1.1 About the CCP-C Exam

IBSC CCP-C Certified Critical Care Paramedic Study Guide Exam

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1 Chapter 1: Introduction & Exam Strategy

1.1 About the CCP-C Exam 1.2 CCP-C Study Strategy & Exam Tactics

2 Chapter 2: Transport and Safety (Part 1)

2.1 Crew Resource Management & Sterile Cockpit Rule 2.2 Transport Risk Assessment & Mission Decision-Making 2.3 Aircraft and Ground Transport Safety Protocols

3 Chapter 2: Transport and Safety (Part 2)

2.4 Environmental Transport Stressors & Gas Laws 2.5 Transport Equipment Management & Post-Mission Operations

4 Chapter 3: Airway, Anesthesia, and Analgesics (Part 1)

3.1 Advanced Airway Assessment & Difficult Airway Identification 3.2 Rapid Sequence Induction (RSI) - Pretreatment & Induction Agents 3.3 Neuromuscular Blockade - Depolarizing vs Non-Depolarizing Agents 3.4 Post-Intubation Sedation, Analgesia & Dissociative Maintenance 3.5 Transport Ventilator Setup & Primary Ventilation Modes

5 Chapter 3: Airway, Anesthesia, and Analgesics (Part 2)

3.6 Mechanical Ventilator Waveforms, Loops & Oxygenation Titration 3.7 Ventilator Alarm Troubleshooting & Peak vs Plateau Pressures 3.8 Rescue Airway Devices, Video Laryngoscopy & Surgical Cricothyrotomy 3.9 Neuromuscular Reversal & Vasoactive Airway Support 3.10 Transport Airway Management in Unique Environments & Extubation

6 Chapter 4: General Medical Patient

4.1 Sepsis, Severe Sepsis & Septic Shock Resuscitation 4.2 Endocrine Emergencies (DKA, HHS, Adrenal Crisis, Thyroid Storm) 4.3 Renal and Hepatic Emergencies in Transport

7 Chapter 5: Cardiac Patient

5.1 Acute Coronary Syndromes & Infarct Specific Complications 5.2 Invasive Hemodynamic Monitoring 5.3 Vasoactive & Inotropic Medication Titration 5.4 Mechanical Circulatory Support & Post-Cardiac Arrest Care

8 Chapter 6: Neurological Patient

6.1 Traumatic Brain Injury & Intracranial Pressure (ICP) Management 6.2 Acute Ischemic Stroke, Hemorrhagic Stroke & Subarachnoid Hemorrhage 6.3 Status Epilepticus, Spinal Cord Injury & Neurogenic Shock

9 Chapter 7: Respiratory Patient

7.1 Acute Respiratory Distress Syndrome (ARDS) & Lung-Protective Ventilation 7.2 Severe Asthma & COPD Exacerbations in Critical Care 7.3 Chest Tube Management, Pleural Drains & Tension Pneumothorax 7.4 Pulmonary Embolism, Pulmonary Hypertension & Transport Respiratory Meds

10 Chapter 8: Toxic Exposure and Environmental Patient

8.1 Toxicology Emergencies, Toxidromes & Antidote Therapy 8.2 Environmental Emergencies (Hypothermia, Hyperthermia, Frostbite) 8.3 Submersion, Diving Emergencies & Envenomation/HazMat

11 Chapter 9: Trauma and Burn Patient

9.1 Hemorrhagic Shock Resuscitation & Massive Transfusion Protocols (MTP) 9.2 Severe Thoracic & Abdominal Trauma Management 9.3 Thermal, Chemical & Electrical Burn Assessment & Fluid Resuscitation 9.4 Musculoskeletal Trauma, Pelvic Fractures & Compartment Syndrome

12 Chapter 10: Maternal and Fetal Medicine

10.1 High-Risk Obstetric Assessment & Hypertensive Disorders of Pregnancy 10.2 Obstetric Hemorrhage, Placental Abruption & Preterm Labor 10.3 Emergency Transport Delivery, Umbilical Cord Prolapse & Fetal Monitoring

13 Chapter 11: Pediatric Patient

11.1 Pediatric Critical Care Airway & Transport Ventilation 11.2 Pediatric Shock, Dehydration & Weight-Based Dosing 11.3 Neonatal Resuscitation Program (NRP) & Transport of the Critical Neonate

14 Chapter 12: Special Populations

12.1 Bariatric Critical Care Transport & Positional Management 12.2 Geriatric Critical Care & Patients with Specialized Medical Technology

15 Chapter 13: Professional Considerations

13.1 Legal Aspects, EMTALA & Transport Ethics 13.2 Quality Improvement, Transport Safety Research & Evidence-Based Practice

1.1 About the CCP-C Exam

Key Takeaways Explain This Topic AI

The April 2026 IBSC CCP-C exam has 135 items in two locked sections (68 then 67), 150 minutes total testing time, and an optional 5-minute break after Section 1.

The published raw passing score is 68 correct answers out of 110 scored items; fees are $285 affiliate / $385 non-member, and full fees apply for each retest after a 30-day wait.

Domain weights in the 2026 handbook differ from older outline PDFs—Airway is 14 scored items and Cardiac is 13, not the legacy 30/15-item Transport-heavy split.

Recertification requires 100 contact hours in four years, including ≥75 clinical hours with 16 hours from an approved CCP-C review course, or retesting.

Last updated: July 2026

1.1 About the CCP-C Exam

The Certified Critical Care Paramedic (CCP-C®) examination is the gold-standard credential for advanced prehospital and interfacility transport clinicians. Administered by the International Board of Specialty Certification (IBSC®) —formerly known as the Board for Critical Care Transport Paramedic Certification (BCCTPC)—the CCP-C certification validates that a paramedic possesses the advanced cognitive knowledge, analytical capability, and clinical judgment required to manage critically ill or injured patients across complex ground and air transport environments.

1. Executive Overview & The IBSC Mission

Critical care transport medicine operates at the high-acuity intersection of emergency medicine, intensive care, and specialized transport physiology. While standard entry-level paramedic practice focuses on prehospital emergency resuscitation and initial stabilization, critical care paramedics routinely manage patients with multi-organ failure, complex mechanical ventilation, invasive hemodynamic monitoring, multi-agent vasoactive infusions, and mechanical circulatory support devices.

The mission of the IBSC is to establish, measure, and maintain uniform international standards of excellence for specialty paramedic practice. Earning the CCP-C credential demonstrates to medical directors, transport agencies, hospital systems, and patients that the clinician has mastered the complex body of knowledge defined by the critical care transport community.

Distinction Standard Paramedic (NRP / State License) Certified Critical Care Paramedic (CCP-C)

Primary Scope Emergency response, basic/advanced life support, initial field stabilization Advanced interfacility & critical ground/air transport, prolonged intensive care

Airway & Ventilation ETT, SGA, basic ventilator modes (BiPAP/CPAP, simple CMV) RSI, video laryngoscopy, surgical cricothyrotomy, PRVC/APRV ventilator modes, PEEP titration

Hemodynamics Non-invasive BP, 4-lead / 12-lead ECG, fluid resuscitation Arterial lines, CVP, PA catheters, vasoactive drip titration, IABP/VAD/ECMO transport monitoring

Pharmacology ACLS algorithms, analgesia, basic antiarrhythmics, emergency meds Continuous paralytics, sedatives, push-dose pressors, thrombolytics, blood products, high-risk OB meds

Assessment Focus Rapid trauma/medical primary & secondary survey Advanced organ-system assessment, lab interpretation (ABG, TEG, electrolytes, lactate)

2. Exam Structure, Scoring Dynamics, and Question Anatomy

The CCP-C examination is a rigorous, computer-based testing assessment designed to evaluate clinical decision-making under simulated transport conditions.

Question Count and Item Distribution

The examination consists of 135 total multiple-choice items :

110 Scored Items : These items directly contribute to your final pass/fail result. They are benchmarked against the 12 official IBSC content domains.

25 Pre-test (Pilot) Items : These items are unscored questions randomly interspersed throughout the test. They are being field-tested for statistical validity and psychometric reliability prior to inclusion on future exam forms.

Important Exam Tactical Note: Candidates cannot distinguish between scored items and pilot items during the examination. Every single question must be approached with equal focus and diligence.

Time Allocation, Section Structure & Passing Cut Score

Per the April 2026 IBSC CCP-C Candidate Handbook , the examination is delivered as two locked sections with a single optional break:

• Segment Items Time Limit Navigation Rule
• Section 1 68 questions 75 minutes Once submitted, you cannot return to Section 1 items
• Optional Break — Up to 5 minutes Only break provided during the testing period
• Section 2 67 questions 75 minutes Independent section clock

Total 135 items (110 scored + 25 unscored pilots) 150 minutes testing time Pilots are randomly distributed and indistinguishable

Passing Threshold : The IBSC FAQ publishes a raw passing score of 68 correct responses out of the 110 scored items (~61.8%). Passing candidates receive a pass/fail result without a numeric score breakdown.

Pacing implication : Budget roughly 66 seconds per item within each section , and do not rely on end-of-exam review across sections—Section 1 is permanently sealed when you advance.

• Exam Metric Official Value / Specification
• Total Test Items 135 multiple-choice questions in 2 sections
• Scored Items 110 questions
• Unscored Pilot Items 25 questions (randomly distributed)
• Time Allowed 150 minutes total (75 + 75), plus an optional 5-minute break
• Raw Passing Score 68 / 110 scored items (IBSC FAQ)
• Passing Percentage ~61.8% of scored items
• Question Format 4-option multiple-choice (single best answer)
• Delivery Medium Computer-Based Testing (Prometric center, MED, or Live Remote Proctoring)
• Cognitive Level & Vignette Anatomy

The CCP-C examination intentionally avoids simple recall questions (e.g., "What is the normal dose of epinephrine?"). Items emphasize application and analysis —candidates must apply clinical principles, gas laws, and dosing calculations to transport vignettes, and synthesize multi-parameter data (telemetry, ventilator graphics, labs, hemodynamics) to choose the single best immediate action . IBSC does not publish an official percentage split by cognitive level.

3. Test Delivery Logistics: Prometric & Live Remote Proctoring (LRP)

The IBSC contracts with Prometric to deliver the CCP-C examination globally. Candidates have two primary modes of administration:

Option A: Prometric Computer-Based Testing Centers

Candidates can schedule their exam at any authorized Prometric testing center worldwide.

Check-in Procedure : Plan to arrive early for Prometric check-in (IBSC voids starts if you are more than 15 minutes late from the exam start time). You must present two forms of valid identification (one primary government-issued photo ID with signature, such as a driver's license or passport).

Security Standards : Prometric enforces strict security measures, including biometric palm vein scanning, metal detector wands, visual inspection of sleeves and pockets, and continuous video monitoring.

Testing Environment : You will be seated in an isolated testing carrel with noise-canceling headphones, a computer terminal, and a physical scratch paper sheet or dry-erase booklet (which must be returned at the end of the exam).

Option B: Live Remote Proctoring (LRP) via ProProctor™

Candidates who prefer to test from home or office can utilize Prometric’s ProProctor™ platform .

System Requirements : Requires a reliable laptop or desktop computer with a functional webcam, microphone, and high-speed internet connection (minimum 3.0 Mbps download/upload). Dual monitors, touchscreens, and virtual machines are strictly prohibited.

Room Audit & Environmental Clearance : Prior to launching the exam, a remote proctor conducts a mandatory 360-degree camera inspection of your room. The desk surface must be completely clear of all items (no paper, pens, phones, beverage containers without clear wrappers, or secondary electronics).

Strict Proctoring Rules : Your head and face must remain centered in the webcam frame at all times. Reading questions aloud, leaning out of frame, ambient room noise, or another person entering the room will trigger an immediate exam suspension and potential voiding of test results.

• 4. Candidate Eligibility, Recommended Background, and Fees
• Prerequisites & Eligibility

To sit for the CCP-C examination, candidates must hold an active, unrestricted paramedic license (or international equivalent authority to practice).

Recommended Clinical Background

While any licensed paramedic may register, the IBSC strongly recommends that candidates possess:

At least 3 to 5 years of active practice in high-volume Advanced Life Support (ALS) or critical care environments.

Active provider credentials in advanced resuscitation disciplines:

• ACLS (Advanced Cardiac Life Support)
• PALS (Pediatric Advanced Life Support) or PEPP (Pediatric Education for Prehospital Professionals)
• NRP (Neonatal Resuscitation Program)
• ITLS (International Trauma Life Support) or PHTLS (Prehospital Trauma Life Support)
• Examination Fee Structure

The examination fee varies based on professional membership status with IBSC partner organizations (such as ASTNA, IAFCCP/IAFCT, or NAEMT):

• Fee Category Candidate Status Fee Amount
• Initial Examination (CBT / MED) Affiliate member $285 USD
• Initial Examination (CBT / MED) Non-member $385 USD
• Retake Examination Any retest (full fee applies; wait ≥30 days) $285 / $385 USD
• Recertification by Exam Current certificant renewing via examination $285 / $385 USD
• Recertification by CE CE submission pathway $285 / $385 USD

Exam fees do not expire and are non-refundable . Switching certification choice or delivery method costs $100 . Prometric rescheduling/cancellation fees in the 2026 handbook are $100 (29–5 days before the appointment) and $150 (4 or fewer days before). A $125 late processing fee applies to CE recertifications received less than 30 days before expiration.

5. Certification Maintenance & 4-Year Recertification Cycle

CCP-C certification is granted for a 4-year period . To maintain active certification without lapse, certificants must complete the recertification process prior to their expiration date.

Option 1: Recertification via Continuing Education (CE)

Per the April 2026 Candidate Handbook, certificants must submit a minimum of 100 contact hours earned during the four-year certification period, with clear and direct application to the specialty:

Clinical category : At least 75 of the 100 hours must be CLINICAL. It is acceptable for more than 75 hours to be clinical.

Approved review course : Sixteen (16) of the clinical hours must come from an IBSC-approved CCP-C review class .

Other category : Up to 25 hours may be in the OTHER category to complete the 100-hour total.

Submit CE documentation 2–4 months before expiration . CE received less than 30 days prior incurs a $125 late processing fee (which does not guarantee approval before expiration).

Option 2: Recertification by Re-Examination

Certificants may retake and pass the current CCP-C examination (full registration fee applies) as an alternative to the CE pathway.

6. The 12 Official Blueprint Domains

The CCP-C examination content is governed by a rigorous job task analysis performed by the IBSC. The exam tests content across 12 distinct clinical and operational domains :

Domain # Domain Name Exam Weight (%) Scored Items Primary Clinical & Operational Focus Areas

1 Transport & Safety 6% 7 Personal wellness / fitness for duty, communication and radio operations, safety and restraint systems, risk assessment, crew resource management, transport stressors.

2 Airway, Anesthesia & Analgesics 13% 14 Airway assessment and anatomy, pharmacology, medication-facilitated airway management, algorithms, surgical airway, mechanical ventilation, alternative devices, peri-intubation arrest, tracheostomy considerations, tube confirmation, suctioning, waveform capnography, NIPPV, specialized equipment (HFNC, video laryngoscopy, HFOV, nitric oxide).

3 General Medical Patient 10% 11 Endocrine, renal, gastrointestinal, acid-base/metabolic, and infectious/immunologic (including sepsis) emergencies; blood products; fluid resuscitation; labs; invasive lines; hemodynamic monitoring; radiographic interpretation.

4 Cardiac Patient 12% 13 Advanced multi-lead ECG, assist devices (Impella, ECMO, VAD, IABP, invasive pacemaker), ACS, cardiogenic shock, heart failure, infectious cardiac disease, arrhythmias, hypertensive emergencies, hemodynamic instability, vascular disorders, post-cardiac arrest care, labs, pharmacology, monitoring.

5 Neurological Patient 9% 10 Neuro assessment, seizures, altered mental status, cerebral ischemia (including LVO), cerebral hemorrhage, TBI, spinal cord injury, neuroprotective strategies (positioning, hemodynamics, EVD), diagnostics, pharmacology, ICP monitoring.

6 Respiratory Patient 10% 11 ARDS, pneumothorax, infectious respiratory disease, obstructive airway disease (asthma/COPD), pulmonary edema, pulmonary embolism, radiographic interpretation, pharmacology, chest drainage systems.

7 Toxic Exposure & Environmental 5% 5 Environmental exposure, CBRNE injuries, dive/altitude illness, adverse flora/fauna reactions, toxicology, overdose/poisoning, labs, pharmacology.

8 Trauma & Burn Patient 10% 12 Trauma lethal triad, burns (thermal/electrical/chemical/radiological), inhalation injury, isolated and multi-system trauma, thoracostomy, pericardiocentesis, escharotomy, blood products, REBOA/open thoracotomy concepts, burn fluid resuscitation.

9 Maternal & Fetal Medicine 7% 8 High-risk prenatal disorders (PIH, preeclampsia/eclampsia/HELLP), delivery complications (cord prolapse, abruption, multiple birth, PROM, PPH, hypertonic contractions), obstetric maneuvers (McRoberts, emergent hysterotomy), neonatal emergencies, labs, pharmacology, fetal monitoring.

10 Pediatric Patient 8% 9 Pediatric airway and ventilation, general medical disorders (DKA, sepsis, meningitis), cardiac/neuro/respiratory disease, toxic/environmental exposure, trauma/burns, specialty needs (developmental delay, home ventilation), fluids, labs, pharmacology.

11 Special Populations 5% 5 Bariatric anatomy/physiology, transport-specific equipment, geriatric physiologic alterations, end-of-life decisions, pharmacology, monitoring.

12 Professional Considerations 5% 5 Common accreditation standards, research design/methodology terminology, Just Culture, evidence-based medicine, ethics (including DNR/end-of-life), quality and safety measurements (e.g., GAMUT metrics), cultural and diversity considerations.

Source note: Domain names, weights, and scored-item counts above follow the April 2026 CCP-C Candidate Handbook content outline (110 scored items total). Prefer this handbook over older standalone outline PDFs when weights conflict.

Mastering the CCP-C examination requires a structured, domain-focused study strategy. Under the April 2026 blueprint , the largest scored domains are Airway, Anesthesia & Analgesics (14 items) , Cardiac Patient (13 items) , Trauma/Burn Patient (12 items) , General Medical Patient (11 items) , Respiratory Patient (11 items) , and Neurological Patient (10 items) . Together these six domains represent 71 of 110 scored items (~65%) , so allocate study time accordingly—while still covering Transport & Safety, toxicology, maternal/fetal, pediatric, special populations, and professional considerations, which remain mandatory.

The subsequent sections of this study guide provide exam-specific coverage of each handbook domain so you can build the depth of knowledge required for first-attempt success.