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What is Tactical Combat Casualty Care (TCCC)

Tactical Combat Casualty Care: Beginnings
By Frank K. Butler Jr., MD, FAAO, FUHM 

From the Committee on Tactical Combat Casualty Care (CoTCCC), Joint Trauma System (JTS), US Army Institute of Surgical Research, San Antonio, TX. 

Tactical Combat Casualty Care (TCCC) is the evidence-based, best-practice prehospital trauma care guidelines established for use on the modern battlefield. 

The origins of TCCC program began as a U.S. Naval Special Warfare and Special Operations Command Medical Research and Development initiative project after the realization that extremity hemorrhage was the leading cause of preventable death on the battlefield. 

This leading cause of death was not being treated with an easily available and highly effective intervention: the tourniquet (Only use a CoTCCC approved Tourniquet). 

This insight prompted a systematic reassessment of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by the special operations medical personnel and the Uniformed Services University of the Health Sciences. 

The product of that 3-year research project was Tactical Combat Casualty Care, or TCCC. TCCC is the first-ever set of battlefield trauma care guidelines designed to combine good medicine with good small-unit tactics. 

TCCC guidelines are now the established global standard of care for the modern battlefield for good medicine and good tactics, because good medicine at the wrong time can get you and others killed. 

The overall objective of TCCC is to teach service members from all branches of the military how to effectively treat combat casualties while preventing additional casualties and completing the mission.

 TCCC is divided into three phases of care: Care Under Fire (CUF), Tactical Field Care (TFC), and Tactical Evacuation Care (TACEVAC). 

  • Care Under Fire/Threat (CUF) Once a casualty is established. The primary goal is fire superiority and movement of the casualty to cover. The only initial medical intervention during CUF is the early application of tourniquets for major hemorrhage control.
  • Tactical Field Care (TFC) Is the basis of EMS/medic or prehospital tactical care which is rendered once the appropriate cover has been achieved while still within the battlefield environment but not under immediate effective threat. Generally, medical care is provided through equipment carried by the medical personnel. Care during TFC follows the MARCH algorithm.
  • The Tactical Evacuation Care (TACEVAC) Continues with continued monitoring and intervention through TFC during transport out of the tactical environment to the hospital or trauma facility. During this phase of care, more invasive medical treatment is provided and performed along with ongoing evaluation and monitoring following the MARCH algorithm.

Tactical Combat Casualty Care (TCCC) is now the standard of care for all members of the U.S. Military, not just the Special Operations community. 

Tactical Combat Casualty Care (TCCC): Now developed by the U.S. Department of Defense, Defense Health Agency (DHA) Joint Trauma System (JTS) to teach evidence-based, life-saving techniques and strategies for providing the best trauma care on the battlefield. 

There are Three levels of TCCC based upon the level of training of the participants..

  • TCCC-ASM (TCCC All Service Members – Tier 1) is a 7-hour course for all service members. 
  • TCCC-CLS (TCCC Combat Lifesaver – Tier 2) is a 40-hour course for non-medical military personnel deploying in support of combat operations. *Prerequisites required.  
  • TCCC-CMC (TCCC Combat Medic/Corpsman – Tier 3) is a 63-hour course for military medical personnel including medics, corpsmen and pararescue personnel deploying in support of combat operations. *Prerequisites required.

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