Revision sheet: Battlefield Tactical Casualty Care Fundamentals

📋 Course Outline

1. TCCC як основа догоспітальної допомоги
2. Фаза 1 Care Under Fire та турнікет
3. Фаза 2 Tactical Field Care алгоритм MARCH
4. Фаза 3 Tactical Evacuation Care моніторинг
5. Взаємодія з підрозділом і розподіл ресурсів

📖 1. TCCC як основа догоспітальної допомоги

🔑 Key Concepts & Definitions

• TCCC : TCCC is a battlefield standard for prehospital care that balances treatment with the need to keep the mission going.
• Tactical Combat Casualty Care : Tactical Combat Casualty Care is the full name of TCCC, focused on saving lives while operating under combat constraints.
• Three TCCC goals : Three TCCC goals are to treat the wounded, prevent additional casualties, and support completion of the combat task.
• TCCC phases : TCCC phases are three stages of care chosen based on the medic’s and casualty’s position relative to the enemy.

📝 Essential Points

• TCCC differs from civilian care by prioritizing the balance between medical aid and combat task execution.
• TCCC aims to reduce both mortality and the creation of new casualties during ongoing combat.
• Phase selection depends on where the medic and the wounded are relative to enemy fire and visibility.
• The framework organizes care into three distinct phases rather than a single continuous approach.
• The overarching priority is medic safety to avoid increasing casualties and reducing unit combat effectiveness.
• TCCC is presented as an industry standard for prehospital battlefield survival.

💡 Memory Hook

TCCC = Treat + Stop more harm + Task success (3 goals).

📖 2. Фаза 1 Care Under Fire та турнікет

🔑 Key Concepts & Definitions

• Care Under Fire : Care Under Fire is the phase when the medic and casualty are under active enemy fire or in direct line of sight.
• CUF priorities : CUF priorities are return fire and seek cover, keep the casualty in the fight if possible, and perform only one lifesaving intervention.
• High and Tight tourniquet : High and Tight is the tourniquet placement method: applied high and tightened firmly over clothing.
• Self-aid : Self-aid is the casualty’s ability to apply aid themselves when instructed to remain in the fight if possible.

📝 Essential Points

• The CUF guiding principle is that fire superiority is the best “medicine” on the battlefield.
• The medic should respond with fire and move to cover before attempting broader care.
• The casualty should be ordered to stay in the fight if feasible and to use self-aid.
• Only one medical action is performed on this phase: stopping life-threatening extremity bleeding with a tourniquet.
• The tourniquet is placed as high as possible and tightened firmly over clothing.
• Airway checks are not performed during CUF.

💡 Memory Hook

CUF = Cover + Command + Catastrophic bleed only (tourniquet); no airway check.

📖 3. Фаза 2 Tactical Field Care алгоритм MARCH

🔑 Key Concepts & Definitions

• Tactical Field Care : Tactical Field Care is the phase when direct enemy fire is no longer immediate, but the threat of attack remains.
• MARCH : MARCH is the ordered algorithm for Tactical Field Care: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head.
• Massive Hemorrhage : Massive Hemorrhage is the first MARCH step focused on controlling severe bleeding.
• Airway : Airway is the MARCH step focused on clearing the airway and using a nasopharyngeal airway.
• Hypothermia/Head : Hypothermia/Head is the MARCH step focused on preventing cold injury and checking for head trauma.

📝 Essential Points

• TFC uses the MARCH algorithm as the main operating principle.
• MARCH step M includes checking tourniquets, packing wounds, and applying pressure dressings.
• MARCH step A includes clearing the airway and using a nasopharyngeal airway.
• MARCH step R includes chest assessment, an occlusive dressing for penetrating chest wounds, and needle decompression for pneumothorax.
• MARCH step C includes a full circulation assessment, stopping small bleeds, and checking for shock.
• MARCH step H includes hypothermia prevention and inspection for traumatic brain injury/head trauma.

💡 Memory Hook

MARCH = M-A-R-C-H in order: bleed, airway, breathing, circulation, cold/head.

📖 4. Фаза 3 Tactical Evacuation Care моніторинг

🔑 Key Concepts & Definitions

• Tactical Evacuation Care : Tactical Evacuation Care is the phase that begins once the casualty is loaded into transport for movement to the hospital.
• TACEVAC monitoring : TACEVAC monitoring is the ongoing observation of the casualty’s condition during transport to detect changes early.
• Form 1380 : Form 1380 is the casualty documentation form completed during Tactical Evacuation Care.
• Pain medication : Pain medication is the administration of analgesics during evacuation according to the protocol.
• Fracture fixation : Fracture fixation is the stabilization of fractures during transport to reduce harm and complications.

📝 Essential Points

• TACEVAC starts when the casualty is loaded into a vehicle or helicopter for hospital transport.
• The guiding principle is repeat assessment plus support of vital functions during movement.
• TACEVAC includes detailed monitoring of the casualty’s status.
• Analgesics are administered during this phase according to the protocol.
• Fractures are stabilized (fixed) during evacuation care.
• Documentation is completed using Form 1380.

💡 Memory Hook

TACEVAC = Transport care: Monitor + Pain control + Fix fractures + Form 1380.

📖 5. Взаємодія з підрозділом і розподіл ресурсів

🔑 Key Concepts & Definitions

• Communication with the commander : Communication with the commander is the medic’s duty to report the casualty’s status and whether they can continue fighting or need evacuation.
• Tactical movement command : Tactical movement command is the unit instruction that authorizes movement to the casualty or evacuation into cover.
• Крию! : “Крию!” is the command that triggers authorized movement to the casualty or to evacuation into cover.
• IFAK : IFAK is the casualty’s individual first aid kit used first for immediate lifesaving needs.
• Medic safety priority : Medic safety priority is the rule that the medic must not expose themselves without cover to avoid increasing casualties.

📝 Essential Points

• Rescue effectiveness depends on coordination, not only on the medic’s skills.
• The medic must report whether the casualty can keep fighting or requires evacuation.
• Movement to the casualty or evacuation into cover is done only after the unit issues the command “Крию!”.
• Resource allocation prioritizes using the casualty’s IFAK first.
• The medic keeps their own kit for critical cases or mass-casualty situations.
• If the medic dies trying to rescue without cover, casualties double and unit combat readiness decreases.

💡 Memory Hook

Team + timing + kits: report status, move only after “Крию!”, use casualty IFAK first, protect the medic.

📊 Synthesis Tables

TCCC phases by environment and main action

Phase	Where	Main action	Key focus
Care Under Fire	Under fire	Return fire + cover; tourniquet only	Fire superiority and life-threatening extremity bleeding control
Tactical Field Care	In cover	MARCH algorithm	Systematic treatment of M-A-R-C-H problems
Tactical Evacuation Care	In transport	Repeat assessment + vital support	Monitoring, analgesia, fracture fixation, documentation

⚠️ Common Pitfalls & Confusions

1. Trying to do airway or broader care during Care Under Fire instead of limiting to tourniquet for life-threatening extremity bleeding.
2. Forgetting that TFC is run by the ordered MARCH sequence rather than random treatment.
3. Skipping pneumothorax-specific action in the Respiration step (needle decompression) when indicated.
4. Administering or documenting evacuation steps without ongoing monitoring during transport.
5. Moving to the casualty without the unit’s “Крию!” command or neglecting medic safety, which increases casualties.

✅ Exam Checklist

1. Define TCCC and list its three goals in the correct combat-balance framing.
2. Identify the conditions that define Care Under Fire and state the CUF guiding principle.
3. State CUF priorities and the single allowed medical intervention (tourniquet) plus its High and Tight placement over clothing.
4. State what is not checked during CUF (airway).
5. Define Tactical Field Care conditions and state that MARCH is the governing algorithm.
6. List MARCH steps in order and give the specific actions for each step (M, A, R, C, H).
7. Define Tactical Evacuation Care start point (loading into transport) and its guiding principle (repeat assessment + vital support).
8. List TACEVAC priorities: detailed monitoring, analgesics per protocol, fracture fixation, and Form 1380 documentation.
9. Explain interaction with the unit: what the medic reports to the commander and when movement is authorized.
10. Explain resource distribution: use the casualty’s IFAK first and preserve the medic’s kit for critical/mass-casualty needs.
11. State the key safety rule about what happens if the medic dies without cover and how it affects casualties and unit readiness.