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    Module 03 - Care Under Fire: Speaker Notes

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    Sae Tum
    This document provides an overview of Tactical Combat Casualty Care (TCCC) for Combat Lifesavers. It discusses the four roles of TCCC care and focuses on the Combat Lifesaver role. The Care Under Fire phase is described, which is care provided while still under enemy threat. The priorities during this phase are gaining fire superiority, applying tourniquets to control life-threatening bleeding from extremities, and moving casualties to cover. Bleeding from major blood vessels can cause death within 3 minutes, so tourniquet application is critical during Care Under Fire to prevent shock and death from hemorrhage.

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    © All Rights Reserved
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    Module 03 - Care Under Fire: Speaker Notes

    Uploaded by

    Sae Tum
    76 views12 pages
    This document provides an overview of Tactical Combat Casualty Care (TCCC) for Combat Lifesavers. It discusses the four roles of TCCC care and focuses on the Combat Lifesaver role. The Care Under Fire phase is described, which is care provided while still under enemy threat. The priorities during this phase are gaining fire superiority, applying tourniquets to control life-threatening bleeding from extremities, and moving casualties to cover. Bleeding from major blood vessels can cause death within 3 minutes, so tourniquet application is critical during Care Under Fire to prevent shock and death from hemorrhage.

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    This document provides an overview of Tactical Combat Casualty Care (TCCC) for Combat Lifesavers. It discusses the four roles of TCCC care and focuses on the Combat Lifesaver role. The Care Under Fire phase is described, which is care provided while still under enemy threat. The priorities during this phase are gaining fire superiority, applying tourniquets to control life-threatening bleeding from extremities, and moving casualties to cover. Bleeding from major blood vessels can cause death within 3 minutes, so tourniquet application is critical during Care Under Fire to prevent shock and death from hemorrhage.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    76 views12 pages

    Module 03 - Care Under Fire: Speaker Notes

    Uploaded by

    Sae Tum
    This document provides an overview of Tactical Combat Casualty Care (TCCC) for Combat Lifesavers. It discusses the four roles of TCCC care and focuses on the Combat Lifesaver role. The Care Under Fire phase is described, which is care provided while still under enemy threat. The priorities during this phase are gaining fire superiority, applying tourniquets to control life-threatening bleeding from extremities, and moving casualties to cover. Bleeding from major blood vessels can cause death within 3 minutes, so tourniquet application is critical during Care Under Fire to prevent shock and death from hemorrhage.

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    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    MODULE 03 – CARE UNDER FIRE

    SLIDE 1 – TITLE SLIDE

    SLIDE 2 – TCCC ROLES


    Tactical Combat Casualty Care is broken up into four
    roles of care. The most basic is taught to All Service
    Members (ASM), which is designed to instruct in the
    absolute basics of hemorrhage control and to recognize
    more serious injuries.
    You are in the Combat Lifesaver (CLS) role.
    This teaches you more advanced care to treat the
    most common causes of death on the battlefield, and to
    recognize, prevent, and communicate with medical
    personnel the life-threatening complications of
    these injuries.
    The Combat Medic/Corpsman (CMC) role includes much more advanced and invasive care requiring
    significantly more medical knowledge and skills.
    Finally, the last role, Combat Paramedic/Provider (CPP) is for Combat paramedics and advanced
    providers, to provide the most sophisticated care to keep our wounded warriors alive and get them to
    definitive care.
    Your role as a CLS is to treat the most common causes of death on the battlefield, which are massive
    hemorrhage and airway/respiratory problems. Also, you are given the skills to prevent complications and
    treat other associated but not immediately life-threatening injuries.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    SLIDE 3 – TLO/ELO
    The Care Under Fire (CUF) module has five cognitive
    learning objectives and four performance learning
    objectives. The cognitive learning objectives are to:

    1. Describe the role of fire superiority and threat


    containment and the impact of the tactical
    environment on Tactical Combat Casualty Care
    (TCCC)

    2. Describe the actions required before engaging with a casualty to prevent harm or additional
    casualties in accordance with CoTCCC guidelines

    3. Identify appropriate actions and priorities to treat and move casualties in CUF

    4. Identify the importance of early application of limb tourniquets to control life-threatening bleeding

    5. Describe the principles, advantages, and disadvantages of one-person drag/carry or two-person


    drag/carry in CUF

    The four performance learning objectives are to:


    1. Demonstrate the one-handed tourniquet application to self in CUF
    2. Demonstrate the two-handed tourniquet application to a casualty in CUF
    3. Demonstrate the one-person drag/carry of a casualty in CUF
    4. Demonstrate the two-person drag/carry of a casualty in CUF
    The initial priority of CUF is to return fire, suppress the enemy, and gain fire superiority. Treatment
    priorities while still under effective enemy fire/threat are addressing massive hemorrhage with tourniquets
    and moving the casualty to cover.

    SLIDE 4 – THREE PHASES OF TCCC


    CUF is the first of three phases of TCCC. It is the
    lifesaving care provided while still under active enemy
    fire or threat. Actions are prioritized to suppress enemy
    fire, gain fire superiority to prevent further harm or
    additional casualties, identify and control life-
    threatening bleeding, and move the casualty to cover.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    SLIDE 5 – PHASE 1: CARE UNDER FIRE
    CUF is the care rendered by the first responder/CLS at
    the scene of the injury while still under effective hostile
    fire. Available medical equipment is limited to that
    carried by the individual responder or casualty (Joint
    First Aid Kit (JFAK) or a CLS bag). Remember: Always
    use the casualty’s JFAK first.
    The critical feature of CUF is that the casualty and
    responder/CLS are still under effective hostile fire.
    The mission does not stop just because there is a casualty. Most battlefield casualty scenarios involve
    making medical and tactical decisions rapidly. In the combat environment there is no “time-out” when
    casualties occur. Good medicine can sometimes be bad tactics; doing the RIGHT thing at the WRONG
    time can get you and your teammates killed or cause the mission to fail.
    Remember: Do not become a casualty! Assess the situation and the risk. Suppress enemy fire
    and gain fire superiority first. Communicate with and direct the casualty to return fire, move to
    cover, apply self-aid, and develop a plan before moving to care for a casualty under fire.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    SLIDE 6 – ROLE OF FIRE SUPERIORITY
    Remember to return fire and take cover. The best
    medicine on the battlefield is fire superiority!

    SLIDE 7 – FIRE SUPERIORITY


    PRINCIPLES
    Order of initial actions will be dictated by the tactical
    situation.
    Little time is available to provide casualty care while
    under effective enemy fire. Suppressing hostile fire and
    gaining fire superiority should be the priorities to minimize
    the risk of injury to other personnel and minimize
    additional injury to the casualty while completing the
    mission. Personnel may need to assist in returning fire instead of stopping to care for casualties
    (this includes the casualty if they are still able to fight). Wounded service members who are exposed to
    enemy fire should be directed to continue to return fire, move as quickly as possible to any nearby cover,
    and perform self-aid if able.

    SLIDE 8 – CASUALTY SELF-AID


    If the casualty is responsive and able, the first
    responder/CLS should direct the casualty to return fire,
    apply self-aid (tourniquet), re-engage, and move to
    cover (if possible).

    SLIDE 9 – IF CASUALTY IS UNABLE


    TO MOVE
    If a casualty is responsive but can’t move, a rescue
    plan should be devised and executed if tactically
    feasible.
    Do not put two people at risk if it can be avoided. If
    cover is not available or the wounded Service member
    cannot move to cover, they should lie flat and
    motionless.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    SLIDE 10 – PHASE 1: CARE UNDER FIRE
    If the casualty cannot apply self-aid or move to cover,
    devise and execute a rescue plan to reach the
    casualty. Apply a tourniquet “high and tight” as quickly
    as possible to stop bleeding (within 1 minute, ideally)
    and move the casualty to cover. A casualty can bleed
    to death in as little as 3 minutes. The faster you apply a
    tourniquet, the better the outcome and the less chance
    of shock and death.

    SLIDE 11 – MASSIVE BLEEDING IN CARE UNDER FIRE


    Remember: If you can do only ONE thing for the
    casualty, it should be to identify and stop life-
    threatening bleeding, and keep them from bleeding
    to death.

    SLIDE 12 – CARE UNDER FIRE


    OVERVIEW – BLEEDING CONTROL
    (VIDEO)
    Play video.

    SLIDE 13 – IDENTIFY LIFE-


    THREATENING BLEEDING
    The following are examples of when bleeding is
    considered life-threatening: 1) there is a traumatic
    amputation of an arm or leg; 2) there is pulsing or
    steady bleeding from the wound; 3) blood is pooling on
    the ground; 4) the overlying clothes are soaked with
    blood; 5) bandages or makeshift bandages used to
    cover the wound are ineffective and are steadily

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    becoming soaked with blood; 6) there was prior bleeding, and the patient is now in shock (unconscious,
    confused, pale). If you see any of these examples, it means that a tourniquet is needed to stop life-
    threatening bleeding.
    You may not really know if hemorrhage is life-threatening until the Tactical Field Care phase when the
    wound can be exposed and evaluated. If a life-threatening hemorrhage is suspected, you should treat it
    immediately.
    Remember during CUF the only medical intervention is applying a tourniquet to stop life-threatening
    bleeding from an extremity injury. Other wounds (neck, armpit, groin, or abdomen) are not treated during
    CUF. If the casualty is able, direct them to apply pressure to the wounds as self-aid. Airway and other
    issues are also not treated until the TFC phase.
    Notes about the tourniquet:
    • Constricting band placed around an arm or leg to stop bleeding
    • Typically, 2 inches wide
    o Width reduces tissue damage
    • Quick to apply and can stop life-threatening extremity bleeding
    • High and tight during CUF
    • 2–3 inches above the wound during TFC
    • Do not document the tourniquet time during CUF; document during TFC

    SLIDE 14 – TIME TO BLEED OUT


    The number one medical priority in CUF is early
    control of severe bleeding. Extremity hemorrhage is
    the most frequent cause of preventable battlefield
    deaths. Over 2,500 deaths occurred in Vietnam
    secondary to hemorrhage from extremity wounds. A
    large number of deaths in Iraq and Afghanistan were
    also seen from hemorrhage. Injury to a major vessel
    can quickly lead to shock and death. Only life-threatening bleeding warrants intervention during Care
    Under Fire. Casualties with injuries to large central blood vessels (like the femoral artery in the groin, the
    axillary artery in the arm, or the carotid artery in the neck) can bleed to death in as little as 3 minutes.
    Play video of Care Under Fire Bleeding Video.

    SLIDE 15 – KNOW YOUR ACCESS TO


    A TOURNIQUET
    All personnel on combat missions should have a
    CoTCCC-recommended tourniquet readily available
    (standard location on their battle gear) and be trained
    in its use. Casualties should be able to easily and
    quickly reach and apply their own tourniquet.
    Tourniquets should NEVER be at the bottom of the
    pack. Always use the casualty’s tourniquet (JFAK) first.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    SLIDE 16 – ONE-HANDED TOURNIQUET
    SELF-APPLICATION
    Casualty may need to apply one-handed tourniquet
    to an upper extremity when applying self-aid. One-
    handed tourniquets are used to apply self-aid for
    bleeding from an injury to the upper arm or forearm.

    SLIDE 17 – ONE-HANDED WINDLASS


    TOURNIQUET APPLICATION (VIDEO)
    Play the video.

    SLIDE 18 – ONE-HANDED RATCHET


    TOURNIQUET APPLICATION (VIDEO)
    Play the video.

    SLIDE 19 – ONE-HANDED TOURNIQUET


    APPLICATION CRITICAL POINTS
    All personnel on combat missions should have a
    CoTCCC-recommended tourniquet readily available
    (standard location on their battle gear) and be trained
    in its use. Casualties should be able to easily and
    quickly reach and apply their own tourniquet.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES

    SLIDE 20 – BUDDY AID IF CASUALTY IS


    UNRESPONSIVE OR UNABLE TO MOVE
    If a casualty is unresponsive and/or unable move, a
    rescue plan should be devised and executed if
    tactically feasible. Do not put two people at risk if it can
    be avoided. If cover is not available or the wounded
    Service member cannot move to cover, they should lie
    flat and motionless. Quickly perform a blood sweep
    (looking for major bleeding). Apply a hasty tourniquet
    high and tight on the injured extremity and get to cover as quickly as possible. Be sure to use equipment
    (tourniquet) in the casualty’s JFAK and not your own. Do not put a tourniquet directly over the knee or
    elbow or over a holster or cargo pocket that contains bulky items.

    SLIDE 21 – TWO-HANDED RATCHET TOURNIQUET APPLICATION (VIDEO)


    Play the video.

    SLIDE 22 – TWO-HANDED (WINDLASS)


    TOURNIQUET APPLICATION (VIDEO)
    Play the video.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    SLIDE 23 – SKILL STATION
    At this time we will break into skill stations to practice
    the following skills:

    • One-Handed (Windlass) TQ Application in CUF

    • One-Handed (Ratchet) TQ Application in CUF

    • Two-Handed (Ratchet) TQ Application in CUF

    • Two-Handed (Windlass) TQ Application in CUF

    SLIDE 24 – EXTRACTION OF
    CASUALTIES
    Follow unit standard operating procedures for
    removing/extracting casualties from vehicles.
    If the casualty is on fire, put out the fire, address life-
    threatening bleeding with a tourniquet if indicated, and
    move to cover as quickly as possible.

    SLIDE 25 – CRITICAL OBJECTIVES


    FOR THE ONE- OR TWO-PERSON
    DRAG/CARRY
    Remember: Once a tourniquet has been applied, the
    priority is to get the casualty to the nearest cover and
    out of effective enemy fire/threat.
    Carries and drags will enable the first responder/CLS
    to do this as quickly as possible without causing
    further harm to the casualty.

    SLIDE 26 – ONE-PERSON DRAG/CARRY


    A variety of effective carries can be used depending on
    the casualty’s level of consciousness, enemy threat level,
    terrain, etc.

    Here are some examples of the one-person drag/carry:


    support carry (for a conscious casualty), neck drag (helps
    limit exposure from enemy fire based on low crawl of
    rescuer), kit/arm drag (rescuer pulls casualty backwards
    to safety), and cradle-drop, which allows rescuer to move
    the casualty short distances.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES

    SLIDE 27 – ONE-PERSON CASUALTY


    DRAG/CARRY (VIDEO)
    Play the video.

    SLIDE 28 – TWO-PERSON DRAG/CARRY


    A variety of effective carries can be used, depending on
    the casualty’s level of consciousness, enemy threat
    level, terrain, etc.

    Some examples of the two-person drag/carry include:


    two-man supporting carry (casualty is carried between
    two rescuers), kit/arm (two rescuers drag the casualty
    by their drag handle), and fore/aft (casualty is carried
    between two rescuers moving forward in unison).

    SLIDE 29 – TWO-PERSON
    DRAG/CARRY (VIDEO)
    Play the video.

    SLIDE 30 – SKILL STATION


    At this time, we will break into skill stations to practice
    the following skills:

    • One-Person Drag/Carry

    • Two-Person Drag/Carry

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    SLIDE 31 – SUMMARY
    Care Under Fire is the care rendered by the first
    responder/CLS at the scene of the injury while still
    under effective hostile fire.
    Remember to return fire and take cover. The best
    medicine on the battlefield is fire superiority!
    If you can do only ONE thing for the casualty, identify
    and stop life-threatening bleeding, and keep them from
    bleeding to death by using a CoTCCC-recommended
    tourniquet.
    Once a tourniquet has been applied, the priority is to get the casualty to the nearest cover and out of
    effective enemy fire/threat.
    Drag/carry will enable the first responder/CLS to do this as quickly as possible without causing further
    harm to the casualty.

    SLIDE 32 – CHECK ON LEARNING


    Ask questions of the learners, referring to key concepts from the module.
    Now for a check on learning.
    1) What is Care Under Fire?
    - Care Under Fire is the care given by the first
    responder at the scene of the injury while they
    and the casualty are still under effective
    hostile fire or near the threat. Available
    medical equipment is limited to that carried in
    the individual Service member’s JFAK.
    2) What are the signs of life-threatening bleeding?
    - Bright red blood is pooling on the ground
    - The overlying clothes are soaked with blood
    - There is a traumatic AMPUTATION of an arm or leg
    - There is pulsatile (pulsing) or steady bleeding from the wound
    3) How long does it take to bleed to death from a complete femoral artery and vein disruption?
    - 3 minutes
    4) What are the advantages and disadvantages of a one-person drag?
    - Advantages: No equipment required and only one rescuer is exposed to enemy fire.
    - Disadvantages: Relatively slow to move the casualty; does not allow optimal body position for
    dragging the casualty; can be tiring for the first responder if the patient is heavy or wearing a lot
    of gear.
    5) What are the advantages and disadvantages of a two-person carry?
    - Advantages: May be useful in situations where drags do not work well; less painful for the
    casualty than dragging; quicker than most one-person carries.
    - Disadvantages: Causes the rescuers to have a higher silhouette than most drags, exposing
    them to possible hostile fire; hard to accomplish with the rescuer’s and/or the casualty’s
    equipment being worn.

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20


    COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE (TCCC)

    SPEAKER NOTES
    SLIDE 33 – QUESTIONS

    TCCC CLS SPEAKER NOTES #TCCC-CLS-14-01 25 JAN 20

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