Content Domains & Weight Distribution (April 2025 Restructure)

Effective April 2025, NREMT completely restructured the EMT exam domains from the older topic-based model to a patient-centered, assessment-flow model. The new domains mirror the sequence of a real-world patient encounter, from scene arrival through transport.

Important: If you are using older study materials that reference the previous domains (Medical/OB/GYN, Cardiology & Resuscitation, Airway/Respiration/Ventilation, Trauma, EMS Operations), note that those categories no longer apply. The content is the same, but it is now organized by the phase of patient care rather than by clinical topic.

New Domain Weight Distribution (April 2025)

Patient Population Distribution

Pediatric questions are integrated throughout all five domains, not isolated to a single section.

Domain 1: Primary Assessment (39-43%) — LARGEST DOMAIN

This is the biggest section of the exam, reflecting the critical importance of the initial patient assessment. Topics include:

• General impression & level of consciousness: AVPU scale, initial appearance, chief complaint
• Airway assessment: Opening the airway, assessing patency, recognizing obstruction
• Breathing assessment: Respiratory rate, quality, breath sounds, signs of distress or failure
• Circulation assessment: Pulse, skin color/temperature/condition (CTC), capillary refill, major bleeding
• Priority/transport decision: Identifying life threats, determining urgency, rapid vs. focused assessment
• Vital signs: Baseline and serial vital sign measurement and interpretation
• Clinical decision-making: Forming a field impression, identifying immediate interventions needed

Domain 2: Patient Treatment & Transport (20-24%)

• Airway management interventions: Suctioning, OPA/NPA insertion, head-tilt/chin-lift, jaw thrust
• Oxygen delivery & ventilation: Nasal cannula, non-rebreather, BVM, assisted ventilations
• CPR & AED: High-quality CPR, AED use, cardiac arrest management
• Bleeding control & shock management: Direct pressure, tourniquets, shock treatment
• Splinting & immobilization: Musculoskeletal injury management, spinal motion restriction
• Medication administration: Aspirin, epinephrine auto-injector, oral glucose, naloxone, albuterol
• OB emergencies: Normal delivery, neonatal care, obstetric complications
• Transport decisions: Appropriate facility selection, ongoing assessment during transport

Domain 3: Scene Size-Up & Safety (15-19%)

• Scene safety assessment: Personal safety, hazard identification, BSI/PPE selection
• Mechanism of injury / nature of illness: Determining MOI or NOI from scene clues
• Number of patients: Triage considerations, resource requests
• Additional resources: ALS, fire, hazmat, law enforcement requests
• Standard precautions: Infection control, PPE use, exposure prevention
• Environmental hazards: Traffic, weather, structural, chemical, electrical hazards

Domain 4: Operations (10-14%)

• EMS systems & roles: Scope of practice, medical direction, quality improvement
• Communication & documentation: Radio communication, patient care reports (PCR), handoff reports
• Legal & ethical considerations: Consent, refusal, advance directives, HIPAA, mandatory reporting, DNR
• Mass casualty incidents: START triage, incident command system (ICS), resource management
• Ambulance operations: Vehicle safety, equipment readiness, driving considerations
• Hazmat awareness: Recognition, isolation, notification (not mitigation)

Domain 5: Secondary Assessment (5-9%)

• History taking: SAMPLE history, OPQRST for pain assessment
• Detailed physical exam: Head-to-toe or focused physical assessment
• Reassessment: Trending vital signs, intervention effectiveness, status changes
• Glasgow Coma Scale: Eye, verbal, motor response scoring
• Special assessment tools: Stroke scales (Cincinnati, FAST), trauma scoring, pediatric assessment triangle

How the Old Domains Map to the New Structure

Note: Clinical topics like cardiac emergencies, trauma, respiratory conditions, and medical/OB/GYN are still tested — they are now distributed across domains based on the phase of care (assessing vs. treating vs. transporting) rather than being grouped by clinical topic.