NYC REMAC Exam: The Complete 2026 Guide

The NYC REMAC Basic exam is the regional protocol exam every paramedic must pass to be credentialed to work in New York City. It is a 120-question multiple-choice test on the NYC REMAC Protocols, you get 3 hours, and you need 80% to pass. You register through the NYC REMSCO Learning Management System (LMS), the fee is $135 (non-refundable), and the exam runs once a month with limited seats.

This guide pulls together what the official sources say: the REMSCO exam page, the NYC REMAC Certification & Credentialing Administrative Manual (revised June 2025), REMAC Advisory 2025-05, and the 2026 NYC REMAC Prehospital Treatment Protocols. Exam rules, fees and dates can change, so confirm the current details at nycremsco.org (opens in a new tab) before you register.

Key facts

• What it is: the NYC REMAC Basic exam (the Administrative Manual calls it the Original Paramedic Certification Examination)
• Format: 120 multiple-choice questions with four choices each, based on the NYC REMAC Protocols
• Time limit: 3 hours
• Passing grade: 80%
• Extra questions: the exam may include additional noncredit pilot questions
• Content: General Operating Procedures, Treatment Protocols, Appendices, and scenario-based questions
• Fee: $135, non-refundable
• Schedule: once a month, limited seating, no walk-ins
• Registration: online through the NYC REMSCO LMS
• Credential: four years (49 months under the Administrative Manual), on top of your NYS DOH paramedic certification
• Protocols in force: the 2026 NYC REMAC Prehospital Treatment Protocols, version 2026-01, effective August 1, 2026

What the REMAC Basic exam is and why it exists

New York State certifies you as a paramedic. New York City adds a second layer. Under Article 30 of the New York State Public Health Law, paramedics must show they understand the region's treatment and transportation protocols and be credentialed by the Regional Emergency Medical Advisory Committee (REMAC). The REMSCO exam page states that NYC REMAC credentialing must be maintained in addition to your NYS DOH paramedic certification.

The protocol book itself explains the split in roles. Under Article 30, REMSCO (the Regional Emergency Medical Services Council of New York City) coordinates EMS in the region, and REMAC is responsible for medical oversight of the EMS system in the region (2026 NYC REMAC Protocols, GOP: On Scene Medical Control-Operations, p. 4).

That is why the exam tests the NYC REMAC Protocols specifically, not general paramedic knowledge. You can be a strong medic and still miss questions because NYC sets a particular dose, threshold, destination rule or medical control requirement differently from what you learned in class.

One more link to keep in mind: if your NYS DOH certification becomes invalid through expiration, suspension or revocation, your NYC REMAC certification is immediately suspended until New York State recertifies you (Administrative Manual, section 2.7.2).

Who has to take the NYC REMAC exam

According to the REMSCO exam page, the REMAC Basic exam is open to NYS DOH paramedics in three situations:

1. Initial REMAC certification. You are a NYS DOH paramedic who has never held a NYC REMAC credential.
2. CME renewal requirements not met. You were REMAC credentialed but did not complete the CME-based renewal. The Administrative Manual says a paramedic who does not complete the CME-based renewal reverts to the Original Certification pathway (section 1.2.2).
3. Expired more than 30 days. CME-based renewal is accepted up to 30 days after expiration. Any renewal attempt more than 30 days after expiration requires the Original exam and applicable fees (section 3.1.2 D).

Out-of-state and National Registry paramedics

The REMSCO FAQ is clear on this one: you need a completed and approved NYS DOH Bureau of EMS reciprocity application before you register for the NYC REMAC Basic exam. Sort out New York State first, then register for REMAC.

Students in a regional course sponsor program

If you are finishing an original paramedic course with a regional course sponsor, your sponsor coordinates an exam date with the REMAC Liaison and helps with registration. The REMSCO page says candidates must complete the NY State Original Paramedic Certification Examination Application at least 10 business days before the REMAC Basic exam. The Administrative Manual adds that registration fees are waived for the sponsor's independently scheduled exam date (section 2.2.3 C).

Exam format: what is on the test

The REMSCO page and the Administrative Manual (section 2.5.1) agree on the format:

• A single multiple-choice exam with 120 regional protocol questions, four choices each
• It may include additional noncredit pilot questions
• 3-hour limit
• 80% to pass

The manual also gives an approximate breakdown by content area. Here is what that means in question counts (the counts are simple arithmetic on 120 questions, so treat them as rough):

Two practical takeaways:

• Treatment Protocols carry the most weight. That is the 91-page middle section of the protocol book, from cardiac arrest through nerve agents.
• GOP and Appendices together are about a quarter of the exam. Candidates often skim them. Don't. Transport destinations, OLMC rules, CPAP exclusions, burn and trauma center criteria and the S-LAMS stroke scale all live there.

Results are handed out at the end of the exam if available, or emailed to you (Administrative Manual, section 2.5.2).

For a section-by-section tour of the book, see our 2026 NYC REMAC Protocols study overview.

Exam fee, schedule and seats

• Fee: $135, non-refundable. The LMS registration steps list the fee as "if applicable," and the Administrative Manual says the Original exam fee is waived one time if you can provide proof of hardship (section 2.3.1 B).
• Frequency: the exam is hosted once a month.
• Seats: limited. The number of candidates is capped by the exam room's seating capacity. When all seats are filled, registration closes and you wait for the next month's registration to open.
• Deadlines: each exam has a registration deadline, and applications must be submitted before it. The Administrative Manual says your completed application and fee must be submitted by the first day of the month of the exam (section 2.3.1 B).
• Walk-ins: strictly prohibited.

Exam dates and registration live on the NYC REMSCO LMS, in the Course Catalog folder and the LMS Event Date Calendar.

How to register for the NYC REMAC Basic exam, step by step

Registration runs through the NYC REMSCO LMS at nycremsco.org/lms (opens in a new tab). The REMSCO page lists six steps:

1. Log in to the NYC REMSCO LMS, or register for an account.
2. Go to the Exam Calendar to see upcoming REMAC exam sessions.
3. Click the session you want.
4. Complete the REMAC Exam Registration Questionnaire.
5. Pay the $135 exam fee (if applicable).
6. Finalize by clicking "Register."

You should get a confirmation email, and the event shows up on your Learner Dashboard. If you don't see either, follow up before the deadline passes.

If you need accommodations

ADA-based requests must be submitted in writing to the Chair of the Certification & Credentialing Subcommittee at least 30 days before the scheduled exam date (Administrative Manual, section 2.3.3 B). Build that into your timeline.

What to bring on exam day

The REMSCO page says candidates must have all of the following:

• Photo identification
• Proof of current NYS DOH paramedic certification, or on-site scoring results
• Proof of graduation within the last 12 months from a Paramedic Basic Program (a graduation certificate or a letter from the Program Director)

The Administrative Manual's admission rule is short: photo ID plus proof of NYS DOH paramedic certification or on-site scoring results, and candidates who fail to present the required items will not be admitted (section 2.4.1). If you are retesting after a lapse rather than coming straight out of school, check with REMSCO which documents apply to you.

Exam room rules

The proctor reads the Academic Integrity Policy aloud at the start of every exam (section 2.4.2). The highlights:

• Only the exam book and answer sheet are allowed on your desk
• No electronic devices for any purpose, including calls, texts or photos
• No talking to anyone except exam staff
• You may not share exam content with anyone after you leave
• You sign a confidentiality statement

Violations lead to immediate disqualification, and you cannot sit for any NYC REMAC exam until the Chair of the C&C Subcommittee authorizes it.

What happens after you pass

• You are credentialed for four years. Advisory 2025-05 (effective July 1, 2025) moved NYC REMAC paramedic credentialing to a four-year cycle. The Administrative Manual puts it precisely: 49 months, expiring on the first day of the 49th month after the exam (section 2.7.1).
• You keep it through CME-based renewal. Future recertification goes through the CME-based renewal process. If you don't complete it, you lose certification and need to take the Original exam again.
• CME: 84 hours. Category A, Physician Directed Call Review, is 48 hours minimum (at least 30 synchronous, at most 18 asynchronous). Category B, Alternative Source, is 36 hours minimum (at least 18 synchronous, at most 18 asynchronous).
• REMAC Updates. You must stay current with the NYC REMAC Regional Updates, completed through the LMS, for each year of the cycle (sections 3.2.2 and 3.2.5).
• Medical Director attestation. Your agency Medical Director signs a CME Attestation Letter confirming you met the requirements.
• Timing. Submit renewal documents at least 90 days before your expiration date (section 3.4.1). The REMSCO FAQ warns that registering too early gets your CME base review declined.
• Renewal fee. After the REMAC Liaison approves your re-credentialing request, there is a non-refundable $35 credentialing fee covering the four-year period.

Paramedics who already had an active three-year credential finish that cycle as scheduled, with the older 72-hour CME requirement (36 Category A, 36 Category B), per the REMSCO page.

What happens if you fail

The Administrative Manual is the authority here. It says:

• Certification is withheld until you successfully complete the exam process (section 2.6.1).
• A retest may be provided within the same month following the original attempt. That retest expires one month after the Original exam (section 2.6.3).
• Repeated attempts are limited. After two consecutive failures, there is a 6-month preparation period before you may sit for the next exam. After the third and any further consecutive failures, the preparation period is 12 months (section 2.3.1 C).
• If you were absent, you may register for the next available exam (section 2.6.2).

The manual also notes that decisions of the C&C Subcommittee may be appealed in writing to the Chair of the REMAC Medical Standards Committee within 10 business days.

Bottom line: a second failure costs you six months. Prepare to pass the first time, and treat a same-month retest as a chance to fix specific gaps, not to try your luck again.

A realistic study timeline

How long you need depends on where you start:

• New graduates who just finished a NYC paramedic program: 3 to 4 weeks of focused protocol review is a reasonable target, because the clinical foundation is fresh.
• Paramedics coming from out of state or the National Registry: allow longer. Your clinical knowledge is solid, but you need to unlearn other systems' doses and rules and learn NYC's.
• Lapsed NYC medics retaking the exam: the protocols you remember may not be the 2026-01 edition. Re-read the book rather than relying on memory.

Plan backwards from your exam date. Registration closes when seats fill, and the paperwork deadline falls at the start of the exam month, so pick your date and register early, then study toward it.

For a day-by-day version, see How to Study for the NYC REMAC Exam in 30 Days.

How to study for the NYC REMAC exam

Study from the actual protocol book

The exam is written from the NYC REMAC Protocols, so the book is your primary source. Read the current edition (2026-01, effective August 1, 2026). Each treatment protocol follows the same layout: a CFR and all provider levels section, an EMT section, a Paramedic section, Medical Control Options and Key Points / Considerations. Standing orders for each level end at a "STOP," and Medical Control Options may only be given after contacting online medical control (2026 NYC REMAC Protocols, Introduction, p. 1).

That structure is the exam. A large share of questions turn on one of three things:

• Which level does it? CFR, EMT or paramedic.
• Standing order or medical control option? A drug can be a standing order in one protocol and an OLMC option in another.
• The exact number. Dose, maximum, energy, threshold, time.

Learn the rule behind the rule

The GOP sets rules that every protocol inherits. For example, if you cannot reach OLMC, you may only give standing order medications and treatments (2026 NYC REMAC Protocols, GOP: Definitions, p. 2). Once you know that, a whole category of scenario questions answers itself.

Practice with questions that cite the page

Reading alone gives you recognition. Questions force recall, and recall is what the exam measures. Use REMAC practice questions where every answer cites the protocol page so you can check the source and re-read the surrounding text when you miss one. Try a set of free NYC REMAC practice questions with answers to see where you stand.

Rehearse the full exam once

Sit at least one full-length REMAC practice test: 120 questions, 3 hours, no looking things up, scored against 80%. It tells you whether your pacing works and which sections still leak points.

Sample question walkthrough

Here is a GOP question from the RemacReady practice bank, and how to think through it.

A patient in shock needs intravascular access. You are unable to obtain a peripheral IV. According to the GOP, when should intraosseous access be attempted, and how many attempts are permitted?

• A. After two unsuccessful IV attempts, with a maximum of two IO attempts
• B. After a single unsuccessful IV attempt, with unlimited IO attempts
• C. Only after OLMC authorizes IO placement in a patient in shock
• D. After three unsuccessful IV attempts, with a maximum of three IO attempts

How to work it:

1. Name the section. "According to the GOP" plus "intravascular access" points you to GOP: Medication Administration.
2. Recall the numbers. The GOP says that for adult and pediatric patients in shock in whom IV access is not obtained after two attempts, IO access shall be attempted, with a maximum of 2 attempts (2026 NYC REMAC Protocols, GOP: Intravascular Access and Medication Administration, p. 15).
3. Eliminate. B gets both numbers wrong. D inflates both. C invents an OLMC requirement: the GOP says IO "shall be attempted," which is direction, not permission.
4. Answer: A.

Notice the pattern. Good distractors are plausible numbers or a plausible OLMC requirement. Knowing the exact figure and whether OLMC is involved is what separates right from almost right.

Frequently asked questions

How many questions are on the NYC REMAC exam?

120 multiple-choice questions with four choices each, based on the NYC REMAC Protocols. The exam may also include additional noncredit pilot questions. You have 3 hours.

What score do I need to pass the REMAC Basic exam?

80%. On 120 questions, that works out to 96 correct.

How much does the NYC REMAC exam cost?

$135, non-refundable, per the REMSCO exam page. The Administrative Manual allows a one-time waiver of the Original exam fee with proof of hardship, and fees are waived for exams a regional course sponsor schedules for its class. Fees can change, so confirm at nycremsco.org.

How do I register for the REMAC exam?

Through the NYC REMSCO LMS: log in or create an account, open the Exam Calendar, pick a session, complete the REMAC Exam Registration Questionnaire, pay the fee if applicable, and click Register. Walk-ins are not allowed.

How often is the REMAC Basic exam offered?

Once a month, with limited seats. When seats fill, registration closes until the next month's registration opens. Dates are posted on the NYC REMSCO LMS.

What happens if I fail the NYC REMAC exam?

Certification is withheld until you pass. A retest may be offered within the same month, and it expires one month after the original exam. After two consecutive failures there is a 6-month preparation period before the next attempt, and after a third consecutive failure the wait is 12 months.

How long is a NYC REMAC credential good for?

Four years. The Administrative Manual specifies 49 months, expiring on the first day of the 49th month after the exam. You renew through the CME-based pathway: 84 hours of CME, current REMAC Updates and an attestation from your agency Medical Director.

Which protocols does the 2026 exam use?

The NYC REMAC Prehospital Treatment Protocols, version 2026-01, effective August 1, 2026. Always study from, and practice under, the current official version, and follow medical control.

Start practicing

The fastest way to find your weak spots is to answer questions and read why each answer is right. RemacReady has 1,000 NYC REMAC practice questions and a full 120-question, 3-hour mock exam, and every explanation cites the 2026 protocol page so you can check the source yourself. Start free with a daily Quick 10 (opens in a new tab), see how the study modes work on the exam prep page, or check the FAQ.

Keep reading:

• Free NYC REMAC Practice Questions (2026 Protocols) with Answers
• 2026 NYC REMAC Protocols: A Section-by-Section Study Overview
• How to Study for the NYC REMAC Exam in 30 Days