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Tactical Combat Casualty Care Guidelines
for All Combatants
03 June 2016
These recommendations are intended to be guidelines
only and are not a substitute for clinical judgment.
Basic Management Plan
for Care Under Fire
1. Return fire and take cover.
2. Direct or expect casualty to remain
engaged as a combatant if appropriate.
3. Direct casualty to move to cover and
apply self-aid if able.
4. Try to keep the casualty from
sustaining additional wounds.
5.
Casualties should be extricated from burning vehicles
or buildings and moved to places of relative safety. Do what is necessary to
stop the burning process.
6. Airway management is generally best
deferred until the Tactical Field Care phase.
7. Stop life-threatening external hemorrhage if tactically feasible:
· Direct casualty to control hemorrhage
by self-aid if able.
· Use a CoTCCC-recommended limb tourniquet
for hemorrhage that is anatomically amenable to tourniquet use.
·
Apply
the limb tourniquet over the uniform clearly proximal to the bleeding site(s).
If the site of the life-threatening bleeding is not readily apparent, place the
tourniquet “high and tight” (as proximal as possible) on the injured limb and
move the casualty to cover.
Basic Management Plan
for Tactical Field Care
1. Casualties with an altered mental
status should be disarmed immediately.
2.
Airway
Management
a.
Unconscious
casualty without airway obstruction:
-
Chin
lift or jaw thrust maneuver
-
Nasopharyngeal
airway
-
Place
the casualty in the recovery position
b.
Casualty
with airway obstruction or impending airway obstruction:
-
Chin
lift or jaw thrust maneuver
-
Nasopharyngeal
airway
-
Allow
a conscious casualty to assume any position that best protects the airway, to
include sitting up.
-
Place
an unconscious casualty in the recovery position.
-
If
the previous measures are unsuccessful, refer to a medic immediately.
3.
Breathing
a. In a casualty with progressive respiratory
distress and known or suspected torso trauma, consider a tension pneumothorax and
refer to a medic as soon as possible.
b. All open and/or sucking chest wounds should be treated by immediately
applying a vented chest seal to cover the defect. If
a vented chest seal is not available, use a non-vented chest seal. Monitor the casualty for respiratory distress. If it develops, you should
suspect a tension pneumothorax. Treat this by burping or temporarily removing
the dressing. If that doesn’t relieve the respiratory distress, refer to a
medic.
4. Bleeding
a. Assess for
unrecognized hemorrhage and control all sources of bleeding. If not already
done, use a CoTCCC-recommended limb tourniquet to control life-threatening external
hemorrhage that is anatomically amenable to tourniquet use or for any traumatic
amputation. Apply it directly to the skin 2-3 inches above wound. If bleeding is not controlled with the first
tourniquet, apply a second tourniquet side-by-side with the first.
b. For compressible
hemorrhage not amenable to limb tourniquet use, use Combat Gauze as the CoTCCC hemostatic
dressing of choice. Celox Gauze and ChitoGauze may also be used if Combat Gauze is not available.
Hemostatic dressings should be applied with at least 3 minutes of direct
pressure.
c. Reassess every tourniquet
that was applied earlier. Expose the wound and determine if the tourniquet is controlling
the bleeding. Any tourniquet that was applied over the casualty’s uniform should
be replaced by medical personnel with another tourniquet applied directly to the
skin 2-3 inches above the wound, if possible.
d. When time and the
tactical situation permit, check for further bleeding and for pulses further
out on the limb than the tourniquet. If bleeding persists or a pulse is still present distal to the tourniquet, consider
additional tightening of the tourniquet or the use of a second tourniquet,
side-by-side and proximal to the first, to eliminate any bleeding and any distal
pulse.
e. Expose and clearly mark all tourniquet sites with the
time of tourniquet application. Use an indelible marker.
5. Assess for hemorrhagic shock (altered mental status in the absence of
brain injury and/or weak or absent radial pulse).
1. If the
casualty is not in shock:
- No IV
fluids are immediately necessary.
- Fluids
by mouth are permissible if the casualty is conscious and can swallow.
-
Reassess the casualty frequently for the onset of shock.
2. If the casualty is in shock or develops
shock, refer to a medic.
6. Prevention of Hypothermia
a. Minimize the casualty’s
exposure to the elements. Keep protective gear on or with the casualty if
feasible.
b. Replace wet clothing
with dry if possible. Get the casualty onto an insulated surface as soon as
possible.
c. Apply the Ready-Heat Blanket from the Hypothermia Prevention and
Management Kit (HPMK) to the casualty’s torso (not directly on the skin) and
cover the casualty with the Heat-Reflective Shell (HRS).
d. If an HRS is not available, the previously recommended combination of
the Blizzard Survival Blanket and the Ready Heat blanket may also be used.
e. If the items mentioned above are not available, use dry blankets,
poncho liners, sleeping bags, or anything that will retain heat and keep the
casualty dry.
7. Penetrating Eye Trauma
a.
If a penetrating eye injury is noted or suspected:
1. Perform a rapid field test of
visual acuity.
2. Cover the eye with a
rigid eye shield (NOT a pressure patch.)
3. Ensure that the 400
mg moxifloxacin tablet in the combat pill pack is taken if the casualty can
swallow. If she can’t, refer to a medic for IV or IM antibiotics.
8. Inspect and dress known wounds.
9. Check for additional wounds.
10. Pain relief on the battlefield:
For
mild to moderate pain that will not keep the casualty out of the fight:
- TCCC Combat pill
pack:
- Tylenol - 650-mg
bilayer caplet, 2 PO every 8 hours
- Meloxicam - 15 mg PO once a day
If the casualty’s pain
is severe enough to interfere with his ability to fight, refer him to a medic
for treatment.
11. Splint fractures and re-check pulses.
12. Antibiotics: recommended for all open combat wounds
a. If the casualty can swallow:
Moxifloxacin, 400 mg PO one a day
b. If the casualty can’t swallow (shock,
unconsciousness):
Refer to a medic for treatment.
13. Burns
a. Facial burns, especially those that occur in closed spaces, may be
associated with toxic or thermal injury to the airways or lungs. Aggressively
monitor the casualty’s airway status and refer to a medic as soon as possible.
b. Cover the burn area with dry, sterile
dressings. For extensive burns (>20%TBSA), consider placing the casualty in
the Heat-Reflective Shell or Blizzard Survival Blanket from the Hypothermia
Prevention Kit in order to both cover the burned areas and prevent hypothermia.
c. Refer any casualty with extensive or severe burns to a medic as soon
as possible.
14. Communicate with the casualty if possible.
a. Encouragement and
reassurance are helpful.
b. Explain the care you have given.
15. Cardiopulmonary Resuscitation (CPR)
Resuscitation on the battlefield for victims
of blast or penetrating trauma who have no pulse, no ventilations, and no other
signs of life will not be successful and should not be attempted.
16. Documentation of Care
Document any care given and changes in the
casualty’s status on a TCCC Casualty Card (DD Form 1380). Forward this
information with the casualty to the next level of care.
