Critical care ground transport nurses care for some of the sickest patients in the hospital system, then do it again in the back of a moving vehicle with limited resources. The Certified Transport Registered Nurse (CTRN)® credential from the Board of Certification for Emergency Nursing (BCEN) recognizes that expertise. Because the exam covers everything from rapid sequence induction to EMTALA, it can feel overwhelming to organize.

In this guide, we’ll walk you through the exam format, the four domains in the current 2026 content outline, the official resources worth downloading, and the questions candidates ask most often.

What Is the BCEN CTRN Exam?

The CTRN is BCEN’s specialty certification for registered nurses in the critical care ground transport setting. BCEN describes the exam as being “for nurses in the critical care ground transport setting who want to demonstrate their expertise and knowledge in transport nursing.” Its sister credential, the Certified Flight Registered Nurse (CFRN)®, covers air medical transport, and the two now have separate content outlines.

The exam is built from a role delineation study (RDS) of practicing ground transport nurses. That means questions reflect what transport nurses actually do: assessing and packaging unstable patients, managing airways and ventilators en route, running resuscitations in a confined space, and keeping the crew and patient safe on the road.

What Is the BCEN CTRN Exam Format?

Here is the exam at a glance, based on BCEN’s About the CTRN Exam page, the BCEN Candidate Handbook, and the current content outline:

  • Questions: 175 multiple-choice questions.
  • Scored vs. unscored: 150 scored questions plus 25 unscored pretest questions. The pretest items are mixed in, so treat every question as if it counts.
  • Time: 3 hours (180 minutes) of total seat time.
  • Delivery: Computer-based at PSI testing centers or through Live Remote Proctoring (LRP) from home.
  • Testing window: After your application is approved, you have 90 days to schedule and take the exam. Testing is available year-round.
  • Scoring: BCEN sets the passing standard with the modified Angoff method, so the exact passing score can vary slightly from one exam form to another.
  • Results: Immediate. Your score report shows pass or fail, your raw score, and a breakdown by major content area.

With 180 minutes for 175 questions, you have just over one minute per question. Most candidates finish in time, but long scenario stems about ventilator settings or hemodynamics can eat up minutes if you haven’t practiced at pace.

What Content Outline Does the CTRN Exam Use?

The current exam is based on BCEN’s 2026 CTRN Examination Content Outline, which grew out of BCEN’s 2025 role delineation study. It replaced the 2022 outline, which had 130 scored items across five domains (with Trauma and Medical Emergencies as separate domains).

According to BCEN’s update announcement, the new outline combines Trauma and Medical Emergencies into a single domain called Patient Conditions and Principles of Management, adds survival content to scene operations, and removes areas not unique to ground transport, such as disaster management, systems management, mental health, and infection control.

Here is how the 150 scored questions break down. Percentages are calculated from BCEN’s item counts.

  • Domain 1, General Principles of Ground Transport Nursing Practice: 22 items (about 15%)
  • Domain 2, Resuscitation Principles: 40 items (about 27%)
  • Domain 3, Patient Conditions and Principles of Management: 65 items (about 43%)
  • Domain 4, Special Populations: 23 items (about 15%)

Domain 1: General Principles of Ground Transport Nursing Practice (22 items)

This domain covers the parts of the job that make transport nursing different from bedside nursing: the physical environment of the vehicle, safety on scene and on the road, communication, and the legal framework for moving patients between facilities.

  • Transport physiology: Physiologic stressors of transport for both crew and patients, such as noise, vibration, temperature changes, acceleration and deceleration forces, and fatigue.
  • Scene operations management and safety: Scene safety, emergency vehicle operations, transport vehicle emergencies and post-incident procedures, and pre-mission preparation.
  • Communications: Dispatch communications, patient handoff, and crew resource management (CRM).
  • Legal issues: The Emergency Medical Treatment and Labor Act (EMTALA), legal concepts in patient care, and consent.

What questions look like: A stem might describe a crash on the highway with the ambulance parked downhill from a leaking tanker, or a sending facility that wants to transfer an unstable patient before the receiving hospital has accepted. You pick the safest, most legally sound action.

Domain 2: Resuscitation Principles (40 items)

This is the “ABCs plus” domain. It focuses on assessing and preparing a patient for transport, securing the airway, supporting ventilation and oxygenation, and recognizing and treating shock.

  • Assessment and patient preparation: Physical, trauma, and pain and comfort assessment, and preparing the patient for transport.
  • Airway: Airway assessment and management, rapid sequence induction (RSI), and post-intubation management, including pharmacology such as sedation and analgesia.
  • Ventilation and oxygenation: Invasive (mechanical ventilation modes, settings, troubleshooting) and non-invasive support (CPAP, BiPAP, high-flow oxygen).
  • Shock and resuscitation management: Hypovolemic, obstructive, distributive, and cardiogenic shock.

Study tip: Know the DOPE mnemonic for a deteriorating intubated patient (Displacement, Obstruction, Pneumothorax, Equipment failure) and be able to match each shock type to its hemodynamic profile and first-line treatment.

Domain 3: Patient Conditions and Principles of Management (65 items)

At 43% of the exam, this is the largest domain by far. It blends trauma and medical emergencies into body-system categories, so expect a mix of injury and illness within each system.

  • Neurologic: Traumatic brain injury, spinal cord injury, secondary brain injury, seizure disorders, and ischemic and hemorrhagic stroke.
  • Cardiovascular: Acute coronary syndrome, heart failure, dysrhythmias, aortic abnormalities, mechanical and circulatory support devices, and thoracic trauma.
  • Pulmonary: Restrictive and obstructive airway disease, pulmonary embolism, pulmonary hypertension, pulmonary injury, and chest wall injury.
  • Abdominal: Abdominal compartment syndrome, GI bleeding, hollow and solid organ injuries or conditions, and diaphragmatic injury.
  • Musculoskeletal: Vertebral and pelvic injuries, compartment syndrome, rhabdomyolysis, amputations, extremity injuries, and maxillofacial and neck injuries.
  • Metabolic and endocrine: Diabetic emergencies, neuroendocrine disorders, and thyroid and adrenal disorders.
  • Other systems: Renal; environmental and toxicological emergencies; chemical, electrical, and thermal burns; and hematology and electrolyte imbalances.

What questions look like: Many items ask what to do before or during a long interfacility transfer, such as managing a patient on an intra-aortic balloon pump, controlling blood pressure in an aortic dissection, or preventing secondary brain injury in a patient with TBI.

Domain 4: Special Populations (23 items)

This domain tests how trauma, medical conditions, drugs, and positioning change for patients who don’t fit the standard adult model.

  • Obstetric: Trauma, medical conditions, pharmacological considerations, positioning, and delivery and postpartum care.
  • Neonatal and pediatric: Trauma, medical conditions, pharmacology, positioning, and transport securement devices.
  • Geriatric: Trauma, medical conditions, pharmacology, and positioning.
  • Bariatric: Trauma, medical conditions, pharmacology, and positioning.

Study tip: Positioning appears under every population. Know left lateral uterine displacement for pregnant patients past about 20 weeks, reverse Trendelenburg or ramped positioning for bariatric airway management, and appropriate securement for infants and children in the ambulance.

How Should You Use the CTRN Blueprint to Build a Study Plan?

Treat the outline as your master checklist. Here’s a practical way to turn it into a plan:

  1. Take a baseline. Answer a mixed set of practice questions before you start reviewing so you know where you stand in each domain.
  2. Weight your time. Domains 2 and 3 together account for 105 of the 150 scored items, or 70% of the exam. Give them most of your hours.
  3. Don’t skip the smaller domains. Domains 1 and 4 still add up to 45 scored items. Nurses who come from the ICU often underestimate the transport operations and legal content.
  4. Map every miss to an outline item. When you get a question wrong, note which subtopic it tests, such as “post-intubation management” or “EMTALA.” Patterns show up fast.
  5. Finish with timed, mixed practice. In the final weeks, practice at exam pace so about one minute per question feels normal.

What Official Resources Should You Use?

Commonly used CTRN study textbooks:

  • Patient Transport: Principles and Practice, 6th Edition (ISBN 978-0443105708)
  • Flight Medical Provider: A Ground and Flight Critical Care Guide (ISBN 979-8218144173)
  • Critical Care Transport, 3rd Edition (ISBN 978-1284263114)

Frequently Asked Questions About the BCEN CTRN Exam

What is the passing score for the CTRN?
BCEN doesn’t publish a single fixed cut score. It uses the modified Angoff method, and the passing score can vary slightly between exam forms. Your score report shows pass or fail, your raw score, and your performance by content area.

How soon will I get my results?
Right away. You see your result at the end of the exam, whether you test at a PSI center or through Live Remote Proctoring.

What happens if I don’t pass?
You must wait 90 days after a failed attempt before retesting, and there is no limit on the number of attempts. BCEN offers a discounted retest fee for up to one year after your exam.

Did the CTRN content outline change recently?
Yes. The 2026 outline replaced the 2022 version. The number of scored items rose from 130 to 150, and the domains dropped from five to four when Trauma and Medical Emergencies were combined into Patient Conditions and Principles of Management.

Are all 175 questions scored?
No. 150 are scored, and 25 are unscored pretest questions that BCEN uses to evaluate items for future exams.

How long is the CTRN certification valid?
Four years. You can recertify by exam or by attesting to 100 continuing education (CE) contact hours.

Start Preparing for the BCEN CTRN Exam With Pocket Prep

Pocket Prep’s BCEN CTRN practice questions give you 720 exam-style questions across all four domains, each with a detailed answer explanation that walks through why the best answer is best. Start with the free questions to see where you stand, then use Weakest Subject quizzes to target your lowest-scoring domain and Timed Quiz sessions to build exam-day pacing. With a clear blueprint and steady practice, you can walk into your exam ready.