Page 132 - JSOM Fall 2025

FIGURE 4 Timeline of effective interventions interpretation. have them geographically located as groups to physically
enable loading onto evacuation platforms. 3
• Casualties with an altered mental status secondary to in-
jury, illness, or mind-altering analgesia, should have weap-
ons and communication equipment disabled or removed.
• Expectant casualty care should be deliberately planned, re-
hearsed, and prepared for all MCM plans. Additional con-
siderations should be given to separating deceased from live
casualties, if appropriate, to reduce trauma to the survivors
and ensuring alternate plans for when there are not enough
body bags. A plan such as wrapping the torso and head of the
deceased (as well as mutilated body parts) with a space blan-
ket and duct tape will aid in the dignified handling of human
remains and reduce trauma to survivors and responders.

Conclusion
As the U.S. military, international partners, government agen-
Image based on data outlined in Shackelford et al. 4 cies, and other non-governmental organizations prepare for
the possibility of all-hazard MASCAL incidents, a simplified
they will work through impacts on the mission and determine and standardized principles-based approach to prehospital
whether dedicated medical evacuation assets are available; if MCM is needed. The methods described by the CoTCCC can
primary mission assets are used for initial casualty movements, be taught to a wide array of responders to perform prehospi-
reliance on alternate or contingency evacuation or exfiltration tal MCM and enable effective triage, initiate life-saving treat-
platforms may be required. As demonstrated in this illustra- ments, and improve casualty survival. Triage is a system of
tion, using the same terminology for triage and evacuation sorting and prioritizing casualties based on clinical status, tac-
categories in the prehospital environment will expedite under- tical environment, mission, and available resources. The goal
5
standing between nonmedical leaders and medical responders of triage in the prehospital environment is to expeditiously
and allow all responders to begin coordinating the MCM re- identify, move, treat, and transport casualties to a higher level
sponse to move, treat, and transport casualties as soon as the of care. As such, a simple and efficient method to quickly
tactical situation allows. triage as many casualties as possible while supporting clear
communication to MCM leaders is needed in TCCC. The two-
pass, principles-based approach recommended in this paper
Additional MCM Actions in TCCC
will allow nonmedical and medical responders to put triage
The following actions are recommended: into action to expeditiously move, treat, and transport casu-
alties. First pass triage is the initial sorting of casualties into
• Work with nonmedical leadership to ensure security, espe- urgent and non-urgent categories while providing life-saving
cially at the CCP, but be ready to rapidly move or respond care as able. Second pass triage is a more deliberate process
based on the ongoing mission or threat to forces. that sorts casualties based upon priority of medical and evac-
• Establish a casualty count by triage category precedence uation needs into UPR categories. The two-pass approach to
and patient type to determine resource allocation and evac- triage in TCCC, used in conjunction with the additional MCM
uation plans. Ongoing care in a casualty collection point actions recommended, will simplify training for all responders,
will be impacted by the number and acuity of the casual- improve communication for shared understanding, expedite
ties; the number of, and experience and level of training of, decision-making, and enhance the efficacy of TCCC to opti-
the medics; the resources available; and environmental or mize both casualty and mission outcomes.
tactical limitations. Leaders must ensure they have systems
in place to maintain accountability of the responders and The triage change wording for supplement A of the TCCC
casualties during MCM. guidelines outlines the CoTCCC-recommended triage meth-
• Communicate casualty status and situation reports with odology for all responders delivering TCCC in the Role 1 bat-
leaders and responders to inform tactical, logistical, and tlefield setting (changes in red text):
medical decision-making processes during MCM. A team
leader who is not providing medical care should be notified SUPPLEMENT A (TRIAGE in TCCC) to
of casualty status by the medics and pass that information TCCC GUIDELINES
on to personnel in an operations center who are involved in
coordinating evacuation assets and notifying medical treat- Triage
ment facilities. 1. Conduct first pass triage to provide immediate life-saving
• Continually reassess and communicate casualty evacuation care and identify urgent and nonurgent categories.
categories during all TCCC phases of care, as triage is a dy- a. Urgent category: Casualties that are dying now and re-
namic process and requires frequent casualty re-evaluation. 9 quire immediate life-saving interventions to survive.
• Geographically organize patients according to triage (ur- b. Nonurgent category: Casualties that do not need immedi-
gent, priority, routine) category. Triage and deliberate ate life-saving interventions but will require medical care.
placement of casualties in the CCP in UPR categories is 2. Conduct second pass triage and sort casualties based upon
done for two reasons. The first is to prioritize care and priority of medical and evacuation needs into three catego-
group urgent casualties to facilitate care. The second is to ries: urgent, priority, and routine.

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