EMT NREMT Exam Prep

This deck is designed to help you build a strong foundation in the core knowledge areas tested on the National Registry of Emergency Medical Technicians (NREMT) exam. The cards walk through key patient assessment frameworks like SAMPLE and OPQRST, normal vital sign ranges across different age groups, the step-by-step order of a primary survey, and the tools used to evaluate a patient's level of consciousness, including the AVPU scale and the Glasgow Coma Scale. Together, these topics cover many of the bread-and-butter facts and protocols that show up repeatedly on the certification exam and in real-world field practice.

The deck is a great fit if you are currently enrolled in an EMT course and want to reinforce what you are learning in class, or if you are in the home stretch of your studies and need a focused way to drill the basics before test day. It also works well for currently certified EMTs who want a quick refresher on foundational concepts like vital sign norms and assessment mnemonics. Because the questions are mostly short and factual, they are well suited for short review sessions during a commute, a break, or any spare moment you have throughout the day.

To get the most out of this deck, try to study in short, frequent sessions rather than long cramming blocks, since memorizing numbers and acronyms is much easier when your brain has time to consolidate the information between reviews. As you go, pay extra attention to the ranges that differ by age group, because distinguishing adult, child, and infant values is a common stumbling block on the NREMT. Pair each review session with hands-on practice or scenario-based thinking when you can, so the facts you memorize here connect to the bigger picture of patient care.

The EMT's first task upon arrival at any scene is the scene size-up, beginning with body substance isolation (BSI) and personal protective equipment, then a quick assessment of hazards, the number of patients, and the need for additional resources. Once the scene is determined safe, the EMT proceeds to the primary assessment, a rapid evaluation designed to identify and immediately address life-threatening conditions. The traditional ABCDE framework (airway, breathing, circulation, disability, exposure) is now often preceded by an X for massive hemorrhage control when significant external bleeding is present. The disability component is typically measured using the AVPU scale (Alert, Verbal, Pain, Unresponsive) for quick use, while the Glasgow Coma Scale provides a more detailed assessment ranging from 3 (deep coma) to 15 (fully alert) based on eye opening (maximum 4), verbal response (maximum 5), and motor response (maximum 6).

After life threats are managed, the EMT gathers a focused or rapid medical history. Two key mnemonics organize this information: SAMPLE captures the broader history (Signs/symptoms, Allergies, Medications, Pertinent history, Last oral intake, Events leading up), while OPQRST is used specifically to characterize the patient's chief complaint (Onset, Provocation/palliation, Quality, Radiation, Severity, Time). Vital signs are obtained and compared against age-appropriate norms because pediatric and adult ranges differ substantially. Normal adult respiratory rate is 12–20 breaths per minute, heart rate is 60–100 beats per minute, and systolic blood pressure should be less than 120 mmHg. For children over one year, minimum acceptable systolic BP is estimated as \(70 + 2 \times \text{age in years}\) mmHg, while newborns have heart rates of 100–160 bpm and respiratory rates of 30–60, and children ages 1–12 breathe 15–30 times per minute.

The choice between a rapid trauma assessment and a focused assessment depends on mechanism of injury (MOI). Patients with significant mechanisms such as falls greater than 20 feet, high-speed vehicle collisions, ejection from the vehicle, or penetrating trauma to the torso or head warrant a rapid head-to-toe exam to identify hidden life threats. In contrast, patients with an isolated injury or no significant mechanism of injury receive a focused assessment centered on their chief complaint. In both cases, transport priority is determined by life threats found in the primary assessment, not by how dramatic an injury appears on the surface. Unresponsive patients with adequate breathing and no suspected spinal injury should be placed in the recovery position to protect the airway from aspiration.

Airway management begins with selecting the appropriate manual maneuver based on suspected spinal injury. In patients without suspected spine injury, the head-tilt chin-lift opens the airway by lifting the tongue away from the posterior pharynx. When spinal injury is possible, the jaw-thrust maneuver is used instead, as it opens the airway without extending the neck. Adjuncts such as the oropharyngeal airway (OPA) are inserted in unresponsive patients without a gag reflex, sized from the corner of the mouth to the earlobe or angle of the jaw. The nasopharyngeal airway (NPA) is preferred for responsive patients or those who cannot tolerate an OPA, sized from the tip of the nose to the earlobe, but is contraindicated in suspected basilar skull fracture or severe facial trauma.

Effective breathing assessment looks for signs of both adequate and inadequate respiration. Adequate breathing includes normal rate and rhythm, equal chest rise, adequate depth, normal skin color, and no accessory muscle use. Inadequate breathing may present as a rate that is too fast or slow, shallow depth, irregular rhythm, cyanosis, accessory muscle use, and altered mental status. Agonal breathing, an ineffective gasping pattern, is not adequate breathing and requires immediate ventilatory support, typically with a bag-valve-mask (BVM), which is the device of choice for ventilating a non-breathing patient with a pulse. Oxygen delivery devices are selected by patient need: a nasal cannula at 1–6 liters per minute delivers roughly 24–44% oxygen, while a nonrebreather mask at 10–15 liters per minute can provide up to approximately 90% oxygen. Capillary refill of less than 2 seconds and pulse oximetry of 95–100% are useful adjuncts; in patients with darker skin, mucous membranes, nail beds, palms, and soles are preferred assessment sites.

Cardiopulmonary resuscitation follows age-specific protocols. For adult CPR with one rescuer, the compression-to-ventilation ratio is 30:2 at a rate of 100–120 compressions per minute and a depth of at least 2 inches (5 cm), not exceeding 2.4 inches (6 cm). For two-rescuer infant or child CPR, the ratio changes to 15:2, with infant compressions about 1.5 inches (4 cm) deep and child compressions about 2 inches (5 cm). Pulse checks are performed at the carotid artery in unresponsive adults and at the brachial artery in infants. Once an advanced airway is in place, ventilation becomes asynchronous with compressions at one breath every 6 seconds (10 breaths per minute). An automated external defibrillator (AED) is used to analyze rhythm and shock lethal arrhythmias like ventricular fibrillation or pulseless ventricular tachycardia; the EMT must ensure no one is touching the patient before delivering a shock. Airway obstruction is managed with abdominal thrusts (Heimlich maneuver) in conscious adults, while conscious infants receive alternating 5 back blows and 5 chest thrusts.

Severe external bleeding is first controlled with direct pressure on the wound. When life-threatening extremity hemorrhage cannot be controlled this way, a tourniquet is applied 2–3 inches proximal to the wound, never over a joint. Hemorrhagic shock is classified by the percentage of blood loss: Class I (less than 15%), Class II (15–30%), Class III (30–40%), and Class IV (greater than 40%). Compensated shock presents early with tachycardia, pale/cool/clammy skin, anxiety, and delayed capillary refill, while decompensated shock shows hypotension, altered mental status, weak or absent peripheral pulses, and cyanosis. The EMT's primary treatment for all forms of shock includes high-flow oxygen, warmth, bleeding control, and rapid transport; a patient without spinal or leg injury may be placed supine with legs elevated to improve perfusion. Beyond hypovolemia, shock can arise from anaphylaxis (severe allergic reaction with widespread vasodilation and airway swelling, treated with epinephrine auto-injector), neurogenic injury (spinal cord damage producing warm skin and hypotension without tachycardia), cardiogenic failure (the heart's inability to pump effectively, often after MI), and sepsis (severe infection causing vasodilation and organ dysfunction).

Thoracic trauma includes several life-threatening conditions. A tension pneumothorax occurs when air accumulates in the pleural space, causing lung collapse and shifting of mediastinal structures; signs include severe respiratory distress, absent breath sounds on one side, tracheal deviation, jugular vein distension, and hypotension. Flail chest results from two or more ribs fractured in two or more places, creating a paradoxical-moving segment that is best managed with positive pressure ventilation and high-flow oxygen. An open or sucking chest wound is treated with an occlusive or vented chest seal to prevent air entry. Other traumatic findings include crepitus, a grating sensation from broken bone ends, an impaled object, which should be stabilized in place unless it obstructs the airway or interferes with CPR, and eviscerations, or protruding organs, which are covered with a moist sterile dressing and an occlusive outer layer, never pushed back in.

Burn management begins with stopping the burning process, removing smoldering clothing and jewelry, and covering with a dry sterile dressing. EMTs should never apply ice, butter, ointments, or ice-cold water due to hypothermia risk and potential further tissue damage. Burns are classified by depth: superficial (first-degree) burns are red and painful without blistering; partial-thickness (second-degree) burns show blistering, moist red or mottled skin, and significant pain; full-thickness (third-degree) burns appear charred, white, or leathery and may be painless due to nerve destruction. The Rule of Nines estimates burn extent in adults (each arm 9%, each leg 18%, anterior trunk 18%, head 9%), while infants use a modified rule with the head representing 18% of total body surface area. Chemical burns require brushing off dry chemicals first, then flushing with copious water for at least 20 minutes.

Spinal trauma requires manual stabilization of the head and neck in a neutral in-line position as soon as possible. Signs of spinal cord injury include numbness, tingling, paralysis, or loss of sensation or motor function below the injury site. Cushing's triad, consisting of rising blood pressure, decreasing heart rate, and irregular respirations, is a late indicator of increased intracranial pressure. Basilar skull fractures may present with Battle's sign (bruising behind the ears), raccoon eyes (bruising around the eyes), or cerebrospinal fluid leakage from ears or nose. Suspected fractures are splinted by immobilizing the joint above and below the injury, and distal pulse, motor function, and sensation (PMS) are checked before and after splinting. Compartment syndrome is suggested by severe pain out of proportion to injury, tightness, pallor, paresthesia, and late pulselessness. An amputated body part is wrapped in sterile dressing, placed in a plastic bag, kept cool on ice without direct contact, and transported with the patient. The golden hour concept emphasizes that definitive trauma care within the first hour of severe injury improves survival.

Cardiac emergencies commonly present with chest pain or pressure, pain radiating to the arm, jaw, or back, shortness of breath, diaphoresis, and nausea. EMTs may assist the patient in taking aspirin (162–324 mg chewed) to reduce clot formation, provided there are no contraindications such as known allergy, active GI bleeding, or recent use of blood thinners that increase bleeding risk. Nitroglycerin, administered sublingually, can relieve chest pain of cardiac origin but is contraindicated when systolic blood pressure falls below protocol threshold (often under 100 mmHg) or when the patient has recently used erectile dysfunction medications. Congestive heart failure and pulmonary edema present with shortness of breath, crackles or rales on auscultation, pink frothy sputum, jugular vein distension, and peripheral edema; these patients breathe most easily in an upright high-Fowler's position.

Respiratory emergencies include asthma, COPD, and hyperventilation. Asthma attacks are managed by assisting with the patient's prescribed metered-dose inhaler and administering oxygen, with severe attacks signaled by wheezing, accessory muscle use, tripod positioning, tachypnea, and inability to speak full sentences. COPD, encompassing chronic bronchitis and emphysema, causes long-term airflow limitation. Hyperventilation from anxiety or emotional causes is treated by coaching slow breathing and reassurance rather than by paper bag rebreathing. The mnemonic AEIOU-TIPS helps recall causes of altered mental status: Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psychiatric, Stroke/shock, with hypoglycemia being a particularly common and reversible cause that must always be considered.

Neurological emergencies include stroke and seizures. The FAST mnemonic (Face drooping, Arm drift, Speech difficulty, Time to call 911 and note last known well) identifies stroke; documenting the time the patient was last known well is critical because it determines eligibility for time-sensitive hospital treatments such as fibrinolytics. A seizure lasting longer than 5 minutes or recurring without return to consciousness is status epilepticus, a medical emergency requiring rapid transport. During an active seizure, EMTs protect the patient from injury without restraining them or placing anything in their mouth, then manage the postictal period of confusion, fatigue, and altered mental status. Diabetic emergencies present as hypoglycemia (rapid-onset confusion, diaphoresis, pale/clammy skin, weakness, tachycardia, combativeness) or hyperglycemia (gradual onset, warm/dry skin, fruity breath, Kussmaul respirations, excessive thirst and urination). A conscious diabetic able to swallow can receive oral glucose between the cheek and gum.

Anaphylaxis is a severe, life-threatening allergic reaction causing widespread vasodilation and airway swelling, presenting with hives, facial or throat swelling, wheezing, difficulty breathing, hypotension, and a weak rapid pulse. Treatment involves assisting with a prescribed epinephrine auto-injector. Opioid overdose, characterized by respiratory depression and altered mental status, is managed by supporting the airway and breathing and administering naloxone if available and within scope. Ingested poisoning is addressed by contacting poison control or medical direction without inducing vomiting unless specifically instructed; activated charcoal can absorb certain poisons but is contraindicated when the patient has altered mental status, cannot swallow, or has ingested acids, alkalis, or petroleum. Carbon monoxide exposure requires immediate removal from the source and administration of 100% high-flow oxygen. Other medical conditions include acute abdomen (severe pain, rigidity, guarding, rebound tenderness, nausea or vomiting), with patients placed in a position of comfort, often with knees flexed, and behavioral emergencies, where scene safety, verbal de-escalation, and possibly law enforcement or restraint per protocol are used when the patient poses a danger to self or others, such as during active suicidal or homicidal ideation with a plan and means.

Environmental emergencies arise from extremes of temperature, water immersion, and encounters with venomous animals and insects. Heat exhaustion presents with heavy sweating, weakness, cool and clammy skin, and normal-to-slightly-elevated temperature, and is generally managed by moving the patient to a cooler environment, removing excess clothing, and providing fluids if fully alert. Heat stroke, by contrast, is a life-threatening emergency characterized by hot skin that may be dry or moist, altered mental status, and very high body temperature; immediate treatment focuses on rapid cooling by removing clothing, applying cool water or ice packs to the neck, groin, and armpits, administering high-flow oxygen, and rapid transport. Hypothermia is treated by removing wet clothing, applying passive rewarming measures, and handling the patient gently to avoid triggering a fatal cardiac arrhythmia. Frostbite, the freezing of tissue, is managed by protecting the affected area, avoiding rubbing or massage, and not attempting rewarming if there is any possibility of refreezing or if direct heat sources could cause further damage.

Water-related emergencies require special attention to suspected spinal injury. A near-drowning patient must have airway and breathing supported with high-flow oxygen, and if the mechanism involves diving or unknown circumstances, full spinal precautions are observed because of the potential for cervical spine injury. Venomous snakebites are marked by puncture wounds, localized pain and swelling, discoloration, and sometimes systemic symptoms such as nausea and weakness. Field treatment focuses on keeping the patient calm and still, immobilizing the limb at or below heart level, removing constrictive items like rings or tight clothing before swelling progresses, and rapid transport; the EMT should not attempt to capture the snake, apply ice, or use a tourniquet. Insect stings that trigger anaphylaxis are treated with the patient's prescribed epinephrine auto-injector along with high-flow oxygen and rapid transport, while non-anaphylactic stings are managed with basic wound care and monitoring for delayed reactions.

Obstetric emergencies require the EMT to recognize the stages of labor, signs of imminent delivery, and several specific complications. Labor progresses through the first stage (cervical dilation), the second stage (delivery of the baby), and the third stage (delivery of the placenta). Imminent delivery is signaled by crowning (the baby's head visible at the vaginal opening), a strong urge to push, and contractions less than 2 minutes apart. If the umbilical cord is wrapped around the newborn's neck (nuchal cord), the EMT gently attempts to slip the cord over the head; if it is too tight, the cord is clamped and cut. Before cutting, two clamps are placed on the cord, cutting between them at approximately 4 and 6 inches from the newborn's abdomen.

Immediately after birth, the newborn is dried, warmed, positioned, suctioned if needed, and stimulated to breathe. Resuscitation is guided by heart rate: a newborn heart rate above 100 bpm indicates adequate perfusion; below 100 bpm after initial stimulation, positive pressure ventilation is begun; below 60 bpm despite ventilation, chest compressions are added. Newborn status is then assessed using the APGAR score at 1 and 5 minutes after birth, evaluating Appearance, Pulse, Grimace, Activity, and Respiration. Complications include prolapsed umbilical cord, in which the mother is positioned with hips elevated or in knee-chest position and the EMT inserts gloved fingers to relieve pressure on the cord without pushing it back in, and breech birth, where the buttocks or feet present first. Preeclampsia is pregnancy-induced hypertension with headache, visual disturbances, and edema; placental abruption causes painful vaginal bleeding with dark blood from premature placental separation; placenta previa produces painless bright red bleeding because the placenta covers or nears the cervix.

Pediatric patients differ from adults in important ways. The pediatric airway has a proportionally larger tongue, smaller airway diameter, a more anterior and superior larynx, and a floppy epiglottis, all of which make airway management more challenging. Slight padding under the shoulders helps maintain a neutral sniffing position because infants have a large occiput. The leading cause of cardiac arrest in children is respiratory failure, in contrast to adults where cardiac causes predominate, so prompt recognition and management of respiratory distress is critical. The Pediatric Assessment Triangle provides a rapid visual evaluation based on appearance, work of breathing, and circulation to the skin, while age-appropriate vital sign norms are essential because children vary significantly by age. Common pediatric respiratory complaints include croup (a viral upper airway infection with seal-bark cough and stridor) and epiglottitis (a bacterial, life-threatening infection with drooling, tripod positioning, and stridor); in suspected epiglottitis, the EMT avoids examining the throat or agitating the child, which could trigger complete airway obstruction.

The leading cause of pediatric trauma death is head injury, and Sudden Infant Death Syndrome (SIDS) refers to the sudden, unexplained death of an infant under one year, usually during sleep. Signs of respiratory distress in infants include nasal flaring, grunting, retractions, and see-saw breathing. Red flags for child abuse include injuries inconsistent with the stated mechanism, injuries in various stages of healing, patterned bruising, and delayed care-seeking; EMTs have a legal obligation to report suspected abuse or neglect to appropriate authorities per state law.

Mass casualty incidents require organized triage and incident management. Triage, often using the START algorithm, sorts patients by severity: walking wounded are first directed to a designated area and tagged Green; Red (immediate) is assigned to patients with respirations over 30 per minute, no radial pulse or capillary refill greater than 2 seconds, or inability to follow simple commands; Yellow (delayed) is given to those whose condition allows some delay; Black (deceased or expectant) is reserved for patients who are not expected to survive. The Incident Command System (ICS) provides a standardized organizational structure with a single Incident Commander responsible for overall management, while a Multiple-Casualty Incident (MCI) is any situation where the number of patients exceeds or challenges available resources.

Scene safety extends beyond initial size-up. At hazardous materials incidents, EMTs stage in the safe cold zone and provide care only after decontamination unless trained and equipped for hot zone entry; safety data sheets (SDS) provide essential information about hazardous substances. With downed power lines, all lines are treated as energized, and the EMT waits for the utility company or fire department to secure the scene before approaching. Standard precautions treat all body fluids as potentially infectious, with appropriate PPE including gloves, masks, and eye protection; for suspected active tuberculosis, an N95 or HEPA respirator is added. Emergency moves are used when a patient is in immediate danger and full spinal precautions cannot be maintained, while safe lifting technique keeps the back straight, bends at the knees and hips, holds the load close to the body, and uses the legs to lift. Emergency vehicle operation follows a legal standard of due regard for the safety of others, and lights and sirens are reserved for patients whose condition warrants expedited transport per local protocol.

Legal and ethical principles govern every patient contact. Consent may be expressed (verbally given by a competent adult), implied (assumed for an unresponsive or incapacitated patient who would reasonably want treatment), or, in true emergencies, applied to minors who lack parental availability; emancipated minors may provide their own consent under specific state laws. A competent adult patient may refuse treatment and transport if they have decision-making capacity, defined as being alert, oriented, and able to understand the risks and consequences of refusal; the EMT documents thoroughly and obtains a signed refusal form. Do Not Resuscitate (DNR) orders are honored when valid, with resuscitation withheld and documented per local protocol. Negligence requires proof of four elements: duty to act, breach of that duty, damages, and causation; scope of practice defines the duties and skills an EMT is legally permitted and trained to perform, and Good Samaritan laws protect those who provide emergency care in good faith within scope and without gross negligence. Abandonment is the termination of care without ensuring an equal or higher level continues.

Documentation is both a clinical and legal record. Every patient contact requires a complete, accurate patient care report (PCR) written in objective, factual language without opinions or judgmental statements. Errors are corrected by drawing a single line through the mistake, initialing it, and writing the correction rather than erasing or obliterating the original. The Health Insurance Portability and Accountability Act (HIPAA) protects patient confidentiality and limits disclosure of medical information to authorized parties.