Tactical Combat Casualty Care: Splinting, CPR, MEDEVAC, Evacuation, and Documentation

Vocabulary flashcards covering fracture management, battlefield CPR considerations, MEDEVAC communication, evacuation rules, categories, and documentation per TCCC guidelines.

Open Fracture

A bone break associated with an overlying skin wound exposing the fracture site.

Closed Fracture

A bone break with no overlying skin wound; skin remains intact.

Crepitus

A crunchy or grinding sound/feeling produced by bone ends or air under the skin at a fracture site.

Objectives of Splinting

Prevent further injury, protect vessels and nerves, maintain distal pulse, and increase casualty comfort.

Principles of Splinting

Check for other injuries, use rigid/bulky materials, pad rigid splints, secure well, splint before moving, include joints above and below, minimize manipulation, re-check pulses.

Pulse, Motor, Sensory Check

Assessment performed before and after splinting to confirm circulation, movement, and sensation distal to the injury.

Pneumatic Splint

A commercially available air-inflated rigid splint used to immobilize extremity fractures.

SAM Splint

A flexible, moldable aluminum-core splint that becomes rigid when shaped; widely used in field care.

Field-Expedient Splint Materials

Improvised items such as shirt sleeves, unloaded weapons, boards, boxes, tree limbs, or sleeping pads used to immobilize fractures.

Cardiopulmonary Resuscitation (CPR) – Battlefield

Not recommended for blast or penetrating trauma without signs of life; rarely successful and jeopardizes mission and providers.

Tension Pneumothorax

Life-threatening buildup of air in the pleural space causing lung collapse and mediastinal shift; treated with needle decompression.

Needle Decompression

Procedure inserting a needle into the chest to relieve tension pneumothorax; done bilaterally if no vitals before stopping care.

Hypothermia-Related Cardiac Arrest

One of the few battlefield exceptions where CPR may be attempted because survival odds are better than traumatic arrest.

Tactical Evacuation Care (TACEVAC)

Phase involving movement of casualties to higher medical care using available tactical or dedicated evacuation assets.

9-Line MEDEVAC Request

Standard nine-line radio format used to request medical evacuation resources through tactical channels.

MIST Report

Supplemental message conveying Mechanism of injury, Injuries, vital Signs/Symptoms, and Treatments to receiving facility.

Line 1 – Pickup Location

Provides grid or pre-coordinated HLZ name of the evacuation site for the inbound aircraft/vehicle.

Line 2 – Radio Frequency & Call Sign

Communicates the unit’s operating frequency and call-sign that evacuation assets will contact on approach.

Line 3 – Number of Patients by Precedence

Lists casualties by evacuation category: Urgent, Urgent-Surgical, Priority, Routine, Convenience.

Line 4 – Special Equipment Required

Requests items such as hoist, extraction gear, ventilator, or blood products for the evacuation mission.

Line 5 – Number of Casualties by Type

States litter (L) or ambulatory (A) patient counts, e.g., "L-2, A-1."

Line 6 – Security at Pickup Site

Describes enemy situation: N (no enemy), P (possible), E (enemy), X (enemy with escort required).

Line 7 – Method of Marking Site

Indicates how the HLZ is marked: panels, smoke, none, IR lights, etc.

Line 8 – Casualty Nationality & Status

Identifies patient categories (A US military, B US civilian, C EPOW, etc.); numbers follow letters if mixed.

Line 9 – CBRN / Terrain

Reports chemical, biological, radiological, nuclear threats or describes terrain when CBRN not a factor.

Evacuation Categories

Precedence levels: A Urgent, B Urgent-Surgical, C Priority, D Routine, E Convenience.

TACEVAC Rule of Thumb #1

Soft-tissue wounds rarely kill acutely unless paired with severe bleeding or airway problems.

TACEVAC Rule of Thumb #2

Bleeding from most extremity wounds is controllable with tourniquets/hemostatics; delay acceptable if bleeding controlled.

TACEVAC Rule of Thumb #3

Casualties in shock require evacuation as soon as possible; internal bleeding cannot be fixed in the field.

TACEVAC Rule of Thumb #4

Chest wounds with respiratory distress unrelieved by needle decompression need rapid evacuation (possible hemothorax).

TACEVAC Rule of Thumb #5

Face trauma causing airway difficulty demands immediate airway and rapid evacuation; allow position of comfort.

TACEVAC Rule of Thumb #6

Massive brain damage with unconsciousness has extremely poor prognosis; emergent evacuation unlikely to change outcome.

TACEVAC Rule of Thumb #7

Penetrating head wounds with conscious casualty warrant emergent evacuation.

TACEVAC Rule of Thumb #9

TBI with red-flag signs (e.g., unequal pupils, seizures, vomiting) requires urgent evacuation to MTF.

CAT A – Urgent

Critical, life-threatening injury requiring evacuation within 1 hour (e.g., airway issues, shock, moderate/severe TBI).

CAT B – Priority

Serious injury needing evacuation within 4 hours (e.g., tourniqueted limb, eye injury, controlled open fracture).

CAT C – Routine

Mild/moderate injury suitable for evacuation within 24 hours (e.g., concussion, minor soft-tissue wounds).

TCCC Casualty Card (DD Form 1380)

Waterproof card for documenting assessments, treatments, and status; travels with casualty to next care level.