CE

ALL SERVI
MEMBERS

TACTICAL COMBAT
CASUALTY CARE
COURSE
TCCC TIER 1 TCCC TIER 2 TCCC TIER 3 TCCC TIER 4
All Service Members Combat Lifesaver Medic/Corpsman Combat Paramedic /Provider
SCENE SETTER

2
 WELCOME

Welcome to the
TACTICAL COMBAT CASUALTY CARE
ALL SERVICE MEMBERS course.
++ Please insert your own welcome message here ++

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 STUDENT COURSE PLAN

HOW WE WILL TRAIN

A C

+ + +
PRESENTATION HANDS-ON SCENARIO- DEBRIEF &
TRAINING DRIVEN SKILLS COURSE
3 practical exercises ASSESSMENT EVALUATION
with assessment

By the end of this course, you will be able to explain the core principles of
Tactical Combat Casualty Care and perform
LIFESAVING SKILLS
at a basic competency level. 4
 TACTICAL COMBAT CASUALTY CARE (TCCC)
or TC3 TRAINING SPECTRUM
TACTICAL COMBAT CASUALTY CARE
ROLE 1 CARE
NONMEDICAL PERSONNEL MEDICAL PERSONNEL

TCCC: TCCC:
TIER 2 COURSE
TCCC: TCCC:
TIER 4 COURSE
TIER 3 COURSE
TIER 1 COURSE

COMBAT
PARAMEDIC/
COMBAT COMBAT PROVIDER
LIFESAVER MEDIC/ ADVANCED
CORPSMAN RESUSCITATIVE CARE

POI/Enroute Care

ALL SERVICE
MEMBER
YOU ARE HERE

STANDARDIZED JOINT CURRICULUM

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 STUDENT LEARNING OBJECTIVES

10 TERMINAL LEARNING OBJECTIVES (TLOs)

01 02 03 04 05
Describe the Describe the use Perform a Demonstrate basic Demonstrate basic care
practice of TCCC of a first aid kit rapid casualty care for a casualty for a casualty with a
assessment with massive compromised airway or
bleeding in respiratory distress

06 07 08 09 10
Describe the basic Describe the Describe the Identify a head Describe point of
care of burns basic care of basic care of an injury injury communication
fractures eye injury strategies and casualty
care documentation

37 ENABLING LEARNING
OBJECTIVES (ELOs)
= Cognitive ELOs

= Performance ELOs
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 LIFESAVING SKILLS

You MUST be able to perform these

LIFESAVING SKILLS:
AIRWAY &
BLEEDING CONTROL
BREATHING

Rapid Tourniquet Hemostatic Pressure Airway

Casualty Application Dressing Dressing Maneuvers
Assessment

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 ASSESSMENT

HOW YOU WILL BE EVALUATED

You will undergo 1 skills assessments

to pass the student portion of the TCCC
ASM Course

You will be evaluated on your ability

to perform skills. There is no
graded written examination

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 Three PHASES of TCCC
are born out of years of war and lives lost:

1 CARE UNDER 2 TACTICAL 3 TACTICAL

FIRE/THREAT FIELD CARE EVACUATION
NOT SAFE SAFER
CARE
Quick decision-making: Quick decision-making: Care provided during transport to
§ Ensure scene safety § Provide medical aid advanced medical care,
§ Move casualty to safety wherever appropriate depending
§ Identify and control on the trauma scenario
life-threatening bleeding
NOTE: This is covered in more
advanced TCCC training tiers!
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 CASUALTY ASSESSMENT

PHASE 1: CARE UNDER FIRE

OR ACTIVE THREATS
SCENE SAFETY CASUALTY MOVEMENT
Never attempt to rescue SECURE the casualty by
a casualty until the scene immediately moving them to safety.
is SAFE! Consider THREATS
Make a PLAN

COMMUNICATION “R’s” PLAY VIDEO

RESPOND/REASSURE
REQUEST HASTY TOURNIQUET
Using a recommended tourniquet
REPORT (such as the C-A-T) is a safe procedure.
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 CASUALTY ASSESSMENT

PHASE 2: TACTICAL FIELD CARE

Following the MARCH sequence
will guide you through the M ASSIVE BLEEDING
RAPID CASUALTY ASSESSMENT
A IRWAY

R ESPIRATION/BREATHING

C IRCULATION

Circulation
Airway
Breathing
Airway
Breathing
Circulation
H YPOTHERMIA
C A B or A B C Different than M A R C H
…then, attend to other injuries. 11
 FIRST AID KITS

THESE ARE THE

PERSONAL
MEDICAL SUPPLIES Joint First Aid Kit
YOU WILL NEED TO or
Individual First
PROVIDE AID: Aid Kit (IFAK)
Tourniquet
Hemostatic Dressing SERVICE
Pressure Bandage/ SPECIFIC
Emergency Trauma Dressing First Aid Kit
DD Form 1380/ EXAMPLE:
Tactical Combat Casualty Navy First Aid Box
Care Card
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 MASSIVE BLEEDING

HOW TO RECOGNIZE
MASSIVE, LIFE-THREATENING BLEEDING
BRIGHT RED BLOOD Overlying clothing or ineffective
is pulsing, spurting or bandaging are becoming
steady bleeding from SOAKED WITH BLOOD
the wound

There was prior

bleeding, and the
casualty is now
BRIGHT RED BLOOD
Casualties with severe in shock
injuries can bleed to death is pooling on the
(unconscious,
in as little as 3 minutes ground
confused, and pale)
 MASSIVE BLEEDING

Three tools in your first aid kit can be used to

CONTROL MASSIVE BLEEDING!

C-A-T HEMOSTATIC PRESSURE

TOURNIQUET DRESSING BANDAGE

M AR CH 14
 MASSIVE BLEEDING

TOURNIQUET APPLICATION
A TOURNIQUET cuts off blood
flow to an arm or leg past the HOW TO IDENTIFY
application site; this is the best LIFE-THREATENING
BLEEDING:
method to control massive bleeding.
The wound is pulsing or steadily
bleeding.

APPLY A Blood is pooling on the ground.

TOURNIQUET Clothes or bandages are
soaked with blood.
AND STOP
BLEEDING An arm or a leg has been
amputated.
WITHIN
The casualty is bleeding and has
now progressed into shock
(unconscious, confused, pale).

M AR CH 15
 MASSIVE BLEEDING

MOST COMMON
TOURNIQUET
SINGLE
WINDLASS ROUTING
ROD BUCKLE
WINDLASS
CLIP WINDLASS
SAFETY STRAP
C-A-T® G7 NSN
6515-010521-7976
(Combat Application
Tourniquet) M AR CH 16
 IMPROVISED TOURNIQUET

USE CAUTION RISKS ASSOCIATED

WITH IMPROVISED
when considering TOURNIQUETS:
the use of an DAMAGE may occur to skin
improvised if the band is too narrow.

tourniquet! Bleeding may WORSEN.

Bleeding MAY NOT BE
If no tourniquet is available, COMPLETELY CONTROLLED.
pack the wound and hold direct
An improvised tourniquet
pressure over the main source
may likely LOOSEN over
of bleeding.
time from not being
properly secured.

M AR CH 17
 CLEARING THE AIRWAY

You MUST ensure a casualty’s SIGNS AND

SYMPTOMS AIRWAY
AIRWAY IS OPEN! MAY BE BLOCKED:
Severe trauma to
the face
Blood or foreign
objects in the airway
The casualty indicates
they can’t breathe
The casualty is making
snoring or gurgling
sounds

M A RCH 18
 OPENING THE AIRWAY

In a CASUALTY without an airway obstruction,

you can perform the following maneuvers:
Assist a conscious
HEAD-TILT CHIN LIFT JAW THRUST For an unconscious
casualty by helping
them assume any casualty, place them
comfortable sitting- into the RECOVERY
POSITION.
up position that
ALLOWS THEM TO
BREATH EASILY.

M A RCH 19
 RESPIRATION/BREATHING

RESPIRATORY DISTRESS
SIGNS OF RESPIRATORY
DISTRESS INCLUDE:
Difficulty breathing

Struggling to get air in and out

Breathing is too weak to be effective
(breathing less than six times per minute)
Rapid breathing (greater than 20 times
per minute)
THESE SIGNS MAY INDICATE A
PENETRATING CHEST WOUND INJURY!

IMPORTANT!
It is critically important to report findings
of RESPIRATORY DISTRESS to medical
personnel at the scene. MA R CH 20
 RESPIRATION/BREATHING

LIFE-THREATENING CHEST INJURY

SIGNIFICANT SUCKING CHEST May result from large
TORSO TRAUMA WOUND/PNEUMOTHORAX defects in the chest wall and
may interfere with ventilation
It takes a hole in the
Treated by medical
chest the size of a nickel
personnel applying a vented
or bigger for this to occur.
occlusive dressing

Allow casualty to adopt the

sitting position if breathing
is more comfortable
Monitor for possible
development of subsequent
Penetrating Blast Injury tension pneumothorax
Wounds
Suspect a LIFE-THREATENING CHEST INJURY
IMPORTANT! when a casualty has significant torso trauma or
It is critically important to report findings primary blast injury accompanied by severe or
of LIFE-THREATENING CHEST INJURY
to medical personnel at the scene. MA R CH progressive respiratory distress (i.e. difficulty
breathing, breathing too slow or too fast). 21
 CIRCULATION/SHOCK

CONTROL BLEEDING and then SIGNS AND SYMPTOMS

take steps to PREVENT SHOCK. OF SHOCK INCLUDE:

Elevate both legs higher than Rapid

the casualty's heart. breathing

Tourniquet Losing focus

applied tightly and having
difficulty
engaging
Sweaty, cool,
clammy skin
Pale/gray
skin

MA R C H 22
 HYPOTHERMIA PREVENTION

You MUST prevent/address HYPOTHERMIA

worsened by MASSIVE BLOOD LOSS.*
* This is not hypothermia due to cold weather!

PREVENT
HYPOTHERMIA:
• Keep clothing/uniform on
the casualty.
• Replace extremely wet clothing
and keep the casualty dry.
• Keep casualty off the ground
SOME SIGNS OF HYPOTHERMIA: (avoid touching the ground -
increases loss of body heat).
Slurred Slow • Use blankets, poncho liners,
speech or breathing & Shivering
sleeping bags, or anything that
mumbling drowsiness will retain heat.
• Minimize exposure to the
MA RC H environment.
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 In addition to
M A R C H

you may need to address

other injuries.
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 SECONDARY INJURIES

Head Injury Eye Trauma Fractures Burns

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 HEAD INJURY RECOGNITION

Result of blunt force, Usually gunshot SIGNS AND SYMPTONS

acceleration, or wounds, stabbings, FROM HEAD INJURY
deceleration forces or fragmentation INCLUDE:
(such as explosion or
from explosives
blast events, motor Altered consciousness
vehicle collision or roll-
overs, fall or sports injury) Disorientation or dizziness

BLUNT HEAD PENETRATING Headache

TRAUMA TRAUMA Ear ringing

Other Injuries: Nausea/vomiting
Head injury, eye trauma, fractures, and burns
Amnesia

IMPORTANT! Double vision

It is critically important to report findings of a head
injury to medical personnel at the scene since a
lack of rapid and appropriate medical care can DOD Instruction (DODI) 6490.11: DoD Policy
Guidance for Management of Mild Traumatic
worsen the head injury and the eventual outcome. Brain Injury/Concussion in the Deployed
IAW Military Acute Concussive Evaluation 2 (MACE 2)
Setting, Change 1 effective 11 June 2018
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 EYE TRAUMA

IF A PENETRATING EYE INJURY IS NOTED

OR SUSPECTED, SHIELD THE INJURED EYE.

DO NOT
APPLY
Rigid Eye PRESSURE!
Shield

A B
Cover the eye with a RIGID EYE SHIELD, If no rigid eye shield is available,
not a pressure patch. Place the shield over the injured TACTICAL EYEWEAR can also be
eye (not both eyes) and tape in place. used to protect the eye.
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 FRACTURES

WARNING SIGNS
OF A FRACTURE:
Significant pain and swelling

An audible or perceived “snap”

Different length or shape of limb

Loss of pulse or sensation in the
injured arm or leg
Crepitus (hearing a crackling or
popping sound under the skin)
CLOSED FRACTURE OPEN FRACTURE

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 FRACTURES

APPLICATION OF A SPLINT
Use a semirigid splint (like a SAM splint)
or improvise using rigid or bulky materials
(i.e., boards, boxes, tree limbs, and even weapons):

Incorporate the joint ABOVE Arm fractures can easily be

AND BELOW the fracture. secured to the shirt using the
sleeve as a sling.
SECURE THE SPLINT with an ace
wrap, cravats, belts, or duct tape NOTE: Make sure not to
(if available). wrap the splint too tight
cutting off circulation below
Try to SPLINT before moving the the splint. Compare the skin
casualty and minimize movement color and temperature
of the fractured extremity. BEFORE and AFTER the
splint is applied to make sure
CHECK PULSE before and it doesn’t turn cool and pale.
after splinting.
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 BURNS

BURNS are classified by the

depth of the wound.

SURFACE OF PARTIAL FULL THICKNESS

THE SKIN THICKNESS OF OF THE SKIN
1ST-DEGREE BURNS THE SKIN 3RD-DEGREE BURNS
are just like a sunburn, with a may appear dry, stiff, and leathery,
2ND-DEGREE BURNS
reddened appearance of the skin. and/or it can also be white, brown,
will also have blisters. or black.
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 BURNS

IN CASE OF
ELECTRICAL
INJURY

COVER COVER Secure the power, if possible.

the burn area the casualty to Otherwise, remove the casualty
with dry, sterile prevent heat loss from the electrical source using
a nonconductive object such as
dressings. and keep the a wooden stick. Move the
casualty dry. casualty to a safe place.

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 COMMUNICATION AND DOCUMENTATION

COMMUNICATE: DOCUMENT:
1.WITH THE CASUALTY 1.CASUALTY
ENCOURAGE, REASSURE, AND
EXPLAIN CARE ASSESSMENT FINDINGS

2.WITH TACTICAL 2.MEDICAL AID

LEADERSHIP RENDERED
Provide leadership with the
casualty status and location. 3.CHANGES IN CASUALTY
DD Form 1380 STATUS
3.WITH MEDICAL
PERSONNEL Attach the DD Form 1380 to the
Discuss the casualty’s injuries casualty’s belt loop, or place it in
and symptoms, as well as any their upper left sleeve or the left
medical aid provided with the trouser cargo pocket.
responding medics.
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 TEST ON KNOWLEDGE

You have encountered an active shooter situation.

An unconscious casualty has sustained multiple
gunshot wounds.

Your assessment reveals the following: two open chest wounds

from apparent gunshots, and bright red blood squirting from the
lower right thigh. The casualty is in respiratory distress.

What is the most important priority in the

treatment of this casualty?
1. Airway maneuvers
2. Wound packing of the right thigh
3. Tourniquet to the right thigh
4. Pressure dressing to the right thigh
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 Using the …following the ...and providing

TCCC M A R C H LIFESAVING
SKILLS
standard of care in sequence to perform a
Prehospital Battlefield RAPID CASUALTY
Medicine ASSESSMENT

…YOU can
SAVE A LIFE!
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 TACTICAL COMBAT CASUALTY CARE

YOUR JOB is to
TAKE ACTION:
PROVIDE DOCUMENT ASSIST
LIFESAVING SKILLS medical aid with evacuation
until first responders or
medical personnel arrive
at the scene

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 KEEP LEARNING

J7, Education and

Training Directorate as
the Course Manager

Also available:
You can DOWNLOAD the ASM TCCC
TRAINING MATERIALS and watch any
of the VIDEOS you have seen or used in
this course at deployedmedicine.com,
or on your personal device using the
DEPLOYED MEDICINE APP

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