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Which of the following best describes the three phases of Tactical Combat Casualty Care (TCCC)?

Triage, Treatment, Transport

Care Under Fire, Tactical Field Care, Tactical Evacuation Care

Primary Survey, Secondary Survey, Definitive Care

Hot Zone, Warm Zone, Cold Zone Care

to track

2026 Statistics

Key Facts: TP-C Exam

135

Total Questions

IBSC

125

Scored Items

IBSC

2.5h

Exam Time

IBSC

$285

Affiliate Fee

IBSC 2026

4 years

Certification Valid

IBSC recertification cycle

The TP-C exam contains 135 questions (125 scored) administered over 2.5 hours. Content focuses on Tactical Combat Casualty Care (TCCC) and Tactical Emergency Casualty Care (TECC) doctrine, the MARCH-PAWS algorithm, three phases of care (Care Under Fire, Tactical Field Care, Tactical Evacuation Care), CBRN agents, and Rescue Task Force operations. Designed for experienced paramedics serving on civilian SWAT teams, federal tactical units, and law enforcement medical support roles.

Sample TP-C Practice Questions

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1Which of the following best describes the three phases of Tactical Combat Casualty Care (TCCC)?

A.Triage, Treatment, Transport

B.Care Under Fire, Tactical Field Care, Tactical Evacuation Care

C.Primary Survey, Secondary Survey, Definitive Care

D.Hot Zone, Warm Zone, Cold Zone Care

Explanation: TCCC is built around three phases of care that match the level of threat: Care Under Fire (active threat, fire superiority is paramount, only major hemorrhage control is performed), Tactical Field Care (threat suppressed, more comprehensive assessment using MARCH-PAWS), and Tactical Evacuation Care (during transport to higher level of care). TECC mirrors this for civilian high-threat environments with corresponding direct-threat, indirect-threat, and evacuation phases.

2What does the 'M' in the MARCH-PAWS algorithm stand for?

A.Mechanism of injury

B.Mental status

C.Massive hemorrhage

D.Medication review

Explanation: In MARCH-PAWS, 'M' stands for Massive hemorrhage. It is intentionally placed first because uncontrolled extremity hemorrhage is the single most common preventable cause of death on the battlefield, and rapid tourniquet or hemostatic application saves lives in seconds. The remaining priorities are Airway, Respiration, Circulation, Hypothermia/Head, then Pain, Antibiotics, Wounds, Splinting.

3During the Care Under Fire phase, what is the only medical intervention typically performed before moving to cover?

A.Full airway management with surgical cricothyrotomy

B.Application of a tourniquet for life-threatening extremity hemorrhage

C.Needle decompression of a tension pneumothorax

D.IV fluid resuscitation

Explanation: Care Under Fire dictates that fire superiority and movement to cover are the priority. The single tactical medicine action that may be performed in this phase is rapid application of a tourniquet (high and tight over the uniform) for life-threatening extremity hemorrhage. Airway, respiration, and other interventions are deferred to Tactical Field Care once the threat is controlled.

4What does TECC stand for, and how does it differ from TCCC?

A.Tactical Emergency Casualty Care - civilian adaptation of TCCC for high-threat civilian incidents

B.Tactical Emergency Combat Care - identical to TCCC but for federal teams only

C.Trauma Emergency Critical Care - hospital-based critical care

D.Threat Evaluation and Combat Casualty - threat assessment doctrine

Explanation: Tactical Emergency Casualty Care (TECC) is the civilian adaptation of TCCC published by the Committee for Tactical Emergency Casualty Care (C-TECC). It mirrors TCCC's phased approach (Direct Threat Care, Indirect Threat Care, Evacuation Care) but is adapted for civilian populations including pediatrics, geriatrics, special-needs patients, and bystanders, and accommodates civilian scope-of-practice and protocol differences.

5Which TECC phase corresponds to the TCCC phase of Tactical Field Care?

A.Direct Threat Care

B.Indirect Threat Care

C.Evacuation Care

D.Definitive Care

Explanation: TECC uses the terms Direct Threat Care (TCCC's Care Under Fire), Indirect Threat Care (TCCC's Tactical Field Care), and Evacuation Care (TCCC's Tactical Evacuation Care). The Indirect Threat phase represents a setting where the immediate threat has been mitigated or moved away, allowing more thorough MARCH-PAWS assessment and interventions while still acknowledging ongoing scene risk.

6In the MARCH-PAWS algorithm, what does the 'C' represent?

A.Cervical spine immobilization

B.Capnography

C.Circulation (perfusion, IV/IO access, TXA, pelvic stabilization)

D.Combat lifesaver status

Explanation: In MARCH-PAWS, 'C' stands for Circulation. This step assesses perfusion (mental status, pulse character, skin signs), establishes IV or IO access, considers TXA within 3 hours of injury for high hemorrhage risk, and addresses pelvic stabilization with a binder if pelvic fracture is suspected.

7What is the purpose of the 'H' in MARCH-PAWS?

A.Hyperventilation for head injury

B.Hypothermia prevention and Head injury management

C.Hemorrhage reassessment

D.Helmet removal

Explanation: The 'H' in MARCH-PAWS represents Hypothermia prevention and Head injury management. Trauma triggers the lethal triad (hypothermia, acidosis, coagulopathy), so even in hot climates trauma patients must be insulated using a HPMK (Hypothermia Prevention and Management Kit), Ranger blanket, or commercial wrap. Head injury management includes positioning, GCS monitoring, and avoiding hypotension/hypoxia.

8Which of the following best describes a Casualty Collection Point (CCP)?

A.A predetermined location where wounded are gathered for triage, treatment, and prepared for evacuation

B.The exact location where a casualty was injured

C.An ambulance staging area outside the inner perimeter

D.Only the helicopter landing zone

Explanation: A Casualty Collection Point (CCP) is a pre-identified, relatively secure location where casualties are gathered to receive Tactical Field Care, undergo triage, and be prepared for movement to evacuation assets. Selection considers cover/concealment, accessibility, and proximity to the evacuation route. CCPs may move as the operation evolves.

9A SWAT operator is wounded by gunfire to the upper thigh during dynamic entry. Hostiles are still actively engaging the team. What is the operator's first priority?

A.Apply a pressure dressing while exposed to fire

B.Move to cover and return fire if able; self-apply a tourniquet if hemorrhage is life-threatening

C.Wait for the medic to crawl forward and treat them

D.Begin IV fluid resuscitation immediately

Explanation: Under Care Under Fire / Direct Threat Care, the wounded operator's first priority is to keep fighting and move to cover. Self-aid is encouraged: if a major extremity bleed is present, the operator self-applies their CAT or SOFTT-W tourniquet. Medical care that requires exposure is deferred until the threat is suppressed or the casualty is moved to cover.

10What is the recommended sequence of MARCH-PAWS?

A.Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head, Pain, Antibiotics, Wounds, Splinting

B.Mental status, Airway, Respiration, Circulation, Hemorrhage, Pain, Antibiotics, Wounds, Splinting

C.Mechanism, Assessment, Resuscitation, Communication, Hypothermia, Pain, Airway, Wounds, Splinting

D.Massive hemorrhage, Airway, Respiration, Cervical spine, Hypothermia, Position, Antibiotics, Wounds, Splinting

Explanation: The current TCCC MARCH-PAWS sequence is: M-Massive hemorrhage, A-Airway, R-Respiration, C-Circulation, H-Hypothermia/Head, P-Pain, A-Antibiotics, W-Wounds, S-Splinting. The order reflects the most preventable causes of battlefield death first (hemorrhage, airway obstruction, tension pneumothorax) and then secondary considerations.

About the TP-C Exam

The TP-C (Certified Tactical Paramedic) validates advanced knowledge of tactical emergency medicine for paramedics supporting SWAT, federal tactical teams, and law enforcement special operations. The exam emphasizes the TCCC/TECC framework with the MARCH-PAWS algorithm, massive hemorrhage control with tourniquets and hemostatic agents, tactical airway management including surgical cricothyrotomy, tension pneumothorax decompression, special operations considerations (CBRN, blast injury, hostage rescue), and communication standards (MIST, 9-line MEDEVAC). The exam consists of 135 items (125 scored + 10 unscored) over 2.5 hours.

Questions

135 scored questions

Time Limit

2.5 hours

Passing Score

Pass/fail (IBSC cut-score methodology)

Exam Fee

$285 affiliate / $385 non-member (IBSC (International Board of Specialty Certification))

TP-C Exam Content Outline

25%

TCCC/TECC Framework

Three phases of tactical care (Care Under Fire, Tactical Field Care, Tactical Evacuation Care), MARCH-PAWS algorithm, casualty collection points, and self-aid/buddy aid principles

15%

Massive Hemorrhage Control

CAT and SOFTT-W tourniquet placement, Combat Gauze hemostatic packing, junctional tourniquets (SAM Junctional, JETT), pelvic binders, pressure dressings, and tranexamic acid (TXA)

10%

Tactical Airway Management

Surgical cricothyrotomy (scalpel-Bougie-tube), nasopharyngeal airways, supraglottic devices, RSI in austere settings, and position-of-comfort airway management

Tension Pneumothorax & Chest Trauma

Needle decompression sites (5th ICS AAL or 2nd ICS MCL), 14-gauge 3.25-inch needle, finger thoracostomy, and vented chest seal application for sucking chest wounds

10%

Tactical Environment Medicine

Heat illness management, hypothermia prevention (HPMK kit, Ranger blanket), drowning, blast injury phases (primary through quaternary), and gunshot wound mechanics

10%

Special Operations & CBRN

Nerve agent treatment (DuoDote: atropine + 2-PAM), cyanide (Cyanokit), vesicant exposure, biological agent recognition, radiation injury, and TASER/less-lethal injuries

10%

Special Teams & Missions

SWAT team integration, Rescue Task Force (RTF) for active shooter, dynamic vs deliberate operations, hostage rescue medical support, K9 medic awareness, and medical threat assessment

Communication & Mission Planning

ICS structure, SALUTE/SMEAC reports, 9-line MEDEVAC, MIST handoff report, and after-action review (AAR) processes

Equipment & Load-out

IFAK and M-FAK contents, breakaway pouches, vented chest seals, hemostatic gauze, decompression needles, and field drug storage considerations

Legal, Ethical & Operational Psychology

Rules of engagement (ROE) and patient care, scope of practice in tactical environments, post-incident stress and peer support, and ethical decision-making under threat

How to Pass the TP-C Exam

What You Need to Know

Passing score: Pass/fail (IBSC cut-score methodology)
Exam length: 135 questions
Time limit: 2.5 hours
Exam fee: $285 affiliate / $385 non-member

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

TP-C Study Tips from Top Performers

1Memorize MARCH-PAWS in order and the priorities of each phase of care

2Drill tourniquet placement (CAT/SOFTT-W) - high and tight 2-3 inches above wound, time-marked

3Know decompression site options - 5th ICS AAL or 2nd ICS MCL with 14g 3.25-inch needle

4Memorize CBRN antidotes - DuoDote (atropine 2 mg + 2-PAM 600 mg), Cyanokit (hydroxocobalamin 5 g IV)

5Master Care Under Fire vs Tactical Field Care vs TACEVAC priorities

6Practice MIST and 9-line MEDEVAC report formats until automatic

7Review Rescue Task Force concepts for active shooter / hostile MCI response

8Study blast injury physics (primary, secondary, tertiary, quaternary) and gunshot wound mechanics

Frequently Asked Questions

What is the TP-C exam?

The TP-C (Certified Tactical Paramedic) is a specialty certification offered by IBSC (International Board of Specialty Certification) that validates advanced knowledge of tactical emergency medicine for paramedics supporting SWAT teams, federal tactical units, and law enforcement special operations.

How many questions are on the TP-C exam?

The TP-C exam contains 135 total questions: 125 scored items and 10 unscored pretest items. You have 150 minutes (2.5 hours) to complete the computer-based exam at Prometric or via IBSC Live Remote Proctoring.

What is the TP-C passing score?

IBSC uses a pass/fail scoring methodology with cut scores set by content experts. Score reports are pass/fail, with diagnostic feedback provided for unsuccessful attempts. The exam tests entry-level competence for tactical paramedic practice.

What are the TP-C eligibility requirements?

Candidates must hold a current, unrestricted paramedic license. IBSC recommends candidates have experience supporting tactical operations, SWAT, or law enforcement special operations and prior completion of a recognized tactical medicine course (TCCC, TECC, or equivalent).

What content areas are covered on the TP-C exam?

The TP-C exam covers TCCC/TECC framework (~25%), massive hemorrhage control (~15%), tactical airway management (~10%), tension pneumothorax management (~5%), tactical environment medicine (~10%), CBRN and special operations (~10%), special teams (~10%), communication (~5%), equipment (~5%), and legal/ethical considerations (~5%).

How long is TP-C certification valid?

TP-C certification is valid for 4 years. Recertification can be achieved through approved continuing education or by retaking the exam. IBSC requires ongoing professional development to maintain certification.

How should I prepare for the TP-C exam?

Master the current Committee on TCCC guidelines and the MARCH-PAWS algorithm. Prioritize hemorrhage control (tourniquet placement and hemostatic packing), tactical airway decisions, and the three phases of care. Review CBRN antidotes (DuoDote, Cyanokit), Rescue Task Force operations, and 9-line MEDEVAC. Plan for 2-4 months of dedicated study, supplemented with live tactical medicine training.