If you care for ventilated, drip-dependent, or otherwise unstable patients between facilities, the Certified Critical Care Paramedic (CCP-C)® credential from the International Board of Specialty Certification (IBSC) shows your skills go well beyond entry-level paramedicine. The exam covers a lot of ground, from ventilator management and hemodynamics to obstetric emergencies and transport safety, so it’s normal to feel unsure where to start.

The good news is that IBSC tells you exactly what it expects, and a study plan built around that blueprint makes a first-try pass very achievable.

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

What Is the IBSC CCP-C Exam?

The CCP-C is IBSC’s specialty certification for critical care paramedics. According to the IBSC critical care paramedic page, the exam is intended for “master-level paramedics who have experience working as a critical care paramedic” in the prehospital, inter-hospital, and hospital environments.

It is not a repeat of your paramedic licensing exam. IBSC says the exam draws on the full range of transport medicine mission profiles, not just the transports your own program runs, and expects competency in ACLS, PALS, NALS, and BTLS or ITLS.

What Is the CCP-C Exam Format?

Here is the exam at a glance, based on the IBSC critical care paramedic page and the IBSC Exam FAQs:

  • Questions: 135 multiple-choice questions.
  • Scored vs. unscored: 110 scored questions and 25 unscored pilot items. The pilot items aren’t marked, so give every question your full effort.
  • Time: 2.5 hours (150 minutes).
  • Delivery: Computer-based testing at Prometric test centers, Live Remote Proctor (LRP) testing from home, or IBSC onsite options such as paper-and-pencil and Mobile Exam Delivery sessions.
  • Passing score: 68 correct answers out of the 110 scored questions, or about 62%.
  • 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 a little over a minute per question. That’s plenty for a recall item, but multistep questions (a ventilator adjustment, an oxygen cylinder calculation, or an IABP timing problem) take longer, so bank time on the quick ones.

What Content Outline Does the CCP-C Exam Use?

The exam is built from the CCP-C Detailed Content Outline, and the CCP-C Candidate Handbook (April 2026) covers testing policies. Pocket Prep’s current CCP-C content aligns with this exam version.

The outline divides the exam into five domains and lists how many questions come from each:

  • Transport and Safety: 15 questions (12%)
  • Airway, Anesthesia, and Analgesics: 30 questions (24%)
  • Medical: 30 questions (24%)
  • Trauma/Burn Patient: 25 questions (20%)
  • Special Populations: 25 questions (20%)

One detail can be confusing. The outline’s counts add up to 125 questions, but IBSC’s current exam page describes 110 scored questions plus 25 unscored pilot items. The outline document carries a 2016 copyright, so treat its numbers as the relative weight of each domain rather than an exact count of the scored items you’ll see. Either way, the picture is the same: airway and medical content make up about half the exam, and transport and safety is the smallest domain.

Domain 1: Transport and Safety (15 Questions, 12%)

This domain is about keeping the crew, the patient, and everyone else on board safe. It tests judgment and teamwork more than clinical skill.

  • Practicing crew resource management and using risk assessment matrices.
  • Taking part in mission safety decisions, such as go/no-go calls.
  • Managing safety equipment in transport, such as personnel restraints and equipment harnesses.
  • Keeping all passengers safe, including specialty teams, family members, law enforcement, and observers.
  • Identifying transport stressors (thermal, humidity, noise, vibration, and fatigue) and correcting those that affect your patient.

Study tip: Know why each safety rule exists. Questions often pit crew safety against clinical urgency.

Domain 2: Airway, Anesthesia, and Analgesics (30 Questions, 24%)

The outline asks you to develop and then implement two kinds of plans that fit the patient in front of you:

  • An anesthesia plan that covers analgesia, sedation, and paralytic agents plus a full airway strategy (first attempt, backup devices, and a surgical option).
  • A mechanical ventilation and oxygenation strategy, such as choosing a mode, tidal volume, rate, PEEP, and FiO2, then adjusting to blood gases and capnography.

“Context specific” is the key phrase: the right drug or vent setting for a hypotensive septic patient differs from the right choice for a head injury or severe asthma.

Domain 3: Medical (30 Questions, 24%)

The Medical domain is split into five patient groups. Each follows the same pattern: assess the patient well enough to build a physiology-based problem list, start critical interventions, adapt the care plan using lab values, monitoring equipment, and diagnostics, and manage drugs and complications.

  • General medical patient: Shock, GI/GU problems, metabolic and endocrine disorders, immunology, sepsis, and infectious disease, plus managing blood products.
  • Cardiac patient: Acute coronary syndrome, heart failure, cardiogenic shock, primary arrhythmias, hypertensive crisis, hemodynamic instability, chronic cardiac conditions, vascular disorders such as AAA and thoracic dissection, and infectious cardiac disease such as pericarditis and endocarditis. Monitoring includes multi-lead ECG and hemodynamic monitoring.
  • Neurologic patient: Altered mental status, seizures, cerebral ischemia and hemorrhage, head and spinal cord injuries, and chronic neurologic conditions, including ICP monitoring and blood products.
  • Respiratory patient: Conditions such as ARDS, spontaneous pneumothorax, and pneumonia, with chest radiography, VQ scans, and CT as diagnostics.
  • Toxic exposure and environmental patient: Environmental exposures, chemical, biological, radiological, nuclear, and explosive (CBRNE) events, dive and altitude illnesses, and bad reactions to plants and animals.

What questions look like: Expect to interpret a lab panel, a monitor reading, or an imaging result and decide how it changes your plan.

Domain 4: Trauma/Burn Patient (25 Questions, 20%)

This domain follows the same assess, intervene, and adapt pattern for injured patients.

  • Managing life-threatening isolated trauma and life-threatening multi-system trauma.
  • Managing patients with burns.
  • Adapting care based on lab values, invasive line monitoring and drains, and imaging such as chest X-ray, ultrasound, and CT.
  • Managing pharmacologic agents, complications, and blood products.

Study tip: Be comfortable with hemorrhage control, transfusion decisions, and burn fluid resuscitation, since these tie several tasks together.

Domain 5: Special Populations (25 Questions, 20%)

This domain covers patients whose physiology changes the usual rules. It includes five groups:

  • Obstetric patients: Pregnancy-induced hypertension, abnormal (hypertonic or tetanic) contractions, cord prolapse, and placental abruption, plus fetal heart tone and tocodynamometer monitoring and managing fetal distress.
  • Neonatal, pediatric, bariatric, and geriatric patients: The same assess, intervene, and adapt tasks, plus drugs and complications. All but neonatal also list blood products.

Study tip: If your service rarely transports OB, neonatal, or bariatric patients, give this domain extra time. It carries as much weight as trauma.

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

Treat the outline as your master checklist, then work through these steps:

  1. Take a baseline. Answer a mixed set of questions before you open a book.
  2. Map every miss. Tag each missed question to one of the five domains and, where it applies, the specific patient group or task (for example, Medical: cardiac patient, adapting the plan to hemodynamic monitoring).
  3. Prioritize big and weak. Airway, Anesthesia, and Analgesics and Medical together make up about half the exam, so start there if you’re weak in either subject. Then work through Trauma/Burn and Special Populations, and finish with Transport and Safety.
  4. Close your practice gaps. If your program rarely transports obstetric, neonatal, bariatric, or balloon pump patients, study those topics on purpose. The exam covers every mission profile.
  5. Use the outline’s pattern. Nearly every patient group repeats the same tasks: assess, build a problem list, intervene, adapt to labs, monitoring, and diagnostics, then manage drugs, complications, and blood products. Practice walking each condition through those steps.
  6. Finish with timed, mixed practice. Build toward about a minute per question and practice calculations until they’re automatic.

What Official CCP-C Resources Should You Use?

Commonly used CCP-C 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)
  • Transport of the Critical Care Patient, 1st Edition (ISBN 978-0323082723)
  • Critical Care Transport, 3rd Edition (ISBN 978-1284263114)

Frequently Asked Questions About the IBSC CCP-C Exam

What score do I need to pass the CCP-C exam?
You need 68 correct answers out of the 110 scored questions. IBSC doesn’t release exact scores. If you don’t pass, your score report shows your relative strengths and weaknesses by content area.

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

Can I retake the CCP-C exam if I fail?
Yes. You can attempt the same exam up to three times in total, with at least 30 calendar days between attempts.

How much does the CCP-C exam cost?
IBSC lists the CCP-C at $285 for IBSC Affiliate Members and $385 for non-members. Rescheduling within 30 days of your test date costs $100, and exam fees are non-refundable. See the IBSC exam fees page for current pricing.

How long is the CCP-C valid?
Four years. You can renew by retaking the exam or by submitting 100 approved continuing education credits.

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

Pocket Prep’s IBSC CCP-C exam prep includes 630 practice questions with detailed explanations and two full-length mock exams, so you can rehearse the pace of test day. Use the Weakest Subject quiz to identify gaps across airway, medical, trauma, special populations, and transport safety, then use the Missed Questions quiz to close them. With a steady plan, you can walk into the testing center ready to pass on your first try.