In South Dakota, EMTs respond to accidents in open plains, small towns, and on highways with calmness and confidence. When someone in Sioux Falls, Rapid City, or anywhere else in the state needs help, those EMTs truly make a difference. If you’re looking to take the first step toward this role, this guide is for you.

We’ll walk you through the steps involved in getting certified. From meeting basic requirements to passing theNREMT cognitive exam, this guide outlines everything you need to know to become an EMT. The NREMT cognitive examisn’t just another test; it tests your mindset. Study smart, and you’ll pass. Study hard, and you might still fall short.

Let's go through the full process, including the best way to study, step by step.

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Step 1: Meet the Basics First

Before enrolling in any EMT course, you must:

  • Be at least 18 years old
  • Hold a high school diploma or GED
  • Have a current CPR certification (BLS for Healthcare Providers)
  • Be physically and mentally fit for EMS duties
  • Pass a criminal background check
  • Other requirements, such as residency requirements, a valid driver’s license, and specific training certifications, may also be prerequisites.

Once you meet these basic requirements, you can move forward with confidence.

Step 2: Choose a State-Approved EMT Course

The candidates must train in a state-approved EMT program. Training in South Dakota is overseen by the South Dakota Department of Health, Division of EMS.  You can find approved courses at regional health systems, community colleges, and local EMS training centers. Coursework includes clinical experiences, hands-on skills labs, and classroom instruction. When you finish this training, you'll be eligible to take the NREMT cognitive exam.

Step 3: Master the NREMT Cognitive Exam

The NREMT cognitive exam is designed to measure how well a candidate performs under pressure. It doesn’t just test your knowledge; it also assesses your ability to apply that knowledge in clinical scenarios. It is a computer-adaptive test with 70 to 120 questions, assessing performance in five main areas:

  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.

Understanding the NREMT Cognitive Exam

This test demands decisions rather than definitions:

  • You’ll choose the most appropriate actions, not generic correct answers
  • You’ll navigate patient scenarios with close distractions
  • You’ll encounter interactive question types like TEIs

This requires deeper study. You need understanding, strategy, and practice. This test isn’t just about rote memorization. It requires quick decisions and good reasoning. That’s why the best way to study for the NREMT is to simulate the real experience:

  • Use NREMT practice exams that mimic the actual test
  • Study with a recognized NREMT prep class for guidance
  • Seek focused help from an experienced NREMT prep tutor

This combination is how the most prepared students succeed.

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Step 4: Submit Your South Dakota EMT Application

After passing the NREMT cognitive exam, apply to the South Dakota Department of Health.  You must submit the following documents along with your application:

  • Proof of EMT course completion
  • NREMT cognitive exam results
  • CPR certification
  • Background check
  • Completed license application and fee

Once approved, you are officially certified to work as an EMT in South Dakota.

Step 5: Maintain Your EMT Certification

South Dakota EMTs must renew their license every two years. You’ll need the following to renew your licensure:

  • A valid CPR certification
  • Required continuing education hours
  • A valid NREMT credential or proof of meeting state renewal requirements

Letting your certification lapse requires re-testing, which can delay your practice. Stay current and ready.

National vs. South Dakota EMT Certification

Here’s a comparison to clarify requirements at the national and state levels:

Requirement NREMT South Dakota
NREMT cognitive exam Required Required
Current CPR certification Required Required
State-approved Training Required Required
ALS psychomotor skills test Not required Required
Background check Not required Required
State application Not applicable Required

Note: The ALS psychomotor skills test is no longer required by the National Registry. It’s only a state-level requirement.

Why Over 70% of Students Choose How To NREMT

At How To NREMT, our members fall into two main groups:

  1. 70% are first-time test takers, hoping to succeed on their first attempt
  2. 30% are retakers, eager to improve from past attempts

None of them wasted their training. They choose How To NREMT because the NREMT is different from traditional classroom tests, and they want the right tools to excel.

What Sets Our Program Apart

Here’s what you’ll get with How To NREMT:

  • A structured 10-step training plan
  • Over 2,000 NREMT-style practice questions with explanations
  • A live, guided NREMT prep class via Zoom
  • 24/7 access to "Mr. How To", your NREMT prep tutor
  • TEI prep for drag-and-drop, build-list, and clinical scenarios

This program is built to train your brain to think in exam mode—smart, confident, and ready.

When to Begin Prep

If your course is ongoing or your test is near, now is the time to act.  Participate in a guided NREMT prep class to track your progress. Check your skills with regular NREMT practice exams, and seek help from an NREMT prep tutor to correct mistakes before they become habits. That’s how students study effectively.

Try the 7 or 14-Day NREMT Boot Camp.

For focused, quick preparation, consider our 7 or 14-Day Zoom Boot Camp for daily live sessions with EMS professionals, accountability and peer support from a large community, and real-world scenarios. It’s a sprint designed to build confidence, but spots are limited each quarter. Reserve your seat now and get 50% off.