NREMT guide · updated 2026-09-29

The NREMT EMT test plan (2025 specifications)

Since spring 2025 the NREMT EMT exam follows specifications based on the 2023 Basic Level Support Practice Analysis: Scene Size-up and Safety 15-19%, Primary Assessment 39-43%, Secondary Assessment 5-9%, Patient Treatment and Transport 20-24%, and Operations 10-14%. The five domains contain 28 job tasks.

Domains and weights

Domain	Share of exam	Job tasks
1. Scene Size-up and Safety	15-19%	6
2. Primary Assessment	39-43%	9
3. Secondary Assessment	5-9%	2
4. Patient Treatment and Transport	20-24%	7
5. Operations	10-14%	4

All 28 job tasks

These are the job tasks exactly as the specifications list them. Every exam question is written to one of them.

Task	Domain	Job task
1.1	Scene Size-up and Safety	Develop a plan of action prior to arrival using all available information to ensure safe and effective operations
1.2	Scene Size-up and Safety	Protect self, other responders, patient, public, and the emergency scene from existing and potential hazards
1.3	Scene Size-up and Safety	Don appropriate personal protective equipment (PPE) based on known hazards to protect responders from exposure
1.4	Scene Size-up and Safety	Investigate the scene to determine potential patients
1.5	Scene Size-up and Safety	Triage patients to ensure optimal care
1.6	Scene Size-up and Safety	Request appropriate resources based on known hazards and patient conditions to mitigate all facets of the emergency scene
2.1	Primary Assessment	Communicate with the patient and/or bystanders to establish rapport
2.2	Primary Assessment	Determine a general impression of the patient
2.3	Primary Assessment	Assess patient's level of consciousness
2.4	Primary Assessment	Assess patient's airway
2.5	Primary Assessment	Assess patient's breathing status
2.6	Primary Assessment	Assess patient's circulation
2.7	Primary Assessment	Determine chief complaint and life threats
2.8	Primary Assessment	Obtain results of patient's baseline vital signs and diagnostic testing
2.9	Primary Assessment	Identify the need for rapid treatment, rapid transport, or additional resources
3.1	Secondary Assessment	Investigate patient's current condition and needs through focused physical assessment, interviewing, and past medical history to develop a continued treatment plan
3.2	Secondary Assessment	Investigate previous findings and interventions through reassessment to determine any changes in the patient's condition
4.1	Patient Treatment and Transport	Manage patient's airway, ventilation, and oxygenation
4.2	Patient Treatment and Transport	Manage patient's cardiovascular and circulatory system
4.3	Patient Treatment and Transport	Manage motion restriction of patient's musculoskeletal system
4.4	Patient Treatment and Transport	Administer medication
4.5	Patient Treatment and Transport	Manage interventions specific to special populations
4.6	Patient Treatment and Transport	Manage patient transport
4.7	Patient Treatment and Transport	Communicate pertinent patient information
5.1	Operations	Ensure the equipment is in proper working order
5.2	Operations	Ensure sufficient inventory of medication and supplies utilized in patient care
5.3	Operations	Ensure that proper documentation is completed
5.4	Operations	Ensure the well-being of self and other responders

What changed from the old exam

The previous EMT exam was organized by clinical topic: airway, respiration and ventilation; cardiology and resuscitation; trauma; medical and obstetrics/gynecology; and EMS operations. The 2025 specifications are organized by what an EMT does on a call, from preparing before arrival to handing over the patient and restocking the truck.

Clinical content has not disappeared. A respiratory patient still shows up, but the question is framed as a task: assessing breathing status (Primary Assessment) or managing airway, ventilation and oxygenation (Patient Treatment and Transport). Study materials still sorted under the old five clinical headings cover the knowledge, but they do not match the new weighting.

Where to spend your time

Primary Assessment, 39-43%: general impression, level of consciousness, airway, breathing, circulation, chief complaint and life threats, baseline vitals, and deciding on rapid treatment or transport. This is the core of the exam.
Patient Treatment and Transport, 20-24%: airway management, cardiovascular care including CPR and AED use, spinal motion restriction and splinting, EMT-level medications, special populations, transport decisions and radio reports.
Scene Size-up and Safety, 15-19%: hazards, PPE, number of patients, triage and requesting resources.
Operations, 10-14%: equipment checks, supplies, documentation and responder well-being.
Secondary Assessment, 5-9%: focused exam, history and reassessment.

Scope of practice matters

Every item is reviewed for alignment with EMT scope of practice. Correct answers will not require advanced life support skills such as IV access or rhythm interpretation. If a practice question depends on them, it is not written for this exam.

Frequently asked questions

When did the new NREMT EMT exam start?

The specifications say the exam built on the 2023 Basic Level Support Practice Analysis would be administered starting spring 2025.

What is the biggest section of the NREMT EMT exam?

Primary Assessment, at 39-43% of the exam.

How many job tasks are in the EMT test plan?

28: six in Scene Size-up and Safety, nine in Primary Assessment, two in Secondary Assessment, seven in Patient Treatment and Transport, and four in Operations.

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Sources: National Registry EMT Examination Specifications · EMT Candidate Handbook: About the Examination. Independent study material. Not affiliated with or endorsed by the National Registry.