If you provide medical support to a SWAT team, special operations unit, or other tactical element, the Certified Tactical Paramedic (TP-C)® credential from the International Board of Specialty Certification (IBSC) proves you can deliver sound paramedicine in hostile, austere environments. The exam draws on trauma care, tactical operations, and mission planning, so it can feel like a lot to organize. The good news is that IBSC publishes exactly what it tests and how many questions come from each area.

In this guide, we’ll walk you through the exam format, the four domains of the official content outline, the resources worth downloading, and the questions candidates ask most often.

What Is the IBSC TP-C Exam?

The TP-C is IBSC’s specialty certification for tactical paramedics. IBSC describes the exam as evaluating the knowledge of accomplished tactical paramedics operating in hostile and austere environments, based on sound paramedicine and tactical principles. It is designed for experienced military special operations medics and law enforcement tactical paramedics, and the National Commission for Certifying Agencies (NCCA) accredits the program.

IBSC says the exam is built on the critical tactical emergency medical support (TEMS) domains of the National TEMS Initiative and Council (NTIC). Questions also reflect the Committee on Tactical Combat Casualty Care (CoTCCC) and Committee for Tactical Emergency Casualty Care (C-TECC) guidelines, and IBSC expects candidates to be current in ACLS, ITLS or PHTLS, TCCC, and TECC standards.

What Is the TP-C Exam Format?

Here is the exam at a glance, based on the IBSC TP-C Exam FAQs and the IBSC tactical paramedic page:

  • Questions: 135 multiple-choice questions.
  • Scored vs. unscored: 125 scored questions and 10 unscored pilot questions. The pilot items aren’t identified, so answer every question as if it counts.
  • Time: 2.5 hours (150 minutes).
  • Question levels: Items are written at three cognitive levels: recall, application, and analysis.
  • Delivery: Computer-based testing at Prometric centers, live remote proctoring, IBSC-MEDBOX onsite, or paper-and-pencil sessions.
  • Passing score: 88 correct answers out of the 125 scored items, or roughly 70%.
  • Results: Computer-based results are available within about an hour of finishing. Paper-and-pencil results take 4 to 6 weeks.

With 150 minutes for 135 questions, you have just over a minute per question. That’s comfortable for recall items, but scenario questions reward a disciplined read: find the threat level, the phase of care, and the casualty’s priority problem before you look at the options.

What Content Outline Does the TP-C Exam Use?

Pocket Prep’s TP-C content aligns with the TP-C Detailed Content Outline and the TP-C Candidate Handbook (April 2026). The outline is the official list of what can be tested, and the handbook covers registration, testing, and scoring rules.

The outline divides the 125 scored questions into four domains. IBSC lists question counts rather than percentages, so the percentages below are simply each count divided by 125:

  • Domain I, Tactical Casualty Care (TECC/TCCC): 55 questions (44%)
  • Domain II, Tactical Operations: 30 questions (24%)
  • Domain III, Planning: 21 questions (about 17%)
  • Domain IV, Specialized Medical Care: 19 questions (about 15%)

Domain I: Tactical Casualty Care (TECC/TCCC) (55 Questions)

This is the clinical heart of the exam and nearly half of your score. It asks how you assess and treat casualties in each phase of care: Direct Threat / Care Under Fire / Hot Zone, Indirect Threat / Tactical Field Care / Warm Zone, and Evacuation / Tactical Evacuation Care / Cold Zone. The outline breaks it into 10 subtopics:

  • Methodology and Hemostasis: Phase-appropriate care, plus tourniquets (extremity and junctional), direct and indirect pressure, wound packing, pressure dressings, and hemostatic agents such as Combat Gauze.
  • Airway and Respiration/Breathing: Positioning, NPAs, supraglottic airways, cricothyroidotomy, intubation and RSI with tube confirmation (bougie, capnography, esophageal detector), chest seals, needle decompression, chest tubes, and “burping” a chest seal.
  • Circulation and Vascular Access: Recognizing shock, damage control resuscitation (crystalloids, colloids, blood products, TXA), oral fluid resuscitation, and IV and IO access.
  • Medication Administration: Oxygen, analgesia and sedation (morphine, ketamine, midazolam, diazepam, fentanyl, naloxone), over-the-counter medications, and prescription drugs outside standard paramedic scope, such as antibiotics, antiemetics, and nerve agent and cyanide antidotes.
  • Casualty Immobilization and Packaging: Neurologic assessment and GCS, spinal injury decisions for blunt, penetrating, and blast trauma, head injuries and rising intracranial pressure, seizures, fractures and dislocations, and burns (Rule of Nines, Rule of Tens, Parkland formula).
  • Trauma Management and Mass Casualty Triage: The top three causes of preventable tactical death, the MARCH algorithm, mechanism-based injury patterns, thoracic and abdominal trauma, and START and SALT triage.

What questions look like: A casualty is bleeding heavily while the team is still taking fire. The best answer controls the bleeding with a tourniquet and gets the casualty to cover. Airway checks and IV access wait until the threat is reduced.

Domain II: Tactical Operations (30 Questions)

Tactical Operations cover what makes a tactical medic different from a street paramedic: working as part of an armed team inside a dynamic threat environment. It has three subtopics:

  • Remote Medical Assessment and Surrogate Treatment: Assessing a casualty you can’t safely reach, directing a surrogate (sometimes the casualty) to perform lifesaving care, and reporting findings to the team leader for the extraction plan.
  • Operational Rescue and Casualty Extraction: High-threat extraction, rescue breaching (such as moving through drywall, cinderblock, or a window), and recommending an extraction method based on the casualty’s injuries.
  • Tactical Familiarization: PPE, breaching and diversionary tools, clearing and rendering weapons safe, staging team medical gear, team movement (cover and concealment, fatal funnel, stack, wedge, slicing the pie, building sectoring), situational awareness (noise and light discipline, the 5 S’s, contact and cover, PIE, stress management), less-lethal weapon injuries (CS and OC, conducted energy weapons, impact rounds, flash-bangs), and working dog care.

Study tip: Many operations questions are about team safety first and medicine second. If you haven’t trained with a team, spend extra time on movement and situational awareness vocabulary.

Domain III: Planning (21 Questions)

Good tactical medicine starts before the callout. This domain has two subtopics:

  • Medical Planning: Medical mission analysis across each phase (pre-mission, infiltration, actions on objective, exfiltration, post-mission), setting up and running a Casualty Collection Point (CCP), and planning for special populations such as children, older adults, and cultural considerations. It also includes the medical threat assessment (weather, weapons, dogs, IEDs, hazmat and clandestine labs, and CBRNE threats) and the Incident Command System, including working with the local medical authority.
  • Legal Aspects of TEMS: Patient privacy, evidence preservation and chain of custody, scope of practice, and warrants and search and seizure laws.

What questions look like: You’re asked where to place the CCP for a warrant service, or what to do with a suspect’s clothing that has a bullet hole in it after you cut it off during treatment.

Domain IV: Specialized Medical Care (19 Questions)

This domain focuses on keeping the team healthy and handling hazards beyond ballistic trauma. Its three subtopics are:

  • Force Health Protection: Work, rest, and sleep cycles; team medical histories; immunizations and chemoprophylaxis (such as malaria prevention); hydration; nutrition and food safety; field sanitation; and monitoring use of body armor, ballistic eyewear, and other protective gear.
  • Environmental Factors: Recognizing and managing environmental emergencies such as heat illness and cold injury.
  • Hazardous Materials Management: Recognizing hazardous materials, giving antidotes, and performing field decontamination.

Study tip: Think like the medic responsible for the team’s readiness over a long operation, not just the next casualty.

How Should You Use the TP-C Blueprint to Build a Study Plan?

Treat the outline as your master checklist, then study in this order:

  1. Take a baseline. Answer a mixed set of questions before you open a textbook so you know where you actually stand.
  2. Map every miss. Tag each missed question to an outline domain and subtopic.
  3. Weight your time. Tactical Casualty Care is 55 of 125 scored questions. Spend the most time ensuring you can answer these questions accurately and quickly.
  4. Refresh the standards. The outline dates from 2016, and TCCC and TECC recommendations for TXA, blood products, fluids, and analgesia have changed since. Read the current guidelines alongside it.
  5. Finish with timed, mixed practice. Build your pace toward about a minute per question.

What Official TP-C Resources Should You Use?

Commonly used references:

  • Tactical Paramedic: Certification and Practical Application Kindle Edition
  • Advanced Tactical Paramedic Protocols Handbook Revised, 11th Edition (ISBN 979-8990225718)
  • Tactical Medicine Essentials, 2nd Edition (ISBN 978-1284030297)
  • TECC: Tactical Emergency Casualty Care, 2nd Edition (ISBN 978-1284483871)

Frequently Asked Questions About the IBSC TP-C Exam

What score do I need to pass the TP-C?
You need 88 correct answers out of the 125 scored questions. If you don’t pass, IBSC sends a score report that shows your relative strengths and weaknesses by content area.

Which domain is the biggest?
Tactical Casualty Care (TECC/TCCC), with 55 of the 125 scored questions. Tactical Operations has 30, Planning has 21, and Specialized Medical Care has 19.

How soon will I get my results?
Computer-based candidates get results within about an hour. Paper-and-pencil results take 4 to 6 weeks.

Can I retake the TP-C if I fail?
Yes. You can attempt the same exam up to three times in total, with at least 30 calendar days between attempts. You pay the full registration fee for each attempt.

How much does the TP-C exam cost?
IBSC lists the TP-C exam at $285 for IBSC Affiliate Members and $385 for non-members. See the IBSC exam fees page for current pricing.

Can I take the TP-C online?
Yes. IBSC offers the TP-C through live remote proctoring and at Prometric test centers. IBSC recommends registering at least two weeks before your target date for remote testing.

How long is the TP-C valid?
The TP-C is a four-year certification. You can renew by retaking the exam or by submitting 100 approved continuing education credits.

Start Preparing for the IBSC TP-C Exam With Pocket Prep

Pocket Prep’s IBSC TP-C exam prep includes 400 practice questions, each with a detailed explanation, plus a full-length mock exam to test your pacing. Use the Weakest Subject quiz and Missed Questions quiz to close gaps across all four domains. With a steady plan, you can walk into the exam ready to pass on your first try.