Tactical Combat Casualty Care

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1-4. BATTLEFIELD DEATHS

Around 90 percent of combat deaths occur on the battlefield before the casualties reach a medical treatment facility (MTF). Most of these deaths are inevitable (massive trauma, massive head injuries, and so forth). However, some conditions such as bleeding from a wound on an arm or leg, tension pneumothorax, and airway problems can be treated on the battlefield. This treatment can be the difference between being a combat death on the battlefield and a recovering soldier in an MTF.

It has been estimated that proper use of self-aid, buddy-aid, and combat lifesaver skills can reduce battlefield deaths by 15 to 18
percent. Figure 1-1 gives a breakdown of battlefield deaths in the Vietnam conflict showing that extremity hemorrhage (severe bleeding from an arm or leg), tension pneumothorax, and airway obstruction to be the primary preventable causes of death in combat with extremity hemorrhage resulting in the most deaths. (The statistics have been essentially the same in conflicts which have occurred since Vietnam.)

DEATHS DUE TO GROUND COMBAT

31 percent–Penetrating head trauma.
25 percent–Surgically uncorrectable torso trauma.
10 percent–Potentially surgically correctable trauma.
9 percent–Bleeding from wounds on the extremity.
7 percent–Mutilating blast trauma.
5 percent–Tension pneumothorax.
1 percent–Airway problems.
Less than 5 percent–Died of wounds (DOW) after evacuation
to an MTF, mostly from infections and complications of shock.

NOTE: Numbers do not add up to 100 percent. Not all causes of death are listed. Some deaths are due to multiple causes.

1-5. PHASES OF TACTICAL COMBAT CASUALTY CARE

Tactical combat casualty care (TCCC) can be divided into three phases. The first is care under fire, the second is tactical field care, and the third is tactical evacuation care.

a. Care Under Fire.

In care under fire, you are under hostile fire and are very limited as to the care you can provide. Treatment consists primarily of using a tourniquet to stop life threat ening bleeding from wounds on the extremities and moving the casualty to safety (see Lesson 2). Remember, in combat, functioning as a combat lifesaver is
your secondary mission. Your combat duties remain your primary mission. Your first priority while under fire is to return fire and kill the enemy. You should render care to injured soldiers only when such care does not endanger your primary mission.

b. Tactical Field Care.

In tactical field care, you and the casualty are not under effective enemy fire and you are free to provide casualty care to the best of your ability. However, the tactical situation can change and you could find yourself back in a care-under-fire situation.

(1) Tactical field care may be rendered by the combat lifesaver after the casualty has been moved to a safe location or when enemy fire has been suppressed (see Lesson 2).

(2) Tactical field care also refers to care rendered by the combat lifesaver when the casualty is discovered in a tactical field care situation. That is, the casualty was not in a care-under-fire situation to begin with (see Lesson 3).

(3) In tactical field care, available medical equipment and supplies are limited to that carried into the field by the combat lifesaver and individual soldiers.

c. Tactical Evacuation Care. In tactical evacuation care, the care is rendered while the casualty is being evacuated to a collection point or medical treatment facility (see Lesson 10).

(1) Casualty evacuation (CASEVAC) refers to the movement of casualties using non-medical vehicles or aircraft. In CASEVAC, the combat lifesaver may travel with the casualty to provide care during transportation.

(2) Medical evacuation (MEDEVAC) refers to evacuating casualties using medical ground ambulances or medical air ambulances. Medical evacuation vehicles (ground and air) have medical personnel to care for casualties during evacuation.

1-6. TERMINOLOGY

As you go through this subcourse, it will be helpful to know the meaning of certain terms. It is also recommended that you consult a medical dictionary for unfamiliar terms.

a. Casualty. The casualty is the soldier who is injured.

b. Rescuer. The term rescuer refers to another soldier who is attempting to aid the casualty (provide treatment and/or move the casualty to safety).

c. Self-Aid. Self-aid is the care (treatment) that the casualty gives to himself. (Care given by another soldier is buddy-aid. Care given by medical personnel such as a combat medic is medical aid.)

d. Medical Treatment Facility. A medical treatment facility (MTF) is a facility established to provide medical and/or dental care. In combat, the battalion aid station (BAS) is a mobile medical treatment facility close to the front lines.

e. Collection Point. A collection point is a site to which combat casualties are delivered, usually by non-medical means (CASEVAC). There, the casualties are transferred to medical vehicles (ground or
air ambulances) and transported to an MTF (MEDEVAC).

f. Extremity. The term extremity refers to one of the limbs.

(1) Upper extremity. Upper extremity refers to the arm (located between the shoulder and the elbow) and the forearm (located between the elbow and the wrist). Often, the term “arm” is used to refer to the arm, forearm, and hand. The terms “upper arm” and “lower arm” are sometimes used to refer to the arm and forearm respectively.

(2) Lower extremity . Lower extremity refers to the thigh (located between the hip and the knee) and the leg (located between the knee and the ankle). Often, the term “leg” is used to refer to the thigh, leg, and foot. The terms “upper leg” and “lower leg” are sometimes used to refer to the thigh and leg respectively.

g. Hemorrhage. Hemorrhage is another word for bleeding. It usually refers to serious bleeding.

h. Dressing. The term “dressing” refers to the material that is placed directly over the wound. The dressing absorbs some of the blood and helps a clot to form. The clot “plugs” the wound to stop the bleeding. The dressing also protects the wound from additional contamination and injury.

i. Bandage. A bandage is the material used to hold (secure) the dressing in place so the dressing will not slip and destroy the clot that is forming. The ends of the bandage are called the tails.

j. Field Dressing. The field dressing consists of a pad of sterile (germ-free) white dressing with a bandage (usually olive drab) already attached to the dressing pad (see figure 1-3). The field dressing is wrapped in paper which is then sealed in a plastic envelope. The field dressing is also called the field first aid dressing and the combat dressing. It is being replaced by the Emergency Bandage, but may still be encountered.

k. Emergency Bandage. The Emergency Bandage® (figure 1-4) consists of a sterile white pad with an elastic tail and a pressure device used to apply continuous pressure to the wound. This bandage is also known as the “emergency trauma dressing,” “emergency trauma bandage,” “Israeli pressure dressing,” and “Israeli bandage.” It is replacing the field dressing in the soldier’s individual first aid kit. Each soldier should have an Emergency Bandage in his Improved First Aid Kit (IFAK). You should have two Emergency Bandages in your combat lifesaver aid bag.

l. Combat Gauze. Combat Gauze™ (figure 1-5) is also called the hemostatic bandage. It uses pressure and a chemical to help stop the bleeding. It is a component of the soldier’s Improved First Aid Kit (IFAK). You have three Combat Gauze bandages in your combat lifesaver aid bag.  NOTE: A hemostatic agent is an agent that arrests the flow of blood.

Combat Gauze

m. Tourniquet. A tourniquet is a device for compressing the blood vessels of an extremity in order to stop blood flow distal to the tourniquet band.

n. Combat Application Tourniquet. The Combat Application Tourniquet® (CAT) is a device developed specifically to be used as a tourniquet. See figure 1-6. It is a component of the soldier’s Improved First Aid Kit (IFAK). You should have two in your combat lifesaver aid bag.

Combat Application Tourniquet (CAT)

o. Combat Casualty Pill Pack. Each soldier may be issued a combat pill pack (see figure 1-7) containing pain medications and antibiotics to control infection prior to deployment on tactical missions.

Combat Pill Pack

p. Improved First Aid Kit. The Improved First Aid Kit (IFAK) is the first aid kit carried by individual soldiers. Normally, the kit contains a Combat Application Tourniquet, an Emergency Bandage, Combat Gauze, a nasopharyngeal airway, a roll of 2-inch tape, and two pairs of examination gloves.

q. Combat Lifesaver Medical Equipment Set. The combat lifesaver medical equipment set (MES) is also called the combat lifesaver aid bag. It is carried by the combat lifesaver in combat. The contents of the MES are given in Appendix A of the Army’s Combat Lifesaver Course: Student Self-Study (PDF) available here.

r. Distal. Distal means away from the point of reference. In this lesson, the heart is the central point of reference. The hand is distal to the elbow because the hand is farther from the heart than is
the elbow. (Follow the path of blood flow from the heart
through the arteries as a guideline.) It is the opposite of proximal.

s. Proximal. Proximal means toward the point of reference (heart). The knee is proximal to the foot because the knee is closer to the heart (following blood flow) than is the foot. It is the opposite of distal.

t. Artery. Arteries are blood vessels that carry blood away from
the heart to the parts of the body.

u. Vein. Veins are blood vessels that carry blood from the parts of the body back to the heart.