If you had to attempt to drink water out of a firehose, three things would probably happen:

  1. You’d get a 100-PSI wet smack in the face,
  2. Everyone in your immediate vicinity would laugh at you, and
  3. You’d definitely never try it again.

And yet, every year, thousands of brave souls register for paramedic training, which is the metaphorical equivalent of drinking out a firehose; except that in place of the water is fundamental medical information.

Your job? To keep up.

Unfortunately, half of all candidates drop out because they are overwhelmed by the volume of information and the staggering pace at which it’s covered.

That won’t be your fate.

It’s the aim of this paramedic study guide to equip you with the right tools and approach to ace your paramedic prep and the NREMT-P exam. Step-by-step, our experienced team, led by National Registry and Flight Paramedic Jesse Owens, is going to walk you through what you need to do to pass and pass well.

The key to success? Proper preparation. But we’ll get to that in just a minute. Right now, let’s briefly introduce ourselves and our certified paramedic flashcards, which can be pivotal to helping you smash the NREMT-Paramedic exam …

Hi! We’re Brainscape

We’re the brains, minds, and hearts behind the world’s smartest study app. We’ve brought together some of the most experienced people in the emergency medical services to compile a comprehensive collection of paramedic flashcards for the NREMT-P, as well as this paramedic study guide.

Our lead author is Jesse Owens (NRP, FP-C) who has, since the tender age of 18 operated in many capacities as a 911 Paramedic, Critical Care Army Flight Paramedic, Civilian Flight Paramedic, and SWAT medic.

In other words, he knows a thing or two and now he’s here to give you some crucial tips for acing the NREMT-P exam. So now, let’s take a closer look at what you can expect from the challenge …

(Pssst. If Jesse’s job history gets you excited about your own career in EMS, check out ‘How to get the best paramedic jobs’!)

What can you expect from the NREMT-P cognitive exam?

NREMT-P Pearson Vue testing centers
Pearson Vue testing centers offer Computer-Based Testing venues for training paramedics to attain their NREMT-P certification (source: https://home.pearsonvue.com/)

As you probably know, in order to become a paramedic, you must have at least six months’ experience as an Emergency Medical Technician (EMT) under your belt, which means that this won’t be your first time taking an NREMT exam. (If, however, it is your first time and you want to know more about what’s involved in becoming a paramedic, check out Brainscape’s academy article: ‘How to become a paramedic.’)

To refresh your memory, the National Registry uses Computer-Based Testing (CBT) to administer its certification exams, which are hosted by Pearson Vue testing centers all over the United States.

The NREMT-P cognitive exam is a two-and-a-half-hour affair that’s designed to assess your true proficiency as a paramedic. But it’s not like your regular exam, which has a fixed number of questions.

Rather, the NREMT-P exam starts off with easy questions that get progressively harder as you answer them correctly. (In other words, if you find the questions becoming more and more difficult, it’s a good sign you’re getting things right!)

At some point, however, you might get a question wrong, which will prompt the computer to back off on challenging you too much. You’ll resume with easier questions that, once again, get harder and harder as you answer them correctly. After several cycles of this, the algorithm will be able to determine your true proficiency with a certainty of 95%.

You pass the NREMT-Paramedic exam by having your proficiency level land above the passing standard. If it falls below, you’ll have to retake the test in 14 days. Candidates can also fail because they run out of questions or time, although that happens much less frequently.

Now that you know how the certification exam works, here’s our best advice on (1) preparing for your paramedic training and then (2) coping with your studies for the NREMT-P exam!

Top tips for preparing for your paramedic training

If you leave this paramedic study guide having learned one thing only, let it be this: preparation is KEY to passing your paramedic training (and the NREMT-P exam). Your schooling will speed along at 100 mph so the more you’ve studied and learned going into it, the better you’ll cope.

What this means is that the minute you’re accepted and have paid your tuition, it’s go time! Here are the steps you can take to prepare yourself to embark upon your paramedic prep:

  1. Create a daily study schedule
  2. Learn the content before class
  3. Use paramedic flashcards to drill yourself on the important facts
  4. Cardiology: Understand the basics of ECGs
  5. Pharmacology: Know your meds!
  6. Familiarize yourself with ALS tools and techniques

1. Create a daily study schedule

There’s an overwhelming mountain of content to learn before you’ll be ready to take the NREMT-P cognitive exam (and embark upon a career as a paramedic). The best way to start, therefore, is to portion out the key areas of study—like cardiology, trauma, pharmacology, and anatomy, for example—into daily study goals.

Approaching the challenge of paramedic training with a detailed study schedule will help you to establish achievable daily goals, making it easier to monitor your progress AND feel a lot less stressed about the amount of work you need to get through.

Pro Tip: You can access comprehensive collections of flashcards for all of the above-mentioned subjects in Brainscape’s certified paramedic class, which is a powerful supplementary study tool for your textbooks and study resources.

2. Learn the content before class

As we said before, the minute you’ve paid your tuition, start studying. The goal is to study, process, and learn the material you’ll cover in class before you actually embark upon your training. (This might sound like the opposite of what you did during school but paramedic training ain’t nothing like high school, baby.)

  • Actively read through the textbook, using a highlighter and making study notes to capture the most important concepts and definitions you need to remember.
  • Make flashcards or use Brainscape’s mobile NREMT-Paramedic flashcards to drill yourself on these essential facts.
  • Write down any questions or points of confusion you’d like cleared up.
  • Use class time for consolidating information already learned and for asking questions.

If you begin your paramedic prep without a decent working knowledge of everything, you’ll be overwhelmed and constantly trying to play catch-up. This is particularly true of the cardiology and pharmacology section, which we’ll look at next, followed by a powerful tool for helping you memorize the mountain of content you’ll encounter during your paramedic training …

Pro Tip: If you think your study methods could use improvement, check out ‘How to study effectively: The ultimate guide’ so that you don’t waste a second of your precious time.

3. Cardiology: Understand the basics of ECGs

Paramedic training is incredibly accelerated so going into it with a basic understanding of ECG rhythms and what they look like will be an enormous foot up on the competition. For example, can you tell the difference between the following heart arrhythmias?

Common heart arrhythmia ECG rhythms
ECG 1 shows ventricular tachycardia; ECG 2 shows ventricular fibrillation.

A really helpful resource for studying ECG rhythms is SkillStat, which covers 27 of the most common arrhythmias, for example, atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, junctional rhythm, and more. You can also work through Brainscape’s flashcard decks on cardiology & resuscitation.

4. Pharmacology: Know your meds!

Common paramedic medications epinephrine

Building a working knowledge of the medications used in modern pharmacology and their various indications, interactions, dosages, and side effects will be one of the most important, yet demanding aspects of paramedic prep. Additionally, on average, a paramedic has 30 to 40 drugs in their medic bag and you’ll need to learn what each one does, in which scenarios you should use them, and how.

For example: Why might you administer glucagon to a patient? And how would you administer it?

Glucagon is administered via intramuscular injection to patients with low blood glucose. It can also be used for an overdose of beta-blockers or calcium channel blockers.

Another example: Which medication should be administered first in a patient presenting with anaphylaxis? And why?

Epinephrine. Epinephrine is a potent Alpha-I agonist and bronchodilator that improves the systemic vasodilation and bronchoconstriction found in an anaphylaxis patient.

Learning this information constitutes a significant amount of sheer memory work so if you can get this done before your paramedic training even begins, you will place yourself miles ahead of your peers.

Now that you understand the task ahead of you, here’s the “secret sauce” to getting it done!

5. Use paramedic flashcards to drill yourself on the important facts

NREMT Paramedic flashcards
Through its engaging and colorful user interface, Brainscape’s flashcards deliver facts in short question-and-answer pairs. These are neatly organized into decks, which you can study anytime, anywhere, online or off.

Smart flashcards that use spaced repetition are the best possible tool for studying for content-heavy exams like the NREMT-P cognitive exam. (It’s why Brainscape is so popular amongst law graduates and medical students!)

But rather than making the flashcards yourself, Brainscape has distilled the entire paramedic curriculum, as defined by the latest NREMT-P test plan, down into a collection of 7 classes and over 2,100 flashcards for you. And these cover every topic, concept, fact, and medication you need to know in preparation for the National Registry exam.

Brainscape's paramedic flashcards
Brainscape’s NREMT Paramedic Flashcard collection features 2,100+ engaging flashcards, neatly organized into 48 decks, tackling topics from anatomy, pharmacology, and trauma to toxicology, operations, and ACLS. In other words: EVERYTHING you need to know to ace the NREMT-P exam!

Delivered via a sophisticated spaced repetition algorithm, Brainscape’s certified NREMT-Paramedic flashcards are designed to drill you on the most essential facts, while targeting your weaknesses and saving you time on the concepts you already know well. This empowers you to learn (and remember) twice as efficiently as any other paramedic prep tool or method.

In short, our certified paramedic flashcards are a hyper-efficient and personalized study system that can help you dominate the content before you even begin your paramedic training.

Paramedic flashcards for NREMT-P exam
Brainscape’s web and mobile app breaks knowledge down into logical bite-sized question-and-answer pairs, which compel users to engage active recall and metacognition to learn, while the spaced repetition of flashcards ensures more efficient learning.

6. Familiarize yourself with ALS tools and techniques

Advanced Life Support training

One final way you can prepare yourself for paramedic training is to familiarize yourself with the suite of ALS (Advanced Life Support) equipment and techniques you’ll be called upon to use and perfect during your schooling.

How you can do that is through volunteering, going for a “ride-along” with qualified paramedics, or even just asking someone you know in EMS to show you the tools of the trade and how they work.

Failing all of the above, YouTube is a truly fathomless source of demonstration videos on EMS tools and techniques, like these ones:

Remember, the goal is to know what the various pieces of equipment are and what they’re used for. You’ll learn how to use them during your paramedic training so don’t worry about that too much for now. But going into it with at least a little familiarity of these tools primes your brain for learning, making the practical aspect of your paramedic training a more seamless experience.

And now that you understand how you can best prepare for your paramedic training and the NREMT-P cognitive exam, here are our best tips for acing your studies!

Top tips for acing the NREMT-Paramedic exam

Paramedic equipment

We’ve covered quite a bit of ground so far, with the focus of helping you to prepare. Now, with your paramedic training proceeding at full speed, here are some crucial tips to keeping up and avoiding overwhelm.

7. Repetition is key! Continuously revise the content

By studying a little bit every day, before, during, and throughout your paramedic prep, you’ll ensure that you keep all of that content fresh in your mind so that, come the final day of your training, you’ll be ready to take on the NREMT-P exam!

Here are some essential daily steps you can take to stay on top of your workload:

  • Revise the necessary sections/chapters ahead of each class.
  • Go into class with a decent working knowledge of what’s being covered.
  • Have questions prepared.
  • At the end (or beginning of) every week, revise what’s been covered. Knowledge decays over time and you don’t want to get to the NREMT-P exam only to discover you’ve forgotten everything!

Pro Tip: You can use Brainscape’s certified NREMT-P flashcards to conveniently and constantly review those fundamental concepts!

In addition to this …

8. Do practice exams and questions

NREMT Paramedic practice exams

It’s imperative for successful paramedic prep that you do as many practice questions and exams as you can get your hands on. And the sooner you do them—even right from the beginning of your paramedic training—the better! Here’s why: answering practice questions shows you …

  • How the information you’re learning will be tested in the exam,
  • The important concepts you should be paying attention to,
  • How to use critical thinking and reasoning to arrive at the best possible answer, and
  • Which concepts/facts you might have a problem with (and therefore need to focus on).

Moreover, seeing the information framed as exam questions will help you remember it SO much better than if you just read it in a textbook. (There’s nothing like the threat of seeing something show up in an exam to compel your brain to hang on to that information.)

And, finally, doing practice questions will also show you the NREMT-P exam isn’t anything to be feared! As long as you know your stuff—and you will—you’ll do just fine.

Pro Tip: When you do a practice exam, set a timer to 150 minutes (two-and-a-half hours) so that you learn how to manage your time properly.

9. Practice your emergency care skills perfectly

Paramedic emergency care skills

Until now, we’ve been rather focused on the NREMT-P cognitive exam, but what about those crucial emergency care skills? You’ll need to demonstrate a great proficiency of practical skill during your paramedic training, without which you simply won’t pass.

Our advice is to practice, practice, practice those skills as often as you possibly can … but practice them PERFECTLY. What this means is that speed comes second to perfection. And you definitely don’t want to evolve any bad or sloppy habits that become harder to unlearn later on.

So, when you practice, practice perfectly. With time and repetition, your skills and speed will improve. And before long, those techniques will become muscle memory!

10. Get comfortable with learning and asking questions

Paramedic training school

So, you’re shy? Afraid of looking stupid?

You and everyone else in your class.

It’s time to grow out of that, my friend. Be brave and ask questions. Remember, the only stupid question is the unasked question. Besides, asking questions is an integral part of the paramedic’s job: when they’re not asking patients questions, they’re consulting with their teammates and superiors or following up with doctors and nurses.

[Speaking of: What is the difference between a paramedic and a nurse?]

In the realm of emergency medicine, your learning is never done. With every medical, pharmacological, and technological advancement, you’ll need to learn, adapt, and evolve. And so, a part of being a good paramedic is being a diligent life-long student of medicine.

11. Participate, communicate, and collaborate

As the front-line of care for the sick and injured, it is essential that you become an effective communicator and team member. What does this look like?

  • Have a good attitude and be easy to work with,
  • Build a rapport with your class and teammates,
  • Always leave the rig (ambulance) in good condition,
  • Help your peers when they struggle, and
  • Keep learning and asking questions.

You might be a grumpy sod in real life but in emergency medicine, if you’re unpleasant to work with, you won’t get very far. So, use your paramedic training as an opportunity to work on your attitude and become a better team player.

Paramedic team saving lives

12. Embark upon your internship fully schooled

Finally, your paramedic training culminates in a field internship in which you’ll trade in the controlled classroom environment for the chaos of the streets. And while you can never predict what’ll happen “out there” you can be damned sure that you yourself are fully prepared by being organized and knowledgeable.

So, our advice is to make sure you embark upon your internship as fluent in all that crucial paramedic content as possible. Know your medications, treatment protocols, emergency care skills, local hospitals, and ambulance inventory and, with frequent review, make sure to keep your memory of all this as sharp as the day you first learned it.

(Our certified NREMT-Paramedic flashcards will help you do that!)

It’s perfectly okay to make a few on-scene mistakes but what’ll be harder for your superiors to overlook is a paramedic who’s missing out on basic information that could, potentially, make them a liability to the team.

A final note on acing your paramedic training

Ace your paramedic training

So, there you have it! The tools, tricks, and tips for acing your paramedic training and the NREMT-P cognitive exam:

  • Start studying as soon as your application is accepted,
  • Portion out the content into manageable daily study goals,
  • Pay special attention to cardiology and pharmacology,
  • Use these certified NREMT-Paramedic flashcards to memorize the facts,
  • Review older content throughout your training so that you never forget it,
  • Do frequent practice questions and exams,
  • Practice your emergency care skills perfectly (and often),
  • Get comfortable with asking questions, and

If you follow the advice laid out in this paramedic study guide, you will have everything you need to rise to the challenge of the NREMT-P cognitive exam and a rewarding career in emergency medicine!