Care under fire


  • One of the three phases of care within the Tactical Combat Casualty Care (TCCC) guidelines.
  • Defined as care rendered to a casualty while still under active fire.

Principles of Care[1]

  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 tourniquet for hemorrhage that is anatomically amenable to tourniquet application.
    • Apply the tourniquet proximal to the bleeding site, over the uniform, tighten, and move the casualty to cover.

See Also


  1. Tactical Combat Casualty Care Guidelines; 2 June 2014;