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1. What are the 3 most common causes of preventable death on the battle- field? Ans 1. Hemorrhage from extremity 2. Tension pneumothorax 3. Airway problems 2. What are the 3 phases of care in TCCC? Ans 1. Care under fire 2. Tactical Field Care 3. Tactical Evac Care (TACEVAC) 3. What are the 3 goals of TCCC? Ans 1. Treat the casualty 2. Prevent additional casualties 3. Complete the mission 4. What are the different carries for Care Under Fire? Ans 1 person with/ without line 2 person with/ without line Fireman's carry Hawes carry SEAL team 3 carry 5. What is the most frequent cause of preventable death on the battlefield? Ans - Extremity hemorrhage 6. How many minutes does it take for someone to bleed to death from a femoral artery lac? Ans 3 minutes 7. What is the first step in the Care Under Fire Phase? Ans Return fire and take cover 8. What is the second step in Care Under Fire? Ans Ask casualty if they can't return fire 9. What is the third step in Care Under Fire? Ans Ask casualty if they can seek cover and apply self aid 10. If you must move a casualty under fire, consider the following Ans Ans 1. Location of nearest cover 2. How best to move them to the cover 3. The risk to the rescuers 4. Weight of casualty and rescuers 5. Distance to be covered 6. Use suppression fire to best advantage 7. Recover weapon if possible 11. MARCH Acronym Ans MARCH (massive hemorrhage, airway, respirations, circu- lation, head injury/hypothermia) is an acronym used by TCCC-trained individuals to help remember the proper order of treatment who is breathing can benefit from the nasopharyngeal airway (NPA). An unconscious casualty who is not breathing may require a definitive airway such as a surgical cricothyroido- tomy. In a combat setting, endotracheal intubation is highly difficult, if not impossible. 13. Respirations Ans The third potentially survivable cause of death on the battlefield is the development of a tension pneumothorax (PTX). Air trapped in the chest cavity begins to displace functional lung tissue and places pressure on the heart, resulting in cardiac arrest. Seal open chest wounds with a vented chest seal decompress a suspected PTX and support ventilation/oxygenation, as required. Treat a PTX via needle chest decompression (NCD) using a 14-gauge, 3.25-inch-long needle with a catheter 14. Circulation Ans Control of bleeding takes precedence over infusing fluids. Only individuals in shock or those who need intravenous (IV) medications need to have IV access established. Use an 18-gauge catheter and saline lock in a field setting. Give tranexamic acid (TXA) as soon as feasible to casualties in or at risk of hemorrhagic shock. Once a saline lock is established, secure it with transparent wound-dressing film. Administer fluids by a second needle and a catheter through the film dressing. When the infusion is complete, withdraw the needle, leaving the saline lock in place. An intraosseous (IO) device is an alternative route for administering fluids when fluid resuscitation is required and an IV access 4 cannot be obtained. Clinical signs of shock on the battlefield are Ans 1) unconsciousness or altered mental status not due to coexisting traumatic brain injury (TBI) or drug therapy; and/or 2) abnormal radial pulse. 15. Head injury/hypothermia Ans Hypotension (systolic blood pressure [SBP] under 90) and hypoxia (peripheral capillary oxygen saturation [SpO2] under 90) worsen secondary brain injury. Medical personnel identify mild traumatic brain injury (mTBI) using the Military Acute Concussion Evaluation (MACE) (more information on MACE is available online at https Ans//dvbic.dcoe.mil/ma- terial/military-acute-concussion-evaluation- mace-pocket- cards). Non-medical personnel utilize the alert, verbal, pain, unresponsive (AVPU) scale. Hypothermia is a survivable cause of further injury and is defined as a whole body temperature below 95 F (35 C). Hypothermia, acidosis, and coagulopathy constitute the lethal triad in trauma patients. Hypothermia can occur secondary to orally. If the casualty can tolerate oral fluids, moxifloxacin, 400 milligrams (mg), can be given instead of ertapenem of cefotetan. All battlefield wounds are considered contaminated. All wounded casual- ties with penetrating injuries should receive antibiotics. 19. Wounds Ans Assessing and treating casualties with additional wounds improves morbidity and mortality. Minor scalp lacerations can be the cause of excessive hemorrhage. First responders must address burns, open fractures, facial trauma, amputation dressings, and security of tourniquets. Reassessment of wounds and interventions prior to movement is critical. When preparing the patient for transport, casualties with penetrating trauma to the chest or abdomen should be evacuated on an emergent basis, due to the possibility of internal hemorrhage. Responders should give TXA as soon as feasible to casualties in or at risk of hemorrhagic shock. 20. Splinting Ans Medical personnel should address pelvic disruptions and eye injuries. The energy required to cause a lower extremity traumatic amputation (from an improvised explosive device [IED], land mine, etc.) moves upward through the body, potentially causing further bone disruption, hollow organ collapse, or internal bleeding. Responders should use the Combat Ready Clamp (CRoC), the Junctional Emergency Treatment Tool (JETT), or the SAM Junctional Tourniquet to control junctional hemorrhage and stabilize the pelvis. Splinting of fractures can result in significant pain relief and minimize bleeding. In cases of suspected penetrating eye trauma, responders should Ans 1) perform a rapid field test of visual acuity; 2) tape a rigid shield over the eye to prevent further trauma to the eye; and 3) give moxifloxacin, 400 mg, by mouth as soon as possible to prevent infection in- side the eye. Never apply a pressure dressing to an eye with a suspected penetrating injury. 21. Hemorrhage Control Step 1 Ans During the care under fire phase, p tourniquet as high on the extremity as possible and over the uniform. T tourniquet. (This will be transitioned to a deliberate tourniquet on the s above the injury in the tactical field care phase.) 22. Hemorrhage Control Step 7 this tourniquet and recheck the distal pulse. 23. Hemorrhage Control Step 3 Ans Feed the self-adhering band tight a extremity and securely fasten it back on itself. No more than three fin fit between the band and the injured extremity. 24. Hemorrhage Control Step 4 Place any excess combat gauze directly over the wound and apply direct pressure for 3 minutes. NOTE Ans More than one combat gauze may be required to completely fill the wound. If Oe > TR bleeding continues after 3 minutes of pressure, first remove the combes gauze and YY “¥ 2 Vv repeat step 1. NOTE ook for flowing Ans Attempt to visualize the bleeding during dressing transition. L blood from veins or spurting blood from arteries. Attempt to place the second combat gauze on the source of the bleeding. 2. Once bleeding is controlled, apply an outer bandage (Ace wrap or emergency dressing) to secure the dressing to the wound. 29. Nasopharyngeal Airway (NPA) Ans 1. Place the casualty supine with the head in a neutral position. 2. Lubricate the tube with a water-based lubricant. 3. Insert the NPA «* Push the tip of the nose upward gently. «+ Position the tube so the bevel of the airway faces toward the septum. «* Insert the airway into the nostril and advance it until the flange rests against the nostril. 
