National Credential
Credential: Adult Critical Care Specialty Examination (ACCS)  NCCA resource
Credentialing Agency: National Board for Respiratory Care (NBRC)

The National Board for Respiratory Care (NBRC), Adult Critical Care Specialty examination (ACCS) program is for respiratory therapists who have earned the Registered Respiratory Therapist (RRT) credential and also have experience in the field of adult critical care. The Adult Critical Care Specialty Examination assesses the knowledge, skills and abilities required of respiratory therapists in this specialty area. Candidates must be practicing RRTs for at least one year prior to applying for the examination. The ACCS examination concentrates on those competencies specific to adult critical care settings and will not include items about general respiratory care.

More information can be found on the certifying agency's website.

Renewal Period: 5 years

Adult Critical Care Specialty Examination (ACCS)

The following Army Occupations provide training and/or experience that contributes to attaining this credential:

Personnel Category Occupation Occupation Type Related As Promotion Points Skill Level Star Proponent Funded Gap Analysis
Enlisted 68V Respiratory Specialist MOS some  Promotion Points: This certification has been approved for promotion points. Click for more information.   Star credentialStar    

Army Table Legend


Related As

The military occupations shown in this table are related to this credential in one of four ways: Most, Some, or Other.

Most: This credential is directly related to most of the major duties associated with the military occupation (at least 80%). Note that the credential may require additional education, training or experience before you are eligible for it.

Some: This credential is related to some tasks associated with the duties of the military occupation (related 80% to at least one or more critical tasks but less than 80% of all of the entire military occupation). Note that the credential may require additional education, training or experience before you are eligible for it.

Other: This credential is related to this military occupation, but is more advanced or specialized and therefore will likely require additional education, training, or experience.

Promotion Points Promotion Points icon

This credential has been approved for promotion points for this MOS towards promotion to Sergeant and Staff Sergeant. Clicking the Promotion Points icon will open a link to the promotion points fact sheet.

Skill Level Designation

Skill Level I: This skill level consists of all Soldiers in the ranks of Private (pay grade E-1) up to Specialist (pay grade E-4). Time in Service (TIS) is generally between initial entry and four Years of Service (YOS). This skill level is Entry-level positions requiring performance of tasks under direct supervision.

Institutional training:

  • Structured Self-Development (SSD) level I
  • Basic Leader Course (BLC)

Skill Level II: This skill level is obtained when promoted to Sergeant (paygrade E-5). TIS is generally between 4-8 YOS. Positions requiring performance of more difficult tasks under general supervision; and in some instances, involving supervision of Soldiers in SL1.

Institutional training:

  • Structured Self-Development (SSD) level II
  • Advance Leader Course (ALC)

Skill Level III: This skill level is obtained when promoted to Staff Sergeant (paygrade E-6). TIS is generally between 8-12 YOS. Positions requiring performance of still more difficult tasks and involving first line supervision of Soldiers in SL1 & SL2.

Institutional training:

  • Senior Leader Course (SLC)
  • Structured Self-Development (SSD) level III

Skill level IV: This skill level is obtained when promoted to the rank of Sergeant First Class (paygrade E-7). TIS is generally between 12-18 YOS. Positions requiring relatively detailed knowledge of all tasks specified for a given MOS, normally involving first-line supervision of Soldiers in SLs 1, 2, and 3, and involving managerial duties.

Institutional training:

  • Master Leader Course (MLC)
  • Structured Self-Development (SSD) level IV
  • Senior Enlisted Joint Professional Military Education (SEJPME) I Course

Skill level V: This skill level is obtained when promoted to the rank of Master Sergeant (paygrade E-8). TIS is generally between 18-22 YOS. Positions requiring direct and indirect leadership roles with expertise in company and battalion-level operations and competency across a given CMF, serving as members of a staff at every level in the Army, with a full understanding of the allocation of resources and their utilization in order to accomplish Army functions and missions.

Institutional training:

  • United States Army Sergeants Major Academy (USASMA)
  • Structured Self-Development (SSD) level V

Skill level VI: This skill level is obtained when promoted to the rank of Sergeants Major (paygrade E-9). TIS is generally between 22-30 YOS. Positions requiring organizational leadership roles with multi-dimensional expertise in units and teams on division, corps, and Army staffs, integrated with Joint, Interagency, Intergovernmental, and Multinational (JIIM) partners with a full understanding of the Force Generation process, operations at all echelons, and how the Army runs.

Star Credential Star icon

Star credentials are MOS enhancing, as designated by the Proponent. MOS enhancing credentials are directly related to an MOS or ASI, are taught either partially or completely as part of a Program of Instruction (POI), and improve the MOS technical proficiency.

Proponent Funded Funded icon

This icon indicates credentials which Soldiers may have funded through their MOS proponent. Some proponents offer credentialing opportunities in conjunction with military training and/or as part of MOS development beyond the training base.

Gap Analysis Has Analysis icon

A detailed analysis comparing the credential requirements to the military occupation has been completed. Click on the gap analysis icon to view the analysis page.

Adult Critical Care Specialty Examination (ACCS)

Eligibility Requirements ()

Note: This credential may have multiple options for becoming eligible. Listed below are the minimum requirements based on the minimum degree required. To view other options, see the Eligibility tab.

  • Credential Prerequisite: Applicants shall be a Registered Respiratory Therapist (RRT) for at least one year prior to applying for the Adult Critical Care Specialty Examination.
  • Experience
  • Education
  • Training
  • Membership
  • Other
  • Fee

Exam Requirements ()

  • Written Exam
  • Oral Exam
  • Practical Exam
  • Performance Assessment

Renewal Period: 5 years

  • Continuing Education
  • Exam
  • Continuing Education OR Exam
  • Fee
  • Other

National Board for Respiratory Care (NBRC)
10801 Mastin Street
Suite 300
Overland Park, KS  66210
Phone: (888) 341-4811
Fax: (913) 712-9283
Email: nbrc-info@nbrc.org

Adult Critical Care Specialty Examination (ACCS)

Candidate must be a Registered Respiratory Therapist (RRT) for at least one year prior to applying for the examination.

Adult Critical Care Specialty Examination (ACCS)

  • Respiratory Critical Care (39%)
    • Manage Airways
      • Airway clearance techniques
      • Difficult airway recognition and techniques
      • Advanced techniques during intubation
      • Artificial airways
    • Administer Specialty Gases
      • Nitric oxide
      • Helium-oxygen
    • Manage Ventilation
      • Initial settings
      • Advanced modes
      • Noninvasive
      • Waveform analyses
      • Rescue techniques
      • Strategies
      • Differential / independent lung ventilation
      • Intrahospital transport of unstable and high-risk patients
      • Optimizing patient-ventilator interaction
    • Deliver Pharmacologic Agents
      • Aerosolized agents other than bronchodilators
      • Airway instillations other than for ACLS
  • General Critical Care (61%)
    • Assess Patient Status and Changes in Status
      • Difficult airway issues
      • Chest imaging
      • Indices of respiratory physiology and mechanics
      • Neurologic
      • Cardiovascular
      • Hemodynamics
      • Differentiation among types of shock
      • Recognition of respiratory failure mechanisms
      • Renal function
      • Metabolic
      • Gastrointestinal
      • Coagulation
      • Musculoskeletal
    • Anticipate Care Based on Laboratory Results
      • CBC
      • Cardiac markers
      • Electrolytes, magnesium, calcium, and phosphate
      • Acid-base status and lactate level
      • Coagulation studies
      • Culture and sensitivities
      • Sputum Gram stain
      • Hemoximetry (co-oximetry)
      • BUN and creatinine
      • Fluid analyses
    • Anticipate Care Based on Imaging and Reports of Imaging
      • Plain radiographs
      • CT
      • MRI
      • Ultrasound
      • Nuclear scans
      • Angiography
    • Anticipate Effects of Pharmacologic Agents
      • Sedatives / hypnotics
      • Analgesia
      • Neuromuscular blocking agents
      • Reversal agents
      • Vasoactive and inotropic agents
      • Drugs that induce methemoglobinemia
      • Prophylaxis
      • Diuretics
      • Drug interactions
      • Influence of co-morbid conditions
    • Anticipate Care Based on Nutritional Status
      • Complications of malnutrition
      • Complications of feedings
      • Route of feeding
      • Morbid obesity
      • Metabolic study
    • Prevent Ventilator Associated Pneumonia
      • Oral care
      • Bed position
      • Minimizing intubation time
      • Ventilator circuit care
      • Using specialty airways
    • Recognize and Manage Patients with Infections and Sepsis
      • Recognition of clinical and laboratory signs consistent with infections and sepsis
      • Management of patients with infections and sepsis
      • Prevention measures
    • Manage End-of-Life Care
      • Differentiation of the potential need for end-of-life care
      • Determination of brain death
      • Withdrawal of life support
      • Care of organ donors
    • Prepare for Disasters
      • Procedures for patient movement and protection
      • Triage procedures
      • Equipment and supply management
    • Interact with Members of an Interdisciplinary Team
      • Suggested modifications to the care plan based on the respiratory assessment
      • Response to modifications to the care plan from other team members
    • Perform Procedures
      • Arterial line insertion and monitoring
      • Mini-BAL
    • Troubleshoot Systems
      • Chest tube drainage
      • Bronchoscopy
      • Hemodynamic monitoring
      • Inhaled vasodilator delivery

There are a number of resources available to help you prepare for the Adult Critical Care Specialty Examination (ACCS) examination:

An additional resource is Safari Books Online, a searchable digital library that provides online access to thousands of books, training videos and conference sessions. See the Educational Resources page here on COOL to learn how to get free access.

Testing for this credential is handled by PSI. The test centers are located in the U.S.

To find out more, use the following links on the PSI website:

For more information on the National Board for Respiratory Care (NBRC) testing process, visit the agency website.

Adult Critical Care Specialty Examination (ACCS)

Renewal Period: 5 years

The Adult Critical Care Specialty Examination (ACCS) credential has the following recertification information:

Individuals have the following three options from which to choose in renewing their credentials for an additional five years beyond their initial credentialing date:
  • Provide proof of completion of a minimum of 30 hours of Category I Continuing Education (CE) acceptable to the NBRC.
  • Retake the respective examination(s) for the credential being renewed and achieve a passing score.
  • Pass another NBRC credentialing examination not previously completed.