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Tactical Combat Casualty Care 

for All Combatants 
02 June 2014 


Tactical Casualty 

• If the basic TCCC combat trauma 
management plan doesn't work for the 
specific tactical situation, then for 
combat medics, corpsmen, PJs and 
combatants - it doesn't work. 

• There are no rigid guidelines for 
combat tactics - THINK ON YOUR 

• Scenario-based planni 
success in TCCC 

• Examples follow: 


SEAL Casualty - 

• August 2002 

• Somewhere in 

• SEAL element on 
direct action mission 

• Story of the casualty 
as described by the 
first responder - NOT 


SEAL Casualty - 

"There were four people in my team, 
two had been shot. Myself and the 
other uninjured teammate low 
crawled to the downed men. The 
man I came to was lying on his back, 
conscious, with his left leg pinned 
awkwardly beneath him. He was 
alert and oriented to person, place, 
time, and event. At that point I 
radioed C2 (mission control) to notify 
them of the downed man." 

SEAL Casualty - 

"Upon closer inspection, his knee 
was as big as a basketball and his 
femur had broken. The patient 
was in extreme pain and did not 
allow me to do a sweep of his 
injured leg. He would literally 
shove me or grab me whenever I 
touched his leg or wounds. I 
needed to find the entrance and 
exit wound and stop any possible 
arterial bleeding." 

SEAL Casualty - 

"But there was zero illumination 
and he was lying in a wet 
irrigation ditch. So I couldn't see 

SEAL Casualty - 

"We were also in danger because 
our position was in an open field 
(where the firefight had been) and 
I had to provide security for him 
and myself. So, I couldn't afford to 
turn on any kind of light to 
examine his wounds. I told him to 
point to where he felt the pain. He 
had to sort through his pains." 

SEAL Casualty - 

“He had extreme pain in his knee 
and where his femur had been 
shattered as well as a hematoma 
at the site of the entrance wound 
(interior and upper left thigh). 
Finally, he pointed to his exit 
wound (anterior and upper left 
thigh). Again, 1 had no way of 
telling how much blood he had 
lost. But 1 did know that he was 

SEAL Casualty - 

"So I called C2 again. I gave him the 
disposition of the patient as well as a 
request for casevac, a Corpsman, 
and additional personnel to secure 
my position and assist in moving the 
patient to the helicopter. I thought 
about moving the two of us to some 
concealment 25 meters away but we 
were both really low in a shallow 
irrigation ditch. I felt safer there 
than trying to drag or carry a 
screaming man to concealment." 

SEAL Casualty - 

"Between providing security and 
spending a lot of time on the radio 
I didn't get to treat the patient as 
much as I wanted to. I had given 
him a Kerlix bandage to hold 
against his exit wound. When he 
frantically told me that he was 
feeling a lot of blood, 1 went back 
to trying to treat him. 1 couldn't 
elevate his leg. To move it would 
mean he'd scream in pain, which 
wasn't tactical." 

SEAL Casualty - 

"There was just no way he would 
allow me to apply a pressure 
dressing to the exit wound even if 
I could locate it and pack it with 
Kerlix. So, I decid 
tourniquet on hi 

SEAL Casualty - 

"His wounds were just low enough 
on his leg to get the tourniquet an 
inch or so above the site. 1 had a 
cravat and a wooden dowel with 550 
cord (parachute cord) attached to it 
to use as a tourniquet. 1 told him to 
expect a lot of pain as 1 would be 
tightening the cravat down." 

SEAL Casualty - 


At this point he feared for his life 
so he agreed. Once I got it 
tightened I had trouble securing 
it. The 550 cord was hard to get 




SEAL Casualty - 

"After over 5 minutes, the Corpsman 
arrived along with a CASEVAC bird 
and a security force. Moving the 
patient was very hard. Four of us 
struggled to move him and his gear 
25 meters to the bird. The patient 
was over 200 pounds alone and we 
were moving over very uneven 

SEAL Casualty - 

"We wanted to do a three-man 
carry with two men under his 
arms and one under his legs. But 
again, his leg was flopping around 
at the thigh and cfouldn't be used 
to lift him." 

SEAL Casualty - 

"The bird, (a Task Force 160 MH-60) 
had a 50-cal sniper rifle strapped 
down, which made it hard for us to 
get him in. It took us minutes to get 
him 25 meters into the bird. The 
Corpsman went with my patient as 
well as the other downed man in my 
team and I went back to the op." 


Urban Warfare 


• High-threat urban environment 

• 16-man Ranger team 

• 70-foot fast rope insertion for a 
building assault 

• One man misses the rope and falls 

• Unconscious on the ground 

• Bleeding from mouth and ears 

• Unit is taking sporadic fire from all 
directions from hostile crowds 

The Battle of 

• Somalia - Oct 1993 

•US casualties: 18 dead, 73 

• Estimated Somali casualties: 350 
dead, 500 wounded 

Battle was 1 5 hours in length 

Complicating Factors 

• Helo CASEVAC not possible because of 
crowds, narrow streets and RPGs 

• Vehicle CASEVAC not possible initially 
because of ambushes, roadblocks, and 

• Cunfire support problems 

- Somali crowds included non-combatants 

- Somalis able to take cover in buildings 

- RPC threat to helo fire-support gunships 

Care under 


• Return fire? 

• Move patient to cover right away 
or wait for long board? 

• How should he be moved? 

• Urgency for evacuation? 

Mogadishu Scenario 2 
Helo Hit by RPG Round 

Mogadishu Scenario 2 
Helo Hit by RPG Round 

• Hostile and well-armed (AK-47s, 
RPG) crowds in an urban 

• Building assault to capture 
members of a hostile clan 

• Blackhawk helicopter trying to 
cover helo crash site 

• Flying at 300 feet 

Mogadishu Scenario 2 
Helo Hit by RPG Round 

• Left door gunner manning a 6-barrel 
M-134 minigun (4000 rpm) 

• Hit in hand by ground fire 

• Another crew member takes over 
the mini-gun 

• An RPG impacts under the right door 

Mogadishu Scenario 2 
Helo Hit by RPG Round 

• Windshields all blown out 

• Smoke filling the aircraft 

• Right minigun not functioning 

• Left minigun unmanned and firing 

• Pilot transiently unconscious - now 
becoming alert 

Mogadishu Scenario 2 
Helo Hit by RPG Round 

Co-pilot unconscious - lying 
forward on the helo's controls 

Crew Member 

- Leg blown off 

- Lying in puddle of his own 

- Femoral bleeding 

Mogadishu Scenario 2 
Helo Hit by RPG Round 

• YOU are the person providing care 
in the helo. 

What do you do first? 


llitary Operations in Urban Terr; 

■•Ik * 



MOUT Scenario 1 

• A U.S. ground element is moving on 
a high-value target in an urban 

• The first two men in a 8-man patrol 
are shot by an individual with an 
automatic weapon while moving 
down a hallway in a building. 

• The attacker follows this burst with 
a grenade. 

MOUT Scenario 1 

• One casualty is shot in the 
abdomen, but conscious. 

• The second casualty is shot in the 
shoulder with severe external 

• The third casualty is unconscious 
from the grenade blast. 

• The attacker withdraws around a 

MOUT Scenario 1 

• YOU are the person providing 
medical care. 

What do you do? 

MOUT Scenario 2 

MOUT Scenario 2 


patrol in the city of Tal Afar your 
platoon receives effective direct small 
arms fire. A 2 2 -year-old unit member 
falls to the ground and begins 
screaming, holding his right leg. The 
platoon, including you, reacts to the 
ongoing contact by returning fire. 

MOUT Scenario 2 

• You can see that the casualty is 
bleeding heavily from his leg wound. 

• YOU are the person providing 
medical care for this casualty. 

What do you do? 



Casualty scenarios on the 
battlefield usually entail both 
medical and tactical problems. 

Emergency actions must address 

Medical personnel should be 
involved in mission planning. 


• The TCCC guidelines for combat trauma 
scenarios are advisory rather than 
directive in nature. 

• Rarely does an actual tactical situation 
exactly reflect the conditions described 
in planning scenarios. 

• Those providing casualty care will 
typically need to modify the medical 
care plan to optimize it for the real 

The 3 Objectives of 


• Treat the casualty 

• Prevent additional 

Complete the mission 

The End 

The U.S.S. Arizona 


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