100+ Free TR-C Practice Questions

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What anatomical landmark is used for surgical cricothyrotomy?

Between the hyoid bone and thyroid cartilage

Between the cricoid cartilage and first tracheal ring

The suprasternal notch

Between the thyroid cartilage and cricoid cartilage (cricothyroid membrane)

to track

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2026 Statistics

Key Facts: TR-C Exam

110

Total Items

100 scored + 10 beta

2 hrs

Exam Time

IBSC

EMR/EMT/AEMT or LEO

Eligibility

IBSC

4 yrs

Cert Validity

Renewable by retest or CE

IBSC TR-C (Certified Tactical Responder) is the non-paramedic tactical EMS credential. 110 items (100 scored + 10 beta), 2 hours. Eligibility: EMR/EMT/AEMT license OR licensed law enforcement officer. Master TCCC/TECC phases (CUF/TFC/TACEVAC), MARCH-PAWS, CAT tourniquet application, hemostatic dressings, needle decompression (5th ICS AAL), and Hartford Consensus THREAT acronym for active shooter response.

Sample TR-C Practice Questions

Try these sample questions to test your TR-C exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1During Care Under Fire (CUF) in a tactical engagement, what is the FIRST priority intervention for a casualty with a life-threatening extremity hemorrhage?

A.Return effective fire and direct/expect the casualty to apply self-aid if able

B.Perform a comprehensive MARCH assessment

C.Establish IV access and begin fluid resuscitation

D.Initiate hypothermia prevention with an HPMK

Explanation: In Care Under Fire, the greatest threat is the active threat itself. Returning effective fire (fire superiority) is the first medical intervention because it prevents additional casualties. The casualty should self-apply a tourniquet if able while responders suppress the threat.

2Which TECC phase is characterized by the responder operating in the warm zone with the threat suppressed but not eliminated?

A.Direct Threat Care

B.Indirect Threat Care

C.Evacuation Care

D.Definitive Care

Explanation: Indirect Threat Care (TECC equivalent of Tactical Field Care) occurs in the warm zone where the threat is suppressed but not fully neutralized. Responders perform a comprehensive MARCH assessment with more interventions than possible under direct fire.

3The MARCH-PAWS algorithm is used in Tactical Field Care. What does the 'M' represent?

A.Mechanism of injury

B.Massive hemorrhage

C.Mental status

D.Monitoring vitals

Explanation: M stands for Massive hemorrhage. It is addressed first because uncontrolled external hemorrhage is the leading cause of preventable death on the battlefield and in tactical environments.

4Where on an extremity should a Combat Application Tourniquet (CAT) be initially placed during Care Under Fire?

A.Two inches above the wound site

B.Directly over the wound

C.High and tight on the extremity, over clothing

D.At the joint nearest the bleeding

Explanation: Per current TCCC guidelines, during Care Under Fire the tourniquet should be placed 'high and tight' on the extremity over clothing, since the exact wound location may be obscured and time is critical. In TFC, it can be reassessed and moved 2-3 inches above the wound if appropriate.

5After applying a tourniquet, what MUST be documented and visible on the casualty?

A.Casualty's name and DOB

B.Time of application

C.Type of weapon used

D.Estimated blood loss

Explanation: The time of tourniquet application must be clearly written on the tourniquet (or casualty's forehead) and documented. This is critical for downstream providers to manage limb ischemia and conversion decisions.

6An extremity hemorrhage continues despite a properly applied tourniquet. What is the next BEST action?

A.Loosen the first tourniquet and reposition

B.Apply a second tourniquet immediately proximal (above) the first

C.Replace with a pressure dressing

D.Elevate the limb and wait 5 minutes

Explanation: If hemorrhage continues despite a properly applied tourniquet, a second tourniquet should be applied side-by-side immediately above (proximal to) the first to occlude collateral circulation. Both should be tightened until bleeding stops.

7Which type of wound is most appropriate for treatment with hemostatic gauze (Combat Gauze) and wound packing?

A.An open mid-thigh hemorrhage amenable to tourniquet

B.A junctional groin wound where a tourniquet cannot be applied

C.A small superficial laceration of the forearm

D.An eye penetrating injury

Explanation: Wound packing with hemostatic gauze is indicated for junctional (groin, axilla, neck) and torso wounds where a tourniquet cannot be effectively applied. The gauze is packed firmly into the wound and held with direct pressure for at least 3 minutes.

8After packing a wound with hemostatic gauze, for how long must firm direct pressure be maintained?

A.30 seconds

B.1 minute

C.At least 3 minutes

D.10 minutes

Explanation: Per TCCC guidelines, direct pressure must be maintained on a hemostatic-packed wound for at least 3 minutes to allow the agent to activate clotting and form a stable clot.

9Tranexamic acid (TXA) for severe trauma hemorrhage should ideally be administered within what time window from injury?

A.30 minutes

B.1 hour

C.3 hours

D.12 hours

Explanation: TXA should be administered within 3 hours of injury for the maximum mortality benefit. Administration after 3 hours has been associated with increased mortality in the CRASH-2 trial and TCCC guidelines.

10What is the standard initial dose of tranexamic acid (TXA) in tactical trauma per TCCC guidelines?

A.100 mg IV slow push

B.500 mg IV bolus

C.1 g IV/IO over 10 minutes

D.5 g IV over 1 hour

Explanation: The standard TCCC dose is 1 gram of TXA IV/IO infused over 10 minutes, followed by a second 1 g dose in 8 hours. Rapid push can cause hypotension.

About the TR-C Exam

IBSC/BCCTPC credential for non-paramedic tactical responders. Designed for EMR/EMT/AEMT-licensed personnel and law enforcement officers serving in tactical EMS roles (LEOs with secondary medic role, RTF — Rescue Task Force operators). Validates tactical casualty care across TCCC/TECC phases (Care Under Fire, Tactical Field Care, TACEVAC), MARCH-PAWS algorithm, hemorrhage control (CAT tourniquets, hemostatic gauze, TXA), tension pneumothorax decompression, tactical operations and triage, and special-scenario response (active shooter, blast, CBRNE).

Questions

110 scored questions

Time Limit

2 hours

Passing Score

Scaled

Exam Fee

Per IBSC (IBSC (BCCTPC))

TR-C Exam Content Outline

25%

Tactical Casualty Care (TCCC/TECC)

Care Under Fire (Hot Zone), Tactical Field Care (Warm Zone), TACEVAC (Cool Zone)

20%

Hemorrhage Control

CAT tourniquet, junctional TQs (CRoC, JETT, SAM), hemostatic gauze (Combat Gauze, Celox), TXA 1g IV/IO ≤3h

15%

Airway, Breathing

NPA, surgical cric, needle decompression 5th ICS AAL, vented chest seal (Hyfin, HALO)

10%

Circulation, Shock, Hypothermia

Permissive hypotension SBP 80-90, IO humeral preferred, HPMK hypothermia kit

15%

Tactical Operations & Communications

SALT triage, MIST report, 9-line MEDEVAC, RTF (Rescue Task Force) integration

15%

Special Scenarios

Active shooter (Hartford Consensus THREAT), blast injury patterns, CBRNE, K9

How to Pass the TR-C Exam

What You Need to Know

Passing score: Scaled
Exam length: 110 questions
Time limit: 2 hours
Exam fee: Per IBSC

Keys to Passing

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

TR-C Study Tips from Top Performers

1Master CAT tourniquet: high and tight on extremity, second TQ proximal if needed, document application time on TQ + chart

2Memorize MARCH-PAWS algorithm — same memorable order saves seconds in chaos

3Know needle decompression: 5th ICS anterior axillary OR 2nd ICS midclavicular, 14g 3.25-inch needle, listen for rush of air

4Apply TXA 1 g IV/IO within 3 hours of injury for severe hemorrhage; second 1 g over 8 hours infusion

5Understand Hartford Consensus THREAT: Threat suppression, Hemorrhage control, Rapid Extraction, Assessment, Transport

Frequently Asked Questions

What's the difference between TR-C and TP-C?

Both are IBSC tactical EMS credentials. TR-C (Certified Tactical Responder) is for non-paramedic providers — EMR/EMT/AEMT-licensed personnel and law enforcement officers serving in tactical roles. TP-C (Certified Tactical Paramedic) is for paramedic-level providers. Both share TCCC/TECC fundamentals but TP-C requires paramedic-scope skills (advanced airway, pharmacology, advanced cardiac care).

What are TCCC/TECC phases?

Three phases: Care Under Fire (CUF, Hot Zone) — return fire, move to cover, immediate life-threatening hemorrhage with tourniquet only; Tactical Field Care (TFC, Warm Zone) — comprehensive MARCH assessment, additional interventions, basic airway/breathing/circulation; Tactical Evacuation Care (TACEVAC, Cool Zone) — definitive interventions, fluid resuscitation, evacuation prep. TCCC = military framework; TECC = civilian adaptation.

What is MARCH-PAWS?

Tactical assessment algorithm: Massive hemorrhage (tourniquets, hemostatic dressings) → Airway (NPA, cricothyrotomy) → Respirations (decompress tension PTX, chest seal) → Circulation (IV/IO access, permissive hypotension, TXA) → Hypothermia/Head injury (HPMK, prevent secondary injury). Then PAWS extension: Pain (ketamine, fentanyl), Antibiotics (per protocol), Wound packing (additional), Splints/Stabilization.

How should I study for TR-C?

Plan 40-60 hours over 6-8 weeks. Focus heaviest on TCCC/TECC (25%) and Hemorrhage Control (20%) — together nearly half the exam. Master CAT tourniquet application (high and tight, document time), needle decompression site (5th ICS anterior axillary OR 2nd ICS midclavicular, 14g 3.25-inch), TXA timing (within 3 hours), and the Hartford Consensus THREAT acronym for active shooter response.