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There are three phases for Tactical Combat Casualty Care, or TCCC, they are as follows:

1. Care under Fire (CUF)
2. Tactical Field Care
3. Tactical Evacuation Care

When evaluating a casualty, HMs and Combat Life Savers (CLS) marines will follow the MARCH algorithm, which is as follows;

Massive Hemorrhaging
Airway
Respiratory
Circulatory
Head/hypothermia

pic unrelated

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CUF

The first step when you receive a casualty is to return fire immediately and gain fire superiority. Remember, the best battlefield medicine is rounds down range.

During this phase, when you are not under effective enemy fire, try to reach the patient and treat ONLY life threatening bleeding, usually meaning amputations or severe hemorrhage from femoral bleeds. If the patient can do it himself, instruct him to do so. This negates unnecessary risk of another person getting shot. If not, approach the patient carefully and quickly, and provide aid. The only treatment you will do in CUF is apply a tourniquet (TQ). There isnt time for anything else. Once you place the TQ, move patient to cover as fast as possible. Once the patient is behind cover, you can begin tactical field care

Tactical Field Care

When you are behind cover, first thing you must do is re-assess any TQs placed. Ensure tightness, if not apply another. Mark patient with "T" on forehead or other visible area. this helps identify as a critical patient. From here, procede to the A portion, airway.

Easiest way to determine airway patency is to talk to the patient. If the patient is screaming and yelling, his airway is open and you can move to the next step, being mindful to continually re-assess to make sure he doesn't lose airway patency. If hes not speaking and you cannot feel breath moving, reposition patient to open the airway. This can mean having the patient sit up and lean forward, place him in recovery position, or use headtilt/chinlift or jaw thrust manuever to try and open the airway. You may want to consider using an nasopharyngeal airway or another adjunct to ensure airway remains patent.

What's the acronym used for a hemorrhage

>>33909180
We use PmarchP now

Next step is R, respiratory

Assess the patients ability to breathe by observing and feeling for any chest trauma and chest movement, If the patient ha a clear penetrating trauma and/or one side of the chest wall isnt moving, and he has increasing breathing difficulty, it is very likely the patient has sustained a tension pneumothorax. Treatment for this is to apply an occlusive dressing to any open holes in the chest wall, including areas on sides of torso, back, and armpit regions. once all holes have been dressed, you can perform a needle decompression by placing a 3 1/4 in 14 ga needle on the affected side in either 1:midclavicular line, 2-3rd intracostal space or 2: midaxillary line, 4-5th intracostal space (approx the width of pts 4 fingers under the armpit). Decompression should be an audible hiss and pt should feel immediate relief in breathing. needle can either be removed or remain in place. secure all dressings and reassess breathing and procede to next step

>>33909327
As in how to treat hemorrhage?

Next step is circulatory. Start by determining blood pressure over palpation, or BP/P. If you feel a:

Radial pulse = 80/P, if not present, then
Femoral pulse = 70/P, if not present then
Carotid pulse = 60/P or less

After noting this, proceed to check for fractures, especially on long bones and pelvis, being careful not to aggravate the pelvis as to cause life threatening bleeding. Splint any fractures. sweep body for other bleeding ad soft tissue injuries and treat appropriately. Finally, reassess M A and R. Then move on to H

>>33909469
no fluids? for shame.

>>33909502
I'm putting the CLS i teach marines, they generally aren't allowed to administer fluids. There's a few i trust with it, a few that would botch it pretty bad.

>>33909502
On top of that, I'd be conservative with fluid replacement therapy. On one hand, it can increase blood volume, but on the other, it can lead to coagulopathy and send them further into shock, especially if they are not hemodynamically stable or are still in the midst of a combat environment.

Finally, Head/hypothermia

Here, we assess the patients mental status and quickly evaluate for any signs of traumatic brain injuries, as well as monitor for signs of shock and take steps to prevent it.
Use AVPU (Alert, Verbal, Pain, or unresponsive) to describe patient, and if alert, check to see if he is alert and oriented to person, place, time, and events prior (i.e, ask "whats your name? Do you know where you are?" etc)
Then assess and treat for shock. There are a tons of signs and symptoms of shock, and different stages which would take a whole few posts to discuss, but this is where the HM/CLS marine would take action to keep patient warm, administer fluids if indicated, as well as other medication and pain management therapy.

All of the above should be done in about 10 minutes, 15 MAX. It is a very quick and rudimentary exam designed to catch the immediate life threatening injuries.

Once you have completed the MARCH algorithm, you can proceed to Tactical Evacuation Care, assuming your RO has already called in for TACEVAC.
For this step, you are primarily reassessing all of your previous interventions, noting down vitals and responses to treatment, and in between doing so, perform more detailed assessments on all body systems and treat accordingly. This stage is done from the time after the tactical field care to the time when the patient reaches a higher more capable echelon of care

>>33909594
if you have time for tfc, you've created the ccp. if they have an absent radial pulse; IO, push fluids, and pop txa. they're going to go into shock regardless at that point.

As for the above, this is just a very rough and quick outline of CLS, Obviously there's a lot more detail that goes into a lot of it. Ill be more than happy to explain any specific questions y'all have. Im certain theres a few old /k/omrades that have infopics of guides i made a while back that has more detailed information. Other medfags, lemme hear your input. I r grunt doc after all, certainly not the best either.

>>33909747
you certainly arent wrong brother. TXA is definitely great, and if the patient were exhibiting signs of decompensating shock and hemodynamically stable, or even in compensated shock, but not hemodynamically stable, id use it, but id do so minimizing the amount of bolus fluid as to minimize both hypothermia and coagulopathy.

>good shit doe
idk what you guys do with your cls certified, but we had specific cls bags with enough hemo supplies to keep one patient stable. i'd stuff a bag of fluid and tubing in there with no needle. that way if i needed them to prep a bag, they'd have what they needed instead of going through my aid bag. tourniquet drills are always fun for general fuckery when you're waiting for the day to end. and i cannot stress trauma naked enough.

anyways good shit corpsman. you'd make a fine er nurse one day.

>>33910109
Haha our medical supply is always fucked. I've had to tactically acquire like 75% of my medbag supply. When we deployed, we had enough H bandages and combat gauze to run a small hospital, but IV supplies and stuff were too hard to get, i could never get enough to train my guys in more advanced things like med admin and more advanced adjuncts, etc. I certified every single one in my platoon, and we train CLS at least once a week, and casualty care is in all of our other exercises, so they are pretty hot shit with what they got. And TQ drills we practice with the new guys when work is over and the seniors are drunk

>>33910247
>tactically acquire like 75% of my medbag
that's everybody dude. even army bsb is like that. while i was in the aid station, i always gave line dudes shit we could spare. when i left theater, i had 5 fresh bottles of cyclo to add to our collection of meds that were too expensive to order. meanwhile, med plt leadership orders 30 fast 1 trainers that are to my knowledge still unused to this day. nothing made me happier than having a grunt steal shit from the clinic while at an appointment though. ace wraps, tape, and coband for days.

can someone screencap these im on mobile in class i want to read these later

Pretty neat, but what I want to know is how often do you actually hand out no-shave chits? I saw maybe one person with one from medical the whole time I was in.

>>33910806
You only get them if you are a roody-poo.

>>33909139
Honestly as a soldier and emt I dont see how this post is supposed to help anyone. Would it be more beneficial to people on here with no medical training to actually go over (for example) what an occlusive dressing is and how to make and pace one. This post is mile wide and inch deep and doesn't really teach anything.

here's a good trauma assessment video.
https://www.youtube.com/watch?v=LoFXLiVHaj8

>>33911186
i've done a whole bunch of guides along that route already, some 3-4 years ago, im sure some of the oldfags here have them saved, or they make their way around.

>>33909180
>>33909240
>>33909283
>>33909350
>>33909469
>>33909671
>>33909726

I had this same class as an 11b. let me give the translation for the grunts and retards here I had to give my buddies who didn't pay the fuck attention so they wound let me bleed out..

Tourniquet Tourniquet Tourniquet. Over the clothes real fast and high. Shove an Israeli in the non limb wounds. Never take a tourniquet off.

If he is hit in the lungs cut an mre bag and tape it over the hole.

Use his IFAC not yours.

anything more get me or the medic.