TC3 for Dummies

The 'down-n-dirty' on battlefield first aid...

Intro

TC3 = TCCC = Tactical Combat Casualty Care

"Nearly 90 percent of combat fatalities occur before a casualty reaches a medical treatment facility. Therefore, the pre-hospital phase of care is needed to focus on reducing the number of combat deaths"

"The pre-hospital phase of care is needed to focus on reducing the number of combat deaths"

"When you have casualties on the battlefield, you must determine the sequence in which the casualties are to be treated and how to treat their injuries"

Most common types of injuries on the battlefield:

• injury to extremities including amputations

• hemorrhage

• chest/abdominal/head

• controlling shock/pain

Types of TCCC

TCCC-Medical Provider (TCCC-MP) is training for medical personnel

TCCC-All Combatants (TCCC-AC) is training for first responders and non-medical personnel

Tactical Considerations

Sometimes the mission will take precedence over medical care (MC before first aid)

Aid should not be rendered until tactical/local fire superiority has been achieved

First aid may need to be periodically stopped in order to maintain tactical advantage

If possible, wounded Soldiers should return fire, seek cover and perform self aid

First aid supplies from the injured Soldier should be used, not your own supply

Hemorrhage is the leading cause of preventable battlefield death

Tourniquets are the best way to control severe bleeding on the battlefield

Fire superiority can be achieved by:

• small arms/crew served weapons

• indirect fire/CAS

• use of smoke as concealment

"How to" Videos

Care Under Fire

React to Contact ! !

Burn Management

Seek Cover/Buddy Carries

Hemorrhage Control

Tactical Field Care

Airway Management

XStat use

Wound Packing

Pressure Dressing

Surgical Cricothyroidotomy

Airway Management

Chest Trauma

Chest Seal

Needle Decompression

IV Fluid Administration

Rigid Eye Shield

Pelvic Binder

Hypothermia Mitigation

'Combat Pill Pack'

Phases of TC3

3 phases of care:

• Care under fire (CUF)

"Care under fire is the care rendered by the soldier medic at the scene of the injury while he and the casualty are still under effective hostile fire. Available medical equipment is limited to that carried by the individual soldier or the soldier medic in his medical aid bag"

• Tactical field care (TFC)

"Tactical field care is the care rendered by the soldier medic once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred, but there is no hostile fire. Available medical equipment is still limited to that being carried into the field by medical personnel. The time needed to evacuate the casualty to a medical treatment facility (MTF) may vary considerably"

• Tactical evacuation care (TEC)

"Combat casualty evacuation (CASEVAC) care is the care rendered once the casualty has been picked up by an aircraft, vehicle, or boat. Additional medical personnel and equipment may have been pre-staged and are available at this stage of casualty management"

Care Under Fire

1) *** Fire superiority is paramount ***
Nothing can proceed unless the tactical advantage is returned to the unit in contact, even if temporarily and/or only in certain parts of the battlefield

Injured Soldiers should return fire and seek cover. Once they reach cover they should perform self aid with their own medical supplies, if possible. If they can't move and/or are injured, they should 'play dead'

Incapacitated Soldiers should only be moved once fire superiority/concealment has been reached


2) *** Hemorrhage control is key to survivability ***
Failure to stop major bleeding can quickly result in hypovolemic shock and subsequent death

The use of temporary tourniquets is the #1 action that can save a Soldier's life on the battlefield


3) Airway Management
Airway management is NOT performed at this phase due the limited time available:

• to achieve fire superiority

• low percentage of airway obstructions (<1% cases)

• need to move to cover/concealment

4) C-spine immobilization
In the CUF phase, cervical immobilization is:

• not performed for penetrating injuries (<2% needed)

• other cervical related injuries may require a rigid collar (from a Medic's Aid Bag)

• the danger to life must be more imminent than hostile fire

• a 'splint' may be used to replace a rigid collar

5) Litters
Since litters may not be available in this phase consider:

• 'poleless' litters

• ponchos

• SKEDCO/Talon litters

• Battlefield debris such as tables/doors

• manual carry (dragging/one-man/buddy carries)

6) Injured equipment
Do NOT salvage equipment that is not mission essential (rucksacks etc.)
DO retain an injured Soldier's:

• weapon

• ammunition

• sensitive items (NVGs/GPS/thermal/radio/maps/code words etc.)

Actions to be taken in CUF phase:
1 Non-injured personnel should return fire

2 Injured personnel should also return fire (if possible)

3 Verbally direct the casualty to cover and apply self-aid (if possible)

4 Try best to keep the casualty from receiving any additional wounds.

5 Stop any life-threatening hemorrhage with a tourniquet and/or hemostatic dressing

6 Airway management is generally best deferred until the Tactical Field Care phase

Tactical Field Care

Tactical field care is a phase in which:

• more care can be given

• less danger from hostile fire

• time allowed to treat injuries is often fluid from minutes to hours

Blast/burn/penetrating victims with: no pulse; respirations,
Even in peacetime settings, these types of injuries are overwhelmingly fatal
Do NOT perform CPR on injuries involving:

• blast

• burns

• penetrating injuries

DO perform CPR for non-traumatic conditions:

• hypothermia

• near drowning

• electrocution

*** Injured Soldiers with signs of altered mental status should: ***

• be disarmed of all weapons (long rifle/pistol/grenades/knives etc.)

• have their communications taken away

Initial assessment consists of airway, breathing and circulation

1) Airway
Make sure the Soldier has a patent airway (not obstructed)

2) Breathing
Traumatic chest wall injuries should be:

• sealed on all '4 sides' (especially if a needle decompression is available)

• sealed on '3 sides' to allow the cavity to remain properly pressurized

*** Applying a '3 sided' chest seal under tactical conditions is NOT easy ***

*** It is easier to apply a '4 sided' seal and perform a needle decompression soon after ***

*** Tension pneumothorax is the second leading cause of preventable battlefield death ***

3) Circulation
Check tourniquets/bandages for continued bleeding
Check the injured Soldier for other bleeds not previously noted
Consider loosening a tourniquet if the bleeding is controlled
- if bleeding continues, tighten the 'T' and leave in place
Apply direct pressure/elevate limb for at least 3 minutes to control bleeding
Utilize hemostatic dressing
'Pack' wound utilizing:

• 'clock' method

• Cardinal method (N/S/E/W)

Intravenous access
Gain IV use by way of a single 18-gauge catheter
The IV site should be proximal to the injury (not distal)
If no IV site can be achieved:

• consider creating a sternal intraosseous (IO) line

• utilize a 'First Access for Shock and Trauma' (F.A.S.T.1) device

Fluid of choice is: Hextend (colloid over solution crystalloid)

Significant traumatic injuries often require IV/IO access
Even without significant trauma you should create an IV/IO port
*** No casualty should receive more than 1,000 ml of Hextend ***
500 ml of Hextend is equivalent to 3,000 ml of lactated Ringer's lactate

*** Uncontrolled hemorrhage must be controlled BEFORE adding fluids ***

Check injured Soldiers for entrance/exit wounds

Protect inured from hypothermia

Pain Management
If Soldier CAN fight, administer :

• anti-inflammatory drug (NSAID) to reduce swelling/inflammation such as Meloxicam (15 mg)

• an analgesic drug such as 1,000 mg acetominophen to reduce pain

• an antibiotic such as Gatifloxacin (400 mg) to reduce the risk pf infection

Use of OTP (On The Person) antibiotics
During Operation Gothic Serpent, ALL traumatic open wounds of Rangers became infected
Battlefield ingestion of the Soldier's Combat Pill Pack significantly reduces the chance of such infections

IFAK Comparison

Conclusion

TC3 advances have been a battlefield game changer. Learn these techniques to improve your Unit's capabilities.

[Greybeard]

a sub-five minute km...lol

[V.A.L. Commorby]

Dude he has 1530 hours in ARMA 3 he is obviously a elite player and pussy destroyer

[Kalen]

Bro shut the fuck up. I swear to god this fucking dude man. This is a game. I can guess with certainty that you have little to no real life experience whatsoever and the fact that you post some wannabe smartass shit on a forum for a videogame you cant even apply these things on just shows that you´re nothing but a dumbass larper. "hurr durr look at me this is just like being a soldier". Fuck off man. Try to run a sub five minute km and work out instead of playing pretend under a videogame.

[Greybeard]

This guy...

[Skee 11B/CIB]

How many of you betas ACTUALLY have real life experience rendering combat medicine. Just go join the military already ffs