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As a Combat Medic or Corpsman, you are the first medical provider responsible for assessing casualties and initiating more advanced treatments. In the prehospital environment, you will also work alongside non-medical personnel who may already be providing care.

It is important to understand the roles of All Service Members and Combat Lifesavers. They may control bleeding, move casualties, assist with airway positioning, help with monitoring, and support casualty movement and evacuation tasks. Your job is to take control of medical priorities, direct assisting personnel, and ensure care is organized, documented, and communicated.

This module includes six cognitive learning objectives and two performance learning objectives. By the end of this module, you should be able to identify:

• The importance of security and safety in Tactical Field Care
• Basic principles of casualty removal and extraction from unit-specific platforms
• The importance of, and techniques for, communicating casualty information with unit leadership and other medical personnel
• The tactical and casualty information required for effective communication and documentation
• Triage considerations in Tactical Field Care
• You should also be able to demonstrate:
• Communication of casualty information to tactical leadership and other medical personnel
• Consolidation and triage of casualties at a casualty collection point

Tactical Field Care is the second of three phases of Tactical Combat Casualty Care. It is the care provided once the responder and casualty are no longer under direct threat from effective enemy fire. This allows for time and relative safety for a more deliberate approach to casualty assessment and treatment.

Keep in mind that the duration of the TFC phase of care could vary from minutes to hours depending on the tactical situation and the availability of evacuation assets.

This video introduces the purpose and function of a Casualty Collection Point. Pay attention to casualty flow, triage control, security, and how communication supports evacuation.

Tactical Field Care, or TFC, is the care rendered by the first responder, Combat Lifesaver and/or Combat Medic/ Corpsman (CMC) and there is no longer a direct threat or under effective enemy fire. TFC also encompasses care in the combat/tactical environment not involving enemy fire, such as a parachute injury or vehicle crash. The TFC environment allows the time and relative safety for the medic to assess and treat casualties more deliberately following the MARCH PAWS algorithm. Keep in mind that the tactical situation could revert to care under fire at any time.

Although extraction scenarios will vary based on unit, mission, and vehicle types, a couple of principles apply universally.

The first principle is SAFETY. Avoid additional casualties during any attempts at extraction. Extraction scenarios present many hazards, including fire, smoke, secondary explosions, instability of damaged vehicles or buildings, etc.

The second principle is to remember that the MARCH treatment priorities still apply and do not change because the casualty scenario requires extraction. If lifesaving treatments like tourniquet application can be done before completing the extraction, they should be done and monitored during the extraction process. If the casualty is in a position where access to provide immediate lifesaving treatments can’t be accomplished, then they need to be extracted as quickly as is safely possible.

The third principle is TRAINING. It is important for both medical and non-medical personnel to gain and maintain proficiency in extraction of casualties from unit-specific vehicles through training before and during deployments. The time to learn and establish battle drills is before deployment and before the mission.

Establish a security perimeter in accordance with unit standard operating procedures and/or battle drills. The tactical situation is fluid and can change quickly. Maintain tactical situational awareness and be aware of your surroundings.

Casualties with altered mental status (shock, head injuries, narcotics, etc.) should immediately be disarmed of weapons, communications equipment, and/or other sensitive items. The items should then be secured by their unit point of contact (POC), taking responsibility for it.

The CMC should always be ready to receive casualties in an area that provides adequate cover, so that lifesaving interventions can be performed. If possible, communicate with the first responder and casualty about the MOI and what treatment has been rendered.

Always reassess lifesaving interventions that were conducted in CUF or TFC using the MARCH PAWS algorithm. If a first responder is available, direct them to assist with exposing and treating the casualty. First responders can also help to prepare medical equipment, pre-stage litters, and document basic information.

Ensure that you document all findings and treatments on a DD Form 1380 TCCC Casualty Card and attach it to the casualty.

In TFC, available medical equipment is still limited to that carried on the mission by the casualty (their JFAK), other first responders/CLSs (JFAK or unit combat lifesaver bag), and/or a responding CMC (aid bag, etc.).Remember, whenever possible, use the casualty’s JFAK supplies first. As the tactical situation can change unexpectedly, the first responders and combat medics should be prepared to move with their casualties and equipment on short notice if needed.

In the Tactical Field Care phase, the MARCH PAWS algorithm is followed for a more deliberate approach to the assessment and treatment of casualties than was possible during Care Under Fire.

A full tactical trauma assessment should follow the MARCH PAWS sequence.

• Massive bleeding
• Airway
• Respiration/breathing
• Circulation
• Hypothermia/Head injuries 
• Pain
• Antibiotics
• Wounds
• Splinting

The specifics of assessment and treatment performed by the Combat Medic/Corpsman in each step of the MARCH PAWS sequence will be discussed in subsequent modules.

The Combat Medic/Corpsmen (CMC) will continuously communicate with the casualty (if possible) by encouraging, reassuring, and explaining each step of care being rendered. Being wounded can cause significant anxiety and fear above and beyond the psychological trauma of combat. Talking frankly with the casualty about their injuries and offering reassurance by describing the treatments being rendered and emphasizing that everything possible is being done to care for them can help decrease their anxiety.

Be honest about the injuries sustained but maintain a positive attitude about treatment and timely evacuation. Talking with the casualty helps assess their mental status, while talking through procedures helps maintain your own focus and confidence as well as the casualty’s confidence in you.

Communicate with first responders, other medical personnel, and tactical leadership about casualty injuries, condition, movement, status, and ongoing care (including annotating treatment on DD Form 1380). 

Communicate with tactical leadership immediately on evacuation requirements and throughout casualty treatment. Tactical leadership needs to understand the potential impact to the mission. Unit tactical standard operating procedures and/or battle drills will determine who will communicate with the evacuation system including the 9-line MEDEVAC requests and MIST report(s) (complete review of the 9-line MEDEVAC request and MIST report covered in Module 21). It is up to the CMC to help teach and supply information that is required for evacuation requests and reports.

The CMC will continue treatment until handoff to a higher or equal level of care. Example of what information the tactical leadership may need to know:

• How many casualties?
• What is the casualty's initial evacuation category?
• Who was injured (key leader/personnel)?
• Can the casualty still fight (ambulatory vs. litter)?
• Urgency of evacuation?

Unit tactical standard operating procedures and/or battle drills determine who communicates with evacuation assets (the medical evacuation coordination cell) to coordinate for TACEVAC/MEDEVAC and with responding medical personnel. This includes 9-line MEDEVAC requests and MIST reports, including:

• Number of casualties
• Injuries that were sustained
• Status of each casualty
• Treatments rendered and treatments needed
• Medical or evacuation equipment requirements

Document and update all casualty assessment and treatment (including interventions and medications) on the DD Form 1380 and communicate these findings during the hand-off to receiving medical and/or evacuation personnel.

Triage supports Mass Casualty Management (MCM) and is used when there are more casualties than resources.

Move, Treat, Transport is the guiding framework and keeps actions focused on safety, lifesaving care, and organized evacuation.

Triage uses a two-pass approach. The First Pass is a rapid sort to separate urgent from nonurgent. The Second Pass refines categorization into Urgent, Priority, and Routine to support evacuation decisions.

Re-triage is expected. Casualties, resources, and the tactical situation can change, so categories may need to be updated. Standardized triage language improves communication between medical personnel and unit leadership.

First pass triage is conducted as soon as tactically feasible. The purpose is to identify which casualties are dying now and require immediate lifesaving interventions, such as control of massive hemorrhage or airway compromise. These casualties are categorized as urgent.

All other casualties, who do not need immediate lifesaving interventions, are categorized as nonurgent. The goal in first pass triage is speed and efficiency. This allows the CMC to quickly evaluate multiple casualties without becoming overwhelmed by the care of any single casualty. First pass triage provides the information necessary to coordinate evacuation and informs subsequent second pass triage.

Second pass triage is more deliberate and is designed to support casualty evacuation. Casualties are categorized into Urgent, Priority, And Routine (UPR) groups. Urgent casualties are those with severe or critical injuries who will only survive with immediate surgery, rapid damage control resuscitation, or advanced treatment.

Priority casualties are those with serious injuries who require advanced care but can withstand a delay, such as limb- or eyesight-threatening injuries. Routine casualties are those with minimal injuries or expectant casualties who are unlikely to survive due to their clinical status or available resources. These UPR categories directly match evacuation doctrine and improve coordination between medical providers and leaders.

Mass Casualty Management (MCM) extends beyond Triage or casualty categorization. It is a command-directed, leader-driven system designed to synchronize planning, rehearsal, and execution of both medical and nonmedical tasks to manage the entire event. The objective of MCM is to manage the incident while optimizing casualty outcomes and maintaining mission effectiveness.

Casualty care is one part of MCM and includes the rapid sorting of casualties by acuity and need, performance of lifesaving interventions, and effective use of limited resources while ensuring the safety and security of responders and casualties. The CMC must establish casualty counts by category, maintain accountability of casualties and personnel, and ensure coordination, security, and communication at the casualty collection point.

Expectant and deceased casualty care must be planned for and rehearsed, including the dignified handling of human remains. Triage is not static; it is a dynamic and continuous process requiring regular reassessment as injuries evolve and resources change. Effective communication with leaders, responders, and evacuation assets ensures triage and resource decisions support both casualty survival and mission accomplishment.

The concept of “Move, Treat, Transport” provides a simplified and effective framework for mass casualty management (MCM) that prioritizes overall incident control rather than a linear focus on individual triage. In the Move phase, responders first relocate casualties to a safe area when there is an ongoing threat, such as enemy fire or structural danger. The focus is on safety and survival through movement before treatment begins. Once the environment is secure, the Treat phase involves performing limited lifesaving interventions, such as controlling major bleeding or opening airways, when and where it is tactically feasible.

The Transport phase focuses on moving casualties to a casualty collection point or designated area where responders can assess resources, prioritize evacuation, and coordinate movement to a higher level of care. This approach ensures that tactical safety, mission success, and effective casualty management remain the priority rather than strict adherence to formal triage systems. It provides a flexible, dynamic response suitable for complex or resource-limited operational environments. Reference Figure 2 on the slide to reinforce the sequence and flow of these phases.

Triage considerations during Tactical Field Care still follow the MARCH sequence to identify and treat immediate life-threatening conditions. However, the triage system itself has transitioned from the older Immediate, Minimal, Expectant categories to a principles-based, two-pass method.

During the first pass, casualties are sorted rapidly into urgent or nonurgent based on immediate survivability. Those with life-threatening hemorrhage or airway compromise are prioritized as urgent. The second pass allows for a more deliberate refinement into urgent, priority, or routine categories. This approach ensures interventions are directed where they will save the most lives and aligns with evacuation categories for clear communication across medical and nonmedical leadership.

The following examples show how non-medical and medical responders may understand reported triage information:

Urgent

• Medical Interpretation of an Urgent Casualty Report:
  • Casualty has suffered life-threatening trauma and is at risk of or is actively decompensating. Medical interventions may extend casualty survivability, but survival will require timely surgical intervention and advanced resuscitation/stabilization. These casualties will require a majority of the co-located medical personnel’s time and resources.
• Nonmedical Leader Interpretation of an Urgent Casualty Report:
  • Litter-bound casualty that will require evacuation to the next echelon of care as soon as possible but prior to completion of the mission. Will have to determine risk acceptable to risk evacuation platform, the force, and the mission to evacuate this casualty. Will need to rely on alternate or contingency assets once primary evacuation assets are expended evacuating this casualty

Priority

• Medical Interpretation of a Priority casualty report:
  • Casualty will likely need surgery to correct underlying condition; however, damage control surgery is not required. Casualty condition permits delay in definitive care without endangering life. Casualty has stable vital signs and normal level of consciousness in the absence or narcotics for pain control.
• Nonmedical Interpretation of a Priority casualty report:
  •  Ambulatory or litter patient. No immediate life threats. Do not attempt evacuation if it imposes increased risk asset, mission or force. Prioritize the tactical problem and then coordinate for evacuation once secure to do so. If tactical problems take an extended period and it is deemed safe to do so, performing evacuation for the casualty will reduce logistical burden on the force.

Routine

• Medical Interpretation of a Routine casualty report:
  • “Walking wounded” with minor injuries such as small burns, lacerations, abrasions or small/non-weight bearing musculoskeletal injuries. Does not require advanced analgesia or sedation. Casualty will follow-up post mission for continued care.
• Nonmedical Interpretation of a Routine casualty report:
  • Minor injury to member of the force. Can shoot, move, communicate effectively. For awareness and reporting only, no actions are required. Will depart from the mission with the force and will receive any further medical care upon return to base.

The following are key considerations for unit leadership and medical personnel in planning, establishing, and operating a tactical CCP in support of combat operations:

• Maintain security Maintain command and control
• Maintain appropriate triage and medical treatment protocols
• Maintain situational awareness
• Maintain organization
• Maintain control of medical equipment and supplies
• Maintain accountability of personnel and casualties

The Casualty Collection Point (CCP) is a location on the battlefield for the triage, treatment, and monitoring, and the packaging/staging of casualties for evacuation. Tactical Casualty Collection Points (CCPs) should be established reasonably close to the fight where casualties are likely to occur, be near natural “lines of drift,” provide relative cover and concealment from the enemy whenever possible and have access to evacuation routes.

There are several different examples of potential CCP layouts, since each situation is different and the exact configuration will vary based upon unit SOPs, mission, tactical situation, terrain, etc., but the layout of a CCP follows certain principles.

In an ideal layout, there are separate entry and exit points (which are potential chokepoints) to control casualty flow through the CCP, similar to what is seen in this example.

There are several different examples of potential CCP layouts, since each situation is different and the exact configuration will vary based upon unit SOPs, mission, tactical situation, terrain, etc., but the layout of a CCP follows certain principles.

In an ideal layout, there are separate entry and exit points (which are potential chokepoints) to control casualty flow through the CCP, like what is seen in this example.

Not every situation allows for separate entry and exit points; it is easy to see how having a single entry and exit point for the CCP could create a problem with casualty flow if casualties continue to arrive as others are being moved out to the evacuation point.

Medical personnel are responsible for everything inside the CCP, including triage, casualty treatment and monitoring, packaging and staging casualties for evacuation, requesting assistance as needed from other unit assets, providing guidance and recommendations to leadership on casualty management and evacuation, medical equipment and supplies.

In an ideal layout, there are separate entry and exit points (which are potential chokepoints) to control casualty flow through the CCP, similar to what is seen in this example.

Establish a security perimeter in accordance with unit tactical standard operating procedures and/or battle drills.

Casualty movement will be provided by unit personnel in accordance with unit tactical operating procedures and/or battle drills.

Triage/chokepoint will be unit leadership categorizing casualties.

Casualties will then be placed in the Casualty Collection Point (CCP), which should be marked/identified.

URGENT: These casualties require an immediate lifesaving intervention (LSI) and/or surgery. Put simply, if medical attention is not provided, they will die. The key to successful triage is to locate these individuals as quickly as possible.

PRIORITY: This category includes those wounded who are likely to need surgery, but whose general condition permits delay in surgical treatment without unduly endangering the life, limb, or eyesight of the casualty. Sustaining treatment will be required (e.g., oral or IV fluids, splinting, administration of antibiotics and pain control) but can possibly wait.

ROUTINE: Casualties in this category are often referred as the “walking wounded.” Although these casualties may appear to be in bad shape at first, it is their physiological state that tells the true story. Casualties who fit into the routine category may not present themselves until late in the triage process.

EXPECTANT: Casualties in this category have wounds that are so extensive that even if they were the sole casualty and had the benefit of optimal medical resources, their survival would be highly unlikely. Even so, expectant casualties should not be neglected. They should receive comfort measures and pain medication if possible, and they deserve re-triage as appropriate.

Medical personnel are responsible for everything inside the CCP, including triage, casualty treatment and monitoring, packaging and staging casualties for evacuation, requesting assistance as needed from other unit assets, providing guidance and recommendations to leadership on casualty management and evacuation, medical equipment and supplies.

In an ideal layout, there are separate entry and exit points (which are potential chokepoints) to control casualty flow through the CCP, like what is seen in this example.

Unit leadership will determine where the pre-stage evacuation area will be placed, as well as securing the MEDEVAC/ TACEVAC zone.

The medic oversees categorizing the casualties by evacuation category (Urgent, Priority, Routine).

URGENT

Evacuation within 2 hours denotes a critical, life- threatening injury. Suggestions for different injury patterns in this category are:

• Significant injuries from a dismounted IED attack
• Gunshot wound or penetrating shrapnel to chest, abdomen, or pelvis
• Blunt chest, abdominal, or pelvic trauma with suspected noncompressible hemorrhage
• Ongoing airway difficulty
• Ongoing respiratory difficulty
• Unconscious casualty
• Known or suspected spinal injury
• Hemorrhagic shock
• External bleeding that is difficult to control
• Extremity injury with absent distal pulses
• Moderate/severe TBI
• Burns greater than 20% TBSA

PRIORITY

Evacuation within 4 hours, serious injury. Suggestions for different injury patterns in this category are:

• Isolated, open extremity fracture with bleeding controlled
• Extremity injury with a tourniquet in place
• Penetrating or other serious eye injury
• Significant soft-tissue injury without major bleeding
• Burns of 10% to 20% TBSA

ROUTINE

Evacuation within 24 hours, mild to moderate injury. Suggestions for different injury patterns in this category are:

• Concussion (mild TBI)
• Gunshot wound to extremity - bleeding controlled without tourniquet – distal circulation intact
• Minor soft-tissue shrapnel injury
• Closed fracture with intact distal pulses
• Burns of <10% TBSA

Demonstrates organized casualty flow from triage to treatment and evacuation.

Medical personnel are responsible for everything inside the CCP, including triage, casualty treatment and monitoring, packaging and staging casualties for evacuation, requesting assistance as needed from other unit assets, providing guidance and recommendations to leadership on casualty management and evacuation, medical equipment and supplies.

In an ideal layout, there are separate entry and exit points (which are potential chokepoints) to control casualty flow through the CCP, similar to what is seen in this example.

There are several different examples of potential CCP layouts, since each situation is different and the exact configuration will vary based upon unit SOPs, mission, tactical situation, terrain, etc.; but the layout of a CCP follows certain principles.

Many Combat Medics and Corpsmen find it useful to print, laminate, and carry a mass casualty tracker. The format and use are unit and Service SOP dependent, but the purpose is consistent. It helps you maintain a running picture of the event by tracking casualty precedence, evacuation order, and a working summary of injuries and interventions, especially when multiple responders are providing care.

This detailed tracker supports accountability, casualty flow, and evacuation coordination during MASCAL and CCP operations. Use it to keep triage category and disposition organized, track mechanism of injury and injury location, and support updates and handoff.

Do not use a tracker during First Pass triage and do not allow documentation to slow the rapid sort or delay lifesaving actions. Trackers are most useful during Second Pass triage and sustained CCP operations.

This slide shows the simplified tracker option. It is designed for speed when you need quick updates across multiple casualties without getting buried in documentation.

Use it to capture brief reassessment snapshots and keep triage categories current as the situation changes. It supports continuity when casualties are moving and when different responders are sharing care.

This is for Second Pass triage and CCP operations. Do not use it during First Pass triage and do not delay the rapid sort.

During this skill station, you will demonstrate communication of casualty information with tactical leadership and demonstrate the consolidation and triage of casualties in a Casualty Collection Point (CCP).

Tactical Field Care is provided once the Combat Medic/Corpsman and the casualty are no longer under direct threat from effective enemy fire. This phase allows for a more deliberate approach to casualty assessment and treatment while maintaining situational awareness in a dynamic tactical environment.

During Tactical Field Care, the Combat Medic/Corpsman establishes security in accordance with unit SOPs and battle drills. Casualties with altered mental status should be disarmed, and weapons, communications equipment, and other sensitive items secured or redistributed as appropriate.

A full tactical trauma assessment is conducted using the MARCH PAWS sequence. When multiple casualties are present, triage is required to prioritize care and evacuation. Triage in Tactical Field Care follows a principles-based, two-pass approach. The first pass rapidly identifies casualties who are dying now, primarily those with uncontrolled hemorrhage or airway compromise. The second pass refines prioritization into Urgent, Priority, and Routine categories to support evacuation planning.

Effective communication remains critical throughout this phase. The Combat Medic/Corpsman communicates with the casualty, coordinates with other first responders and Combat Lifesavers, document care using the DD Form 1380, and reports casualty status and evacuation requirements to tactical leadership and the evacuation system using standard reports.Casualty Collection Points should be established near the fight, along natural lines of drift when possible, in locations that provide relative cover and concealment, and with access to evacuation routes to support organized casualty flow and timely evacuation.

Ask questions of the learners, referring to key concepts from the module. Now for a check on learning.

1. What is the difference between TFC and CUF?

• Answer: Tactical Field Care is the care rendered once the combat medic/corpsman and casualty are no longer under direct threat from effective enemy fire. This allows for time and the relative safety for a more deliberate approach to casualty assessment and treatment.

2. True or False: During TFC, the tactical situation could change back to CUF again at any time?

• Answer: True.

3. What is triage?

• Answer: Triage is the deliberate sorting of casualties and allocation of limited treatment resources according to a system of priorities designed to maximize the number of survivors on the battlefield.

4. What are two life threatening conditions most likely to determine urgent designation during FIRST PASS Triage?

• Answer: Uncontrolled hemorrhage and airway compromise.

5. What is a CCP?

• Answer: The Casualty Collection Point (CCP) is a location on the battlefield for the triage, treatment and monitoring, and the packaging/staging of casualties for evacuation. The CCP should be established reasonably close to the fight where casualties are likely to occur, be near natural “lines of drift”, provide relative cover and concealment from the enemy whenever possible, and have access to evacuation routes

Throughout the course, you’ll note several references, but keep in mind that the TCCC Guidelines are the core guidance for assessing and treating casualties in a TCCC setting, as well as the emphasis for training. Likewise, the Prehospital Trauma Life Support (PHTLS)., Military Edition, teaches and reinforces the principles of rapidly assessing a trauma casualty using an orderly approach.