TCCC / Military First Aid

Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head injury

Care Under Fire (CUF), Tactical Field Care (TFC), and Tactical Evacuation Care (TACEVAC)

Return fire and take cover. The best medicine on the battlefield is fire superiority.

Application of a tourniquet for life-threatening extremity hemorrhage

High and tight on the affected extremity, over the uniform, as proximal as possible

The Combat Application Tourniquet (CAT) or the SOF Tactical Tourniquet Wide (SOFTT-W)

Tight enough to completely stop the distal pulse and eliminate all bleeding from the wound

False. Once applied, a tourniquet should not be loosened or removed in the field unless directed by medical personnel during Tactical Field Care

The time of application, written directly on the tourniquet or on the casualty's skin near the tourniquet

2 hours. After 2 hours, the risk of limb damage increases significantly, and conversion to a pressure dressing or hemostatic agent should be considered if tactically feasible

Wound packing is stuffing hemostatic or plain gauze directly into a wound cavity to control hemorrhage in junctional areas (groin, axilla, neck) where tourniquets cannot be applied

Combat Gauze (QuikClot) impregnated with kaolin, and Celox Gauze impregnated with chitosan

A minimum of 3 minutes of direct pressure, then apply a pressure dressing

Bleeding from the junction of a limb and the torso (groin, axilla, neck) where a tourniquet cannot be effectively applied. These areas are highly vascular and can result in rapid death

The Junctional Emergency Treatment Tool (JETT) or the Combat Ready Clamp (CRoC)

Airway management — ensure the casualty has a patent (open) airway

A soft rubber tube inserted through the nostril into the nasopharynx to maintain an open airway in an unconscious casualty who has a gag reflex. It is the basic TCCC airway adjunct

28 French (Fr) for adults, lubricated with water-based lubricant or water before insertion

False. An NPA is contraindicated when there is evidence of mid-face trauma or suspected basilar skull fracture

A surgical airway created by cutting through the cricothyroid membrane to insert a tube. It is performed when the airway cannot be maintained by positioning, NPA, or other means (e.g., severe facial trauma)

The recovery position (lateral recumbent position) to prevent aspiration and maintain airway patency

Respiration — assess for tension pneumothorax, open pneumothorax (sucking chest wound), and other respiratory issues

Progressive respiratory distress, decreased or absent breath sounds on the affected side, tracheal deviation (late sign), distended neck veins, and hypotension/shock

Needle decompression (needle thoracentesis) at the 2nd intercostal space midclavicular line or the 5th intercostal space anterior axillary line on the affected side, using a 14-gauge, 3.25-inch needle/catheter

A penetrating wound to the chest that allows air to enter the pleural space. Treat by applying a vented chest seal (or an occlusive dressing taped on three sides) over the wound

A vented chest seal has a one-way valve that allows air to escape during exhalation but prevents air from entering during inhalation, reducing the risk of tension pneumothorax

True. Both the entry and exit wound should be sealed to prevent air from entering the chest cavity from either wound

Circulation — assess for signs of shock (altered mental status, weak/rapid pulse, pale/cool/clammy skin) and establish IV/IO access for fluid resuscitation

Whole blood or blood products are preferred. If unavailable, Lactated Ringer's (LR) or Hextend (6% hetastarch) may be used. Normal saline is also acceptable

Maintaining a lower-than-normal blood pressure (systolic ~80-90 mmHg or palpable radial pulse) to reduce the risk of disrupting clot formation while still maintaining organ perfusion. Does NOT apply to TBI casualties

TXA is an antifibrinolytic drug that prevents clot breakdown. It should be given as early as possible (within 3 hours of injury) to casualties with significant hemorrhage or at risk for significant hemorrhage — 1g IV over 10 minutes

Hypothermia/Head injury — prevent hypothermia because it worsens the lethal triad (hypothermia, acidosis, coagulopathy) and assess for traumatic brain injury

Hypothermia, acidosis, and coagulopathy. These three conditions create a vicious cycle that makes hemorrhage harder to control and significantly increases mortality

Minimize exposure to the elements, remove wet clothing, use the Hypothermia Prevention and Management Kit (HPMK) or a casualty blanket, place insulation between the casualty and the ground, and use warm IV fluids when available

Urgent (within 2 hours to save life/limb/eyesight), Priority (within 4 hours or condition will deteriorate), and Routine (within 24 hours, not expected to deteriorate)

Line 1: Location (grid), Line 2: Radio frequency/call sign, Line 3: Number of patients by precedence, Line 4: Special equipment needed, Line 5: Number of patients by type (litter/ambulatory), Line 6: Security of pickup site, Line 7: Method of marking, Line 8: Patient nationality/status, Line 9: CBRN contamination (terrain description in peacetime)

The number of patients by precedence category: A=Urgent, B=Urgent Surgical, C=Priority, D=Routine, E=Convenience

Special equipment required at the pickup site: A=None, B=Hoist, C=Extraction equipment, D=Ventilator

A=Panels, B=Pyrotechnic signal, C=Smoke signal, D=None, E=Other (e.g., VS-17 panel, infrared strobe, chemical light)

To document all injuries found and treatments given to a casualty on the battlefield. It stays with the casualty throughout the evacuation chain to ensure continuity of care

Acetaminophen (Tylenol) and/or Meloxicam (a non-steroidal anti-inflammatory). Opioids are avoided because they can impair the ability to fight

Ketamine (50mg IV/IO or 100mg IM) is the preferred analgesic. Oral transmucosal fentanyl citrate (OTFC) 800mcg lozenge is an alternative

True. TCCC recommends every service member carry at least one tourniquet in a readily accessible location for rapid self-aid or buddy aid

Care Under Fire is performed while still under effective hostile fire with limited interventions (mainly tourniquet). Tactical Field Care is performed when no longer under effective fire, allowing a more thorough MARCH assessment and expanded treatment options

Secure the casualty's weapon and sensitive equipment. Ensure the weapon is on safe and accounted for. Redistribute ammunition and equipment to other team members if the casualty cannot continue the mission

Place one hand on the forehead and tilt the head back while lifting the chin forward with the fingers of the other hand. Do NOT use this technique if cervical spine injury is suspected — use jaw-thrust instead

Respiratory rate less than 8 or greater than 30 per minute, shallow or irregular breathing, cyanosis (blue discoloration of lips/nail beds), use of accessory muscles, and altered mental status

AVPU is a rapid mental status assessment: A=Alert, V=responds to Voice, P=responds to Pain, U=Unresponsive. A declining AVPU score may indicate worsening shock

IO infusion delivers fluids/medications directly into the bone marrow cavity (usually the proximal tibia or humeral head). It is used when IV access cannot be obtained quickly, especially in hypovolemic shock

True. TCCC guidelines recommend oral antibiotics (moxifloxacin 400mg) for all open combat wounds to prevent infection. If the casualty cannot take oral medications, ertapenem 1g IV/IM is an alternative

A pre-packaged set of medications for combat casualties, typically containing: Acetaminophen (pain), Meloxicam (anti-inflammatory/pain), and Moxifloxacin (antibiotic)

TACEVAC may include additional medical personnel, equipment (monitors, oxygen, advanced airway tools), blood products, and the ability to perform more advanced interventions en route to a medical treatment facility

Address Massive hemorrhage first (M in MARCH), then Airway. Hemorrhage control takes priority because exsanguination (bleeding out) is the #1 preventable cause of death on the battlefield

Approximately 90% of preventable combat deaths are caused by hemorrhage, with extremity hemorrhage being the most common (60% of those)