:

NREMR- Expiration Date and Recertification Cycles

Initial Certification

Initial Cycle

Following Cycles

If you successfully completed the national certification process between:

Your initial recertification cycle is:

Every cycle after your initial cycle:

  • January 1-June 30



Completed national certification on February 14, 2014

  • Your initial certification date-September 30, 2 years in the future


February 14, 2014-September 30, 2016

  • October 1-September 30 (2 years)


October 1, 2016-September 30, 2018
(2 years expiring on even years)

  • July 1-December 31



Completed national certification on July 7, 2014

  • Your initial certification date-September 30, 3 years in the future


July 7, 2014-September 30, 2017

  • October 1-September 30  (2 years)


October 1, 2017-September 30, 2019
(2 years expiring on odd years)

Lapsed Certification

If your National EMS Certification lapsed as an Emergency Medical Responder (EMR) within a two year period or you are currently state licensed as an Emergency Medical Responder (EMR), you can obtain National EMS Certification by completing a state-approved Refresher course and successfully completing the cognitive and psychomotor examinations. If your EMS certification expired more than two years ago, you must complete an entire state-approved Emergency Medical Responder (EMR) course, and complete the cognitive and psychomotor examinations.

ADA Compliancy

The NREMT complies with the Americans with Disabilities Act (ADA) of 1990, and offers reasonable accommodations for individuals with disabilities. Pearson VUE test centers are also ADA compliant.

Complete information about the NREMT Accommodations Disability Policy can be found here.

Disciplinary Policy and Rights of Appeal

The NREMT has disciplinary procedures, rights of appeal and due process within its policies. Complete information about the NREMT Disciplinary Policy and Rights of Appeal can be found here.

Download a Certification Brochure.

Responsibilities of Certified Emergency Medical Responders (EMRs)

Certified Emergency Medical Responders (EMRs) must notify the NREMT within 30 days regarding the following matters:

  • change in mailing address.

  • any criminal conviction.

  • disciplinary action taken by any state has resulted in suspension, revocation, or expiration of state registration/licensure; termination of right to practice; voluntary surrender of state registration/licensure while under investigation.

The NREMT considers the individual to be solely responsible for their certification.

Emergency Medical Responder (NREMR) Recertification

In applying for recertification, certified EMS professionals agree to comply with all recertification requirements, rules and standards of the National Registry of Emergency Medical Technicians (NREMT). The recertification applicant bears the burden of demonstrating and maintaining compliance at all times.

To Apply For Recertification You Must:

  1. Be actively working within an emergency medical service, rescue service, or patient health care facility using your EMR skills.

  2. Demonstrate continued cognitive competency by examination or documentation of continuing education.

  3. Maintain skills as verified by your Training Officer/Supervisor (requires signature or electronic signature on your recertification application validating competency of skills).

  4. Have a BLS-CPR for Healthcare Providers credential that is current on your September 30 expiration date. Verification may be in the form of an instructor's signature on the recertification application or a copy of both sides of the card.

  5. Submit your completed recertification application prior to September 30 of the year your certification expires.

Cognitive Competency Options (2):
  1. Exam Option

    The recertification by examination option enables you to demonstrate continued cognitive competence without requiring you to document your continuing education.

    • Log in to your NREMT account. Complete a recertification by examination application and pay the exam fee. Be sure you are completing the recertification application and not the initial entry application.
    • After 24 - 48 hours, go to the NREMT website, log in to your account and print your Authorization to Test (ATT) letter. Follow the directions on the letter to schedule your exam.
    • Take and pass the exam between April 1 and September 30 of the year your certification expires. You may make one attempt in the last six (6) months of your certification cycle to demonstrate continued cognitive competency by taking an exam in lieu of documenting continuing education. You will receive an abbreviated recertification application upon successful completion of the exam.
    • Return the completed abbreviated recertification application by September 30 of the year your certification expires with signatures and supporting documentation.
    All other recertification requirements (including criminal statement, CPR, active affiliation/practice and verification of skills) must still be met and verified.

  2. Continuing Education Option

  • Complete a State or CECBEMS (F1, F2, F5) approved 12 hour EMR refresher or equivalent continuing education as outlined below.

  • Pay the $10 (U.S. funds) non-refundable processing fee at the time of submission of documentation

All continuing education hours must be completed within the current certification cycle. Education completed on or prior to your previous September 30 expiration date will NOT be accepted. If this is your first certification cycle, only education completed after the date of your initial certification will be accepted. See below for detailed recertification requirements.


The EMR refresher course can be completed through two different options:

    • Traditional refresher course - Completion of a State or CECBEMS (F1, F2, F5) approved 12 hour EMR refresher course

    • Continuing education topic hours - EMR refresher may be completed by continuing education* and must include the topics and hours listed below:
    Topics Hours Required** Suggested Courses
    Preparatory 1 hour Roles and Responsibilities, Well-being of the Emergency Medical Responder, Medical Direction, Quality Improvement, Personal Protection, Scene Safety, Medical/Legal, Human Anatomy, Lifting and Moving
    Airway 2 hours Basic Airway Management, Oxygen Delivery Systems and Techniques, Adjuncts, Oxygen Therapy
    Patient Assessment 2 hours Scene Size-up, Primary Survey, Vital Signs and History Taking, Assessment of Trauma Patients, Assessment of Medical Patients, Secondary Assessment, Communications, Documentation
    Circulation 3 hours Management of Shock, Cardiac Emergencies, Bleeding/Wounds/Shock, Cardiac Arrest Management
    Illness & Injury 3 hours General Pharmacology, Respiratory Emergencies, Environmental Emergencies, Acute Abdominal Emergencies, Diabetic Emergencies, Allergic Reactions, Poisoning and Overdose, Behavioral Emergencies, Soft Tissue Injuries, Musculoskeleta l Injuries, Injuries to Head and Spine
    Childbirth & Children 1 hour Obstetrical Emergencies, Gynecological Emergencies, Childbirth and Complications, Care of the Newborn, Assessing the Pediatric Patient, Medical Emergencies in Pediatric Patients, Airway Management in Pediatric Patients, Trauma Emergencies and Care in Pediatric Patients
    Total 12 hours  

* Some states require the traditional refresher course and will not accept continuing education hours. Please refer to your state’s particular requirements.

** A maximum number of 6 hours can be applied from Distributive Education towards this section and must be state or CECBEMS approved.

  • Hour-for-hour credit can be applied for standardized courses (including, but not limited to, ABLS, ACLS, AMLS, EMPACT, EPC, ITLS, PHTLS, PALS, PEPP, etc.)

  • Credit can be applied for college courses that relate to your role as an EMS professional (1 college credit = 8 hours of continuing education). For example, but not limited to anatomy, physiology, biology, chemistry, pharmacology, psychology, sociology, statistics, etc.

  • Hours from the following courses can be applied hour-for-hour with no maximum: Advanced Trauma Life Support, EMS Course Instruction, and Wilderness EMS Training.

Courses That Cannot Be Applied towards Additional Continuing Education Hours: Clinical Rotations, CPR, instructor courses, management/leadership courses, performance of duty, preceptor hours, serving as a skill examiner, and volunteer time with agencies.

Download the NREMR Recertification Requirements Brochure.

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