Tactical Combat Casualty Care
Charles W. Beadling, MD, FAAFP, IDHA, DMCC
Center for Disaster and Humanitarian Assistance Medicine
Department of Military and Emergency Medicine
Uniformed Services University
PART I
Objectives
 Tactical vs. Civilian
Trauma Care
 Mortality in Combat
 Stages of Tactical
Care
 Tactics, Techniques
and Procedures (TTPs)
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Students will compare and contrast the
differences between civilian and tactical
trauma.
The student will evaluate the importance of
this unique body of knowledge (TCCC) that
can decrease the KIA rate in modern
warfare.
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Know the three phases of care
Identify the top three causes of preventable
combat mortality
List three methods of controlling
hemorrhage in the field
Outline additional equipment and skills
available with evacuation assets
Perform the CORRECT Intervention at
the CORRECT Time
Advantages
 Widely accepted in US and internationally
 The standard of care in civilian hospitals
Limitations in Combat
 Intended for Advanced HCPs
 Assumes availability of hospital diagnostic and
therapeutic equipment
 Assumes immediate surgical capability
ATLS was never designed or
intended to be used in the tactical
environment.
90% die before reaching MTF
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Epidemiology of Trauma
Tactical Environment
Equipment and Tactics
Techniques & Procedures
Significance to YOU
*Graphic Photo Content*
Burns
Burns
Blast = 3%
3%
6%
6% Blast
Other
Other ==6%
6%
Bullets
Bullets
= =
23%23%
Fragments
Fragments
Bullets
Bullets
Burns
Burns
Blast
Blast
Other
Other
Fragments
Fragments
62%
62%
(WWI, WWII, Korea, Vietnam, Middle East)
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Those that will survive regardless
Those that will die regardless
Those who will die from preventable deaths
unless the proper life saving steps are taken
immediately
Killed in Action
(86% KIA)
versus
Died of Wounds
(12% DOW)
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Understand Epidemiology = Develop
Appropriate Critical Skill Sets
Understand Environment = Modify Skill
Sets/Equipment to Maximize Benefit
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Equipment
Training
Research
Multiple 2%
Aviation 13%
GSW 26%
MVC 3%
Unk 2%
Explosion
54%
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Exanguinating extremity wounds – 61%
Tension pneumothorax – 33%
Airway obstruction – 6%
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Control Hemorrhage
Open/Maintain Airway
Decompress a Tension Pneumothorax
Seal Open Chest Wound
Initiate Treatment for Shock
Employ Hypothermia Prevention
XABC
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Care Under Fire
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Tactical Field Care
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Combat Casualty Evacuation Care
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Care rendered at the scene of the
injury while rescuer and casualty are
still under effective hostile fire.
First action: Return Fire!
Your no good, if you are DEAD
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Return Fire/Gain Fire Superiority
Devise Rescue Plan
Direct Conscious Casualty in Self Aid (SABA)
Aggressive Hemorrhage Control
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Tourniquet
Airway?
C-spine?
60% Extremity Hemorrhage
Effective Tourniquets Save Lives
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Improper training
Use when severe bleeding is not present
Loosening the device to allow intermittent
return of blood flow
Not applying it tight enough
Removing it prematurely