TCCC — PERFORM A TACTICAL COMBAT CASUALTY CARE PATIENT ASSESSMENT
Perform tactical field care procedures. -d. Perform an initial assessment. 6) Assess breathing E)
(e) Observe for progressive respiratory distress. NOTE: Progressive respiratory distress secondary to unilateral chest trauma should be considered a tension pneumothorax and requires needle decompression.
Perform a rapid trauma assessment. 8) Assess the posterior e)
(e) Reassess all life saving interventions or treatments to ensure they have not been compromised due to the movement of the patient. NOTE: All life saving interventions must be reassessed each time the patient is moved or transported to ensure that they have not been compromised.
Perform a rapid trauma assessment. (1) Assess the head. F)
(f) Inspect the nose, mouth and ears for cerebral spinal fluid (CSF) and/or blood.
Perform a rapid trauma assessment. 3) Assess the chest. F)
(f) Perform needle chest decompression, if necessary (Evaluated IAW Perform Needle Chest Decompression task).
Perform tactical field care procedures. -d. Perform an initial assessment. 6) Assess breathing F)
(f) Perform needle chest decompression, if necessary (Evaluated IAW Perform Needle Chest Decompression task).
Perform tactical field care procedures. -d. Perform an initial assessment. (7) Assess Circulation.
(f) Prevent hypothermia and treat for shock, if applicable (Evaluated IAW Initiate Treatment for Hypovolemic Shock and Prevent Hypothermia task).
Perform a rapid trauma assessment. (1) Assess the head. G)
(g) Treat an open head wound, if present (Evaluated IAW Treat an Open Head Wound task).
Perform a rapid trauma assessment. (1) Assess the head. H)
(h) Treat lacerations, contusions, and extrusions of the eye (Evaluated IAW Treat Lacerations, Contusions, and Extrusions of the Eye task).
Perform tactical field care procedures. -d. Perform an initial assessment. (7) Assess Circulation. E)
(e) Initiate hypotensive fluid protocol (Evaluated IAW Initiate a Saline Lock and IV task). (i) Initiate fluids only if in hypovolemic shock. (ii) Give Hextend 500-ml IV bolus. (iii) Repeat once after 30 minutes if casualty is still in shock, not to exceed 1,000 ml of Hextend.
Perform tactical field care procedures. -d. Perform an initial assessment. 8)
(8) Determine the patient's evacuation priority and make a MEDEVAC decision.
Perform a rapid trauma assessment. 3) Assess the chest. A)
(a) Inspect for DCAP-BTLS and equal bilateral rise and fall of the chest.
Perform a rapid trauma assessment. (2) Assess the neck. A)
(a) Inspect for DCAP-BTLS.
Perform a rapid trauma assessment. (6) Assess the lower extremities. A)
(a) Inspect for DCAP-BTLS.
Perform a rapid trauma assessment. (7) Assess the upper extremities. A)
(a) Inspect for DCAP-BTLS.
Perform a rapid trauma assessment. 4) Assess the abdomen. A)
(a) Inspect for DCAP-BTLS.
Perform a rapid trauma assessment. 5) Assess the pelvis. A)
(a) Inspect for DCAP-BTLS.
Perform a rapid trauma assessment. 8) Assess the posterior A)
(a) Inspect for DCAP-BTLS.
Perform a rapid trauma assessment. (1) Assess the head. E)
(e) Inspect the mouth for broken teeth or airway obstructions.
Perform a rapid trauma assessment. (1) Assess the head. A)
(a) Inspect for deformities, contusions, abrasions, punctures or penetration, burns, tenderness, lacerations, and swelling (DCAP-BTLS).
Perform tactical field care procedures. -d. Perform an initial assessment. 6) Assess breathing A)
(a) Inspect the chest. (i) Open body armor (if present) and expose the chest. (ii) Inspect for any penetrating chest wounds, deformities, contusions, abrasions, punctures or penetration, burns, tenderness, lacerations, swelling (DCAP-BTLS) and equal bilateral rise and fall of the chest. (iii) If a penetrating chest wound is present, apply an occlusive dressing to both entrance and exit wound if present (Evaluated IAW Treat a Penetrating Chest Wound task).
Administer appropriate medications (analgesics and antibiotics). If not able to take PO (shock, unconscious, or penetrating torso injuries).
(a) Morphine sulfate 5 mg IV/IO repeat q 10 min PRN. (b) Promethazine (Phenergen) 25 mg IV/IO/IM q 4 hours, for synergistic analgesic effect and as a counter to potential nausea. (c) Cefotetan 2 g IV or Ertapenem 1 gm IV.
Perform tactical field care procedures. -d. Perform an initial assessment. (5) Assess the airway. a
(a) Perform appropriate maneuver to open and maintain the airway.
Perform a rapid trauma assessment. 3) Assess the chest. C)
(c) Palpate the anterior area of the chest feeling for TIC.
Perform tactical field care procedures. -d. Perform an initial assessment. 6) Assess breathing C)
(c) Palpate the anterior area of the chest feeling for tenderness, instability and crepitus (TIC).
Perform a rapid trauma assessment. (1) Assess the head. C)
(c) Use pen light to inspect eyes for pupils equal round and reactive to light (PERRL).
Gather AMPLE history.
(check ID tags, medication bracelets, squad members). (1) Allergies. (2) Medications. (3) Past prior medical history. (4) Last oral intake. (5) Events leading up to the injury.
Perform a rapid trauma assessment. 3) Assess the chest. D)
(d) Apply appropriate oxygen therapy, if available.
Perform tactical field care procedures. -d. Perform an initial assessment. 6) Assess breathing D)
(d) Apply appropriate oxygen therapy, if available.
Perform tactical field care procedures. -d. Perform an initial assessment. (7) Assess Circulation. D)
(d) Identify signs and symptoms of shock, if present. (i) Weak or absent radial pulses. (ii) Altered mental status. (iii) Pale, cool and clammy skin.
Perform a rapid trauma assessment. (7) Assess the upper extremities. D)
(d) Immobilize a suspected fracture of the arm, if present (Evaluated IAW Immobilize a Suspected Fracture of the Arm task).
Perform a rapid trauma assessment. (1) Assess the head. D)
(d) Inspect for raccoon eyes and battle sign behind ears.
Perform a rapid trauma assessment. (2) Assess the neck. D)
(d) Inspect for tracheal deviation.
Perform a rapid trauma assessment. 8) Assess the posterior d)
(d) Log roll patient onto litter/stretcher.
Perform a rapid trauma assessment. (2) Assess the neck. E)
(e) Apply cervical collar, if necessary.
Perform a rapid trauma assessment. 3) Assess the chest. E)
(e) Observe for progressive respiratory distress. NOTE: A casualty with penetrating chest trauma will generally have some degree of hemo/pneumothorax as a result of the primary wound.
PMS
pulse, motor, and sensory
PERRL
pupils equal round and reactive to light
Perform a rapid trauma assessment. 5)
(5) Assess the pelvis.
Perform a rapid trauma assessment. 7)
(7) Assess the upper extremities.
Perform a rapid trauma assessment. 8)
(8) Assess the posterior
Perform tactical field care procedures. -d. Perform an initial assessment. 6)
(6) Assess breathing.
Perform a rapid trauma assessment. 6)
(6) Assess the lower extremities.
Perform tactical field care procedures. -d. Perform an initial assessment. 7-
(7) Assess Circulation.
Perform a rapid trauma assessment. 1)
(1) Assess the head.
Perform tactical field care procedures. -d. Perform an initial assessment. -1
(1) Develop a general impression of the patient. NOTE: A general impression is the observation of the casualty. Note clues to the patient's mechanism of injury, the patient's approximate age, height, weight, body position, appearance, signs of distress and any odors present (i.e., urine, vomit, feces).
Perform a focused assessment. 1)
(1) Perform a focused physical examination of the injured or affected body part(s).
Assess vital signs. What are they for TCCC?
(1) Pulse. (2) Blood Pressure. (3) Respirations. (4) Skin color, condition, and temperature. (5) Pupils equal round and reactive to light.
Perform tactical field care procedures. b. Communicate updates to the medical situation to the unit leader in the following situations (Evaluated IAW Triage Casualties task). -1
(1) Upon determining that the casualty will not be able to continue with the mission.
Perform a rapid trauma assessment. 2)
(2) Assess the neck.
Perform tactical field care procedures. b. Communicate updates to the medical situation to the unit leader in the following situations (Evaluated IAW Triage Casualties task). -2
(2) Before initiating any medical procedures. Ensure that the tactical situation allows for time to treat the casualty before initiating any medical procedures.
Perform a focused assessment. 2)
(2) Provide interventions and treatment per triage priority.
Perform a rapid trauma assessment. 3)
(3) Assess the chest.
Perform tactical field care procedures. -d. Perform an initial assessment.-3
(3) Determine the patient's chief complaint and life threats. NOTE: The chief complaint is the casualty's description of the injuries. Life threats are how those injuries threaten the casualty's life (i.e., an open chest wound might lead to a tension pneumothorax, which could lead to cardiac shock).
Perform tactical field care procedures. b. Communicate updates to the medical situation to the unit leader in the following situations (Evaluated IAW Triage Casualties task). -3
(3) Upon any significant change in the casualty's status.
Perform tactical field care procedures. -d. Perform an initial assessment. -4
(4) Assess for Hemorrhage.
Perform a rapid trauma assessment. 4)
(4) Assess the abdomen.
Perform tactical field care procedures. -d. Perform an initial assessment.
(5) Assess the airway.
Perform tactical field care procedures. -d. Perform an initial assessment. (7) Assess Circulation. A0
(a) Perform blood sweep for any additional hemorrhages. (i) Control bleeding, if present, with direct pressure, pressure bandage, elevation, hemostatic device, or tourniquet (Evaluated IAW appropriate Control Bleeding tasks). NOTE: Significant hemorrhage from an extremity wound should be stopped as quickly as possible using a tourniquet. Once the tactical situation permits, consideration should be given to applying a pressure type dressing and then loosening the tourniquet. (ii) Loosen tourniquet and convert to pressure dressing or use hemostatic device to control bleeding, if appropriate (Evaluated IAW appropriate Control Bleeding tasks).
Perform tactical field care procedures. -d. Perform an initial assessment. -4) Assess for Hemorrhage. -a
(a) Reassess any treatment for hemorrhage performed during the care under fire phase of care. NOTE: All life saving interventions must be reassessed each time the patient is moved or transported to ensure that it has not been compromised.
Initiate a US Field Medical Card (DD Form 1380) on each casualty.
(a) Remove the protective sheet from the carbon copy. (b) Complete the minimum required blocks (1, 3, 4, 7, 9, and 11) correctly on each casualty. Complete the rest of the blocks as time permits. Attach to each casualty.
Initiate a Tactical Combat Casualty Care Card (DA Form 7656) on each casualty.
(a) Search casualty for pre-filled DA Form 7656 prior to utilizing blank form. NOTE: DA Form 7656 is a component of the improved first aid kit (IFAK). Soldiers may have completed name and allergies portion and inserted the form into their IFAK. (b) Complete all entries fully.(i) Write Soldier's name and unit. (ii) Add date and time and group. For example, 2PB on Sat, 15 Aug 2009 would be: 151400ZAUG2009. (iii) Write the Soldier's known medication allergies: if no allergies, record "NKDA" (no known drug allergies) (iv) Circle which exposure resulted in this injury [friendly; exposure unknown; or NBC (nuclear, biological, chemical)]. (v) If a tourniquet is applied, circle "TQ" and write the time of application. (vi) Mark an "X" at the site of the injury(ies) on the body picture. For burn injuries, circle the burn percentage(s) on the figure. (vii) Circle the cause of injury [gunshot wound, blast, motor vehicle accident, other (specify)]. (viii) Record the level of consciousness AVPU (alert, verbal stimulus, painful stimulus, unresponsive) and vital signs (pulse, respiration, blood pressure) with time. (ix) Circle Airway interventions [Intact, Adjunct, Cric (Cricothyrotomy), Intubated]. (x) Circle Breathing interventions [Chest Seal, Needle D (needle decompression), Chest Tube]. (xi) Circle bleeding control measures addressing Circulation. Don't forget tourniquet time on front of card [TQ (tourniquet), Hemostatic, Packed, Pressure Drsg (pressure dressing)]. (xii) Circle route of fluid [IV (intravenous) or IO (intraosseous)]; type [NS (normal saline solution), LR (lactated ringers solution), Hextend]; and amount given. Specify other fluids. (xiii) Record the type, dose, and route of any drugs given [pain medications, ABX (antibiotics), or other]. (xiv) Use the Other section to record any other pertinent notes and to explain any action that needs clarification. NOTE: When more space is needed, attach another DA Form 7656 to the original. Label the second card in the upper right corner "DA Form 7656 #2." It will show the casualty's name and unit. NOTE: Use only authorized abbreviations. Except for those listed below, abbreviations may not be used for diagnostic terminology. Abr W - Abraded wound. Cont W - Contused wound. FC - Fracture (compound) open. FCC - Fracture (compound) open comminuted. FS - Fracture (simple) closed. LW - Lacerated wound. MW - Multiple wounds. Pen W - Penetrating wound. Perf W - Perforating wound. SL - Slight. SV - Severe. (xv) The first responder will sign the card. (d) Attach the correctly completed TCCC Card to each casualty.
Initiate documentation using the Armed Forces Health Longitudinal Technology Application (AHLTA) or other computerized system on each casualty.
(a) Using the AHLTA-Mobile handheld device, record data on a digital version of the DD1380 for improved readability and tracking of legible data that will be used as part of the treatment plan. (i) Select patient from the pre-populated data; Select DD1380; Select BI - Battle Injury Box; Tap Battle Injury checkbox; Select Injury from pop-up screen; Tap on anatomical diagram of body image at injury site; Add correct time on Time of Onset or Injury box; Click the Down Arrow; Select corresponding Injury Type; Tap Add. NOTE: Once injury is added treatment starts to populate at treatment box. (ii) Tap Vital Sign; Tap Level of Consciousness down arrow; Tap Add; Tap Close. (iii) Select Pain Meds/IV's; Tap Down arrow at Pain Med; Select Med; Tap Add; Tap Down arrow at IV; Tap Add; Tap Close. (iv) Tap Specific Treatment; Select Tourniquet box; Select Save; Select Finish; Verify DD1380 encounter; Tap Sign and Save. Candidate states requirement to sync to laptop.
Perform a rapid trauma assessment. 3) Assess the chest. B)
(b) Auscultate at least four fields for equality and presence of respirations.
Perform tactical field care procedures. -d. Perform an initial assessment. 6) Assess breathing B)
(b) Auscultate at least four fields of the chest for equality and presence of respirations. NOTE: Successful auscultation may not be possible due to the noise on the battlefield.
Perform tactical field care procedures. -d. Perform an initial assessment. (7) Assess Circulation. B)
(b) Check for pulses. (i) Check the radial pulse, if present the blood pressure is at least 80mmHg. (ii) If radial pulse is not present, check for the carotid pulse. If present the blood pressure is at least 60mmHg.
Perform tactical field care procedures. -d. Perform an initial assessment. (5) Assess the airway. b
(b) Determine if the airway is patent or not. Look, listen and feel to ensure the patient's airway is patent and not compromised.
Perform a rapid trauma assessment. 5) Assess the pelvis. B)
(b) Gently compress to detect TIC if no signs and symptoms of trauma exist.
Perform a rapid trauma assessment. (2) Assess the neck. B)
(b) Palpate C-spine for TIC and step-offs.
Perform a rapid trauma assessment. (6) Assess the lower extremities. B)
(b) Palpate for TIC.
Perform a rapid trauma assessment. (7) Assess the upper extremities. B)
(b) Palpate for TIC.
Perform a rapid trauma assessment. (1) Assess the head. B)
(b) Palpate for tenderness, instability, and crepitus (TIC).
Perform a rapid trauma assessment. 8) Assess the posterior B)
(b) Palpate the long spine for TIC and step-offs.
Perform tactical field care procedures. -d. Perform an initial assessment. -4) Assess for Hemorrhage. -b
(b) Perform a blood sweep to identify any life threatening hemorrhage.
Perform a rapid trauma assessment. 4) Assess the abdomen. B)
(b) Treat an open abdominal wound, if present (Evaluated IAW Treat an Open Abdominal Wound task).
Perform tactical field care procedures. -d. Perform an initial assessment. (7) Assess Circulation. C)
(c) Assess the skin's color, condition, and temperature (CCT).
Perform a rapid trauma assessment. (7) Assess the upper extremities. C)
(c) Check for PMS.
Perform a rapid trauma assessment. (6) Assess the lower extremities. C)
(c) Check for pulse, motor, and sensory (PMS).
Perform tactical field care procedures. -d. Perform an initial assessment. -4) Assess for Hemorrhage. -c
(c) Immediately treat life threatening hemorrhage, if present. (i) Use a tourniquet for hemorrhage that is anatomically amendable to tourniquet application (Evaluated IAW Control Bleeding with Tourniquet task). (ii) For hemorrhage that cannot be controlled with a tourniquet, apply a HemCon dressing or Quick Clot (Evaluated IAW Control Bleeding with Hemostatic Device task).
Perform tactical field care procedures. -d. Perform an initial assessment. (5) Assess the airway. c
(c) Insert a nasopharyngeal airway adjunct, if required (Evaluated IAW Insert a Nasopharyngeal Airway task).
Perform a rapid trauma assessment. (2) Assess the neck. C)
(c) Inspect for jugular vein distention (JVD).
Perform a rapid trauma assessment. 5) Assess the pelvis. C)
(c) Inspect for priaprism.
Perform a rapid trauma assessment. 8) Assess the posterior c)
(c) Inspect for rectal bleeding.
Perform a rapid trauma assessment. 4) Assess the abdomen. C)
(c) Palpate for tenderness, rigidity and distention (TRD) if no open abdominal wound exist.
Perform tactical field care procedures. -d. Perform an initial assessment. -2
2) Determine the patient's responsiveness using the AVPU scale. (a) A - Alert and oriented. (b) V - Responsive to verbal stimuli. (c) P - Responsive to painful stimuli. (d) U - Unresponsive.
Perform care under fire procedures-F
Assess the casualties for life threatening extremity hemorrhage. NOTE: Once fire superiority has been gained begin assessing and treating life threatening hemorrhage. (1) If the casualty is unresponsive or unable to move and has severe extremity bleeding, administer life-saving hemorrhage control before moving the casualty. (a) Use a tourniquet for hemorrhage that is anatomically amenable to tourniquet application (Evaluated IAW Control Bleeding with Tourniquet task). (b) For hemorrhage that cannot be controlled with a tourniquet, apply a hemostatic dressing (Evaluated IAW Control Bleeding with Hemostatic Device task). (2) Direct the casualty to control hemorrhage by self-aid if he is able.
Perform care under fire procedures-G
Communicate the medical situation to the team leader, the evaluator for EFMB testing purposes (Evaluated IAW Triage Casualties task).
Perform care under fire procedures-D
Determine the number and location of the injured and severity of their injuries (Evaluated IAW Triage Casualties task)
Perform care under fire procedures-C
Determine the scene safety/security. NOTE: Despite fire superiority being gained during the care under fire phase of care, it does not mean that the enemy threat has been eliminated. You must exercise caution when maneuvering to casualties utilizing available cover, concealment, and suppressive fire. If the tactical situation permits have the casualties move to your position exercising the same caution. NOTE: You must determine the relative threat of the tactical situation versus the risk to the casualty. Can you remove the casualty to a place of relative safety without becoming a casualty yourself? Is the casualty safer where he is? If possible, seek assistance from your leader
Perform care under fire procedures-E
Direct team members/combat life savers to assist, if available. NOTE: For EFMB testing purposes, the candidate cannot direct other individuals or a casualty to perform tasks that he is being evaluated on. This is also applicable for other performance steps/measures within this task. For example, the candidate cannot direct a team member to control bleeding using a tourniquet and only check that it was applied correctly. The candidate must be evaluated on performing each of the TCCC tasks at least once.
Perform care under fire procedures-B
Direct the casualties to return fire, if able
Perform care under fire procedures-J
Recheck the bleeding control measures as the tactical situation permits.
Administer appropriate medications (analgesics and antibiotics). PO
If able to take PO (by mouth). (a) Mobic 15 mg PO qd. (b) Tylenol, 650 mg bi-layer caplet, 2 PO q 8 hours. (c) Gatifloxacin 400 mg PO qd.
Perform care under fire procedures-I
If casualty is unresponsive, move the casualty and his weapon to cover as the tactical situation permits (Evaluated IAW Evacuate Casualties tasks).
Perform ongoing assessment (while waiting for transport, repeat every 5 to 15 minutes depending on the casualty's condition), if applicable.
NOTE: For EFMB testing purposes, the candidate will verbalize the following to the evaluator. a. Repeat initial assessment. b. Repeat vital signs. c. Repeat a focused assessment on all injuries and reevaluate interventions and treatments. d. Reevaluate the casualties' evacuation category.
Perform care under fire procedures-H
Tactically transport the casualty, his weapon, and mission-essential equipment to cover, as required (Evaluated IAW Evacuate Casualties tasks). NOTE: If the casualty has equipment that is essential to the mission, move the mission-essential equipment also. Do not try to move equipment that is not mission essential.
Perform care under fire procedures -A
Take cover. Return fire as directed or required before providing medical treatment
Perform tactical field care procedures. -A
a. Immediately disarm any casualty with an altered mental status.
CCT
color, condition, and temperature
BSI
body substance isolation
Perform tactical field care procedures. -c
c. Take body substance isolation (BSI) precautions.
Perform tactical field care procedures. -d
d. Perform an initial assessment. NOTE: If multiple casualties exist, at a minimum, the initial assessment will be completed on each casualty before moving to the next casualty unless they are expectant. NOTE: Life-threatening injuries should be treated as they are identified according to casualty triage in conjunction with the tactical situation and TCCC principles. If the casualty is expectant, move on to the next casualty.
DCAP-BTLS
deformities, contusions, abrasions, punctures or penetration, burns, tenderness, lacerations, swelling
TIC
tenderness, instability, and crepitus
TRD
tenderness, rigidity and distention