National Registry of EMTs

Advanced Emergency Medical Technicians

The primary focus of the Advanced Emergency Medical Technician is to provide basic and limited advanced emergency medical care and transportation for critical and emergent patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. Advanced Emergency Medical Technicians function as part of a comprehensive EMS response, under medical oversight. Advanced Emergency Medical Technicians perform interventions with the basic and advanced equipment typically found on an ambulance. The Advanced Emergency Medical Technician is a link from the scene to the emergency health care system.
[From the: National EMS Scope of Practice Model]

How to become a Nationally Certified Advanced-EMT?

Individuals applying for Emergency Medical Technician certification must meet the following requirements:
  1. 18 years of age or older.
  2. Possess current National Certification at the EMT level or a current state license at the EMT level or higher.
  3. Successful completion of a state-approved Advanced Emergency Medical Technician (AEMT) course that meets or exceeds the National Emergency Medical Services Education Standards for the Advanced Emergency Medical Technician.
    • Candidates must have completed the course within the past two years and the course Program Director must verify successful course completion on the NREMT website.
    • If the initial Advanced Emergency Medical Technician (AEMT) educational program was completed more than two years ago, and the candidate is currently state licensed at the AEMT level, the candidate must document successful completion of a state-approved AEMT refresher course or 36 hours of equivalent continuing education topic hours within the past two years.
    • If the candidate is not currently state licensed as an EMT and it has been more than two years from the completion of an approved AEMT course, the candidate must complete a new state-approved AEMT course prior to applying for National Certification.
  4. Have a current CPR-BLS for Healthcare Providers or equivalent credential.
  5. Successful completion of the National Registry Advanced Emergency Medical Technician psychomotor exam.
  6. Successful completion of the Advanced EMT Cognitive Exam

Application Process

  • Create an account/login profile on this website.
  • Submit a NREMT application and answer all questions truthfully.
  • 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 $100 (US funds). The application fee is non-transferable and non-refundable. This fee is charged for each attempt of the cognitive examination.
  • Candidates will receive an electronic Authorization to Test (ATT) once you are eligible for the exam. The electronic ATT contains scheduling instructions and important details concerning proper identification required at testing centers. You can find the ATT in the 'Check Application Status' page.

Certification Process

National Advanced Emergency Medical Technician certification requires successful completion of both a cognitive (knowledge) and psychomotor (skills) exam. Passed portions of the exam (both cognitive and psychomotor) remain valid for up to a twelve (12) month period, provided all other requirements for NREMR certification are met.

The Cognitive Exam Apply For A Cognitive Exam

The NREMT Advanced Emergency Medical Technician (EMT) cognitive exam is a linear computer based test (CBT). Each candidate will answer 135 questions (items). The maximum amount of time given to complete the exam is 2 hours.

The exam will cover the entire spectrum of EMS care including: Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical; Obstetrics/Gynecology; 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, candidates 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.

We strongly encourage candidates to review the following information:

Advanced EMT Cognitive Exam Test Plan

Based on the most recent practice analysis, the NREMT Board approves a cognitive exam test plan. A test plan is a blue-print that tells the computer testing software how to build a candidate's exam. The table below indicates what percent of the test will focus on each topic area.

Content Area Percent of Exam Adult / Pediatric Mix
Airway, Respiration & Ventilation 18%-22% 85% Adult; 15% Pediatric
Cardiology & Resuscitation 21%-25% 85% Adult; 15% Pediatric
Trauma 14%-18% 85% Adult; 15% Pediatric
Medical; Obstetrics & Gyn 26%-30% 85% Adult; 15% Pediatric
EMS Ops 11%-15% N/A

Cognitive Exam Retest Information

If a candidate is not successful in passing the cognitive exam, the NREMT will provide a candidate feedback on their performance. Candidates may apply to retest 15 days after the last examination.

Candidates are given a total of six opportunities to pass the Advanced EMT 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.* After remedial training is complete, the candidate is given three additional attempts to pass the EMT cognitive exam, provided all other requirements for National Certification are met. Candidates who fail to pass after a total of six attempts are required to repeat the entire Advanced Emergency Medical Technician (EMT) course.
Note: 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 10 hours can be applied from Distributive Education towards this section and must be state or CAPCE approved.

The Psychomotor Exam Find A Psychomotor Exam

The Advanced EMT psychomotor examination consists of ten skills presented in a scenario-type format. All skills have been developed in accordance with the U.S. Department of Transportation National EMS Education Standards (EMT and/or AEMT), the American Heart Association Guidelines for CPR and ECC, and the U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Trauma Triage Protocol.

The psychomotor examination process is a formal verification of the candidate's "hands-on" abilities and knowledge. Apart from Pass or Fail, candidates are not provided with specific feedback regarding their exam performance.

Advanced Emergency Medical Technicians are required to demonstrate proficiency on the following skills:

Patient Assessment-Trauma

Candidates are required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:

  • Scene Size-Up
  • Initial Assessment/Resuscitation
  • Focused History and Physical Examination - Rapid Trauma Assessment
  • Detailed Physical Examination

Patient Assessment-Medical

Candidates are required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:

  • Scene Size-Up
  • Initial Assessment/Resuscitation
  • Focused History and Physical Examination - Rapid Trauma Assessment
  • On-Going Assessment

Ventilatory Management

Candidates are evaluated over the following two (2) ventilatory management scenarios:

  • Apneic Adult

Given a scenario of having just found an apneic adult patient with a palpable carotid pulse, candidates must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen, followed by the placement of a supraglottic airway device (King®,Combitube®, etc.).

  • Pediatric Respiratory Compromise

Given a scenario with an infant in respiratory distress, candidates must demonstrate immediate management of the patient using simple airway maneuvers, adjuncts, and supplemental oxygen. You will then be required to demonstrate bag-valve-mask ventilation as the patient progresses from respiratory distress to respiratory failure.

Cardiac Arrest Management/AED

Candidates will be evaluated on their ability to manage a cardiac arrest situation the proper use of an AED and 1-rescuer CPR.

IV and Medication Skills

Intravenous Therapy: Candidates are required to establish a patent IV in a manikin arm in accordance with a given scenario.
Intravenous Bolus Medications: After establishing a patient IV line, candidates must administer an IV bolus of medication in accordance with a given scenario.

Pediatric Intraosseous Infusion Skills

Candidates are required to establish an intraosseous line in a pediatric IO manikin. (Manual insertion with a Jamshidi® needle or battery-powered drill-type devices are permitted.)

Spinal Immobilization (Supine Patient)

Candidates are required to immobilize an adult patient who is found supine with a suspected unstable spine using a long spine immobilization device. An EMT assistant will be provided, but the candidate is responsible for communicating with and directing the EMT assistant.

Random EMT Skills

Each candidate will be evaluated on one of the following randomly selected EMT skills.

Psychomotor Exam Retest Information

Advanced Emergency Medical Technician candidates are allowed two (2) full attempts to pass the psychomotor examination (one "full attempt" is defined as completing all skills and two retesting opportunities if so entitled).

Candidates are eligible to retest four (4) or less skills when taking a full attempt of the psychomotor examination. Candidates are eligible for two (2) retest attempts of the four (4) or less skills failed for no more than twelve (12) months from the date of the examination, provided they meet all other current requirements for National EMS Certification. If offered, only one (1) retest attempt may be completed on the same day. Candidates not completing the failed portion of the examination within that twelve (12) month period will be required to repeat the invalid portion. Failure of any skill on the second retest attempt constitutes complete failure of the entire psychomotor examination. Candidates who fail five (5) or more skills have failed the entire psychomotor examination. Candidates who fail the entire psychomotor examination must submit official documentation of remedial education before attempting the entire psychomotor examination (all ten [10] skills) on their second and final attempt of the psychomotor examination. Passed NREMT examination results are valid for up to twelve (12) months from the date of the examination, provided all other “Entry Requirements” of the NREMT are met.

Should a candidate fail the second full and final attempt of the psychomotor examination, the candidate must complete a new, state approved Advanced Emergency Medical Technician Training Program.

Expiration Dates

Initial expiration dates are determined by the date the candidate successfully completes the entire national certification process (cognitive and psychomotor exams). EMT, AEMT, and Paramedic candidates completing the national certification process between the January 1 and June 30 will receive an expiration date of March 31 two years in the future. Individuals successfully completing the national certification process between July 1 and December 31 will receive an expiration date of March 31 three years in the future.

Expiration Dates and Recertification Cycles

Initial Certification

Initial Cycle

Following Cycles

If you successfully completed the national certification process between: Your initial certification date will be March 31 Every cycle, after your initial cycle, will be:
January 01-June 30 2 years in the future April 1-March 31 (2 years)
July 1-December 31 3 years in the future April 1- March 31  (2 years)
How do I recertify?

Detailed information about the recertification process for Advanced-EMTs is on the AEMT Recertification Page.

Frequently Asked Questions

Responsibilities of Nationally Certified EMS Personnel

Certified Advanced Emergency Medical Technicians (EMTs) must notify the NREMT within 30 days regarding the following matters:

  • change in mailing address (the best way to update a mailing address is by editing the user profile page)
  • 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.

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.

Americans with Disabilities Act

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.

Cognitive Exam
Exam Type: Computer Based Linear
Questions: 135
Time Limit: 2 hours, 15 minutes
Cognitive Exam Fee: $100
(Per exam attempt)
2017 Cognitive Exam Fee: $115
(Per exam attempt)
Renewal Fee: $15
Late Fee: $50+Renewal Fee
Age: 18 Years Old