When in a combat situation, the rules of the regular world simply do not apply in many cases. One such example of this complex dynamic can be seen in the way medical situations are handled in the civilian versus combat world. This is where TCCC practices come in. Let’s take a closer look at what we mean by TCCC practices.

What is TCCC?

Medics on the front lines were trying to care for medical emergencies using the same standards of care as civilian emergency medical scenarios. There are many reasons why this was simply not successful. As anyone who has ever experienced a combat situation knows, the care needs to be tailored to the types of injuries (often severe and time-critical) as well as the logistics of the location (often remote without immediate medical assistance available) in order to be truly applicable and have a higher success rate. Since regular emergency medical training doesn’t always cover this need, TCCC courses were the solution.

TCCC stands for Tactical Combat Casualty Care. It was officially founded in 1996 when the course was taught in the Undersea Medical Officer course sponsored by the Navy Bureau of Medicine and Surgery. The training was successful in meeting the unique needs of the environment and scenarios combat personnel faced in treating injuries, so the course became a requirement for all US Navy Sea-Air-Land (SEAL) naval special warfare corpsmen. It is now used widely in U.S. and foreign military forces as a requirement for medical personnel and occasionally in specialized law enforcement agencies for special scenarios.

What are the three phases of TCCC?

Tactical Combat Casualty Care is divided into three phases with each one carrying its own special considerations and recommended guidelines.

  1. care-under-fire
  2. tactical field care
  3. tactical evacuation care


This scenario is exactly what it sounds like which is a member of the unit is struck by enemy fire and the assault is still ongoing. In care-under-fire situations, the medical care provider should first return effective fire to eliminate further injuries from the threat, move the casualty to a safe area, and rapidly assess the casualty for sources of massive extremity hemorrhage, applying a tourniquet if necessary. The main TCCC practices to remember for this type of care are the basics of being a solider such as cover and concealment, returning fire to eliminate the threat from growing, and the ability to communicate clearly with a team.

Tactical Field Care

This is typically when you are providing care while not under fire and it runs a wide gamut of injuries. These injuries are still just as serious and time-critical which is why a different set of medical care parameters are used than a basic EMT would use in civilian life. The most critical in the combat field is blood loss or hemorrhaging. In fact, it is reported that 80 percent of combat deaths are a result of hemorrhage. While there are guidelines for dealing with it in the field such as tourniquets and hemostatic agents, these are temporary solutions to allow a better chance of survival en route to further medical care. There are several areas of care which have their own rigorous and combat updated guidelines of care such as a more aggressive wound irrigation to avoid infection prophylaxis than with civilian injuries. The TCCC courses cover these practices in greater detail to ensure medical personnel are ready to treat the unique nature of injuries under the complex conditions of combat care.

Tactical Evacuation Care

Aside from the initial lifesaving steps in a combat casualty case, the transport team also needs unique medial training to deal with the severity of the injuries. In a combat scenario, an injury can quickly go from dangerous to devastating and result in death without the proper care and speed. While the medical team assisting the initial injury will focus on triage and stabilizing the injured, the transport or evacuation team focuses on continued care and speed as well as access to more advanced medical care. This aspect of care follows an echelon system of when to transport and in what order since most casualties on the field come in multiples at a time. For instance, those with severe injuries of a life-threatening nature should be transported within an hour window maximum while those needing immediate surgical intervention to prevent death take priority.

Since this isn’t like civilian life where the ambulance simply drives to the nearest hospital, tactical evacuation care also focuses on delivering the injured to the right location safely to handle the type of injury within the specified window of time. There are a lot of logistics at play in this area of TCCC which is yet another reason why specialized training courses were required.

All of the areas of care are based on the original TCCC treatment measures put in place to address the highly unique and complex needs of medical professionals in combat scenarios. The measures as defined by Committee for Tactical Combat Casualty Care as follows:

  1. Early use of tourniquets to control clinically important extremity hemorrhage
  2. Systemic antibiotic prophylaxis near the point of injury
  3. Tactically appropriate intravenous or intraosseous access and fluid resuscitation
  4. Improved battlefield analgesia (intravenous or intramuscular opiates)
  5. Nasopharyngeal airways as first-line airway devices
  6. Surgical airways for maxillofacial trauma with an obstructed airway
  7. Aggressive diagnosis and treatment of tension pneumothorax via needle decompression
  8. Incorporation of input from CCC providers into TCCC guidelines
  9. Employment of tactically and clinically-relevant scenarios into TCCC training