081-831-1001 - Evaluate a Casualty (Tactical Combat Casualty Care)

Conditions:
You have a casualty who has signs/symptoms of an injury. Your unit may be under
fire.

Standards:
Evaluate the casualty following the correct sequence. Identify all
life-threatening conditions and other serious wounds.

Performance Steps:

Note:
Tactical combat casualty care (TCCC) can be divided into three phases. The first
is care under fire; the second is tactical field care; the third is combat
casualty evacuation care. In the first, you are under hostile fire and are very
limited as to the care you can provide. In the second, you and the casualty are
relatively safe and no longer under effective hostile fire, and you are free to
provide casualty care to the best of your ability. In the third, the care is
rendered during casualty evacuation (CASEVAC).

Warning: If
a broken neck or back is suspected, do not move the casualty unless to save
his/her life.

1. Perform care under fire.

a. Return fire as directed or required before
providing medical treatment.

b. Determine if the casualty is alive or
dead.

Note: In
combat, the most likely threat to the casualty’s life is from bleeding. Attempts
to check for airway and breathing will expose the rescuer to enemy fire. Do not
attempt to provide first aid if your own life is in imminent danger.

Note: In a
combat situation, if you find a casualty with no signs of life-no pulse, no
breathing-do NOT attempt to restore the airway. Do NOT continue first aid
measures.

c. Provide tactical care to the live
casualty.

Note:
Reducing or eliminating enemy fire may be more important to the casualty’s
survival than the treatment you can provide.

(1) Suppress enemy fire.

(2) Use cover or concealment (smoke).

(3) Direct the casualty to return fire,
move to cover, and administer self-aid (stop bleeding), if possible. If the
casualty is unable to move and you are unable to move the casualty to cover
and the casualty is still under direct enemy fire, have the casualty “play
dead.”

(4) If the casualty is unresponsive, move
the casualty, his/her weapon, and mission-essential equipment to cover, as
the tactical situation permits.

(5) Keep the casualty from sustaining
additional wounds.

(6) Reassure the casualty.

d. Administer life-saving hemorrhage control.

(1) Determine the relative threat of the
tactical situation versus the risk of the casualty’s bleeding to death.

(2) If the casualty has severe bleeding
from a limb or has suffered amputation of a limb, administer life-saving
hemorrhage control by applying a tourniquet before moving the casualty. (See
task 081 -831-1032.)

e. Transport the casualty, his/her weapon,
and mission-essential equipment when the tactical situation permits.

f. Recheck bleeding control measures as the
tactical situation permits.

2. Perform tactical field care when no longer
under direct enemy fire.

Note:
Tactical field care is rendered by the individual when no longer under hostile
fire. Tactical field care also applies to situations in which an injury has
occurred during the mission but there has been no hostile fire. Available
medical equipment is limited to that carried into the field by the individual
Soldier.

Warning: If
there are any signs of nerve agent poisoning, stop the evaluation, take the
necessary NBC protective measures, and begin first aid. (See task 081-831-1 044.
)

Note: In the
following situations communicate the medical situation to the unit leader and
ensure that the tactical situation allows for time to perform these steps before
initiating any medical procedure.

Note: When
evaluating and/or treating a casualty, seek medical aid as soon as possible. Do
NOT stop treatment; but, if the situation allows, send another person to find
medical aid.

a. Form a general impression of the casualty
as you approach (extent of injuries, chance of survival).

Note: If a casualty is being burned, take steps
to remove the casualty from the source of the burns before continuing evaluation
and treatment. (See task 081-831-1007.)

b. Check for responsiveness.

(1) Ask in a loud, but calm, voice: “Are
you okay?” Gently shake or tap the casualty on the shoulder.

(2) Determine level of consciousness by
using AVPU: A = Alert; V = responds to Voice; P = responds to Pain; U =
Unresponsive.

Note: To check a casualty’s response to pain,
rub the breastbone briskly with a knuckle or squeeze the first or second toe
over the toenail.

(3) If the casualty is conscious, ask where
his/her body feels different than usual, or where it hurts. Go to step 2e.
If the casualty is conscious but is choking and cannot talk, stop the
evaluation and begin treatment. (See task 081-831-1003.)

(4) If the casualty is unconscious,
continue with step 2c.

c. Position the casualty and open the airway.
(See task 081-831 – 1023.)

d. Assess for breathing and chest injuries.

(1) Look, listen, and feel for respiration.
(See task 081-831-1023.)

Note: If the casualty is breathing, insert a
nasopharyngeal airway (see task 081 -831-1023) and place the casualty in the
recovery position.

Note: On the battlefield the cost of attempting
cardiopulmonary resuscitation (CPR) on casualties with what are inevitably fatal
injuries may result in additional lives lost as care is diverted from casualties
with less severe injuries. Only in the case of nontraumatic disorders such as
hypothermia, near drowning, or electrocution should CPR be considered prior to
the CASEVAC phase.

(2) Expose the chest and check for equal
rise and fall and for any wounds. (See task 081-831-1026.)

(a) If the casualty has a penetrating
chest wound, and is breathing or making an effort to breathe, stop the
evaluation to apply an occlusive dressing.

(b) Monitor for increasing respiratory
distress. If this occurs, decompress the chest on the same side as the
injury. (See task 081 -831-1026.)

(c) Position or transport with the
affected side down, if possible.

e. Identify and control bleeding.

(1) Check for bleeding.

(a) Remove minimum of clothing required
to expose and treat injuries. Protect casualty from the environment (heat
and cold).

(b) Look for blood-soaked clothes.

(c) Look for entry and exit wounds.

(d) Place your hands behind the
casualty’s neck and pass them upward toward the top of the head. Note
whether there is blood or brain tissue on your hands from the casualty’s
wounds.

(e) Place your hands behind the
casualty’s shoulders and pass them downward behind the back, the thighs,
and the legs. Note whether there is blood on your hands from the
casualty’s wounds.

(2) If life-threatening bleeding is
present, stop the evaluation and control the bleeding. Apply a tourniquet,
field dressing, or an emergency trauma dressing, as appropriate. (See tasks
081-831-1025, 081-831-1026, 081-831-1032, and 081-831-1033.) Treat for
shock, as appropriate. (See task 081-831-1005.)

Note: If a tourniquet was previously applied,
consider converting it to a pressure dressing. (See task 081-831-1032.) By
converting the tourniquet to a pressure dressing, it may be possible to save the
casualty’s limb if the tourniquet has not been in place for 6 hours.

(3) Dress all wounds, including exit
wounds.

f. Check for fractures.

(1) Check for open fractures by looking for
bleeding or bone sticking through the skin.

(2) Check for closed fractures by looking
for swelling, discoloration, deformity, or unusual body position.

(3) If a suspected fracture is present,
stop the evaluation and apply a splint. (See task 081-831 -1 034.)

g. Check for burns.

(1) Look carefully for reddened, blistered,
or charred skin. Also check for singed clothes.

(2) If burns are found, stop the evaluation
and begin treatment. (See task 081-831-1007.)

h. Administer pain medications and
antibiotics (the casualty’s combat pill pack) to any Soldier wounded in
combat.

Note: Each Soldier will be issued a combat pill
pack prior to deployment on tactical missions.

i. Transport the casualty to the site where
evacuation is anticipated. (See task 081-831-1046.)

3. Monitor an unconscious casualty during
casualty evacuation (CASEVAC).

Note:
CASEVAC refers to the movement of casualties aboard nonmedical vehicles or
aircraft. Combat casualty evacuation care is rendered while the casualty is
awaiting pickup or is being transported. A Soldier accompanying an unconscious
casualty should monitor the casualty’s airway, breathing, and bleeding.

Evaluation Preparation:

Setup:
Prepare a "casualty" for the Soldier to evaluate in step 2 by simulating one or
more wounds or conditions. Simulate the wounds using a war wounds moulage set,
casualty simulation kit, or other available materials. You can coach a
"conscious casualty" on how to respond to the Soldier’s questions about location
of pain or other symptoms of injury. However, you will have to cue the Soldier
during evaluation of an "unconscious casualty" as to whether the casualty is

breathing and describe the signs or cond itions,
as the Soldier is making the checks.

Brief Soldier:
To test step 1, tell the Soldier that his/her unit is under fire and ask h im/her
what he/she should do to provide aid to casualties. For step 2, tell the Soldier
that the tactical situation permits full evaluation of the casualty. Tell
him/her to do, in order, all necessary steps to evaluate the casualty and
identify all wounds and/or conditions. Tell the Soldier to tell you what first
aid action (give mouth-to-mouth resuscitation, bandage the wound, and so forth)
he/she would take, but that no first aid is to be performed. After he/she has
completed the checks (step 2f), ask him/her what else he/she should do. To test
step 3, ask him/her what he/she should do while evacuating an unconscious
casualty.

Evaluation Guidance:
Score the Soldier GO if all performance measures are passed. Score the Soldier
NO GO if any performance measure is failed. If the Soldier scores NO GO, show
what was done wrong and how to do it correctly.

References   Required Related FM
4-25.11