TCCC Overview

What is TCCC?

Tactical Combat Casualty Care (TCCC) is the standard of care for prehospital battlefield medicine. Developed by the Committee on Tactical Combat Casualty Care (CoTCCC), it represents decades of research into what actually saves lives in combat.

Unlike civilian EMS, TCCC accounts for the unique challenges of the tactical environment: hostile fire, limited resources, delayed evacuation, and multiple casualties.

The Three Phases of Care

TCCC divides casualty care into three distinct phases, each with different priorities and capabilities.

1. Care Under Fire (CUF)

You are actively taking fire. The threat is immediate.

Priorities:

• Return fire and take cover
• Direct the casualty to return fire, move to cover, and apply self-aid if able
• Keep yourself from becoming a casualty
• Stop life-threatening bleeding with a tourniquet — if tactically feasible

What you DON’T do:

• Extensive medical assessment
• Airway management
• CPR (survivability is near zero in this phase)

2. Tactical Field Care (TFC)

You are no longer under direct hostile fire, but still in the tactical environment.

Priorities:

• Follow the MARCH algorithm (detailed in the next module)
• Perform a full assessment
• Treat all injuries
• Prepare for evacuation

This is where most lifesaving interventions happen.

3. Tactical Evacuation Care (TACEVAC)

Care during transport to a higher level of care.

Priorities:

• Reassess and monitor
• Additional interventions if needed (IVs, advanced airway)
• Communicate with receiving facility
• Document everything

Why TCCC Matters

Before TCCC, military medicine often followed civilian protocols that weren’t suited for combat. The result: preventable deaths.

Studies showed that the leading causes of preventable death on the battlefield were:

1. Extremity hemorrhage (60%) — solved by widespread tourniquet use
2. Tension pneumothorax (33%) — solved by needle decompression training
3. Airway obstruction (6%) — solved by NPA and positioning

TCCC protocols specifically target these killers, in priority order.

Core Principles

Treat the Tactical Situation First

The tactical situation always takes precedence. A dead responder saves no one. “Good medicine” that gets you killed isn’t good medicine.

Treat the Most Lethal Things First

MARCH gives you the priority order. Hemorrhage kills faster than airway problems in trauma — that’s why M comes before A.

Do Only What You Can Do

You’re not in a hospital. Focus on interventions that work in your environment with your equipment. Don’t waste time on things you can’t execute.

Document and Communicate

The TCCC Casualty Card captures critical information for the next level of care. What you don’t write down may not get communicated.

Moving Forward

This overview gives you the framework. The next module covers MARCH — the systematic approach you’ll use in Tactical Field Care to assess and treat casualties in priority order.