Page 24 - 2022 Ranger Medic Handbook

TACTICAL COMBAT CASUALTY CARE (TCCC)
SECTION 1 Trauma is the leading cause of death in the first four decades of life. Current protocols for civilian trauma care in the US
are based on the Advanced Trauma Life Support (ATLS) course, which was initially conducted in 1978. Since that time,
ATLS protocols have been accepted as the standard of care for the first hour of trauma management that is taught to both
civilian and military providers. ATLS is a great approach in the civilian setting; however, it was never designed for combat
application.
Historically, most combat-related deaths have occurred in close proximity to the point of injury, prior to a casualty reaching
an established medical treatment facility. The combat environment has many factors that affect medical treatment, includ-
ing temperature and weather extremes, severe visual limitations, delays in treatment and evacuation, long evacuation
distances, a lack of specialized providers and equipment near the scene, and the lethal implications of combat weapons.
Thus, a modified approach to trauma management must be used while conducting combat operations.
The tactical environment and causes of combat death dictate a different approach for ensuring the best possible outcome
for combat casualties while sustaining the primary focus of completing the mission. CAPT Frank Butler and LTC John
Hagmann proposed such an approach in 1996. Their article, “Tactical Combat Casualty Care in Special Operations,”
emphasized three major objectives and outlined three phases of care.

Objectives: Phases of Care:
 Treat the patient 1. Care under fire
 Prevent additional casualties 2. Tactical field care
 Complete the Mission 3. Combat casualty evacuation (CASEVAC) care

The 75 th Ranger Regiment adopted the principles of TCCC in the late 1990s and institutionalized them with training pro-
grams prior to combat operations in Afghanistan and Iraq. Today, mastering the basics of TCCC remains the bedrock of
the Ranger Medic. This, along with casualty response training for Ranger leaders and dedication to meticulous medical
planning, produces astounding casualty survival rates on the modern battlefield.

10 SECTION 1 THE RANGER MEDIC & CASUALTY RESPONSE SYSTEMS