Tactical Combat Casualty Care (TCCC)

The only standard of care dually endorsed by both the American College of Surgeons, and the
National Association of EMT's for Casualty Management in Tactical Environments.

The Evolution of Tactical Combat Casualty Care
The hard lessons learned over centuries of battlefield healthcare were all but ignored until a landmark paper appeared in a 1996 issue of Military Medicine. Previously, military guidelines for trauma management mirrored tactics used in the civilian sector. Initiated by the elements of the Special Operations Command, the new strategies outlined in 1996 were collectively referred to as Tactical Combat Casualty Care (TCCC).

90% of combat deaths occur on the battlefield before the casualty ever reaches a medical treatment facility.
- Col. Ron Bellamy

The hemorrhage that takes place when a main artery is divided is usually so rapid and so copious that the wounded man dies before help can reach him.
- Col. H.M. Gray, 1919


Decrease Preventable Combat Death
TCCC launched a total reassessment of practices with one overarching goal: Decrease Preventable Combat Death at the point of wounding. These new strategies based on historical wounding patterns in combat also bear a particular relevance to the operators of Tactical Law Enforcement who share many operational parallels with their military counterparts.

Instead of the civilian-based approaches of the past, integrated strategies specific to combat realities continue to emerge. Compared to standard pre-hospital treatment modalities, which are fundamentally based on blunt trauma, TCCC distinguishes itself from the norm by focusing primarily on the intrinsic tactical variables of penetrating trauma compounded by prolonged evacuation times.

Today, TCCC is quickly becoming the standard of care for the tactical management of combat casualties within the Department of Defense and is the sole standard of care dually endorsed by both the American College of Surgeons and the National Association of EMT’s for casualty management in tactical environments.

TCCC is built around three definitive phases of casualty care:

Care Under Fire:
Care rendered at the scene of the injury while both the medic and the casualty are under hostile fire. Available medical equipment is limited to that carried by each operator and the medic.

Tactical Field Care:
Rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours.

Tactical Evacuation Care (TACEVAC):
Rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.

Combat Casualty Response EquipmentTM System
A Tiered System for Medical Equipment

During all phases of care the principle mandate of TCCC is the critical execution of the right interventions at the right time. Particularly in the tactical environment, good medicine administered at the wrong time can often prove to be lethal. With this in mind Tactical Healthcare Professionals as well as Individual Warfighters/ Operators will both likely be involved in casualty care at some level and must be trained in and armed with the appropriate medical equipment and procedures corresponding to each level of care. As illustrated below, our macro strategy equips each tier with the critical equipment essential to managing trauma at each phase of casualty care. When employed with Tactical Combat Casualty Care (TCCC) training standards, this tiered approach can decrease Preventable Combat Death by as much as 90+%.

The Target: Preventable Combat Death
Col. Gray hit the nail on the head 85 years ago. Empirical research using data from World War II until today elicited the same conclusion. The overwhelming cause of preventable combat death continues to be extremity hemorrhage (see Figure 1). However, until recently, neither warfighters nor tactical operators were trained or equipped to control the life threatening hemorrhage so common to both operational arenas.

The fate of the wounded lays with those who apply the first dressing.
- Col. Nicholas Senn, 1844-1908


Our goal is to resource the individual warfighter/operator as well as the tactical healthcare professional with
the right tools to significantly decrease preventable combat death.