Being an EMT takes resilience, but preparing to become one requires dedication. Emergency Medical Technicians are responsible for handling complex and hazardous situations on highways, in small towns, and rural areas, especially when it comes to North Dakota.

Becoming an EMT in this agricultural state means stepping up when it matters most. However, before you can help anyone, you’ll need the right training and a passing score on the NREMT cognitive exam.

If you're serious about making it happen, this guide walks you through exactly how to get certified in North Dakota and how to prep the smart way.

Start Prep Now!

Step 1: Meet North Dakota’s EMT Requirements

Before starting your training, make sure you meet the basics:

  • Be 18 years old. However, the licensure is also open to candidates as young as 16 years.
  • Have a high school diploma or GED
  • Hold a valid CPR certification for Healthcare Providers
  • Be able to pass a criminal background check
  • Be physically and mentally fit for EMS work

Once you check off all those boxes, you're ready for training.

Step 2: Enroll in a North Dakota-Approved EMT Course

In North Dakota, EMT training programs are overseen by the North Dakota Department of Health and Human Services – Division of Emergency Medical Systems (EMS). You must complete a state-approved EMT program. These are typically offered by:

  • Community colleges
  • Technical training centers
  • EMS agencies

Courses include classroom instruction, hands-on skills training, and clinical or field experience. Once you complete the course, you’re eligible to take the NREMT cognitive exam.

Step 3: Pass the NREMT Cognitive Exam

This is where most candidates struggle. The NREMT cognitive exam has a 40% ratio of failures among first-time test-takers. The reason behind this high failure rate is its computer-adaptive format. This means the difficulty of a question depends on your answer to the preceding question. Many students come out of the testing center confused and unsure. The lack of feedback makes it difficult to determine what went wrong.

The NREMT cognitive exam is designed to test how well you can think under pressure and not just what you know. Expect 70–120 questions covering these five domains:

  1. Scene Size-Up and Safety
  2. Primary Assessment
  3. Secondary Assessment
  4. Patient Treatment and Transport
  5. Operations

Note: Items related to pediatric patient care are integrated throughout all domains.

The test may end early or late, but it doesn’t guarantee whether you did well. Most students underestimate this exam. They assume more study time is enough. However, the best way to study for NREMT isn’t more hours. It depends on the smarter tools.

That’s where NREMT practice exams, an expert NREMT prep tutor, and a guided NREMT prep class can make all the difference.

Start Prep Now!

Step 4: Apply for North Dakota EMT Licensure

Once you pass the exam, you’re ready to apply for certification. Submit your application and other documents through the North Dakota EMS online licensing system. You’ll need to include:

  • Proof of EMT course completion
  • NREMT cognitive exam results
  • CPR certification
  • Background check and fingerprinting
  • Any required fees

After approval, you’ll be fully licensed to work as an EMT in North Dakota.

Step 5: Keep Your Certification Active

North Dakota EMT licenses are valid for two years. You must renew your license to avoid delays in your work. To renew, you’ll need to:

  • Complete continuing education
  • Maintain your CPR certification
  • Keep your NREMT certification current or meet the state renewal requirements

Don’t let your certification expire. It’s better to stay up to date than to start over.

National Certification vs. North Dakota State License

Here’s a clear comparison of national and state requirements:

Requirement NREMT (National) North Dakota State License
NREMT Cognitive Exam Required Required
CPR Certification Required Required
ALS psychomotor skills test No longer required Required
State-Approved EMT Course Required Required
Background Check Not Required Required
State Application Not Applicable Required

Note: The hands-on skills (psychomotor skills) test is no longer required by the National Registry and is only a state-level requirement in North Dakota.

Why So Many Test-Takers Choose How To NREMT

At How To NREMT, we focus on what works.

70% of our members are first-time test takers who want to pass the NREMT right away. The other 30% are retesters who didn’t make it the first time and don’t want to make the same mistakes again.

The NREMT cognitive exam isn’t about working harder. It’s about learning how the test works, how to think like an emergency medical responder, and how to apply clinical judgment under pressure. That’s exactly what we help with!

What You Get with How To NREMT

  • A 10-Step Study Plan that tells you exactly what to do next
  • Over 2,000 NREMT-style practice questionswith clinical logic
  • Unlimited Live Group Coaching on Zoom, led by real EMS educators
  • 24/7 access to How To, our AI-powered NREMT prep tutor
  • Full coverage of Technology Enhanced Items (TEIs)— drag-and-drop, build lists, and more

Looking for the best way to study for NREMT? We’re your best bet.

Start Prep Now!