Tactical combat casualty care

Background

• Tactical Combat Casualty Care (TCCC) is a set of evidence-based guidelines for trauma care in a tactical or combat environment.
• Developed and updated by the Committee on Tactical Combat Casualty Care (CoTCCC), a division of the US Department of Defense Joint Trauma System (JTS).
• Goal is to reduce preventable combat deaths.
• Guidelines are divided into three "phases of care".

Phases of Care

• Care under fire
• Tactical field care
• Tactical evacuation care

Assessment and Triage

• Rather than typical "ABC" approach to trauma assessment, TCCC prioritizes massive hemorrhage
• MARCH acronym is used to prioritize treatment:
  • M - Massive hemorrhage
    • Emphasize early recognition of significant bleeding. Apply limb tourniquets high, tight, and early. For junctional injuries, utilize direct pressure or hemostatic agents while waiting for OR.
  • A - Airway
    • Consider triage given limited management resources. May require surgical airway if significant facial or oropharyngeal injuries are present.
  • R - Respiration
    • Recognize and manage pneumothoraces with needle or chest tube thoracostomy. Consider chest seals for chest cavity wounds.
  • C - Circulation
    • Reevaluate for peripheral pulses, tourniquets that need to be replaced, and hemorrhage management deferred during "M." Consider eFAST exam.
  • H - Head/Hypothermia
    • Evaluate for head injury, including mental status and GCS. Treat hypothermia.

See Also

• Combat triage
• Nine line CASEVAC
• Military emergency medicine

External Links

• Committee on Tactical Combat Casualty Care (CoTCCC)