This free FP-C study guide walks through the highest-yield content the Certified Flight Paramedic exam tests, organized to mirror the ten official domains of the IBSC Detailed Content Outline.[1] It teaches the advanced critical care you already know — through the lens of the air medical and critical-care transport environment.
It is interactive, not a wall of text: every module has worked transport scenarios, labeled diagrams, dose and lab tables, and built-in flashcards. The thing that makes the FP-C different from a paramedic certification is the flight physiology — the , the , altitude effects, and aircraft safety — so we teach those first and weave them through every system.
Read it module by module, then round out your prep with our practice questions and flashcards. If you are a flight nurse rather than a paramedic, see our companion CFRN study guide — the same transport medicine at the BCEN nurse scope. The FP-C certifies the paramedic who can deliver advanced critical care safely in the back of a moving aircraft.
FP-C Exam Snapshot
| Detail | FP-C exam |
|---|---|
| Items | 135 multiple-choice (110 scored + 25 unscored pilot) |
| Time limit | 2.5 hours (150 minutes) |
| Passing standard | 73 of 110 scored items correct (criterion-referenced) |
| Format | Computer-based at Prometric; pass/fail |
| Eligibility | Current unrestricted paramedic license; ~3 yrs critical-care/transport experience recommended, not required |
| Exam fee | ~385 non-member (dated anchor — verify on ibscertifications.org) |
| Certifying body | International Board of Specialty Certification (IBSC) |
| Certification period | 4 years; renew by 100 CE credits (≥75 clinical) or by exam |
| Credential | Certified Flight Paramedic (FP-C) |
builds the FP-C around ten domains. Airway, Anesthesia & Analgesics (15%) is the single largest, followed by Cardiac and Medical Emergencies (13% each) and Trauma/Burn (12%).
To keep the material coherent we teach the ten official domains in six study modules — for example, the two flight-specific domains (Safety and Transport, Flight Physiology) are taught together in Module 1. Budget your study toward the heaviest domains, but never skip the flight physiology — it is unique to this credential.[1]
Percentages are the share of the 110 scored items and are rounded, so they may not sum to exactly 100. The order of domains in the IBSC outline does not reflect importance.[1]
How the FP-C Is Built: the IBSC Blueprint
The FP-C is built from a role-delineation (practice-analysis) study of what flight and critical-care transport paramedics actually do, which IBSC turns into the Detailed Content Outline. Every scored item maps to one of the ten domains above. The exam is criterion-referenced: there is no curve — you must answer 73 of the 110 scored items correctly.[1]
What sets the FP-C apart from an entry-level paramedic exam is that it tests advanced critical-care judgment plus the physics and logistics of moving a critically ill patient by air. A STEMI is still a STEMI — but now the cabin is loud, cold, low-pressure, and vibrating, and you are often the most experienced clinician on board. Keep that frame on every question: what does altitude, the environment, and the transport timeline add?
Safety, Transport & Flight Physiology
This module teaches the two flight-specific IBSC domains together: Safety and Transport (9 items, 8%) and Flight Physiology (7 items, 6%).[1] They are the heart of what makes you a flight paramedic rather than a ground medic. Master the and the four — they appear here and reappear inside every other domain.
Aircraft Operations & Scene Safety
Safety is always the first priority. A helicopter landing zone should be roughly 100 × 100 ft, level, firm, and free of obstructions, wires, and loose debris, with all hazards communicated to the pilot.
Approach a rotor-wing aircraft from the front, in the pilot’s view, never from the rear (the tail rotor) or the uphill side, and keep all equipment low. Understand density altitude — hot, high, humid air thins the air and reduces available lift precisely when the payload is heaviest, shrinking the takeoff safety margin. Know emergency procedures (fire, decompression, inadvertent IMC) and survival techniques.
CRM, Risk Assessment & Personal Wellness
flattens the authority gradient so any crew member can voice a safety concern in real time — the opposite of a newer medic staying silent about a hazard out of intimidation. It pairs with a verbal team risk assessment before every mission and with personal-readiness tools: the checklist for fitness for duty and the DEATH mnemonic for self-imposed stressors (Drugs, Exhaustion, Alcohol, Tobacco, Hypoglycemia/Hypoxia). Closed-loop, read-back communication over cabin noise prevents lost information.[3]
The Gas Laws of Flight
Several gas laws govern what happens to a patient as the aircraft changes altitude. () is the single highest-yield: at a constant temperature, pressure and volume are inversely related, so as the aircraft climbs and ambient pressure falls, trapped gas expands. A pneumothorax, bowel gas, sinus and middle-ear air, air splints, an cuff, and an IABP balloon all enlarge.[3]
() explains altitude hypoxia: oxygen is still 21% of the air, but as total barometric pressure falls, the partial pressure of oxygen falls with it, so less oxygen is driven into the blood. () says dissolved gas is proportional to its partial pressure — as pressure falls, dissolved nitrogen comes out of solution, the mechanism of decompression sickness.[3]
Hypoxia, Stressors & Altitude Injuries
The FP-C tests the four classifications of hypoxia cold. Anticipate the falsely reassuring SpO₂ in — carbon monoxide binds hemoglobin with ~200–250× the affinity of oxygen, so the patient is critically hypoxic while the pulse oximeter reads high.[7] (cyanide, hydrogen sulfide) means the cells cannot use the oxygen at all.
The transport environment also imposes the recognized stressors of flight — hypoxia, barometric (dysbarism) changes, thermal changes (roughly a 2 °C drop per 1,000 ft, feeding the), decreased humidity, noise, vibration, fatigue, gravitational (G) forces, spatial disorientation, and flicker vertigo. Positive Gz forces pool blood toward the feet, reducing cerebral and retinal perfusion. Know the , which shortens sharply with altitude after a sudden loss of cabin oxygen.[3]
Checkpoint · Safety, Transport & Flight Physiology
Question 1 of 10
Crew resource management in air medical transport is best described as which of the following?
Airway, Anesthesia & Analgesics
Airway is the largest single domain at 17 items (15%).[1] It covers airway assessment, rapid sequence intubation, the failed/surgical airway, RSI pharmacology, mechanical ventilation, and capnography. This is where the flight paramedic’s advanced skill set lives, performed without an anesthesiologist to call.
Airway Assessment & the Difficult Airway
Predict the difficult airway before you commit. Use the LEMON assessment (Look, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility) and always have a rescue plan.
When the laryngoscopic view is poor, a bougie can be passed under the epiglottis (Grade III view) and the tube railroaded over it, and the BURP maneuver (backward, upward, rightward pressure on the thyroid cartilage) brings an anterior glottis into view. Video laryngoscopy sees around the airway curvature. Be ready for a surgical airway (cricothyrotomy) when you cannot intubate or oxygenate.[8]
Rapid Sequence Intubation (the 7 P’s)
follows the — a memorized, ordered sequence that prevents missed steps under pressure. Prepare with a SOAP-ME check, with apneic oxygenation to buy desaturation time, induce and paralyze in rapid succession with minimal positive-pressure ventilation (to limit gastric insufflation and aspiration), intubate, and confirm with waveform — the gold standard in a moving, noisy cabin where breath sounds are unreliable.[8]
SOAP-ME: suction, oxygen, airway gear, pharmacology, monitors, end-tidal CO₂; assess for a difficult airway (LEMON) and plan a rescue.
3 min of 100% O₂ (or 8 vital-capacity breaths) + apneic oxygenation (nasal cannula) to extend the safe apnea time.
Optional agents to blunt the response — fentanyl for the sympathetic surge in dissection/ICP; optimize hemodynamics first.
Push an induction agent (ketamine, etomidate) THEN a paralytic (succinylcholine or rocuronium) in rapid succession.
Sniffing position / ear-to-sternal-notch (ramp the obese patient); maintain in-line stabilization in trauma.
Intubate; CONFIRM with waveform capnography (the gold standard), bilateral breath sounds, and chest rise.
Secure the tube, set the ventilator, start analgesia + sedation, and recheck cuff pressure with altitude (Boyle).
RSI Pharmacology
Match the agent to the patient. supports blood pressure and bronchodilates (good for shock or asthma); is hemodynamically stable but can transiently suppress adrenal cortisol. For paralysis, has the fastest onset but is contraindicated in major burns or crush injury more than ~24–72 hours old, denervating disease, prolonged immobilization, and hyperkalemia (it triggers a lethal potassium efflux) — use instead, which is reversible with .[8]
| Drug | Class / role | Key transport point |
|---|---|---|
| Ketamine | Induction (dissociative) | Supports BP, bronchodilates; good for shock/asthma |
| Etomidate | Induction | Hemodynamically stable; transient adrenal suppression (debated in sepsis) |
| Succinylcholine | Depolarizing paralytic | Fastest onset; AVOID in burns/crush >24–72 h, denervation, hyperkalemia |
| Rocuronium | Nondepolarizing paralytic | No K⁺ shift; longer duration — reversible with sugammadex; pair with sedation |
| Fentanyl | Analgesia / pretreatment | Blunts the sympathetic surge (dissection, ICP); watch for hypotension |
| Ketamine (post-intubation) | Analgosedation | Maintains analgesia + sedation without dropping BP |
Mechanical Ventilation & Capnography
Set the ventilator for the pathology. Use lung-protective low tidal volumes (~6 mL/kg ideal body weight) in , titrate to oxygenation, and avoid breath-stacking in obstructive disease (asthma, COPD) by allowing a longer expiratory time.
Grade oxygenation impairment with the (≤100 is severe ARDS). guides ventilation continuously — a sudden loss of waveform means a dislodged or obstructed tube, a circuit disconnect, or arrest.[10]
Checkpoint · Airway, Anesthesia & Analgesics
Question 1 of 10
A flight paramedic preparing for RSI considers giving a small dose of fentanyl a few minutes before induction in a patient with a hypertensive emergency and aortic dissection. What is the rationale for this pretreatment?
Cardiac & Medical Emergencies
This module groups two of the heaviest domains: Cardiac (14 items, 13%) and Medical Emergencies (14 items, 13%) — together over a quarter of the scored exam.[1] The flight paramedic must read a 12-lead instantly, manage shock and circulatory support devices, and stabilize endocrine, septic, and toxicologic emergencies en route to definitive care.
12-Lead Interpretation & ACS
transport is a “time is muscle” mission — give aspirin, manage pain and oxygenation, and move to PCI (door-to-balloon ≤90 min). For an inferior STEMI (II, III, aVF — usually a right coronary artery occlusion), obtain a : right-ventricular involvement makes the patient preload-dependent, so avoid nitroglycerin.[4] Tall R waves with ST depression in V1–V3 suggest a posterior MI — confirm with posterior leads V7–V9. Verify standard calibration (1 mV = 10 mm) before judging amplitudes, and know that a normal QRS is <120 ms.
| Pattern / lead group | Likely territory / meaning | Transport priority |
|---|---|---|
| ST elevation II, III, aVF | Inferior MI (usually RCA); check RV with V4R | Avoid nitroglycerin if RV infarct; support preload |
| Tall R + ST depression V1–V3 | Posterior MI (mirror image) | Confirm with posterior leads V7–V9; treat as STEMI |
| ST elevation V1–V4 | Anteroseptal MI (LAD) | Rapid PCI; watch for pump failure / shock |
| QRS ≥120 ms | Wide complex (BBB or ventricular origin) | Distinguish VT from SVT-with-aberrancy |
| Sgarbossa criteria (with LBBB/paced) | MI may be present despite the conduction defect | Apply the criteria; do not dismiss the LBBB |
Shock, Heart Failure & Mechanical Support
Classify shock fast — hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), and obstructive (tamponade, tension pneumothorax, massive PE) — and treat the cause while keeping the mean arterial pressure at 65 mmHg or higher. Norepinephrine is the first-line vasopressor in most shock states. The flight crew may transport — an IABP (inflates in diastole, deflates in systole), an Impella, an LVAD, or ECMO — and must understand the basic physiology, alarms, and the Boyle’s-law effect of altitude on an air-filled IABP balloon.[10]
Endocrine, Sepsis & Toxicology
In DKA, give IV isotonic fluids first (these patients are profoundly volume-depleted), then an insulin infusion, then potassium — and hold insulin if potassium is below 3.3 mEq/L. Recognize and treat sepsis early — cultures, broad-spectrum antibiotics within the hour, balanced fluids, and norepinephrine to a MAP ≥65 mmHg. In toxicology, support the ABCs and use antidotes where indicated (naloxone for opioids, sodium bicarbonate for TCA overdose, hydroxocobalamin for cyanide). Watch for extravasation when running a vasopressor through a peripheral line.[8]
Lab Values & Blood Products
The FP-C expects fluency with the labs that drive transport decisions — a CBC (hemoglobin, platelets), a coagulation panel (PT/INR, aPTT), a BMP (potassium, sodium, glucose, renal function), an ABG (acid-base, oxygenation), and a cardiac panel (troponin, lactate). In hemorrhage, favor balanced blood products (packed cells, plasma, and platelets in balanced ratios) over large-volume crystalloid, which dilutes clotting factors and worsens the lethal triad.[8]
Checkpoint · Cardiac & Medical Emergencies
Question 1 of 10
A flight paramedic reviews a 12-lead ECG on a chest-pain patient and wants to confirm a normal-duration ventricular conduction before judging any ST changes. In an adult, what is the upper limit of a normal QRS duration?
Neurological & Trauma/Burn
This module groups Neurological (12 items, 11%) and Trauma/Burn (13 items, 12%).[1] The transport theme throughout is preventing secondary injury — protecting the brain and spinal cord, controlling hemorrhage, and breaking the lethal triad — while moving fast to definitive care.
TBI, Stroke & Neuroprotection
In , the enemy is secondary brain injury. Score consciousness with the ; a GCS ≤ 8 generally means secure the airway.
Prevent hypoxia and hypotension (each independently worsens outcome), elevate the head ~30° and keep it midline, maintain normocapnia (avoid routine hyperventilation), and watch for (hypertension with widened pulse pressure, bradycardia, irregular respirations) signaling herniation.[9]
For stroke, establish the last-known-well time and transport to a thrombectomy-capable center — time is brain. Treat status epilepticus (a seizure ≥5 minutes) with a benzodiazepine first.
Trauma & the Lethal Triad
The central trauma concept is the — hypothermia, acidosis, and coagulopathy — which, with hypocalcemia, becomes the trauma diamond. Break it with damage-control resuscitation: , warmed balanced blood products, aggressive warming, calcium replacement, and early . Control hemorrhage first (tourniquets, pelvic binder, hemostatic dressings) and recognize the chest emergencies that altitude worsens — a expands on ascent (Boyle’s law), so decompress then place a chest tube, ideally before flight.[5]
Burns & Fluid Resuscitation
In burns, the airway is the first threat — singed nasal hairs, soot, stridor, or facial burns mean intubate early before edema closes the airway, and suspect carbon-monoxide and cyanide toxicity in enclosed-space fires. Estimate burn size with the and calculate fluids with the — titrated to urine output, keeping the patient warm. Remove constricting rings and jewelry before edema makes them tourniquets, and anticipate escharotomy (along the mid-axial lines) for circumferential burns and abdominal compartment syndrome from over-resuscitation (“fluid creep”).[8]
Give half in the first 8 hours (from the time of the burn, not arrival) and the other half over the next 16 hours.
Titrate to urine output ≈ 0.5 mL/kg/hr in adults (1 mL/kg/hr in children).
Checkpoint · Neurological & Trauma/Burn
Question 1 of 10
A flight paramedic scores a head-injured patient on the Glasgow Coma Scale. The patient opens his eyes only when his trapezius is pinched, makes incomprehensible groaning sounds, and pulls his arm away from the painful stimulus. What is his total GCS score?
Maternal/Fetal, Neonatal & Pediatric
This module groups Maternal Fetal and Neonatal (8 items, 7%) and Pediatric (9 items, 8%).[1] These special populations each carry trauma, medical, pharmacologic, and transport considerations unique to the group — and weight-/length-based dosing that the FP-C drills hard.
Obstetric & Fetal Emergencies
Maternal physiology can mask hemorrhage: the increased blood volume of pregnancy lets a patient lose roughly 30–35% before showing hypotension, so the fetus may be in distress while maternal vitals still look normal. After ~20 weeks, place the patient in (or manually displace the uterus) to relieve aortocaval compression.
The best fetal treatment is aggressive maternal resuscitation — treat the mother first.[5] Recognize preeclampsia/eclampsia (treat seizures with magnesium), placental abruption, cord prolapse, and PROM, and be ready to manage an emergency delivery in flight.
Neonatal Resuscitation & APGAR
In the newborn, ventilation is the priority (unlike adults, neonates arrest from respiratory failure). Follow the NRP flow; the describes condition but does not direct resuscitation. Begin positive-pressure ventilation if the newborn is apneic or the heart rate is below 100, add compressions at a 3:1 ratio only if the heart rate stays below 60 despite effective ventilation, and give epinephrine (preferably by umbilical venous catheter) if it remains below 60.[6]
In the first 30 s: dry, place under a warmer or skin-to-skin, position the airway, and clear secretions only if needed.
If apneic or HR <100, begin positive-pressure ventilation (PPV) — ventilation is the priority in neonates.
If the HR is not rising, correct ventilation with MR. SOPA: Mask, Reposition, Suction, Open mouth, Pressure, Alternate airway.
Start chest compressions coordinated with PPV at a 3:1 ratio (90 compressions + 30 breaths per minute).
If HR stays <60 despite effective PPV + compressions, give epinephrine (UVC/IO preferred) and consider a volume bolus.
Pediatric Transport
Use weight-based dosing and length-based tools (a , measured crown-to-heel) and remember that children compensate well then crash suddenly — hypotension is a late, ominous sign. Distinguish (barking cough, gradual onset; nebulized racemic epinephrine) from (abrupt fever, drooling, tripod posture; keep the child calm, do not instrument the airway). Calculate maintenance fluids with the and use 2 J/kg for the first pediatric defibrillation.[8]
Checkpoint · Maternal/Fetal, Neonatal & Pediatric
Question 1 of 10
A newborn is assessed one minute after delivery. The heart rate is 130, the infant cries vigorously, all extremities are actively flexed, the baby grimaces and pulls away when the nares are suctioned, and the body is pink while the hands and feet remain blue. What is the APGAR score?
Professional Considerations
Professional Considerations is 7 items (6%) — smaller, but reliably tested.[1] It covers accreditation standards, research and evidence-based medicine, privacy, a , ethics and end-of-life care, , and caregiver wellness.
Legal, Ethical & End-of-Life
Know the intentional torts and duties tested here: assault (creating reasonable apprehension of imminent harmful contact) versus battery (actual unconsented contact); abandonment (unilaterally ending care without transfer to an equal-or-higher level); and negligence. A valid DNR limits resuscitation if arrest occurs but does not bar comfort care, and it does not become void during transport.
Respect for patient autonomy obligates the crew to honor a competent patient’s informed refusal. When a patient lacks capacity and has no advance directive, follow the statutory surrogate hierarchy. A provider must decline an out-of-scope order, and healthcare providers are typically mandatory reporters of suspected abuse.[8]
Accreditation, Research & GAMUT Metrics
Understand common accreditation standards (such as ) and the role of evidence-based medicine and basic research terminology in transport practice. The (Ground and Air Medical qUality in Transport) metrics benchmark performance across programs, and a separates honest error and at-risk behavior (coached) from reckless behavior (disciplined) so crews report near-misses and the system learns. The blueprint also addresses caregiver PTSD and suicide risk — crew wellness is a professional responsibility.[2]
Checkpoint · Professional Considerations
Question 1 of 8
A flight crew is dispatched to a home where a terminally ill patient has a valid out-of-hospital do-not-resuscitate (DNR) order, but the patient is still breathing and alert and consents to transport for comfort care. How should the crew interpret the DNR order during this transport?
How to Use This Study Guide
Work through the guide one module at a time. After each module, check it off in the contents to raise your exam-readiness score, then drill the same content in our free practice questions and flashcards — active recall and timed practice are what move knowledge into transport-day performance.
- Weight your time by the blueprint. Airway (15%), Cardiac and Medical Emergencies (13% each), and Trauma/Burn (12%) are the bulk of the exam — build a deep base there first.
- Own the flight physiology. The gas laws, the four hypoxia types, and aircraft safety are easy, high-yield points that make the FP-C different from a ground paramedic exam.
- Master the dose math. Recompute the Parkland formula, the rule of nines, the 4-2-1 rule, pediatric defibrillation (2 J/kg), and drip rates until they are automatic.
- Add the transport twist to every scenario. Ask what altitude, cold, noise, vibration, and being the most experienced clinician on board change about the answer.
- Practice clinical judgment. Recognize the cue, prioritize, take the safe action within scope and protocol, and reassess.
Common clinical questions FP-C candidates search and get asked — each answered briefly and backed by an official source (IBSC, FAA, NIH, AHA, ACS, AAP, or CDC). Tap any card to test yourself.
FP-C Concept Questions
FP-C Glossary
Key FP-C terms in one place. Hover any dotted term throughout the guide for its definition; the full list is below.
- FP-C
- Certified Flight Paramedic — the International Board of Specialty Certification (IBSC) credential for experienced paramedics who provide advanced critical care during air medical (flight) and other high-acuity transport.
- IBSC
- International Board of Specialty Certification — the certifying body (formerly the BCCTPC) that owns and administers the FP-C, CCP-C, CFRN, TP-C, and related transport-certification exams.
- Boyle's law
- At a constant temperature, the pressure and volume of a gas are inversely proportional (); as the aircraft climbs and pressure falls, trapped gas expands — the basis of barometric (dysbarism) injuries.
- Dalton's law
- The total pressure of a gas mixture equals the sum of the partial pressures of its gases; at altitude total pressure falls, so the partial pressure of oxygen falls and the patient becomes hypoxic at the same FiO₂.
- Henry's law
- The amount of gas dissolved in a liquid is proportional to its partial pressure; as pressure falls, dissolved gas comes out of solution — the basis of decompression sickness.
- Graham's law
- A gas diffuses across a membrane at a rate inversely proportional to the square root of its molecular weight; it governs alveolar gas exchange.
- dysbarism
- Injury caused by changes in ambient pressure, such as barotrauma to the ears, sinuses, GI tract, and lungs, and decompression sickness; trapped-gas effects follow Boyle's law.
- hypemic hypoxia
- Hypoxia from reduced oxygen-carrying capacity of the blood (anemia, hemorrhage, carbon-monoxide poisoning) despite adequate oxygen delivery to the lungs; CO poisoning gives a falsely high SpO₂.
- histotoxic hypoxia
- Hypoxia in which the cells cannot use the oxygen delivered to them, classically from cyanide or hydrogen-sulfide poisoning.
- time of useful consciousness
- The interval from a sudden loss of cabin oxygen (or rapid decompression) until a person can no longer take corrective action; it shortens sharply with altitude.
- CRM
- Crew resource management — the coordinated use of all available people, information, and equipment to make safe decisions and manage workload, flattening the authority gradient so any crew member can voice a concern.
- IMSAFE
- A personal-readiness checklist — Illness, Medication, Stress, Alcohol, Fatigue, Emotion — used before a shift to assess fitness for duty.
- CAMTS
- The Commission on Accreditation of Medical Transport Systems — a voluntary accreditation body whose standards address transport safety, staffing, and quality.
- RSI
- Rapid sequence intubation — near-simultaneous administration of an induction agent and a paralytic to rapidly secure the airway, following the 7 P's.
- 7 P's
- The sequential steps of RSI: Preparation, Preoxygenation, Pretreatment, Paralysis with induction, Positioning, Placement with proof, and Post-intubation management.
- apneic oxygenation
- Delivering supplemental oxygen (e.g., nasal cannula) during the apneic period of intubation to extend the time before desaturation.
- capnography
- Continuous end-tidal CO₂ waveform monitoring — the gold standard for confirming and continuously verifying endotracheal tube placement, essential in the noisy, moving transport setting.
- succinylcholine
- A depolarizing paralytic with rapid onset and short duration; avoided in major burns/crush injury >24–72 h old, denervation, prolonged immobility, and hyperkalemia because it causes potassium efflux.
- rocuronium
- A nondepolarizing paralytic used for RSI when succinylcholine is contraindicated; longer duration without a potassium shift, rapidly reversible with sugammadex.
- sugammadex
- An agent that encapsulates and rapidly reverses aminosteroid nondepolarizing paralytics such as rocuronium and vecuronium.
- ketamine
- A dissociative induction agent that preserves airway reflexes and supports blood pressure, useful in shock and bronchospasm; a common RSI induction agent in trauma.
- etomidate
- A short-acting, hemodynamically stable induction agent; a single dose can transiently suppress adrenal cortisol synthesis, debated in sepsis.
- PEEP
- Positive end-expiratory pressure — pressure kept in the lungs at end-expiration to keep alveoli open and improve oxygenation in mechanical ventilation.
- P/F ratio
- The arterial oxygen tension (PaO₂) divided by the fraction of inspired oxygen (FiO₂); grades oxygenation impairment — ≤100 is severe ARDS by the Berlin definition.
- ARDS
- Acute respiratory distress syndrome — diffuse inflammatory lung injury causing refractory hypoxemia; managed with lung-protective, low-tidal-volume ventilation.
- permissive hypotension
- Deliberately keeping blood pressure lower than normal in uncontrolled hemorrhage until bleeding is surgically controlled, to avoid 'popping the clot.'
- lethal triad
- The mutually reinforcing combination of hypothermia, acidosis, and coagulopathy in severe trauma; with hypocalcemia it is the 'trauma diamond.'
- TXA
- Tranexamic acid — an antifibrinolytic given early in major hemorrhage to reduce clot breakdown and mortality.
- tension pneumothorax
- Air trapped under pressure in the pleural space causing hypotension, distended neck veins, absent breath sounds, and (late) tracheal deviation; treated with needle decompression then a chest tube; expands at altitude (Boyle's law).
- STEMI
- ST-elevation myocardial infarction — a fully occluded coronary artery (≥1 mm ST elevation in ≥2 contiguous leads, or new LBBB) needing emergency reperfusion (PCI ≤90 min).
- right-sided ECG
- A V4R lead obtained in inferior MI to detect right-ventricular involvement; RV infarct makes the patient preload-dependent, so avoid nitroglycerin.
- mechanical circulatory support
- Devices the transport crew may manage — intra-aortic balloon pump (IABP), Impella, LVAD, or ECMO — that augment or replace cardiac output.
- GCS
- The Glasgow Coma Scale — a 3-to-15 score of consciousness (eye, verbal, motor); a GCS ≤8 generally indicates the need to secure the airway.
- TBI
- Traumatic brain injury; transport care focuses on preventing secondary injury — avoid hypoxia and hypotension, elevate the head ~30°, and maintain normocapnia.
- Cushing's triad
- A late sign of raised intracranial pressure — hypertension with a widened pulse pressure, bradycardia, and irregular respirations — indicating impending herniation.
- Parkland formula
- A burn fluid estimate: 4 mL × weight (kg) × %TBSA of Lactated Ringer's over 24 h, half in the first 8 h from the time of the burn, titrated to urine output (~0.5 mL/kg/hr in adults).
- rule of nines
- A rapid method to estimate the percentage of total body surface area burned in adults — head/neck 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.
- APGAR
- A 0-to-10 newborn score at 1 and 5 minutes across Appearance, Pulse, Grimace, Activity, and Respiration; it describes condition but does not direct resuscitation.
- left lateral tilt
- Positioning a pregnant patient (after ~20 weeks) tilted to the left to relieve aortocaval compression by the gravid uterus and restore venous return.
- 4-2-1 rule
- A pediatric hourly maintenance-fluid estimate: 4 mL/kg/hr for the first 10 kg + 2 mL/kg/hr for the next 10 kg + 1 mL/kg/hr for each kg beyond 20.
- Broselow tape
- A length-based (head-to-heel) tape that estimates a child's weight and gives weight-based drug doses and equipment sizes when the weight is unknown.
- croup
- Viral laryngotracheobronchitis — a barking cough and inspiratory stridor in a toddler, treated with nebulized racemic epinephrine and dexamethasone.
- epiglottitis
- A rapidly progressive bacterial infection of the epiglottis — high fever, drooling, muffled voice, tripod posture; keep the child calm and avoid instrumenting the airway.
- GAMUT metrics
- The Ground and Air Medical qUality in Transport quality-improvement metrics used to benchmark transport performance.
- Just Culture
- A safety framework that balances accountability with learning by distinguishing human error and at-risk behavior (coach/console) from reckless behavior (discipline), encouraging non-punitive reporting.
FP-C Study Guide FAQ
The FP-C has 135 multiple-choice items — 110 scored items plus 25 unscored pilot items that are indistinguishable from the scored ones — with a total seat time of 2.5 hours (150 minutes). It is delivered by computer at a Prometric test center and covers the air medical and critical-care transport patient population.
The FP-C is pass/fail and is scored only on the 110 graded items; the 25 pilot items do not count. IBSC uses a criterion-referenced passing standard set through formal standard-setting, and the published passing threshold is 73 correct answers. Candidates typically receive a pass/fail result within about one hour of finishing.
Ten IBSC domains: Airway, Anesthesia & Analgesics (15%) is the largest, followed by Cardiac and Medical Emergencies (13% each), Trauma/Burn (12%), Neurological (11%), Safety and Transport and Pediatric (8% each), Maternal Fetal and Neonatal (7%), and Flight Physiology and Professional Considerations (6% each). Flight Physiology — the gas laws, hypoxia, and altitude effects — is what makes the FP-C unique.
Several gas laws drive flight physiology. Boyle's law (gas expands as pressure falls on ascent) explains barometric injuries — a pneumothorax, bowel gas, and ET-cuff air all enlarge. Dalton's law (the partial pressure of oxygen falls at altitude) explains hypoxia. Henry's law (dissolved gas leaves solution) underlies decompression sickness. Boyle's law is the highest-yield.
You must hold a current, unrestricted paramedic license in your state or country of practice and upload a copy when you register. IBSC recommends, but does not strictly require, about 3 years of experience in a critical-care, air-transport, community, or tactical environment, plus self-study and an approved review course. There is no minimum degree requirement.
Both the FP-C (Certified Flight Paramedic) and the CCP-C (Certified Critical Care Paramedic) are IBSC certifications for advanced transport paramedics and share most of the same critical-care content. The FP-C adds flight-specific material — flight physiology, altitude and gas-law effects, and aircraft safety — while the CCP-C focuses on ground-based critical-care transport. Many paramedics choose the FP-C if they fly.
Per the current IBSC materials, the initial FP-C exam fee is approximately $285 for affiliate members or $385 for non-members (a dated anchor — verify on ibscertifications.org). The credential lasts four years and is renewed either by retaking the exam or by completing 100 approved continuing-education credits (at least 75 clinical, no more than 25 operational), including a minimum of 16 clinical hours from an approved FP-C review class.
Study by blueprint weight. Airway (15%), Cardiac and Medical Emergencies (13% each), and Trauma/Burn (12%) are the bulk of the exam, so build a deep base there, but do not neglect the flight-specific Flight Physiology and Safety domains — the gas laws, hypoxia types, and CRM are high-yield points unique to the FP-C. After each module, drill our free FP-C practice questions and flashcards.
Yes — the full guide, the glossary, the concept questions, the practice questions, and the flashcards are 100% free with no account required.
References
- 1.International Board of Specialty Certification (IBSC). “FP-C Detailed Content Outline (Blueprint) — Certified Flight Paramedic.” IBSC. ↑
- 2.International Board of Specialty Certification (IBSC). “Certified Flight Paramedic (FP-C) — Role & Exam Requirements.” IBSC. ↑
- 3.Federal Aviation Administration (FAA). “Aeromedical Education — Altitude Physiology & Hypoxia.” FAA. ↑
- 4.American Heart Association. “ACLS Guidelines — Acute Coronary Syndromes & Cardiac Arrest.” AHA. ↑
- 5.American College of Surgeons — Committee on Trauma. “Trauma Quality Programs & Damage-Control Resuscitation.” ACS. ↑
- 6.American Academy of Pediatrics. “Neonatal Resuscitation Program (NRP).” AAP. ↑
- 7.Centers for Disease Control and Prevention (CDC). “Carbon Monoxide Poisoning — Clinical Guidance.” CDC. ↑
- 8.National Institutes of Health / National Library of Medicine. “StatPearls & MedlinePlus Clinical Reference (RSI, ARDS, sepsis, DKA, burns, pediatrics).” NIH/NLM. ↑
- 9.National Institutes of Health / NINDS. “Traumatic Brain Injury, Increased ICP & Stroke.” NIH/NINDS. ↑
- 10.National Institutes of Health / NHLBI. “Heart, Lung & Blood Health Topics (ACS, ARDS, shock).” NIH/NHLBI. ↑

Career Employer
Career Employer is the ultimate resource to help you get started working the job of your dreams. We cover topics from general career information, career searching, exam preparation with free study materials, career interviewing, and becoming successful in your career of choice.
All PostsCareer Employer’s Editorial Process
Here at Career Employer, we focus a lot on providing factually accurate information that is always up to date. We strive to provide correct information using strict editorial processes, article editing, and fact-checking for all of the information found on our website. We only utilize trustworthy and relevant resources. To find out more, make sure to read our full editorial process page here.
