Tactical Combat Casualty Care (TCCC) Comprehensive Vocabulary

Comprehensive vocabulary flashcards covering Tactical Combat Casualty Care (TCCC) principles, equipment, pharmacology, and procedural guidelines across all phases of tactical trauma management.

Care Under Fire (CUF)

The first phase of Tactical Combat Casualty Care rendered at the point of injury while under effective hostile fire, where operational priorities are to return fire, gain fire superiority, and stop life-threatening external extremity hemorrhage using a hasty tourniquet before moving the casualty to cover.

Fire Superiority

The tactical condition achieved when friendly fire suppresses or neutralizes hostile fire, serving as the single most critical intervention to prevent additional casualties and enable medical rescue.

Tactical Field Care (TFC)

The phase of care rendered once the casualty and responder are no longer under effective enemy fire or direct threat, permitting more deliberate trauma assessments and interventions following the MARCH PAWS sequence.

MARCH PAWS

The standardized tactical assessment mnemonic: Massive Bleeding, Airway, Respiration, Circulation, Hypothermia/Head Injuries (life-threatening priorities), followed by Pain, Antibiotics, Wounds, and Splinting (after life-threatening priorities).

Visual Blood Sweep

A rapid, systematic head-to-toe examination performed in TCCC to identify unrecognized life-threatening bleeding by checking the neck, axillary, and inguinal regions, as well as the extremities, abdomen, chest, and back.

Deliberate Tourniquet

A limb tourniquet applied during Tactical Field Care directly on exposed skin $2\text{--}3\,\text{inches}$ proximal to the wound (never over clothing or a joint), tightened to arrest hemorrhage within $1\,\text{minute}$, eliminate distal pulses, and be fully secured within $3\,\text{minutes}$.

SAM Junctional Tourniquet (SJT)

A CoTCCC-recommended junctional hemorrhage control device featuring targeted compression devices (TCDs) positioned below the inguinal ligament and inflated to compress large pelvic or groin blood vessels within $90\,\text{seconds}$.

Junctional Emergency Treatment Tool (JETT)

A CoTCCC-recommended junctional tourniquet that uses threaded individual pressure pads placed over the femoral triangle to compress large groin vessels and arrest severe junctional bleeding within $90\,\text{seconds}$.

XSTAT

A syringe-type applicator loaded with compressed mini-sponges that rapidly expand on contact with blood to create internal pressure in narrow tract or junctional wounds; contraindicated in the thorax, pleural cavity, abdomen, retroperitoneal space, sacral space, and above the clavicle.

iTClamp (Wound Closure Device)

A mechanical device designed to seal wound edges together to control external bleeding until definitive surgical repair; suitable for scalp, neck, and extremity wounds, but strictly contraindicated near the eye.

Hemostatic Gauze

Gauze impregnated with an active clotting agent, packed tightly into bleeding wound cavities within $90\,\text{seconds}$ and held with continuous manual pressure for a minimum of $3\,\text{minutes}$ prior to securing with a pressure bandage.

Pelvic Compression Device (PCD)

A circumferential stabilizer (such as the SAM Pelvic Sling II, T-POD, or PelvicBinder) placed at the level of the greater trochanters to reduce internal pelvic volume, stabilize fractures, and control retroperitoneal bleeding following severe blunt or blast trauma.

Tourniquet Replacement

The procedure in Tactical Field Care of applying a deliberate tourniquet directly on the skin $2\text{--}3\,\text{inches}$ above an injury to replace a hasty tourniquet applied over clothing during Care Under Fire, prior to loosening the initial band.

Tourniquet Conversion

The transition of a limb tourniquet to hemostatic gauze packing and a pressure bandage, performed within $2\,\text{hours}$ of injury if the casualty is not in shock, the wound can be closely observed, and there is no traumatic amputation; contraindicated if the tourniquet has been on for $>6\,\text{hours}$.

Nasopharyngeal Airway (NPA)

A soft, flexible rubber tube inserted into the casualty's nostril at a $90^\circ$ angle to the face to maintain airway patency in unconscious or semiconscious casualties without obstruction; contraindicated with clear fluid from nose/ears or midface trauma.

Jaw-Thrust Maneuver

The manual airway-opening technique indicated for casualties with suspected cervical spine trauma, displacing the mandible anteriorly to open the pharyngeal airway without extending the cervical spine.

Surgical Cricothyroidotomy

An emergency surgical airway indicated for massive maxillofacial trauma, upper airway burns, or failed non-invasive maneuvers, performed via a $1\text{-inch}$ vertical skin incision followed by a horizontal incision through the cricothyroid membrane.

Cric-Key

The CoTCCC-preferred device for performing a surgical cricothyroidotomy in Tactical Field Care, combining a guided introducer with an airway cannula to facilitate rapid insertion through the cricothyroid membrane.

Bag Valve Mask (BVM) Ventilation

A manual positive pressure ventilation method delivered to an apneic or hypoventilating casualty, providing one breath every $5\text{--}6\,\text{seconds}$ using a slow, steady squeeze over $1\text{--}2\,\text{seconds}$.

Open Pneumothorax

A penetrating chest wound (sucking chest wound) as small as $2.0\text{--}2.5\,\text{cm}$ that allows air to enter the pleural space during inhalation, resulting in lung collapse and impaired respiratory mechanics.

Vented Chest Seal

An adhesive dressing with a one-way valve applied over an open chest wound that allows trapped intrapleural air and blood to escape during exhalation while preventing air entry during inhalation.

Tension Pneumothorax

A fatal condition where air progressively enters the pleural space with each breath and cannot escape, building pressure that collapses the lung, shifts the mediastinum, and compromises cardiac filling and contralateral ventilation.

Needle Decompression of the Chest (NDC)

The insertion of a $10\text{--}14\,\text{gauge}$, $3.25\text{-inch}$ needle catheter into the 2nd intercostal space midclavicular line or the 5th intercostal space anterior axillary line to evacuate trapped air causing tension pneumothorax.

Lethal Triad

The self-reinforcing vicious cycle of hypothermia, acidosis, and coagulopathy caused by severe traumatic hemorrhage and shock, which drastically accelerates mortality if not aggressively treated.

Refractory Shock

Persistent circulatory failure and hypotension unresponsive to fluid resuscitation and hemorrhage control; on the battlefield, it mandates immediate consideration and decompression of suspected tension pneumothorax.

FAST1 Intraosseous Access

A sternal intraosseous infusion device providing flow rates up to $80\,\text{ml/min}$, approved for adult casualties weighing at least $50\,\text{kg}$ ($110\,\text{lbs}$), and restricted to placement for no more than $24\,\text{hours}$.

EZ-IO Intraosseous Access

A mechanical or powered intraosseous needle system providing rapid vascular access in the proximal humerus ($105\,\text{ml/min}$ flow rate) or proximal tibia ($16.6\,\text{ml/min}$ flow rate).

Tranexamic Acid (TXA)

An antifibrinolytic medication administered as $2\,\text{gm}$ via slow IV/IO push over $1\,\text{minute}$ as early as possible within $3\,\text{hours}$ of injury for casualties in hemorrhagic shock, with major amputations, penetrating torso trauma, or severe TBI.

Low-Titer Group O Whole Blood (LTOWB)

The primary resuscitation fluid of choice in TCCC for hemorrhagic shock, consisting of cold-stored group O whole blood with anti-A and anti-B antibody titers strictly below $<256$.

Fresh Whole Blood (FWB)

Whole blood collected from pre-screened living donors in the tactical environment using a $16\text{-gauge}$ needle collection bag containing citrate anticoagulant when cold-stored whole blood is unavailable.

Freeze-Dried Plasma (FDP)

A room-temperature-stable, freeze-dried plasma product that provides clotting factors and fibrinogen, reconstituted with sterile diluent for hemorrhagic shock or moderate/severe TBI resuscitation.

Calcium Administration Protocol

The administration of $30\,\text{ml}$ of $10\%$ calcium gluconate IV/IO over $2\,\text{minutes}$ ($3\,\text{grams}$) or $10\,\text{ml}$ of $10\%$ calcium chloride IV/IO over $1\,\text{minute}$ ($1\,\text{gram}$) immediately following the first unit of transfused blood products to prevent citrate-induced hypocalcemia.

EldonCard

A field-ready, antigen-impregnated testing card used to determine ABO and Rh (D) blood types of donors and casualties within minutes prior to fresh whole blood collection and transfusion.

Acute Hemolytic Reaction

A severe, potentially fatal transfusion complication caused by ABO incompatibility, presenting early with nausea, followed by flank, arm, or back pain, fever, and disseminated intravascular coagulation (DIC); treated by stopping the transfusion and infusing NS or LR.

Anaphylaxis Transfusion Protocol

The immediate management of severe allergic transfusion reactions: stop transfusion, administer normal saline or lactated Ringer's, give $0.3\,\text{mg}$ ($0.3\,\text{ml}$ of $1:1000$) epinephrine IM, $25\,\text{mg}$ diphenhydramine IM/IV, and consider $10\text{--}40\,\text{mg}$ methylprednisolone slow IV/IO.

Active Hypothermia Management

The external warming of a trauma or severe burn casualty using battery-powered IV fluid warmers ($38^\circ\text{C}$) and active chemical/electric heating blankets placed on the anterior torso, axillae, and head, enclosed within an impermeable vapor barrier.

Moderate to Severe TBI Criteria

A head injury characterized by an inability to follow simple commands (e.g., thumbs up, two fingers, blink) beyond $10\,\text{minutes}$ post-injury; managed by maintaining $SpO_2 \ge 92\%$, $SBP > 100\,\text{mmHg}$, and head/torso elevation $>30^\circ$.

Cushing's Triad

A late clinical sign of impending cerebral herniation and dangerously elevated intracranial pressure, characterized by widening pulse pressure (systolic hypertension), bradycardia, and irregular respirations.

Hypertonic Saline Protocol

The administration of $250\,\text{ml}$ of $3\%$ or $5\%$ hypertonic saline IV/IO bolus, or $30\,\text{ml}$ of $23.4\%$ slow push over $10\,\text{minutes}$, indicated strictly for signs of cerebral herniation (never used prophylactically).

Rigid Eye Shield

A rigid, perforated domed cover secured with tape at $45^\circ$ angles across the forehead and cheek to protect a penetrating eye injury from external pressure and prevent extrusion of intraocular contents.

Rapid Field Visual Acuity Test

An operational vision assessment performed before shielding an injured eye, testing the casualty's ability to read printed text, count fingers, recognize hand motions, and perceive light versus dark.

Combat Wound Medication Pack (CWMP)

A prepackaged oral medication blister pack given to conscious casualties with open combat wounds who remain mission-capable, containing analgesics and broad-spectrum antibiotics with minimal to no cognitive impairment.

Suzetrigine

A non-opioid pain medication in the CWMP dosed at a $100\,\text{mg}$ PO loading dose, followed by $50\,\text{mg}$ PO every $12\,\text{hours}$ for conscious, mission-capable casualties, causing no sedation or respiratory depression.

Esketamine

A non-opioid dissociative analgesic administered intranasally as $14\,\text{mg}$ (one spray) or $28\,\text{mg}$ (two sprays) every $30\,\text{minutes}$ PRN for non-mission capable casualties until pain control or nystagmus is achieved.

Ketamine

The primary dissociative analgesic for non-mission capable casualties, dosed at $100\,\text{mg}$ IM, $50\,\text{mg}$ IN, or $25\,\text{mg}$ ($0.2\text{--}0.3\,\text{mg/kg}$) slow IV/IO push over $1\,\text{minute}$ (repeat every $30\,\text{minutes}$ PRN); provides strong analgesia without depressing respiration or blood pressure.

Ondansetron

The antiemetic of choice in TCCC, dosed at $4\,\text{mg}$ every $8\,\text{hours}$ via oral disintegrating tablet (translingually) or slow IV/IO/IM push (maximum $8\,\text{mg}$ per $8\,\text{hours}$), lacking sedation, respiratory depression, or hypotension.

Cefadroxil

The preferred first-line oral antibiotic in TCCC for casualties with open wounds who are conscious and able to swallow, dosed at $1\,\text{gram}$ PO every $24\,\text{hours}$.

Ceftriaxone

The preferred parenteral broad-spectrum cephalosporin antibiotic in TCCC for open wounds when casualties are in shock, unconscious, or unable to swallow, dosed at $2\,\text{grams}$ IV/IO/IM every $24\,\text{hours}$ (never mixed with calcium-containing solutions like Lactated Ringer's).

Rule of Nines

An anatomical assessment method used to estimate total body surface area (TBSA) burned in adults by assigning $9\%$ (or multiples of $9\%$) to major anatomical regions, excluding superficial first-degree burns.

USAISR Rule of Ten

The burn fluid resuscitation formula for injuries $>20\%$ TBSA: initial IV/IO fluid rate equals $\%\text{TBSA} \times 10\,\text{ml/hr}$ for adults $40\text{--}80\,\text{kg}$, adding an extra $100\,\text{ml/hr}$ for every $10\,\text{kg}$ of body weight above $80\,\text{kg}$.

Open Abdominal Evisceration Management

The management of exposed abdominal viscera: positioning the casualty supine with knees flexed, rinsing with clean fluid, attempting a single brief reduction ($<60\,\text{seconds}$) if no bowel leakage exists, covering with moist sterile dressings, and applying a water-impermeable non-adhesive barrier without packing the wound cavity.

AVPU Scale

A standard rapid mental status assessment evaluating whether a casualty is Alert, responds to Verbal stimuli, responds only to Painful stimuli, or is completely Unresponsive.

Colorimetric End-Tidal CO2 Detector

A qualitative capnometry sensor attached to an advanced airway tube that changes color across six breaths to confirm placement in the trachea and monitor continuous ventilation.

9-Line MEDEVAC Request

A standardized nine-line military operational radio transmission used to request evacuation assets, with lines 1 through 5 mandatory before evacuation vehicles or aircraft can be launched.

MIST Report

A standardized medical handover report summarizing Mechanism of injury, Injuries found or suspected, vital Signs/symptoms, and Treatment given.

Category A – Urgent Evacuation

A NATO casualty evacuation classification for critical, life-threatening injuries (e.g., ongoing airway compromise, shock, severe TBI, burns $>20\%$ TBSA) requiring transport to surgical capabilities within $2\,\text{hours}$.

Category B – Priority Evacuation

A NATO casualty evacuation classification for serious injuries (e.g., open fractures, controlled bleeding with tourniquets, penetrating eye injuries, burns $10\text{--}20\%$ TBSA) requiring transport within $4\,\text{hours}$.

Category C – Routine Evacuation

A NATO casualty evacuation classification for mild to moderate injuries (e.g., concussion, minor shrapnel wounds, closed fractures with intact distal pulses, burns $<10\%$ TBSA) requiring transport within $24\,\text{hours}$.

DD Form 1380 (TCCC Card)

The standard Department of Defense card used by first responders to document all trauma assessments, vital sign trends, and interventions, affixed securely to the casualty before evacuation handoff.

TCCC After Action Report (AAR)

A detailed electronic casualty report completed by the Combat Medic/Corpsman and submitted through the Joint Trauma System website within $72\,\text{hours}$ of mission completion for performance improvement and registry tracking.

Casualty Collection Point (CCP)

A designated staging location providing cover, concealment, and access to evacuation routes where casualties are assembled, triaged, treated, and staged in reverse loading precedence (routine first, urgent last).

Military Acute Concussion Evaluation (MACE 2)

A multi-modal assessment tool utilized in the field to evaluate head trauma, screen for concussions, and detect neurological red flags that dictate immediate urgent evacuation.