The first phase is Care Under Fire, or in the case of a noncombat environment, Care Under Threat. In this phase, the scene is not safe, and the overall priority is to establish scene safety in the form of fire superiority or control of any threats from a noncombat environment. The TCCC Guidelines state that the basic management plan for Care Under Fire is:

1. Return fire and take cover.
2. Direct the casualty to remain engaged as a combatant if appropriate.
3. Direct the casualty to move to cover and apply self-aid if able.
4. Try to keep the casualty from sustaining additional wounds.
5. Stop life-threatening external hemorrhage if tactically feasible.
6. Move the casualty to cover, if the casualty is unable to move.

The mission does not stop just because there is a casualty. Most battlefield casualty scenarios involve making medical and tactical decisions rapidly. In the combat environment, there is no “time-out” when casualties occur. Good medicine can sometimes be bad tactics; doing the RIGHT thing at the WRONG time can get you and your teammates killed or cause the mission to fail.

The order of initial actions will be dictated by the tactical situation. Little time is available to provide casualty care while under effective enemy fire.

Remember: Do not become a casualty! Assess the situation and the risk. Suppress enemy fire and gain fire superiority first. Communicate with and direct the casualty to return fire, move to cover, apply self-aid, and develop a plan before moving to care for a casualty under fire.