FP-C

Certified Flight Paramedic

FP-C is an abbreviation indicating that an individual is Flight Paramedic-Certified. This certification is for paramedics who have demonstrated advanced knowledge of critical care medicine by passing a two-and-a-half-hour exam consisting of 125 multiple-choice questions. As of November 2015 there are only about 5300 certified flight paramedics worldwide.^[1]

The FP-C and/or Critical Care Emergency Medical Transport Program certifications are often a requirement to work as a flight paramedic in the United States. The FP-C does not have an associated course, unlike the CCEMTP, although there are review courses and study guides available. The FP-C is considered to be more difficult to obtain than the CCEMTP certification, often requiring experience in the air medical / critical care transport field before attempting to take the exam.^[2] However, there is no minimum education component required, and the examination does not require minimum years of experience, therefore new paramedics who just completed basic paramedic school are eligible to take the exam and receive certification. In addition, there is no practical skill test associated with the examination (unlike the NRP exam).^[3][4] Many agencies may require prospective employees to demonstrate practical competency in other courses (TPATC, ATLS-audit, CCEMTP, etc.) prior to be considered for employment. A candidate must hold a current paramedic license and have active certifications in Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS/PEPP), Pre-Hospital Trauma Life Support (PHTLS/ITLS), and other advanced certifications.

Examination

The exam is administered by the Board for Critical Care Transport Paramedic Certification (BCCTPC). Oversight for the exam process is provided by Applied Measurement Professionals (AMP), a statistical body that ensures the certification process is in compliance. The methods used by AMP are consistent with professional and technical guidelines detailed in the Standards for Educational and Psychological Testing (1999) by the American Educational Research Association, the American Psychological Association and the National Council on Measurement in Education. These standards provide the research framework that is used as a basis for validity of certification. The methodology used meets or exceeds the current professional and governmental standards to assure the defensibility of the exam, as well as meets or exceeds the standards of the National Commission for Certifying Agencies (NCCA) and the National Organization for Competency Assurance (NOCA). Although the FP-C is not officially recognized by the National Registry of Emergency Medical Technicians (NREMT), it has become the standard for Critical Care Paramedic certification and is considered to be the absolute highest level of paramedic certification in the USA. Unlike the NREMT Paramedic examination, which is required in most States for entry-level paramedic licensure, the FP-C is a professional certification that evaluates knowledge that is well above and beyond the basic scope of practice of most licensed paramedics.

Exam Outline of Major Subjects

• Acid-Base Balance
  • Regulation of acid-base balance
  • Acid-base derangements
• Airway
  • Rapid Sequence Induction inclusive of standard medications
  • Intubation and all other airway procedures
  • Surgical cricothyroidotomy
  • Needle cricothyroidotomy
  • Airway medications – their uses, limitations, and contraindications
• CAMTS
  • Flight Following Standards
  • Proper flight crew uniforms and protective equipment
  • Minimum crew training and staffing standards
• Cardiac
  • Knowledge of cardiovascular disease and cardiac anomalies
  • 12 Lead Electrocardiogram (ECG or EKG) Interpretations
  • Cardiac Anatomy/Cardiac Physiology
  • Cardiac Pharmacology
  • Thrombolytic Therapy
  • Understanding of intra-aortic balloon pump (IABP) operation
    • Mechanics, indications, troubleshooting, and contraindications
  • Invasive Hemodynamic monitoring / Swan-Ganz catheter interpretation
  • Arterial lines
  • Cardiac pacing, synchronized cardioversion, defibrillation, and drugs
• Flight Physiology
  • Knowledge of the gas laws and their effect on patients
• Neurological
  • Treatment/recognition of elevated intracranial pressure, cerebral bleeds, etc.
  • Neuroprotective agents, vasoactive agents, loop diuretics, etc.
  • Indications, limitations, and contraindications
  • Signs and symptoms of head injuries, ICP, cerebral perfusion pressures
  • Mechanism of Injury and Head Injury dynamics.
• OB/Gyn
  • Fetal circulation
  • Maternal complications, such as Pregnancy Induced Hypertension.
  • labor and delivery Complications
  • Maternal Medications
• Pediatric and Neonatal
  • Pediatric and Neonatal Resuscitation
  • Physiological differences
  • Pharmacology
  • Pediatric assessment
  • Respiratory and Airway differences
  • Common Injuries
  • Anatomical differences
  • Pediatric psychosocial issues
  • Non-accidental trauma
  • Orthopedic injuries
  • Isolette use
• Respiratory
  • Evaluation of arterial blood gases and treatment for abnormal values
  • Ventilator settings and parameters
  • Equipment, uses and troubleshooting
  • Managing the rapidly deteriorating (decompensation) patient condition
• Safety Issues
  • Part 135 safety issues and flight regulations
  • AMRM / CRM
  • Flight Stressors
  • Aircraft Operations- fixed and rotary wing
  • Crash safety
  • Survival issues
  • Proper safety gear
• Stress
  • Recognizing substance abuse and related issues
  • Coping with death and dying
  • Interpersonal relationships
  • Equipment failures
• Thoracic
  • Signs and symptoms of early versus late cardiac tamponade
  • Procedures pertaining to thoracic injuries
  • Needle thoracentesis, pericardiocentesis, thoracostomy tube placement, etc.
  • Treatment/signs and symptoms of:
  • Cardiac tamponade, tension pneumothorax, hemothorax, etc.
• Trauma
  • Administration of blood products
  • Fluid replacement
  • Injury Dynamics and Predictable Patterns
  • Define Newton’s 1st, 2nd, & 3rd Laws
  • Predictable patterns of injury due to mechanisms
  • Many questions are scenario based with multiple stem questions

FP-C Detailed Content Overview

• Trauma Management (9)
  • Perform patient triage
  • Differentiate injury patterns associated with specific mechanisms of injury
  • Identify patients who meet trauma center criteria
  • Perform a comprehensive assessment of the trauma patient
  • Initiate the critical interventions for the management of the trauma patient
  • Provide care for the patient with life-threatening thoracic injuries (e.g., pneumothorax, flail chest, tamponade, myocardial rupture)
  • Provide care for the patient with abdominal injuries (e.g., diaphragm, liver and spleen)
  • Provide care for the patient with orthopedic injuries (e.g., pelvic, femur, spinal)
  • Administer appropriate pharmacology for trauma management
• Aircraft Fundamentals, Safety and Survival (12)
  • Assess the safety of the scene
  • Conduct preflight checks to ensure aircraft integrity
  • Conduct preflight checks to ensure equipment is present, functional, and stowed
  • Observe for hazards during aircraft operation
  • Utilize proper safety equipment while in flight
  • Maintain a sterile cockpit during critical phases of flight
  • Approach and depart the aircraft in a safe manner
  • Ensure safety around the aircraft
  • Secure the patient for flight
  • Participate in crew resource management (CRM)
  • Participate in flight mission safety decisions (e.g., Go – No Go, abort)
  • Proper and safe responses to in-flight emergencies (e.g., Aircraft fire, Emergency egress, Emergent landing, Inadvertent changing of weather conditions during flight)
  • Perform immediate post-accident duties at a crash site
  • Build survival shelters
  • Initiate emergency survival procedures
  • Ensure the safety of all passengers (e.g., specialty teams, family, law enforcement, observer)
  • Estimate weather conditions that are below weather minimums
  • CAMTS recommendations
• Flight Physiology (10)
  • Identify causes of hypoxia
  • Take corrective measures to prevent altitude related hypoxia
  • Identify signs of barometric trauma
  • Identify stressors related to transport (e.g., thermal, humidity, noise, vibration, or fatigue related conditions)
  • Take corrective action for patient stressors related to transport
  • Relate the relevant gas laws to patient condition and treatment
  • Relate the stages of hypoxia to patient condition and treatment
  • Identify immediate causes of altitude related conditions in patients
  • Identify immediate causes of altitude related conditions as they affect the air medical crew
  • Provide appropriate interventions to prevent the adverse effects of altitude changes during patient transport
• Advanced Airway Management Techniques (5)
  • Identify the indications for basic and advanced airway management
  • Identify the indications and contraindications for specific airway interventions
  • Perform advanced airway management techniques
  • Administer appropriate pharmacology for airway management (e.g., Rapid Sequence Induction, post intubation sedation)
  • Implement a failed airway algorithm
  • Identify esophageal intubation
  • React to intubation complications
  • Perform alternative airway management techniques (e.g., needle cricothyrotomy, surgical cricothyotomy, Seldinger technique, retrograde intubation, LMA)
  • Monitor airway management and ventilation during transport
  • Use mechanical ventilation
• Neurological Emergencies (10)
  • Conduct differential diagnosis of coma patients
  • Manage patients with seizures
  • Manage patients with cerebral ischemia
  • Initiate the critical interventions for the management of a patient with a neurologic emergency
  • Provide care for a patient with a specific neurologic emergency
  • Perform a baseline neurologic assessment of a trauma patient
  • Perform an ongoing serial evaluation of a neurologic patient
  • Assess changes in intracranial pressure using patient level of consciousness
  • Perform a focused neurological assessment
  • Assess a patient using the Glasgow coma scale
  • Manage patients with head injuries
  • Manage patients with spinal cord injuries
  • Evaluate muscle strength and motor function
  • Administer appropriate pharmacology for neurological management
• Critical Cardiac Patient (20)
  • Perform a detailed cardiovascular assessment
  • Identify patients experiencing an acute cardiac event (e.g., acute myocardial infarction, heart failure, cardiogenic shock, primary arrhythmias, hemodynamic instability)
  • Use invasive monitoring during transport, as indicated, for the purpose of clinical management
  • Provide treatment for patients with acute cardiac events and hemodynamic abnormalities
  • Control cardiopulmonary support devices to patient condition as part of patient management (e.g., ventricular assist devices, transvenous pacer, intra-aortic balloon pump)
  • Assist in the control of cardiopulmonary support devices to patient condition as part of patient management (e.g., ventricular assist devices, transvenous pacer, intra-aortic balloon pump)
  • Conduct defibrillation during transport
  • Administer appropriate pharmacology for cardiac management
• Respiratory Patient (10)
  • Perform a detailed respiratory assessment
  • Identify patients experiencing respiratory compromise (e.g., acute respiratory distress syndrome, spontaneous pneumothorax, pneumonia)
  • Monitor patient’s respiratory status using laboratory values and diagnostic equipment (e.g., pulse oximetry, capnography, blood gas values, chest radiography)
  • Provide treatment for patients with acute respiratory events
  • Administer appropriate pharmacology for respiratory management
• Toxic Exposures (6)
  • Conduct a physical examination of a toxicological patient
  • Decontaminate toxicological patients when indicated
  • Administer poison antidotes when indicated
  • Provide emergency care for victims of envenomation (e.g., snake bite, scorpion sting, spider bite)
  • Administer appropriate pharmacology for toxic exposures
  • Provide treatment for toxicological patients (e.g., medication overdose, chemical/biological/radiological exposure)
• Obstetrical Emergencies (4)
  • Perform an assessment of the obstetrical patient
  • Perform fetal assessment
  • React to special transport considerations of the obstetrical patient
  • Provide treatment for high-risk obstetrical patients
  • Assess uterine contractions
  • Conduct interventions for obstetrical emergencies (e.g., pregnancy induced hypertension, hypertonic or titanic contractions, cord prolapse, placental abruption)
  • Assess whether transport can safely be attempted or whether delivery should be accomplished at the referring facility
  • Administer appropriate pharmacology for obstetrical patients
  • Manage emergent delivery
• Neonates (4)
  • Perform an assessment of the neonatal patient
  • Reevaluate the clinical assessment and management of the neonate when initial emergency measures fail
  • Administer appropriate pharmacology for neonatal patients
  • Implement neonatal resuscitation according to established
  • Manage the isolette transport
  • Provide treatment of neonatal emergencies
• Pediatric (10)
  • Perform an assessment of the pediatric patient
  • Identify the pediatric patient experiencing an acute respiratory event (e.g., epiglottitis, bronchiolitis, asthma) C. Identify the pediatric patient experiencing an acute medical event (e.g., meningitis, overdose, seizures)
  • Identify the pediatric patient experiencing an acute cardiovascular event (e.g., shock, cardiac anomaly, dysrhythmias)
  • Identify the pediatric patient experiencing an acute traumatic event (e.g., auto v. pedestrian, falls, child abuse) F. Administer appropriate pharmacology for pediatric patients
  • Provide treatment of pediatric emergencies
• Burn Patients (5)
  • Perform an assessment of the burn patient
  • Calculate the percentage of total body surface area burned
  • Calculate appropriate fluid replacement amounts based on the patient’s burn injury and physiologic condition D. Diagnose inhalation injuries in burn injury patients
  • Administer appropriate pharmacology for burn patients
  • Provide treatment of burn emergencies
• General Medical Patient (16)
  • Perform a focused medical assessment
  • Identify patients experiencing a medical emergency (e.g., Abdominal Aortic Aneurysm, GI bleed, bowel obstruction, HHNC (Hyperosmolar Hyperglycemic Non-Ketotic Coma)
  • Use invasive monitoring during transport, as indicated, for the purpose of clinical management
  • Provide treatment for patients with medical emergencies
  • Manage patient condition utilizing available laboratory values (e.g., blood glucose, CBC, H/H)
  • Administer appropriate pharmacology for the medical patient
  • Prevent transmissions of infectious disease
  • Provide appropriate pain management
  • Evaluate and record patient pain levels
• Environmental (4)
  • Perform an assessment of the patient suffering from an environmental emergency
  • Identify the patient experiencing a cold related emergency (e.g., frostbite, hypothermia, cold water submersion)
  • Identify the patient experiencing a heat related emergency (e.g., heat stroke, heat exhaustion, heat cramps)
  • Identify the patient experiencing a diving related emergency (e.g., decompression sickness, arterial gas emboli, near drowning)
  • Identify the patient experiencing an altitude related emergency (e.g., HAPE, cerebral edema)
  • Administer appropriate pharmacology for environmental emergency patients
  • Provide treatment of environmental emergencies practice
• Acid/Base Balance
  • Understand fundamentals of Acid/Base balance in the body
  • Understand affects of Acid/Base balance disturbances and their effects in the body

Exam Outline

Board for Critical Care Transport Paramedic Certification, Page 4 (EXAMINATION CONTENT)

Question Category	Number of Questions
Trauma Management	9
Aircraft Fundamentals & Safety and Survival	12
Flight Physiology	10
Advanced Airway Management Techniques	5
Neurological Emergencies	10
Critical Cardiac Patient	20
Respiratory Patient	10
Toxic Exposures	6
Obstetrical Emergencies	4
Neonates	4
Pediatric	10
Burn Patients	5
General Medical Patient	16
Environmental	4

Flight Paramedic Patch

Physical FP-C Patch

See also

• International Association of Flight Paramedics
• Critical Care Emergency Medical Transport Program
• Flight nurse

References

1. http://bcctpc.org/Honors/FPC%20Names/names.htm
2. http://www.flightweb.com/forums/index.php?showtopic=280
3. http://www.nremt.org/nremt/about/reg_para_history.asp>
4. http://www.bcctpc.org

External links

• Board for Critical Care Transport Paramedic Certification
• Aeromedical Certification Exam Prep Course
• Flight Paramedic Review Courses
• ASTNA