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Tactical Combat Casualty Care (TCCC) QUESTIONS
AND ANSWERS RATED A+ 2025 |202 6 UPDATE
Prior to 9/11, what was combat medical training modeled on? correct answer: Emergency Medical Technician and Advanced Trauma Life Support What often causes a junctional hemorrhage? correct answer: IEDs tension pneumothorax correct answer: Air escapes from the injured lung and pressure builds up in the chest which collapses the lung and pushes on the heart. The compressed heart is then not able to pump well. What is the leading cause of preventable death on the battlefield? correct answer: hemorrhagic shock What is the second leading cause of preventable death on the battlefield? correct answer: tension pneumothorax What are the three objectives of TCCC? correct answer: 1. Treat the casualty
- Prevent additional casualties
- Complete the mission
What does the prehospital arm of the Joint Trauma System include? correct answer: 42 members from all services in DoD and civilian sector; trauma surgeons, emergency medicine, critical care physicians, combatant unit physicians, medical educators, combat medics, corpsmen, PJs; 100% deployed experience as of 2017 What is the "Triple Option" for battlefield analgesia? correct answer: PO meds, OTFC, ketamine How was TCCC used early in the Iraq and Afghanistan conflicts? correct answer: It was not widely used at the start of the wars, but increased in use by both Special Operations and conventional units beginning in 2005. Up to how many combat deaths today are potentially preventable? correct answer: 24% What are the three phases of care in TCCC? correct answer: Care Under Fire (CUF), Tactical Field Care (TFC), TACEVAC Care Where is the limb tourniquet placed? correct answer: Over the uniform clearly proximal (2- 3 inches) to the bleeding site, but if it is not obvious, place the tourniquet "high and tight" (as proximal as possible) on the injured limb. During which phase should airway management be performed? correct answer: Tactical Field Care phase
What are signs of life threatening bleeding? correct answer: pulsing or steady bleeding from the wound; blood is pooling; clothes soaked with blood; bandages covering the wound are ineffective and steadily becoming soaked with blood; traumatic amputation of arm or leg; there was prior bleeding and patient is now in shock If the first tourniquet fails to control the bleeding, what should be done? correct answer: Place a second tourniquet just above (proximal) the first. Where should a tourniquet not be placed? correct answer: directly over the knee, elbow, a holster, cargo pocket that contains bulky items How tight should the tourniquet be? correct answer: It should stop the bleeding and eliminate the distal pulse. True or False: You should periodically loosen the tourniquet to allow blood flow to the injured extremity correct answer: False How long should you hold direct pressure on a hemostatic agent (e.g. combat gauze)? correct answer: 3 minutes What is the M in MARCH? correct answer: Massive hemorrhage: control life-threatening bleeding
What is the A in MARCH? correct answer: Airway: maintain a patent airway What is the R in MARCH? correct answer: Respiration: decompress tension pneumothorax, seal open chest wounds, support ventilation/oxygenation What is the C in MARCH? correct answer: Circulation: IV/IO access and administer fluids to treat shock What is the H in MARCH? correct answer: Head injury/Hypothermia: prevent/treat hypotension and hypoxia to prevent worsening of TBI What is MARCH? correct answer: the sequence of care in TFC What is XStat best for? correct answer: deep, narrow-tract junctional wounds What are the three hemostatic dressings recommended in the TCCC guidelines? correct answer: combat gauze, Celox gauze, ChitoGauze Combat Gauze correct answer: first choice for hemostatic dressing; a 3 in. x 4 yd. roll of sterile gauze impregnated with kaolin, a material that causes blood to clot
What is inserted into the XSTAT 12 applicator to deploy the minisponges into a wound? correct answer: a plunger Having XSTAT 12 applicators available at the point of injury is recommended by the manufacturer. correct answer: three The higher the sponge density in the wound cavity - correct answer: the higher the pressure exerted on the damaged vessel When should the minisponges from the XSTAT 12 be removed? correct answer: by a surgeon after achieving proximal and distal vascular control What is the form name for the TCCC Casualty Card? correct answer: DD 1380 junctional hemorrhage correct answer: bleeding from wounds to the groin, buttocks, perineum, axillae, base of neck, extremities at sites too proximal for a limb tourniquet What are the three CoTCCC-recommended junctional tourniquets? correct answer: 1. Combat Ready Clamp (CRoC)
- Junctional Emergency Treatment Tool (JETT)
- SAM Junctional Tourniquet (SJT)
How should you handle an unconscious casualty without airway obstruction? correct answer: chin lift/jaw thrust, nasopharyngeal airway, place casualty in recovery position nasopharyngeal airway (NPA) correct answer: also called "nose hose" and "nasal trumpet"; well tolerated by conscious patient but will gag; don't use an oropharyngeal airway (J tube) with it; easily dislodged If a person has suffered a maxillofacial trauma but his/her are intact, he/she may do well. correct answer: larynx and trachea What are the different ways a surgical cricothyroidotomy can be performed? correct answer: 1. Cric-Key (preferred)
- Bougie-aided open surgical technique using flanged and cuffed airway cannula (less than 10 mm outer diameter, 6-7 mm internal diameter, 5-8 cm intratracheal length)
- standard open surgical technique (least desirable) If the casualty is conscious when performing a cricothyroidotomy, what should you use? correct answer: lidocaine What is the failure rate when performing a battlefield cricothyroidotomy? correct answer: 33% What are the surface landmarks for a cricothyroidotomy? correct answer: thyroid cartilage, thyroid prominence (Adam's apple in males), cricothyroid membrane, cricoid cartilage
lung fills up the entire chest cavity, but with injury, the air is inside the chest but outside the lung. What can a tension pneumothorax impair? correct answer: lung function and heart function, causing respiratory distress and shock What size does a hole in the chest have to be for a sucking chest wound (open pneumothorax) to occur? correct answer: the size of a nickel or bigger How can you manage an open pneumothorax? correct answer: Apply a vented occlusive dressing completely over the defect at the end of one of the casualty's exhalations. Monitor for possible development of tension pneumothorax. Allow the casualty to sit. What should you do if signs of tension pneumothorax develop in a treated sucking chest wound? correct answer: Lift one edge of the seal and allow the tension pneumothorax to decompress ("burping"). All individuals with moderate/severe TBI should be monitored with. correct answer: pulse oximetry What is normal O2 at sea level? correct answer: 98% or higher
What is normal O2 at 12,000 ft? correct answer: 86% due to lower oxygen pressure at that altitude What types of casualties should you consider using a pulse ox for? correct answer: TBI (good O2 sat of >90% is very important for a good outcome); unconscious; penetrating chest trauma; chest contusion; severe blast trauma When may oxygen saturation values be inaccurate? correct answer: hypothermia, shock, carbon monoxide poisoning, very high ambient light levels pelvic binder correct answer: should be applied for cases of suspected pelvic fracture Open Book Pelvis Injury correct answer: front of the pelvis opens like a book; results in tears of the strong pelvic ligaments that hold the pelvis bones together at the symphysis pubis and the sacroiliac joints Vertical Shear Pelvis Injury correct answer: one half of the pelvis is forcefully shifted upward Lateral Crush Injury correct answer: half of the pelvis is crushed either inward or outward What exam findings are suggestive of a pelvic fracture? correct answer: pelvic pain; laceration/bruising at bony prominences of pelvic ring; deformed/unstable pelvis; unequal leg
Pelvic binders may mask the presence of a on CT scanning. correct answer: pelvic fracture Damage to the arm or leg is rare if the tourniquet is left on for less than hours. correct answer: 2 When should tourniquets be converted to hemostatic or pressure dressings? correct answer: 1. The casualty is not in shock
- It is possible to monitor the wound closely for bleeding
- The tourniquet is not being used to control bleeding from an amputated extremity Do not remove a tourniquet that has been in place more than hours unless close monitoring and lab capability are available. correct answer: 6 What will minimize the chance of ischemic damage due to a tourniquet? correct answer: restoring blood flow to the limb by transitioning to Combat Gauze at the 2-hour mark If the transition from tourniquet to Combat Gauze at 2 hours failed, when should you try again? correct answer: at 6 hours When should you not convert the tourniquet? correct answer: casualty in shock; you cannot closely monitor the wound for re-bleeding; the extremity distal to the tourniquet has been
amputated; it has been on more than 6 hours; casualty will arrive at an MTF within 2 hours; tactical or medical considerations make transition inadvisable Who are the only people allowed to reposition or convert tourniquets? correct answer: medics, physician assistants, physicians What kind of IV catheter is preferred? correct answer: 18 - gauge or saline lock When can you go the IO route? correct answer: if vascular access is needed but not quickly obtainable via the IV route What are the indications for IV access? correct answer: fluid resuscitation for hemorrhagic shock or risk of shock; casualty needs meds but cannot take them by mouth; unable to swallow; vomiting; decreased state of consciousness; absent/weak radial pulses Don't insert an IV to a significant wound. correct answer: distal Why is a saline lock recommended instead of an IV line unless fluids are needed immediately? correct answer: easier to move; less chance of traumatic disinsertion; provides rapid access; conserves IV fluids What is the saline lock flushed with? correct answer: 5cc normal saline (NS) and then every 1 - 2 hours to keep it open
Besides inadequate flow/no flow, what is a potential problem of the FAST1? correct answer: infiltration due to insertion not perpendicular to the sternum What is the most commonly used IO device in combat? correct answer: Pyng FAST What is the second most commonly used IO device in combat? correct answer: Vidacare EZ-IO EZ-IO T.A.L.O.N. needle set correct answer: 15g, 304 stainless steel, 38.5 mm needle What must be checked before inserting the EZ-IO? correct answer: skin adipose and muscle thickness For the EZ-IO, special caution must be exercised with patients with BMI greater than. correct answer: 30 What is essential to perform before attempting to infuse fluids into the IO space? correct answer: a rapid normal saline syringe flush of 5 - 10 mL; helps clear the marrow and fibrin from medullary space Why is it important to avoid extreme pressure for the flush of the IO space? correct answer: It may increase the risk of extravasation.
For the proximal humerus insertion of the EZ-IO, what angle must the needle tip be at? correct answer: 45 degrees Where is the proximal humerus insertion site for the EZ-IO? correct answer: 3 cm (2 finger widths) below the patella and 2 cm medial, along the flat part of the tibia What angle do needles need to be at for tibial insertions? correct answer: 90 degrees What is the first confirmation of the tibial placement of the EZ-IO? correct answer: The needle should feel firmly seated in the bone. What is the second confirmation of the tibial placement of the EZ-IO? correct answer: Aspirate for blood/bone marrow (failure to does not mean insertion was unsuccessful); can also be confirmed by ability to administer pressurized fluids, and noting pharmacologic effects of medications How do you infuse an EZ-IO? correct answer: 1. Prime with 2% lidocaine
- Slowly infuse lidocaine 40 mg over 120 seconds
- Allow to dwell in IO space 60 seconds
- Flush with NS
- Slowly infuse lidocaine 20 mg over 60 seconds
TXA should not be given with. correct answer: Hextend If there is a new onset drop in BP during TXA infusion, what should you do? correct answer: slow it down When is a second dose of TXA given? correct answer: after the casualty arrives at a Role II/Role III medical facility; may be given in the field if evacuation is delayed and fluid resuscitation is completed before arrival at the medical facility What are the resuscitation fluids of choice for hemorrhagic shock (most to least preferred)? correct answer: 1. whole blood
- plasma, RBCs, platelets in 1:1:1 ratio
- plasma and RBCs in 1:1 ratio
- plasma or RBCs alone
- Hextend
- crystalloid (Lactated Ringer's or Plasma-Lyte A) Hypothermia prevention measures should be initiated while is being accomplished. correct answer: fluid resuscitation Continue fluid resuscitation of a casualty in shock until: correct answer: a palpable radial pulse, improved mental status, or systolic BP of 80-90 is present
How should you resuscitate a casualty if they are in shock and no blood products are available? correct answer: - use Hextend (or Lactated Ringer's/Plasma-Lyte A if not available)
- reassess after each 500 mL IV bolus shock correct answer: insufficient blood flow to body tissues which results in inadequate oxygen delivery and cellular dysfunction; typically caused by severe blood loss What is the normal adult blood volume? correct answer: 5 liters 500 mL blood loss correct answer: - alert
- full radial pulse
- normal/slightly increased HR
- normal Systolic BP
- normal RR 1000 mL blood loss correct answer: - alert
- full radial pulse
- HR: 100+
- Systolic BP: normal lying down
- RR: may be normal 1500 mL blood loss correct answer: - alert but anxious
- radial pulse: may be weak
