Page 12 - 2021 Advanced Ranger First Responder Handbook

Care Under Fire
TCCC Care under fire (CUF) is the care rendered by the first responder or combatant 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 or by
the medical provider in his aid bag.
Major goals of CUF are to move the casualty to safety, prevent further injury to the casualty and provider, stop life-
threatening external hemorrhage, and gain and maintain fire superiority – the best medicine on the battlefield!
Tactical Field Care
Tactical field care (TFC) is the care rendered by the first responder or combatant once he and the casualty are no longer
under effective hostile fire. TFC may consist of rapid treatment of the most serious wounds with the expectation of a
re-engagement with hostile forces at any moment, or there may be ample time to render whatever care is possible in the
field. It also applies to situations in which an injury has occurred, but there has been no hostile fire. Available medical
equipment is still limited to that carried into the field by unit personnel. Time to evacuation to a medical treatment facility
may vary considerably. Remember – effective hostile fire could resume at any time.
Tactical Evacuation Care
Tactical evacuation care is the care rendered once the casualty has been picked up by an aircraft, vehicle or boat.
Additional medical personnel and equipment that may have been prestaged should be available in this phase of casualty
management. The term “Tactical Evacuation” encompasses both Casualty Evacuation (CASEVAC) and Medical Evacu-
ation (MEDEVAC).
TCCC Concepts
Casualty scenarios in combat usually entail both a medical problem and a tactical problem. We want the best possible
outcome for both the casualty and the mission. Good medicine can sometimes be bad tactics; bad tactics can get
everyone killed or cause the mission to fail. Doing the RIGHT THING at the RIGHT TIME is critical.
Hypotensive Resuscitation
Goals of fluid resuscitation therapy: 1) improved state of consciousness, 2) palpable radial pulse, 3) avoid over- resusci-
tation of shock. Basing the titration of fluids upon a monitored physiologic response may avoid the problem of excessive
blood pressure elevation and fatal re-bleeding from previous clotted injury sites. BLOOD and blood products are the
only fluid for trauma resuscitation.
Preventing the Trauma Lethal Triad
Hypothermia is a significant concern in any trauma victim because it leads to hypothermia-
induced coagulopathy. This occurs by both decreasing platelet function and slowing enzyme
activity in the coagulation cascade.
Prevention of hypothermia, along with hemorrhage control and fluid resuscitation, will help
maintain the casualty’s ability to generate heat. HYPOTHERMIA
DEATH

COAGULOPATHY ACIDOSIS

2 SECTION 1 TCCC