NREMT Spinal Immobilization – Strap Order

Since this question comes up a lot in classes, here’s the current accepted strap order for the long backboard (LBB) and KED:

Long backboard:

  1. Immobilize torso to the board by applying straps across the chest and pelvis and adjust as needed.
  2. Immobilize the patient’s head to the board
  3. Fasten legs, proximal to and distal to the knees

Seated Patient (KED, short backboard, etc)

  1. Secure the device to the patient’s torso.
  2. Evaluate torso and groin fixation and adjust as necessary without excessive movement of the patient.
  3. Evaluate and pad behind the patient’s head as necessary to maintain neutral in-line immobilization.
  4. Secure the patient’s head to the device.
  5. Release manual immobilization of head.
  6. Rotate or lift the patient to the long spine board.
  7. Immobilize patient to long spine board.

The “MBLHT” acronym is out, and I can’t think of any fun acronyms or mnemonics for the new strap order. Oh well.

These strap orders were taken from the EMT-B National Standard Curriculum (NHTSA). You can find the curriculum at this link (PDF).


NREMT Spinal Immobilization – Strap Order

The NREMT Cut Me Off After 70 Questions! Did I pass?

If you’re here for a specific answer, click the link to jump to the right section. Otherwise, you can read this page start-to-finish.

How The NREMT Exam Scores Candidates

So you’re about to take the NREMT, but are confused about how it’s scored? What do you mean there’s not a certain number of questions I need to get right?! You’ve come to the right place: that is, a (marginally) technical overview of how the test works.

Hopefully, your instructor talked with you about what “adaptive” testing means. If not, or if you’re still confused, read on. In a standard (pencil-and-paper) exam, you’re usually graded by percentage:

Number of Questions Correct / Total Questions = Score (%)

Other exams, like the SAT, use a slightly different scoring system which may include a penalty for each wrong answer (e.g., 0.25 points). The NREMT does not do this, per se.

In adaptive testing (CAT), the difficulty of the test adapts to your performance, or your perceived ability. In other words, the NREMT will appear challenging to everyone who takes it. The NREMT isn’t based on the number of questions answered correctly (or the number answered incorrectly for that matter). It’s all based on whether or not it perceives you as entry-level competent.

The scoring starts off with a metaphorical “bar” (as in “raising the bar”). This is the level that entry-level competent EMT’s are supposed to perform to, and is the standard against which you’ll be evaluated during the written exam. Since I don’t know exactly how the NREMT does it, I’ll make up a hypothetical system here:

Level 1 – Knowledge Questions.
Level 2 – Comprehension Questions.
Level 3 – Application Questions
Level 4 – Analysis/Synthesis
Level 5 – Synthesis/Evaluation Questions

And now, a chart!

NREMT Adaptive Test - Illustration

Again, this doesn’t represent their actual scoring system. It’s just an illustration of the concept.

Both students start out with an “average” question. Student one answers correctly, and gets a “level 4” question. After answering that correctly, he gets a “level 5” question wrong, so he gets bumped down to “level 4”. He gets the next “level 4” question correct, and moves up to “level 5”, and so on.

Student #1 passes the test, because he “stayed above the line” (level ‘3’) for most of the test.

Student #2 gets the first question wrong, so the computer gives him an easier question. He gets this one wrong, too. The test gives him an even easier question, which he gets correct, and moves back up to level 2. He eventually starts getting anwers correct, and he is presented with more challenging questions. Despite a strong finish, he stayed “below the line”, and will probably have to re-test.

Remember: these numbers and the progression from question to question is not exact. It’s just an illustration of the concept.

How Good is “Good Enough”?

The NREMT requires a 95% confidence level. This means that the computer has to be 95% sure that you are “entry-level competent” before it will pass you. It will keep presenting you with questions (with difficulty adjusted as described above) until it is 95% sure that you know your stuff. On the other hand, the test can also end early if it is 95% sure that you are below “entry-level competent”.

Also, be aware that you have to pass each section with a 95% CI. I’m sure you’ve heard of folks who have failed because of one category. Logically, the fewer questions there are in the section, the tighter your margin of error is. From people that I’ve talked to, it’s not uncommon to have only 3-4 pediatric questions, if you get them all correct. That’s probably what saved me on my exam!

The NREMT Exam Shut Off at 70 Questions! What Does That Mean?!

Your NREMT exam just finished much quicker than you had expected. “They haven’t even asked me about that stupid Parkland fomula my instructors said to memorize. It must be coming up soon!” you thought, but then the exam unceremoniously terminates.

But it won’t tell you that it’s made up its mind.

The good news is this:

From most people that I’ve talked to, people who get cut off early end up passing. The people who come close to maxing out the questions are the ones that failed. But why?

Someone who consistently answers questions wrong (let’s take the extreme case of someone simply guessing on each question). That person is going to get at least a few questions correct. They’re going to go back and forth around that metaphorical bar, and the computer won’t reach 95% confidence. It’ll keep throwing questions out there until it either reaches the 95% confidence or it runs out of questions. Generally speaking, the more questions you get, the more the computer was initially uncertain about whether to pass or fail you. You were right on the line the whole time. That being said, I’ve talked to several people who have had tons of questions on their NREMT exam and ended up passing. They just happened to have a strong finish, compared to someone else who was right on the edge and got a few of those “we never even covered this in class!” questions.

Case-in-point: If you ended the test in relatively few questions, chances are that you passed. Beyond that, it’s just a wild guess. There’s no point in stressing out over it – spend this time enjoying being done with Paramedic class! (You can always retest later!)

How Many Questions Are On the NREMT? How Long Will I Have?

This data is available on the NREMT website (see below). Note that the EMT-Intermediate (99) exam is a ‘normal’ test, not CAT. You can apply for accomidations under the ADA, which may allow you to have “time and a half” for the test. See the links below for more information.

Number of NREMT Test Questions by Exam

Exam # Questions Max Time (hrs)
Emergency Medical Responder (NREMR) 80-110 1:45
EMT-Basic (NREMT) 70-120 2:00
Advanced EMT (NRAEMT) 135 2:15
EMT-Paramedic 80-150 2:30


Exam Categories by Percentage

Exam Content (%) EMR EMT EMT-I (85) EMT-I (99) AEMT Paramedic
Airway, Respiration & Ventilation 17-21% 17-21% 17-21% 17-21% 17-21% 17-21%
Cardiology & Resuscitation 16-20% 16-20% 16-20% 16-20% 17-21% 17-21%
Trauma 19-23% 19-23% 19-23% 19-23% 18-22% 18-22%
Medical, OB/Gyn. 27-31% 27-31% 26-30% 26-30% 26-30% 26-30%
Operations 11-15% 12-16% 12-16% 12-16% 12-16% 12-16%


How long until I get my NREMT results?!?

So, you just took the NREMT exam. If you’re like most candidates, it was probably within the past hour. The anticipation is killing you. It’s a computer-based test for chrissakes! Why can’t they just grade it already?!? Why won’t I get to the point and just give you the answer?!?

Assuming your check and application were filled out correctly, your “written” results should be on the NREMT website within 1-2 business days. (If you want to reduce your stress levels, don’t take the exam on a Friday!) The NREMT is usually pretty quick about getting results online. You’ll get your shiny new card in the mail in a week or two.


The NREMT Cut Me Off After 70 Questions! Did I pass?