8-30. TCCC is divided into the three phases—care under fire, tactical field care, and tactical evacuation care. TCCC occurs during a combat mission and is the military counterpart to prehospital emergency medical treatment. (See FM 4-02 for additional information.)
Care Under Fire
8-31. In the care under fire phase, combat medical personnel and their units are under effective hostile fire and are very limited in the care they can provide. In essence, only those lifesaving interventions that must be performed immediately are undertaken during this phase. Casualty care under fire has a positive impact on the morale of a unit. Casualties are cared for at the point of injury (or under nearby cover and concealment) and receive self- or buddy-aid, advanced first aid from the CLS, and/or emergency medical treatment from the platoon or company combat medics.
Note. Nonmedical personnel (specifically individuals performing self-aid and buddy-aid and CLSs [see paragraph 1-43]) within the platoon assist combat medics (see paragraphs 1-46 to 1-48) within platoons and the company senior combat medic in their duties. Individuals (self-aid and buddy-aid) and CLS administer appropriate TCCC. If needed, Soldiers are evacuated to the Role 1 medical treatment facility (MTF) (battalion aid station) in the battalion support area, or the Role 2 MTF (brigade support medical company of the brigade support battalion) in the BSA of the IBCT. (See ATP 3-21.20 and FM 3-96 for additional information.)
8-32. All platoon CLSs and the combat medic carry multiple blank versions and use (they complete all entries as fully as possible) DD Form 1380 (see figure 8-2 on page 8-14) to document pre-MTF care at the point of injury. Such care relates to both battle and non battle injuries. Once completed, DD Form 1380 is visibly attached to the patient when transferred to the CCP and/or to a Role 1 or Role 2 MTF. All entries on the DD Form 1380 will be made using a non-smearing pen or marker. All entries on the DD Form 1380 should be printed clearly, including the first responder’s name.
Figure 8-2. DD Form 1380 (Tactical Combat Casualty Care [TCCC] Card)
8-33. During the fight, casualties should remain under cover where they received initial treatment (self- or buddy-aid). (See collective tasks–Evacuate Casualties 07-SQD-9033 and Evacuate Casualties 07-PLT-9033.) As soon as the situation allows, casualties are moved to the platoon CCP (when established). Once the casualties are collected, evaluated, and treated, they are prioritized for evacuation back to the company CCP. Once they arrive at the company CCP, the above process is repeated while awaiting their evacuation back to the battalion aid station or other facility in the battalion support area or BSA. Unit SOPs address these activities, to include the marking of casualties in limited visibility operations. Small, standard, or infrared chemical lights work well for this purpose.
8-34. An effective technique, particularly during an attack, is to task-organize a logistic steam under the first sergeant. This team carries additional ammunition forward to the platoons and evacuates casualties to either the company or the battalion CCP. The commander determines the size of the team during mission analysis.
8-35. When the platoons are widely dispersed, casualties might be evacuated directly from the platoon CCP by nonmedical vehicles and personnel. However, casualties are usually moved to the company CCP before evacuation. If the capacity of the battalion’s organic ambulances is exceeded, unit leaders may re-assign supply or other nonmedical vehicles to backhaul or otherwise transport non urgent casualties to the battalion aid station. In other cases, the platoon sergeant may direct platoon aid and litter teams to carry the casualties to the rear. Unless the threat environment is highly permissive, helicopter evacuation is unlikely to occur farther forward on the battlefield than the battalion’s ambulance exchange points between the battalion aid station (Role 1) and the brigade’s medical company (Role 2) in the BSA.
8-36. Leaders minimize the number of Soldiers required to evacuate casualties. Casualties with minor wounds can walk or even assist with carrying the more seriously wounded. Soldiers can make field-expedient litters by cutting small trees and putting the poles through the sleeves of buttoned uniform blouses. A travois, or skid, might be used for CASEVAC. Wounded are strapped on this type of litter, then one person can pull it. It can be made locally from durable, rollable plastic. Tie-down straps are fastened to it. In rough terrain, or on patrols, litter teams can evacuate casualties to the battalion aid station. Then, they are carried with the unit either until transportation can reach them or until they are left at a position for later pickup.
8-37. Unit SOP and operation order (OPORD) address casualty treatment and evacuation in detail. They cover the duties and responsibilities of key personnel, the evacuation of chemically contaminated casualties (on separate routes from noncontaminated casualties), and the priority for operating key weapons and positions. They specify preferred and alternate methods of evacuation and make provisions for retrieving and safeguarding the weapons, ammunition, and equipment of casualties. Slightly wounded personnel are treated and returned to duty by the lowest echelon possible. Platoon combat medics evaluate (under the control to the platoon sergeant) sick Soldiers and either treat or evacuate them as necessary. MEDEVAC and CASEVAC are rehearsed like any other critical part of an operation.
8-38. As casualties occur, the nearest observer informs the platoon sergeant who then informs the first sergeant via the most expedient method available (for example, radio voice). The first sergeant then submits a personnel status report to the battalion personnel staff officer section. This report documents duty status changes on all casualties. A casualty report is filled out when a casualty occurs, or as soon as the tactical situation permits. This usually is done by the Soldier’s squad leader and turned in to the platoon sergeant, who forwards it to the first sergeant. A brief description of how the casualty occurred (including the place, time, and activity being performed) and who or what inflicted the wound is included. If the squad leader does not have personal knowledge of how the casualty occurred, the squad leader gets this information from Soldiers who have the knowledge.
8-39. DA Form 1156, (Casualty Feeder Card) (see figures 8-3a and 8-3b on page 8-16), are used to report those Soldiers who have been killed and recovered, and those who have been wounded. This form also is used to report captured or killed in action Soldiers who are missing or not recovered. The Soldier with the most knowledge of the incident should complete the witness statement. During lulls in the battle, the platoon forwards casualty information to the company headquarters. The first sergeant ensures a completed DA Form 1156 is forwarded to the Infantry battalion personnel staff officer, who then enters the data into the Defense Casualty Information Processing System.
Figure 8-3a. DA Form 1156 (Casualty Feeder Card) (front)
Figure 8-3b. DA Form 1156 (Casualty Feeder Card) (back)
8-40. Before casualties are evacuated to the CCP or beyond, leaders remove all key operational or sensitive items and equipment, including communications security devices or signal operating instructions, maps, position location devices. Every unit should establish an SOP for handling the weapons and ammunition of its wounded or killed in action. Protective masks and other protective equipment must stay with the individual.
8-41. Casualties are taken to CCP for classification based on their medical condition, assigned evacuation precedence (urgent, priority, routine, and convenience), and availability of MEDEVAC platforms. Within a CCP, the combat medic conducts triage of all patients, takes the necessary steps to stabilize their conditions, and initiates the process of evacuating them to the rear for further treatment. The combat medic helps the first sergeant arrange evacuation via ground or air ambulance, or by nonstandard means. See FM 4-02 and ATP 4-02.2 for additional information on evacuation precedence for Army operations at Roles 1 through 3 MTFs.
8-42. When possible, the battalion medical platoon ambulances provide evacuation and en route care from the Soldier’s point of injury or the CCP to the battalion aid station. The ambulance team supporting the company or platoon works in coordination with the combat medic supporting the company or platoon. In mass casualty situations, nonmedical vehicles can be used to assist in CASEVAC as directed by the platoon leader or company commander. Plans for the use of nonmedical vehicles to perform CASEVAC should be included in the unit SOP. Ground ambulances from the brigade support medical company or other supporting ambulances evacuate patients from the battalion aid station back to the brigade support medical company MTF located in the BSA.
Tactical Field Care
8-43. During the tactical field care phase, medical personnel and their patients are no longer under effective hostile fire and medical personnel can provide more extensive patient care. In this phase, interventions directed at other life-threatening conditions, as well as resuscitation and other measures to increase the comfort of the patient may be performed. The physician and physician assistant at the battalion aid station or during tailgate medicine support provide TCCC. Tailgate medical support is an economy of force device employed primarily to retain maximum mobility during movement halts or to avoid the time and effort required to set up a formal, operational treatment facility (for example, during rapid advance and retrograde operations) (FM 4-02). During tactical field care, personnel must be prepared to transition back to care under fire, or to prepare the casualty for tactical evacuation, as the tactical situation dictates. (See FM 4-02 and ATP 4-02.4 for additional information on tactical field care.)
Note. The Infantry battalion’s organic medical resources within its headquarters and headquarters company include a medical platoon staffed with a field surgeon, physician assistant, and numerous combat medics. The mission of the battalion medical platoon is to provide Role 1 Army Health System support to the Soldiers of the Infantry battalion. Role 1 (also referred to as unit-level medical care) is the first medical care a Soldier receives. The medical platoon within the Infantry battalion is configured with a headquarters section, medical treatment squad, ambulance squad (ground), and combat medic section. The treatment squad consists of two teams (treatment team alpha and team bravo). The treatment squad operates the battalion aid station and provides Role 1 medical care and treatment (to include disease and nonbattle injury prevention, sick call, emergency medical treatment [including TCCC], and patient decontamination). Team alpha is clinically staffed with the physician assistant while team bravo is clinically staffed with the field surgeon. Medical platoon ambulances provide MEDEVAC and en route care from the Soldiers’ point of injury, the CCP, or an ambulance exchange point to the battalion aid station. The ambulance squad is four teams of two ambulances composed of one emergency care sergeant and two ambulance aide/drivers assigned to each ambulance. (See ATP 4-02.4 for additional information on the medical platoon.)
Tactical Evacuation
8-44. In the tactical evacuation phase, casualties are transported from the battlefield to MTFs. MTFs provide medical treatment and include the Role 1 facility (battalion aid station), Role 2 facility (brigade support medical company of the brigade support battalion), dispensaries, clinics, and hospital. Evacuation can be by either MEDEVAC (dedicated platforms [ground or air] manned with dedicated medical providers) or CASEVAC (ranging from nondedicated, but tasked, platforms [ground or air] augmented with medical equipment and providers to platforms of opportunity without medical equipment or providers).
Note. For the purposes of this discussion, CASEVAC will mean that which is done when moving casualties from the point of injury to the platoon CCP or company CCP. Ideally, casualties are transferred from a CCP to an MTF by a MEDEVAC asset. When this is not possible, the casualty is moved from the CCP, when required to move, aboard a nonmedical vehicle or aircraft to a MEDEVAC asset or an MTF.
8-45. Casualty evacuation is the movement of casualties aboard nonmedical vehicles or aircraft without en route medical care (FM 4-02). CASEVAC encompasses a wide spectrum of potential capability—depending on the mix of transport platform, medical equipment, and medical providers allocated to the mission. At the upper end of the spectrum, nondedicated platforms can be outfitted with the requisite medical equipment and MEDEVAC assets. At the lower end of the spectrum, CASEVAC can be no more than the transport of casualties using platforms of opportunity with no medical equipment or medical providers (in using such assets, the risk of not moving the casualty must outweigh the risk evacuating the casualty in such a manner). Effective CASEVAC complements MEDEVAC by providing additional evacuation capacity when number of casualties (workload) or reaction time exceeds the capabilities of MEDEVAC assets. CASEVAC requires detailed assessment and planning to achieve an effective integration of MEDEVAC and CASEVAC capabilities. (See ATP 4-02.13 for additional information on CASEVAC).
CAUTION
Casualties Transported in a CASEVAC platform may not receive proper en route medical care or be transported to the appropriate MTF that can best address the casualty’s medical needs. This may have an adverse impact on the casualty’s prognosis, long-term disability or even death may result.
8-46. Medical evacuation is the timely and effective movement of the wounded, injured, or ill to and between medical treatment facilities on dedicated and properly marked medical platforms with en route care provided by medical personnel (ATP 4-02.2). MEDEVAC is the key factor to ensuring the continuity of care provided to Soldiers by providing en route medical care during evacuation and facilitating the transfer of patients between MTFs to receive the appropriate specialty care. This ensures that scarce medical resources (personnel, equipment, and supplies [to include blood]) can be rapidly transported to areas of critical need on the battlefield.
Note. The Army MEDEVAC system is comprised of dedicated, standardized MEDEVAC platforms (ground and air ambulances). These ambulances have been designed, staffed, and equipped to provide en route medical care to patients being evacuated and are used exclusively to support the medical mission, in accordance with the law of land warfare and the Geneva Conventions (see FM 6-27 for additional information).
Dedicated air MEDEVAC aircraft include specifically trained medical personnel to provide en route care. The 9-line MEDEVAC request (see GTA 08-01-004) is the standard method to request air ambulance MEDEVAC.
Next Page : Appendix A – Direct Fires