Emergency Medical Responder StickerEmergency Medical Responders provide immediate lifesaving care to critical patients who access the emergency medical services system. EMRs have the knowledge and skills necessary to provide immediate lifesaving interventions while awaiting additional EMS resources to arrive. EMRs also provide assistance to higher-level personnel at the scene of emergencies and during transport. Emergency Medical Responders are a vital part of the comprehensive EMS response. Under medical oversight, Emergency Medical Responders perform basic interventions with minimal equipment.
[From the: National EMS Scope of Practice Model]

EMR Certification Handbook
Recertification Information

Individuals applying for Emergency Medical Responder certification must meet the following requirements: 

  • Successful completion of a state-approved Emergency Medical Responder (EMR) course that meets or exceeds the National Emergency Medical Services Education Standards for the Emergency Medical Responder. 

    • Candidates must have completed the course within the past two years and the course Program Director must verify successful course completion on the National Registry website. 
    • If the initial Emergency Medical Responder (EMR) educational program was completed more than two years ago, and the candidate is currently state licensed at the EMR level, the candidate must document proof of education requirements. The following methods are acceptable: 

      • Successful completion of a state‐approved EMR refresher course or  
      • 8 hours of continuing education that meets all requirements of the current National Component of the 2016 National Continued Competency Program within the past two years. 

  • Have a current CPR-BLS for "Healthcare Provider" or equivalent credential. 

  • Successful completion of the EMR cognitive (knowledge) examination and a state approved psychomotor (skills) examination. 

  • Passed portions of the cognitive and psychomotor exam remain valid for 24 months. For candidates with a course completion date prior to November 1, 2018, passed portions of each examination are valid for 12 months. Provided all other entry requirements are met. 

  • Some states integrate the EMR psychomotor exam into the EMR course. Candidates should contact their State EMS Office or course instructor for guidance on their local psychomotor exam requirements. 


  • If a candidate's EMR state license has lapsed, or National EMR Certification has lapsed, the candidate must complete an entire state-approved Emergency Medical Responder (EMR) course and complete the cognitive and psychomotor examinations. 

Application Process

  • Create an account/login profile on this website

  • Submit a National Registry application and answer all questions truthfully

  • The National Registry may deny certification or take other appropriate actions in regards to applicants for certification or recertification when a criminal conviction has occurred

  • Pay the application fee of $85.00 (US funds). The application fee is non-transferable and non-refundable . This fee is charged for each attempt of the cognitive examination.

  • Candidates will receive an electronic Authorization to Test (ATT) once you are eligible for the exam. The electronic ATT contains scheduling instructions and important details concerning proper identification required at testing centers. You can find the ATT in the 'Check Application Status' page.

Responsibilities of Nationally Registered EMS Personnel

Registered Emergency Medical Responders (EMRs) must notify the National Registry within 30 days regarding the following matters:
  • change in mailing address (the best way to update a mailing address is by editing the user profile page)
  • any criminal conviction.
  • disciplinary action taken by any state has resulted in suspension, revocation, or expiration of state registration/licensure; termination of right to practice; voluntary surrender of state registration/licensure while under investigation.
  • The National Registry considers the individual to be solely responsible for their certification.

Disciplinary Policy and Rights of Appeal

The National Registry has disciplinary procedures, rights of appeal and due process within its policies. Complete information about the National Registry Disciplinary Policy and Rights of Appeal can be found here.

Americans with Disabilities Act

The National Registry complies with the Americans with Disabilities Act (ADA) of 1990 and offers reasonable accommodations for individuals with disabilities. Pearson VUE test centers are also ADA compliant. Complete information about the National Registry Accommodations Disability Policy can be found here.

The Cognitive Exam

Apply For A Cognitive Exam

The National Registry Emergency Medical Responder (EMR) cognitive exam is a computer adaptive test (CAT). The number of items a candidate can expect on the EMR exam will range from 90 to 110. Each exam will have between 60 to 80 ‘live’ items that count toward the final score. The exam will also have 30 pilot questions that do not affect the final score. The maximum amount of time given to complete the exam is 1 hour and 45 minutes.

The exam will cover the entire spectrum of EMS care including: Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical; Obstetrics/Gynecology; EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). In order to pass the exam, candidates must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry level emergency medical care.

We strongly encourage candidates to review the following information:

EMR Cognitive Exam Test Plan

Based on the most recent practice analysis, the National Registry Board approves a cognitive exam test plan. A test plan is a blue-print that tells the computer testing software how to build a candidate's exam. The table below indicates what percent of the test will focus on each topic area.

Content Area Percent of Exam Adult / Pediatric Mix
Airway, Respiration & Ventilation 18%-22% 85% Adult; 15% Pediatric
Cardiology & Resuscitation 20%-24% 85% Adult; 15% Pediatric
Trauma 15%-19% 85% Adult; 15% Pediatric
Medical; Obstetrics & Gynecology 27%-31% 85% Adult; 15% Pediatric
EMS Operations 11%-15% N/A

Cognitive Exam Retest Information

If a candidate is not successful in passing the cognitive exam, the National Registry will provide a candidate feedback on their performance. Candidates may apply to retest 15 days after the last examination.

Candidates are given three opportunities to pass the cognitive examination provided all other requirements for National EMS Certification are met. Candidates who fail the examination on the third attempt will be required to repeat the entire Emergency Medical Responder (EMR) program in order to apply for subsequent examination attempts.

The Psychomotor Exam

Emergency Medical Responder psychomotor examinations are not administered by the National Registry. All EMR psychomotor exams are administered by either the State EMS Office or at the training institution (with approval and oversight provided by the State EMS Office). EMR course instructors should provide candidates information regarding this examination.

The following performance checklists are a guide for the verification of required skills. The State EMS Office or training institution may use different forms.

Expiration Dates

Initial expiration dates are determined by the date the candidate successfully completes the entire national certification process (cognitive and psychomotor exams). EMR candidates completing the national certification process between the January 1 and June 30 will receive an expiration date of September 30 two years in the future. Individuals successfully completing the national certification process between July 1 and December 31 will receive an expiration date of September 30 three years in the future.

Expiration Dates

Initial Certification

Initial Cycle

If you successfully completed the national certification process between: Your initial certification date will be September 30
January 01-June 30 2 years in the future
July 1-December 31 3 years in the future
How Do I Recertify?
Detailed information about the recertification process for Emergency Medical Responders is on the EMR Recertification Page.
Lapsed EMR Certification

Requirements to gain national certification for a currently state licensed EMR can be found above in the Certification Process. 

If your EMS certification expired and you are not a currently state licensed EMR, you must complete a new state-approved Emergency Medical Responder (EMR) course and complete the cognitive and psychomotor examinations.