Tactical combat casualty care

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  • 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

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

External Links