Understanding National Registry Scoring and the 1500-Point System

The National Registry of Emergency Medical Technicians (NREMT) uses a computer adaptive testing (CAT) system to determine a candidate's overall competency. The exam is scored on a scale of 1500 points, with 950 being the minimum passing score for all provider levels, including EMT, AEMT, and Paramedic. This score is not a percentage or a raw number of correct answers but rather a scaled score that reflects the difficulty level of questions a candidate successfully answers. The National Registry exam is designed to measure entry-level competency, ensuring that only candidates who meet the required standard pass.

One important aspect of National Registry scoring is that the exam is assessed as a whole rather than by individual content categories. This means that candidates are not required to pass each category separately; instead, their overall performance on the exam determines whether they pass or fail. Even if a candidate struggles in a particular category, they can still pass as long as they perform well enough overall to reach the 950-point threshold. This scoring approach ensures that candidates are evaluated on their general competency rather than being penalized for weaknesses in isolated areas.

The National Registry no longer provides individual category performance breakdowns to candidates. Previously, candidates would receive feedback on how they performed in each content area, such as Airway, Cardiology, or Trauma. However, under the current scoring system, candidates are only given a single score out of 1500. This change means that test-takers will not know how well they did in specific areas, only whether their total performance was sufficient to pass. The rationale behind this change is to encourage a more comprehensive approach to studying and preparation, rather than focusing on individual sections.

Since the National Registry exam is a computer adaptive test (CAT), the scoring process is more complex than a simple percentage-based system. The test begins with questions of medium difficulty, and as a candidate answers correctly, the exam progressively presents more challenging questions. If a candidate answers incorrectly, the test will adjust by presenting easier questions to determine their competency level. This process continues until the computer has gathered enough data to determine the candidate’s ability level with statistical certainty. The final score out of 1500 points is based on both the difficulty of the questions answered correctly and the consistency of performance. A candidate who consistently answers more difficult questions correctly will score higher than someone who answers easier questions correctly but struggles with more advanced concepts.

This scoring method ensures a fair and precise evaluation of each test-taker’s knowledge and skills, providing a reliable measure of their readiness to perform as an emergency medical provider.

Initial courses are valid for 24 months from the date of completion. This means you have 24 months to pass your NREMT Cognitive exam.

Yes, you can reschedule your NREMT exam as long as you do it 24 hours prior to the scheduled start time. You may be charged a small fee to reschedule depending on the test center.

This is highly recommended if you do not feel ready. It is better to reschedule your exam, take longer to study and prepare, and pass on your first attempt.

For EMRs you get 3 attempts and then must retake the EMR program to retest.

For EMTs, AEMTs, and Paramedics You get 3 attempts and then must take a refresher course to get 3 more attempts. If you fail 6 times then you will need to retake the entire EMS state-approved education program again.

To see what CE you need to take to get 3 more attempts please see the "How do I get 3 more attempts?" FAQ.

Yes, many test sites will charge you a rescheduling fee. It is usually $30 to $50.

As of April 7th, 2025, the EMT and EMR provider level exam domains have changed.

The current EMT and EMR National EMS Certification Examinations cover five content areas:

• Scene Size-Up and Safety
• Primary Assessment 
• Secondary Assessment 
• Patient Treatment and Transport 
• Operations 

Please use the following link to learn more: Click HERE

The current AEMT and PARAMEDIC National EMS Certification Examinations cover six content areas:

• Airway, Respiration & Ventilation
• Cardiology & Resuscitation
• Trauma
• Medical/Obstetrics/Gynecology
• EMS Operations
• **Clinical Judgment (AEMT and Paramedic levels only)**

According to the NREMT:

Here are a few simple suggestions that will help you to perform to the best of your ability on the examination:

• Study your textbook thoroughly and consider using the accompanying workbooks to help you master the material.
• Thoroughly review the current American Heart Association’s Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. You will be tested on this material at the level of the exam you are taking.
• The National Registry does not recommend a particular study guide but recognizes that they can be useful. Study guides may help you identify your weaknesses, but should be used carefully. Some study guides have many easy questions leading some candidates to believe that they are prepared for the exam when more study is warranted. If you choose to use a study guide, we suggest that you do so a few weeks before your actual exam. You can obtain these from your local bookstore or library. Use the score to identify your areas of strength and weakness. Re-read and study your notes and materials for the areas you did not do well in.
• The National Registry is not able to provide candidates with information about their specific deficiencies.

There are a 2 main types of questions you will see on your test, they include:

• Judgment-based (any format) - You will be given a scenario with details that are pertinent to you getting the question right. These require you to use critical thinking.
• Knowledge-based (any format) - You will be given a question that requires very little or NO critical thinking but instead tests your knowledge. For example, what is paradoxical motion?

Question Structures - There are several different question structures you will see. They are the:

• Multiple Choice - Choose one of 4 options.
• Multiple Response - The test will require you to choose two or more answers. The test question will specify how many correct answers you are expected to choose. *
• Clinical Judgment Scenario Based (ALS EXAMS ONLY) - you will be given en route info, on-scene info, and post-scene info separately. You will be asked 1 or more questions on each of those 3 categories. *
• The new Technology Enhanced Items (TEIs) - The TEIs are explained below.

* The Clinical Judgment Scenarios will be on the ALS exams and will be scored.

There can also be a combination of these different types of questions. For example, you could be given a scenario but then asked a knowledge-based question at the end making the scenario irrelevant.

The NEW TEIs

The NEW TEIs are the drag and drop, build list, and option/check box question items.

Drag and Drop – This item type requires candidates to move response options into designated areas on the screen. These may include sorting information into categories, completing a sequence, or matching terms to definitions. Candidates must carefully place each option in the correct location to receive credit.

Build List – In this format, candidates must create an ordered list by selecting and arranging items from a provided set. This may involve prioritizing treatment steps, arranging assessment procedures in the correct order, or selecting key components of a protocol. The correct sequence is crucial for full or partial credit.

Option/Check Box – This item type presents candidates with multiple possible answers, where they must select all correct responses. Unlike traditional multiple-choice questions that have only one correct answer, Option/Check Box items require test-takers to identify all correct responses while avoiding incorrect ones.

How it works-

• Candidates are presented with a list of possible answer choices (typically displayed on the left side of the screen).
• At the top of the question, there may be two or more designations (categories or response groupings).
• Candidates must determine which of the answer choices belong under each designation by checking the appropriate boxes.
• Some responses may fit under multiple designations, while others may not fit under any (acting as distractors).

Examples-

A question may ask:
"Select the signs and symptoms that best correspond to either Hypoglycemia or Hyperglycemia. Check all that apply."

• On the left side, there is a list of possible symptoms (e.g., confusion, tachycardia, diaphoresis, fruity breath odor, polyuria, etc.).
• At the top, there are two designations: Hypoglycemia and Hyperglycemia.
• Candidates must check the appropriate symptoms under each designation.

Are all the questions multiple choice on the exam?

No, there are a few different types of questions, and they are not all multiple-choice. 

In the training videos that come with your membership, we cover all the different types of questions you will face and how to best break them down.

There can also be a combination of these different types of questions. For example, you could be given a scenario but then asked a knowledge-based question at the end, making the scenario irrelevant.

During National Registry exams, every candidate receives pilot questions that are indistinguishable from scored items. Examinations do not factor pilot questions into a candidate’s performance. You will answer the exact number of pilot questions allotted for each level of the exam regardless of how many questions you answer in total on the exam. For example, if you are taking the EMT level test and your test ends at 90 questions you will have answered 10 pilot questions and if it ended at 100 questions you will have still answered 10 pilot questions, no more, no less. The number of pilot items included in each exam is detailed below:

• EMR: 30 items
• EMT: 10 items
• AEMT: 35 items
• Paramedic: 20 items

EMR: 90-110 items

EMT: 70-120 items

Advanced EMT: 135 items exactly

Paramedic: 110-150

All sections, except EMS Operations, have a content distribution of 85% adult patients and 15% pediatric patients.

• The EMR, EMT, and Paramedic cognitive exams are Computer Adaptive Tests (CAT).
• The NRAEMT and Intermediate/99 cognitive exams are Linear Computer-Based Tests (CBT).

What is a Computer Adaptive Test (CAT)?

Computer Adaptive Test (CAT) examinations are delivered in a different manner than fixed-length exams such as computer-based linear tests and pencil-paper exams and may feel more difficult.

Read more about CAT Exams

What is a Linear Computer-Based Test (CBT)?

Linear examinations are fixed-length examinations. The Advanced-EMT examination is currently a Linear examination.

Candidates cannot skip questions or go back and change their responses. There is no penalty for guessing. An examination attempt is considered unsuccessful if a candidate does not complete the examination in the allotted time. 

With a How To NREMT membership, you will learn several valuable tips and tricks to help you prepare for the exam. This includes advice for the night before the exam, the morning of the exam, and strategies to use during the exam itself.

Here are a few recommendations from the National Registry.

The Night Before the Exam

• Do not wait until the night before the exam to begin studying. If you encounter a topic that you don't think you know well, there will not be enough time to review it.
• Get a good night’s sleep.

The Day Of the Exam

According to the NREMT:

• Eat a well-balanced meal.
• Arrive at the test center at least 30 minutes before the scheduled testing time, the identification and examination preparation process takes time. A candidate may need this time to review the tutorial on taking a computer-based test. Arriving early will reduce stress.
• Be sure to have the proper identification as outlined in the confirmation materials before heading to the test center.
• A candidate will not be able to take the exam if they do not have the proper form of identification.
• Relax. Thorough preparation and confidence are the best ways to reduce test anxiety.

According to the NREMT, you will have the following amount of time to take each cognitive exam (about 1 minute per maximum number of questions allotted):

EMR: 1 hour 45 minutes

EMT: 2 hours

AEMT: 3 hours

Paramedic: 3.5 hours

Do I need to worry about running out of time on the test?

If you run out of time you will automatically fail regardless of how well you were doing when your time limit expires. However:

Take time to read each question carefully. The National Registry constructed its examinations to allow plenty of time to finish. Most successful candidates spend about 30 – 60 seconds per item reading each question carefully and thinking it through.

• Fewer than 1% of candidates are unable to finish the exam. Thus, the risk of misreading a question is far greater than your risk of running out of time.
• Do not get frustrated. Everyone will think the examination is difficult because of the adaptive nature of the CAT examination. The CAT algorithm adjusts the examination candidate’s maximum ability level, so a candidate may feel that all items are difficult. Instead, focus on one question at a time, do your best on that question, and move on.

Yes, during the test you will be given an erasable note board and a marker. You will not be able to write on the noteboard until after your test has started. You will also not be allowed to erase anything on the note board yourself. If you fill up the note board, you can raise your hand and have an administrator bring you another one. There is no limit on how many note boards fill-up you can use. You can use the note board to help you organize your thoughts and help with math if needed.

Yes, an on-screen calculator was placed on cognitive examinations in 2018 and is available throughout each examination for every level.

Yes, all information about the Americans with Disabilities Act accommodations can be found here:

https://www.nremt.org/Policies/Examination-Policies/ADA-Accommodations

• Examination results are not released at the test center or over the telephone.
• Examination results will be posted to a candidate’s National Registry account within two business days following the completion of the examination, provided the candidate has met all other registration requirements.
• Candidates should log into their account and click on “Dashboard” or “My Application > Application Status” to view examination results.

Why did I fail the exam?

To pass the national registry cognitive exam you must have the following three things:

• Knowledge, you must have a certain amount of knowledge for you to be able to answer the questions on the test correctly.
• Critical thinking skills, you must understand how to break down the questions properly so that you can understand what the question is truly asking. If you misinterpret the question, then you will choose the wrong answer.
• Psychological strength, you could have all the knowledge in the world and understand how to break questions down, however, if you cannot keep yourself calm and confident during the test you will likely fail. Test takers who second guess themselves or get anxious during the test can fail because they cannot keep themselves focused and calm.

If you have taken the National Registry cognitive exam and failed it, you are lacking in one of these three areas. If you are unsure which area you are lacking in reach out to your instructor during your group training session and they will help you figure out exactly what area you need to focus on.

If I fail the NREMT cognitive exam, will I be told how I did?

Yes, If you fail the exam, the NREMT will, as of June 1st, 2023, give you a report outlining how you scored in comparison to the passing standard. Instead of a report on five individual sections (as they did in the past), students will now receive a numerical score for their performance with a reference for minimum, passing standard, and highest possible score.

Yes, According to the NREMT:

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; and
• An opportunity for the candidate to review examination items.

Requesting 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 before 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.

The ALS Redesign took effect July 1, 2024.