Free EMT Study Guide

Patient assessment — the foundation

Patient assessment isn't a single content category on the NREMT outline, but it's the framework underneath every clinical question. If you can't reliably move through scene size-up → primary survey → secondary survey → reassessment, you'll struggle on questions in every other category.

• Scene size-up: BSI/PPE, scene safety, MOI/NOI, number of patients, additional resources.
• Primary survey: general impression, AVPU, airway, breathing, circulation (with major bleeding control).
• Secondary survey: focused or rapid head-to-toe based on MOI/NOI, vital signs, SAMPLE history, OPQRST for pain.
• Reassessment: repeat primary survey, re-check vitals (every 5 min for unstable, every 15 for stable), reassess interventions.

Airway, respiration & ventilation

The airway category tests whether you can recognize inadequate breathing, choose the correct adjunct, and ventilate a patient correctly. About one in five questions on your exam will come from this category.

• Adequate vs inadequate breathing: rate, rhythm, depth, effort.
• OPA vs NPA: indications, contraindications, sizing.
• Oxygen delivery devices: nasal cannula (1–6 LPM, 24–44%), non-rebreather (10–15 LPM, ~90%), BVM with reservoir (15 LPM, near 100%).
• BVM ventilation: 1 breath every 5–6 seconds for an adult with a pulse, 1 every 2–3 seconds for children/infants.
• Suctioning: max 15 seconds for adults, 10 for children, 5 for infants.

Cardiology & resuscitation

About one in five questions will be cardiology. The exam tests both ACS recognition (chest pain pattern, vitals, intervention sequence) and cardiac arrest management (CPR mechanics, AED use, post-resuscitation).

• ACS recognition: chest pain or pressure, radiation, diaphoresis, dyspnea, nausea — atypical presentations are common in women, the elderly, and diabetics.
• Aspirin for ACS: 162–325 mg chewable, contraindications include allergy and active bleeding.
• Nitroglycerin: assist with patient's prescribed med if SBP > 100 and no recent erectile dysfunction medication use.
• Adult CPR: 30:2 ratio if alone, compress 2–2.4 inches, rate 100–120/min, allow full recoil.
• AED: apply as soon as available, follow voice prompts, minimize interruptions in compressions.

Trauma

Trauma questions reward systematic thinking. The candidate who has internalized 'airway → breathing → circulation → control major bleeding' answers correctly even when the scenario is unfamiliar.

• Scene size-up first: a chaotic trauma scene where you skip safety is a critical failure on the NREMT.
• Hemorrhage control: direct pressure → tourniquet for life-threatening extremity bleeding. Don't waste time on a wound dressing if a tourniquet is indicated.
• Shock recognition: tachycardia and altered mental status appear before hypotension. Hypotension is a late finding in compensated shock.
• Spinal motion restriction: based on MOI plus assessment findings, not MOI alone.
• Burn assessment: rule of nines, depth (superficial / partial / full thickness), critical burns include face/airway, hands/feet, genitalia, circumferential, and >10% BSA partial thickness.

Medical, OB/GYN, and toxicology

This is the largest category on the exam — close to one in three questions. Topics span neuro emergencies, respiratory distress, endocrine, allergic reactions, behavioral, OB/GYN, and poisonings.

• Stroke: BE-FAST mnemonic. Time of onset is critical — ask the family the last time the patient was seen normal.
• Respiratory distress: differentiate asthma (wheezing, hx of triggers), COPD (barrel chest, pursed-lip breathing), CHF (rales, JVD, peripheral edema).
• Diabetic emergencies: hypoglycemia presents with altered mental status, diaphoresis, tachycardia. Give oral glucose if conscious and able to swallow.
• Anaphylaxis: epinephrine 0.3 mg IM (auto-injector) for adults, 0.15 mg for pediatrics. Don't withhold for hypotension — it's the treatment.
• OB emergencies: imminent delivery signs, post-partum hemorrhage, eclampsia management.
• Toxicology: recognize toxidromes (opioid, sympathomimetic, anticholinergic, cholinergic). Naloxone for suspected opioid overdose with respiratory depression.

EMS operations

• Scene safety always comes first — including in domestic violence, behavioral, and crime scene responses.
• Lifting & moving: power lifts, body mechanics, when to use emergency moves vs urgent vs non-urgent.
• MCI / triage: START triage adult algorithm (RPM — respirations, perfusion, mental status). JumpSTART for pediatrics.
• Hazmat: stage uphill and upwind, recognize placards (DOT hazard classes), don't enter the hot zone without proper PPE and training.
• Communications: medical control reports follow a standard format — chief complaint, vitals, history, interventions, ETA.
• Documentation: 'if you didn't write it, you didn't do it.' Document what you found, what you did, what changed, and what you handed off.

Mnemonics worth memorizing

• SAMPLE — Signs/symptoms, Allergies, Medications, Past medical history, Last oral intake, Events.
• OPQRST — Onset, Provocation, Quality, Radiation, Severity, Time.
• AVPU — Alert, Verbal, Painful, Unresponsive (level of consciousness).
• DCAP-BTLS — Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling.
• BE-FAST — Balance, Eyes, Face, Arms, Speech, Time (stroke recognition).
• TICLS — Tone, Interactiveness, Consolability, Look/gaze, Speech (pediatric assessment triangle work-of-breathing companion).

Medical math you must know cold

• Weight conversion: kg = lbs ÷ 2.2
• IV drip rate (gtt/min): (mL × drop factor) ÷ time in minutes
• Pediatric minimum systolic BP: 70 + (2 × age in years)
• Adult adequate breathing rate: 12–20/min; tachypnea is a red flag in any context.
• Compression rate: 100–120/min for all ages.

Frequently Asked Questions

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