TCCC 2026 01 MAy

What does TCCC stand for?

Tactical Combat Casualty Care

What is the primary focus of the TCCC Guidelines?

To provide guidelines for managing casualties in tactical environments.

What should be done first in the Basic Management Plan for Care Under Fire?

Return fire and take cover.

What is the role of the casualty during Care Under Fire?

The casualty should remain engaged as a combatant if appropriate.

What is the first step in stopping life-threatening external hemorrhage?

Direct the casualty to control hemorrhage by self-aid if able.

What type of tourniquet is recommended for controlling hemorrhage?

A CoTCCC-recommended limb tourniquet.

Where should a tourniquet be applied?

Over the uniform, clearly proximal to the bleeding site.

What is the recommended action if the first tourniquet does not control bleeding?

Apply a second tourniquet side-by-side with the first.

What is the primary hemostatic dressing recommended by CoTCCC?

Combat Gauze.

What should be done for external hemorrhage of the head and neck?

Use the iTClamp as a primary option for hemorrhage control.

What is the purpose of the iTClamp?

To control hemorrhage without requiring additional direct pressure.

When should a junctional tourniquet be applied?

Immediately, once it is ready for use.

What should be assessed for during airway management?

For an unobstructed airway.

What position should a conscious casualty assume to protect their airway?

Any position that best protects the airway, including sitting up or leaning forward.

What is the initial treatment for suspected tension pneumothorax?

Decompress the chest on the side of the injury with a needle/catheter unit.

What gauge needle is recommended for needle decompression?

A 14-gauge or a 10-gauge, 3.25-inch needle/catheter unit.

What should be monitored in a casualty with suspected tension pneumothorax?

Establish pulse oximetry monitoring.

What is the significance of airway patency in TCCC?

Airway status may change over time and requires frequent reassessment.

What is the recommended action if a casualty has a traumatic airway obstruction?

Prepare for possible direct airway intervention.

What should be done if a casualty's airway obstruction is unmanageable?

Perform a surgical cricothyroidotomy.

What is the purpose of performing a surgical cricothyroidotomy?

To establish an airway in cases of severe obstruction.

What should be done if there is evidence of an expanding hematoma?

Consider placing a definitive airway.

What is the first step in the Basic Management Plan for Tactical Field Care?

Establish a security perimeter in accordance with unit tactical SOPs.

What should be done if a casualty is conscious and has maxillofacial trauma?

Allow them to sit up to help keep the airway clear.

What is the recommended duration for applying hemostatic dressings?

At least 3 minutes of direct pressure.

What is the potential consequence of untreated tension pneumothorax?

It may progress to shock and traumatic cardiac arrest.

What should be done if bleeding is not controlled with the first dressing?

Remove the failed dressing and apply a fresh dressing of the same or different type.

What are the two recommended sites for needle decompression (NDC)?

The 5th intercostal space in the anterior axillary line (AAL) or the 2nd intercostal space in the mid-clavicular line (MCL).

What should be avoided when using the MCL site for NDC?

Do not insert the needle medial to the nipple line.

At what angle should the needle/catheter unit be inserted for NDC?

Perpendicular to the chest wall.

How long should the needle/catheter unit be held in place after insertion for NDC?

5-10 seconds.

What indicates a successful NDC?

Improvement in respiratory distress, hissing sound of escaping air, hemoglobin oxygen saturation increases to 90% or greater, or return of consciousness in a casualty with no vital signs.

What should be done if the initial NDC fails to improve symptoms?

Perform a second NDC on the same side at the other recommended site using a new needle/catheter unit.

What is the procedure for treating open or sucking chest wounds?

Apply a vented chest seal immediately. If unavailable, use a non-vented chest seal.

What is the recommended oxygen saturation level for casualties with moderate/severe TBI?

Maintain oxygen saturation ≥ 92%.

What should be monitored continuously in casualties with moderate/severe TBI?

Pulse oximetry and EtCO2.

What is the indication for applying a pelvic binder?

Suspected pelvic fracture due to severe blunt force or blast injury.

What should be done if bleeding persists after tourniquet application?

Consider additional tightening of the tourniquet or apply a second tourniquet side-by-side.

When should limb tourniquets be converted to hemostatic or pressure dressings?

When the casualty is not in shock, the wound can be monitored closely, and the tourniquet is not controlling bleeding from an amputated extremity.

What is the preferred gauge for IV access in hemorrhagic shock?

An 18-gauge IV or saline lock.

What medication should be administered if a casualty is likely to need a blood transfusion?

Tranexamic acid (TXA) 2 gm via slow IV or IO push as soon as possible, but not later than 3 hours after injury.

What should be assessed for in a casualty with altered mental status?

Assess for hemorrhagic shock.

What is the purpose of continuous monitoring of EtCO2?

To help assess airway patency.

What should be done if a casualty develops increasing hypoxia or respiratory distress?

Consider burping or removing the dressing or performing needle decompression.

What is the significance of marking tourniquets?

To document the time of application, re-application, conversion, and removal on the TCCC Casualty Card.

What is the initial action if a casualty is in traumatic cardiac arrest?

Decompress both sides of the chest before discontinuing treatment.

What should be done if the second NDC is also not successful?

Continue on to the Circulation section of the TCCC Guidelines.

What should be monitored in cases of suspected tension pneumothorax?

Monitor for potential development of hypoxia, respiratory distress, or hypotension.

What is the role of supplemental oxygen in TBI cases?

To maintain oxygen saturation ≥ 92%.

What should be done if a casualty has impaired ventilation and uncorrectable hypoxia?

Consider insertion of a properly sized Nasopharyngeal Airway and ventilate using a 1000ml resuscitator Bag-Valve-Mask.

What is the first choice of resuscitation fluid for casualties in hemorrhagic shock?

Cold stored low titer O whole blood

What should be done if a casualty is not in shock?

No IV fluids are immediately necessary; fluids by mouth are permissible if the casualty is conscious and can swallow.

What is the recommended ratio of plasma, red blood cells, and platelets for resuscitation?

1:1:1 ratio

What is the target systolic blood pressure to maintain during resuscitation?

Greater than 100 mmHg

What should be administered after the first transfused blood product?

One gram of calcium (30 ml of 10% calcium gluconate or 10 ml of 10% calcium chloride) IV/IO.

What is a potential cause of refractory shock in a casualty?

Untreated tension pneumothorax

What measures should be taken to prevent hypothermia during fluid resuscitation?

Take early and aggressive steps to prevent body heat loss and add external heat.

What should be done if a casualty has a weak or absent radial pulse due to suspected TBI?

Resuscitate as necessary to restore and maintain a normal radial pulse.

What is the recommended action if shock recurs in a casualty?

Re-check all external hemorrhage control measures and repeat fluid resuscitation.

What is the protocol for administering blood products if Rh negative is not available?

Use Rh positive blood products in hemorrhagic shock.

What should be monitored in a ventilated patient with suspected TBI?

Target an EtCO2 of 35-45 mmHg.

What is the recommended elevation for a casualty's head and torso to reduce intracranial pressure?

Greater than 30 degrees, if not in shock and tactically feasible.

What should be done if a casualty shows signs of herniation?

Administer 250ml of 3% or 5% hypertonic saline IV/IO over at least 10 minutes.

What is the maximum number of doses for hypertonic saline if no response is observed?

Two doses, with a repeat in 20 minutes if no response.

What should be done with wet clothing during hypothermia prevention?

Replace wet clothing with dry clothing, if possible.

What is the purpose of an active heating blanket during resuscitation?

To prevent burns and add heat to the casualty's anterior torso.

What should be done with the casualty's exposure to cold surfaces?

Minimize exposure by placing insulation material between the casualty and cold surfaces.

What is the first step in managing suspected mild TBI/concussion?

Evaluation and treatment are generally best deferred to Prolonged Casualty Care.

What is the goal oxygen saturation for preventing hypoxemia in TBI patients?

≥ 92%

What should be done if there is no evidence of hemorrhage in a TBI patient?

Administer 1-2 units of plasma.

What is the recommended flow rate for delivering IV/IO resuscitation fluids with a warming device?

Up to 150 ml/min with a 38°C output temperature.

What should be done if the casualty is exposed to wind and precipitation during evacuation?

Protect the casualty from exposure.

What is the significance of reassessing the casualty frequently?

To check for recurrence of shock.

What is the recommended action if finger thoracostomy is used?

It may not remain patent; decompression may need to be repeated.

What is the importance of administering blood products as soon as possible?

To keep the casualty alive after life-threatening hemorrhage.

What should be done to protect the casualty from further heat loss?

Enclose the casualty with an impermeable enclosure bag.

What should be monitored at the IV/IO site?

Monitor for signs of extravasation and discontinue if present.

Is hypertonic saline recommended for preventing herniation?

No, do NOT use hypertonic saline prophylactically to prevent herniation.

What is hypertonic saline classified as?

Hypertonic saline is NOT a resuscitative fluid.

What should be done for penetrating TBI or open skull fractures?

Apply a dressing to prevent contaminants, and if bleeding, use hemostatic gauze.

What should NOT be done with a penetrating wound?

Do NOT pack any material into the wound cavity or close it with staples or sutures.

How should gross contamination of a wound be managed?

Gentle low-pressure irrigation with saline or potable water is acceptable.

How often should neurologic status be reassessed?

Reassess every 5-10 minutes for worsening status.

What is the first step if a penetrating eye injury is suspected?

Perform a rapid field test of visual acuity and document findings.

What should be used to cover a penetrating eye injury?

Cover the eye with a rigid eye shield, NOT a pressure patch.

What antibiotics should be administered for penetrating eye trauma?

Administer ceftriaxone 2g IV or IM, or cefadroxil 1g orally as soon as possible.

What should be initiated if advanced electronic monitoring is indicated?

Initiate advanced electronic monitoring if equipment is available.

What is the recommended analgesia for a casualty who can stay in the fight?

Self-administered analgesia or co-administered by TCCC Personnel using the CWMP.

What medications are included in the TCCC Combat Wound Medication Pack?

Acetaminophen, Meloxicam, and Suzetrigine.

What should be administered to a casualty who cannot stay in the fight?

Direct them to take the TCCC CWMP and administer Ketamine as needed.

What is the initial dose of Ketamine for non-mission capable casualties?

Ketamine 100 mg IM, or 50 mg IN, or 25 mg IV/IO over 1 minute.

What is the goal of battlefield pain management?

Achieve tolerable pain levels that preserve airway patency, respiratory drive, and mentation.

What should be documented before administering Ketamine?

Document a mental status exam using the AVPU method.

What should be monitored closely for casualties given potent analgesics?

Monitor airway, breathing, and circulation closely.

What is the recommendation for co-administration of benzodiazepines with Ketamine?

Co-administration is NOT recommended.

What should be done for casualties with significant severe injuries requiring sedation?

Prepare to secure the airway and administer Ketamine for dissociative anesthesia.

What is the procedure for abdominal evisceration?

Control bleeding, rinse with clean fluid, and cover exposed bowel with a moist, sterile dressing.

What should NOT be done if there is evidence of ruptured bowel?

Do NOT attempt reduction of eviscerated abdominal contents.

How should burns be assessed and treated?

Assess as trauma casualties with burns and cover burn areas with dry, sterile dressings.

What is the Rule of Nines used for?

To estimate total body surface area (TBSA) burned to the nearest 10%.