Free CCP-C practice questions

Answer: C

• A. Coming from behind keeps the team away from the front of the main rotor, which can feel safer, but FAA guidance is never to approach a helicopter from the rear: a turning tail rotor is nearly invisible, and the team is out of the pilot's view.
• B. Carrying downhill is easier on the team, but the upslope side is where the rotor disc comes closest to the ground. A stretcher team walking up there can be struck.
• C. Correct. The rotor disc stays roughly level while the ground rises, so the blades pass closest to the ground on the upslope side. Approaching from the downslope side gives the most head clearance.
• D. Crouching helps, and saving steps is tempting with a closing stroke window, but the side is chosen by slope and rotor clearance, not distance. Patient urgency does not change helicopter safety rules.

On sloping ground the helicopter sits level on the rotor plane while the terrain rises, so the main rotor blades are closest to the ground on the uphill side. FAA and New Zealand CAA safety guidance therefore says to approach and leave on the downslope side, in full view of the pilot, only after a visual signal, crouching, and never toward the tail. CAMTS requires programs to train ground and hospital personnel in personal safety around the helicopter, including procedures with engines running, because hot loads put several people near turning blades at once.

Sources: FAA Propwatcher's Guide; CAA NZ: Safety Around Helicopters (2022); CAMTS Accreditation Standards, 12th ed.; ASTNA Patient Transport, 6th ed.

Answer: A

• A. Correct. All equipment and the patient are restrained with systems certified to the aircraft’s load factors, and the crew wears shoulder harnesses for takeoff and landing.
• B. Hand-held items are unrestrained items.
• C. Equipment is never restrained by the patient.
• D. Unsecured equipment becomes a projectile in turbulence or a hard landing.

Restraint systems protect the crew and patient from the loads of turbulence and crash sequences. Standards address patient litter restraints (including for pediatric and bariatric patients), crew harnesses, and equipment mounting. Loose objects, including pens and cell phones, are secured before every flight.

Sources: CAMTS Accreditation Standards, 12th ed.; ASTNA Patient Transport, 6th ed.

Answer: B

• A. Fasciculations and secretions make unparalyzed intubation difficult and dangerous.
• B. Correct. Cholinesterase inhibition can prolong succinylcholine paralysis for hours; rocuronium is preferred. Atropine is titrated to secretions rather than to pupils or heart rate, and pralidoxime reactivates the enzyme.
• C. Organophosphates inhibit the pseudocholinesterase that breaks down succinylcholine, so its effect is prolonged, not diminished.
• D. Combining agents does not avoid the prolonged effect.

Drug interactions in airway management: succinylcholine is prolonged in pseudocholinesterase deficiency, organophosphate poisoning and liver disease; magnesium potentiates nondepolarizing blockers; aminoglycosides potentiate blockade; and hypothermia prolongs all agents. Sugammadex reverses rocuronium and vecuronium but not succinylcholine.

Sources: Walls Manual of Emergency Airway, 6th ed.; NAEMT AMLS, 4th ed.

Answer: A

• A. Correct. From about 24 to 72 hours after a major burn, crush injury, denervation, stroke or prolonged immobility, extrajunctional receptors proliferate, and succinylcholine triggers massive potassium release. Rocuronium 1.2 mg/kg is the alternative.
• B. Vecuronium releases little histamine and is not contraindicated in burns.
• C. Succinylcholine can transiently raise, not lower, intracranial pressure, and that is not the reason it is avoided in burns.
• D. Rocuronium is safe; burn patients may in fact need higher doses.

Succinylcholine contraindications: hyperkalemia, burns or crush injury beyond 24 hours, denervation injuries and neuromuscular disease (spinal cord injury after the first days, stroke, muscular dystrophy, ALS, myopathies), malignant hyperthermia history, and known pseudocholinesterase deficiency. Sugammadex reverses rocuronium when available, which narrows the argument for succinylcholine.

Sources: Walls Manual of Emergency Airway, 6th ed.; ABA ABLS Provider Manual (2023)

Answer: D

• A. Vasodilators drop the pressure across a fixed obstruction and cause syncope or arrest.
• B. Negative inotropes and vasodilation cause collapse in severe aortic stenosis with hypotension.
• C. An unstable patient is cardioverted rather than observed.
• D. Correct. Patients with fixed outflow obstruction depend on atrial contraction and adequate diastolic time; new atrial fibrillation with instability is cardioverted, and pressure is supported with vasoconstrictors while nitrates and other vasodilators are avoided.

Valvular disease transport principles: aortic stenosis (maintain sinus rhythm, preload and afterload; avoid vasodilators and tachycardia), mitral stenosis (slow the rate, avoid tachycardia), aortic and mitral regurgitation (afterload reduction, avoid bradycardia), and hypertrophic cardiomyopathy (avoid inotropes and vasodilators, give fluids and beta blockers). Endocarditis patients are monitored for embolic events and heart failure from acute regurgitation.

Sources: AHA 2025 Part 9: Adult ALS; Critical Care Transport, 3rd ed.; ACC/AHA/ACCP/HRS AF Guideline (2023)

Answer: A

• A. Correct. In a nonhemorrhagic stroke complicating type A dissection, surgery is favored over medical therapy to reduce mortality and improve neurologic outcome.
• B. Permissive hypertension is standard in ischemic stroke, but in a dissection it raises the risk of rupture; the target is the lowest pressure that keeps the organs perfused.
• C. Waiting for neurologic stability sounds cautious, but untreated type A dissection carries a mortality of about 1% per hour, and many stroke deficits resolve after prompt repair.
• D. Stroke does raise operative risk, which makes this tempting, but mortality with medical management of type A dissection and stroke is far higher than with surgery.

Suspected or confirmed acute type A dissection calls for emergency surgical evaluation and immediate repair, because rupture, tamponade, acute aortic regurgitation, coronary compromise and malperfusion can each be fatal. The 2022 ACC/AHA guideline rates surgery as reasonable over medical therapy when a nonhemorrhagic stroke complicates type A dissection: reported mortality is about 25 to 27% with surgery versus 76% with medical care, and in registry data stroke and coma resolved in most patients after repair. Transfer of a stable patient from a low-volume to a high-volume aortic center is also reasonable, and anti-impulse therapy continues during the flight.

Sources: ACC/AHA Aortic Disease Guideline (2022)

Answer: D

• A. Hyperkalemia can occur with rapid transfusion, but tetany with QT prolongation points to hypocalcemia.
• B. TRALI presents with hypoxemia and pulmonary edema, not tetany.
• C. Acute hemolysis presents with fever, flank pain, hemoglobinuria and hypotension, and the treatment is stopping the transfusion and supporting circulation.
• D. Correct. Citrate anticoagulant in blood products binds ionized calcium, and rapid transfusion overwhelms hepatic clearance, especially in shock and hypothermia. Ionized calcium is monitored and replaced, commonly 1 g of calcium chloride per 2 to 4 units of product.

Massive transfusion complications: hypocalcemia (citrate), hyperkalemia, hypothermia (products are warmed), dilutional coagulopathy (balanced 1:1:1 ratios), acidosis, TRALI and circulatory overload. Transport crews carrying blood follow strict identification, storage temperature and documentation rules, and give tranexamic acid within 3 hours of injury when indicated.

Sources: Critical Care Transport, 3rd ed.; European Trauma Bleeding Guideline (2023)

Answer: C

• A. Digoxin has a large volume of distribution and is not dialyzable.
• B. Antiarrhythmics are second-line and the antidote treats the cause.
• C. Correct. Digoxin immune Fab binds the drug and reverses the toxicity, including the hyperkalemia; a potassium above 5.5 is an indication for it, and the dose is calculated from the amount ingested or the serum level and weight, or given empirically when neither is known (6 vials for chronic toxicity in an adult, 10 to 20 for an acute ingestion).
• D. Calcium in digoxin toxicity has traditionally been avoided because of concern for arrhythmia; the hyperkalemia reflects the toxicity and resolves with the antidote.

Digoxin toxicity: gastrointestinal symptoms, visual changes, confusion, almost any arrhythmia (bidirectional ventricular tachycardia is classic), and hyperkalemia in acute overdose. Precipitants include renal failure, hypokalemia, hypomagnesemia and drug interactions. Cardioversion is used cautiously at low energy because of the risk of ventricular fibrillation.

Sources: NAEMT AMLS, 4th ed.; Critical Care Transport, 3rd ed.; AHA 2025 Part 10: Special Circumstances

Answer: A

• A. Correct. Tamponade physiology depends on filling pressure and spontaneous negative-pressure breathing. Volume, avoidance of positive pressure and vasodilation, and rapid transfer for drainage are the priorities, with pericardiocentesis as the rescue for pre-arrest.
• B. Positive-pressure ventilation and induction drugs reduce venous return and can cause arrest in tamponade; intubation is avoided unless unavoidable.
• C. Diuresis lowers preload and worsens tamponade.
• D. Tachycardia is compensatory; slowing it causes collapse.

Beck’s triad (hypotension, distended neck veins, muffled heart sounds), pulsus paradoxus over 10 mm Hg, electrical alternans and a large effusion on ultrasound identify tamponade. Ultrasound-guided pericardiocentesis in transport is a temporizing measure; the definitive treatment is drainage or a window. Traumatic tamponade with arrest needs thoracotomy at a trauma center.

Sources: Critical Care Transport, 3rd ed.; ESC Myocarditis & Pericarditis (2025); ASTNA Patient Transport: Medical Crit Care

Answer: C

• A. Absence of a pulse is expected with continuous flow, and this patient is awake; compressions are for an unresponsive patient with impaired perfusion.
• B. Rhythm treatment follows assessment of the device and perfusion; the AED is not the first step.
• C. Correct. Continuous-flow devices produce little pulsatility, so perfusion is judged from the controller parameters, a Doppler opening pressure (which approximates the MAP), and clinical signs. Low flow with a high power reading suggests pump thrombosis; low flow with low power suggests hypovolemia, bleeding or right heart failure.
• D. Pressure is obtained with a Doppler and manual cuff.

VAD transport: bring the patient’s backup controller, charged batteries and power cables, involve the caregiver, keep the driveline secured and dry, avoid hypovolemia and dehydration, treat arrhythmias per ACLS (the pump keeps flowing during VF), and contact the VAD coordinator. Bleeding from anticoagulation and acquired von Willebrand disease is common. If the patient becomes unresponsive with impaired perfusion, chest compressions start at once while a second rescuer checks the controller, power and driveline and tries to restart a stopped pump (AHA 2025).

Sources: Critical Care Transport, 3rd ed.; AHA 2025 Part 10: Special Circumstances; ASTNA Patient Transport: Medical Crit Care

Answer: A

• A. Correct. In acute hypoxemic respiratory failure the ERS suggests high flow over both conventional oxygen and noninvasive ventilation. It is better tolerated and reduces dead space, and close reassessment determines whether he needs intubation.
• B. Early intubation is reasonable if he worsens, but he is alert, normotensive and not hypercapnic, so a trial of high flow with close monitoring comes first.
• C. That range is for patients at risk of hypercapnia, and his PaCO₂ is 34; a 40% Venturi mask also gives less oxygen than the non-rebreather on which he is already hypoxemic.
• D. Bilevel support has strong evidence in hypercapnic COPD and cardiogenic edema, but the ERS/ATS panel could make no recommendation for de novo hypoxemic failure, and failure on it delays intubation.

The 2022 ERS guideline makes conditional recommendations for high-flow nasal cannula over conventional oxygen and over noninvasive ventilation in acute hypoxemic respiratory failure, while suggesting a trial of noninvasive ventilation before high flow in hypercapnic COPD. The 2017 ERS/ATS guideline was unable to recommend noninvasive ventilation for de novo hypoxemic failure because failure is common with pneumonia or early ARDS and delayed intubation raises mortality. Whatever device is used, the crew reassesses early and escalates promptly when the patient does not improve.

Sources: ERS High-Flow Nasal Cannula Guideline (2022); ERS/ATS Noninvasive Ventilation (2017)

Answer: A

• A. Correct. The lateral site has a thinner chest wall and a longer catheter reaches the pleural space more reliably; finger thoracostomy is definitive for tension physiology in a ventilated patient and is converted to a chest tube.
• B. Positive pressure worsens tension pneumothorax.
• C. Short catheters at the anterior site fail to reach the pleura in a large proportion of adults.
• D. A chest tube takes longer; decompression or finger thoracostomy relieves tension first.

Tension pneumothorax in ventilated patients progresses rapidly; ultrasound shows absent lung sliding and a lung point. Needle catheters kink and occlude, so the crew reassesses and converts to a thoracostomy. In flight, an untreated pneumothorax expands with altitude, so pneumothoraces are drained before departure whenever possible.

Sources: Critical Care Transport, 3rd ed.; NAEMT PHTLS, 10th ed.; ACS ATLS, 11th ed.

Answer: C

• A. Tempting because the injury is small, healing and has an explanation, but intraoral injuries in an infant who cannot move independently are not expected from feeding and need evaluation now, not at a routine visit.
• B. A tight frenulum (lip tie) is a congenital finding, not a healing tear; this explanation mistakes an injury for an anatomic variant.
• C. Correct. Minor visible injuries in pre-ambulatory infants, especially bruises and intraoral tears, often precede serious abuse; with an unexplained event they prompt a search for occult injury at the receiving hospital.
• D. Herpetic gingivostomatitis causes multiple vesicles and ulcers with fever and drooling, typically in older infants and toddlers; a single healing frenulum tear does not fit.

Sentinel injuries are minor, self-resolving injuries such as bruises and intraoral bleeding, contusions or tears in children who are not yet mobile. In one case-control study about a quarter of abuse victims had a prior sentinel injury and none of the controls did. Frenulum injury is also part of the TEN-4-FACESp bruising rule and carried the highest fatality rate of any region in its validation. The crew documents the finding and the stated mechanism in the caregiver's own words, avoids accusation, and tells the receiving team so a skeletal survey and head imaging can be considered.

Sources: Nonaccidental Trauma Review, Cureus (2022); TEN-4-FACESp Validation, JAMA Netw Open (2021); ACS ATLS, 11th ed.; ENA TNCC Provider Manual, 9th ed.; Wong's Care of Infants & Children, 12th ed.

Answer: A

• A. Correct. A child held flexed in hot water has uniform-depth burns with spared creases (zebra stripes), symmetric glove or stocking margins and tide marks, a pattern that does not occur when a child moves freely.
• B. Delayed blistering is the normal evolution of a partial-thickness burn and does not separate accidental from inflicted scalds; a delay in seeking care would be the concern.
• C. Asymmetry and variable depth are characteristic of accidental spill injuries, which are asymmetric in most cases; forced immersion produces symmetric burns.
• D. Irregular edges and splash marks are typical of spill and splash scalds, which fit an accidental mechanism; a child who climbs into hot water also tends to thrash and splash.

Forced immersion burns are symmetric, uniform in depth and sharply demarcated by tide marks at the water line, often in a glove or stocking distribution. Flexed body creases are spared, and the buttocks may show doughnut sparing where they were pressed against the cooler tub. Spill and splash scalds have irregular margins and variable depth and are usually asymmetric. The American Burn Association advises that pediatric burns may benefit from burn center referral, including for suspected non-accidental trauma, so the crew documents the pattern and the stated history for the receiving team.

Sources: Nonaccidental Trauma Review, Cureus (2022); ABA Burn Center Referral Guidelines (2022); ACS ATLS, 11th ed.; Wong's Care of Infants & Children, 12th ed.

Answer: B

• A. Prolonged beta-agonist infusions cause maternal tachycardia, hyperglycemia and pulmonary edema and are not recommended.
• B. Correct. Antenatal steroids reduce respiratory distress syndrome, magnesium before 32 weeks reduces cerebral palsy, tocolysis buys time for steroids and transfer, and group B streptococcus prophylaxis protects the newborn.
• C. Steroids and magnesium have time-dependent benefits and should be started.
• D. A 30-week fetus benefits from delivery at a center with neonatal intensive care, not from expedited delivery in a facility without it.

Contraindications to tocolysis include abruption, chorioamnionitis, severe preeclampsia, fetal demise and nonreassuring fetal status. Nifedipine and indomethacin (before 32 weeks) are first-line tocolytics; magnesium is used for neuroprotection rather than tocolysis. The crew is prepared for delivery en route with a neonatal resuscitation kit and warming measures.

Sources: ASTNA Patient Transport, 6th ed.; ACOG PB 171: Preterm Labor (2016)