The first phase of Tactical Combat Casualty Care (TCCC) is Care Under Fire (CUF). Care Under Fire is the care rendered by the first responder or combatant at the scene of the injury while he/she and the casualty are still under effective hostile fire. Available medical equipment is limited to that carried by the individual or by the medical provider in his or her aid bag.

Suppression of hostile fire will minimize the risk of both new casualties and additional injuries to the existing casualties. Casualty movement or extraction may be required to get them out of the kill zone before treatment should be initiated.

Massive bleeding or uncontrolled hemorrhage is the leading cause of preventable death on the battlefield, and as a result it is the number one medical priority in the CUF phase of TCCC. Early control of severe hemorrhage is critical to survival. Injury to a major vessel can quickly lead to shock and death. Due to the hostile environment encountered during CUF, only life-threatening bleeding warrants intervention.

In this module, you will learn to recognize life-threatening bleeding and the options available to control the bleeding while you are still under hostile fire. We will discuss strategies for proper tourniquet application when you have to work quickly, and identify common mistakes made during initial tourniquet applications.