In accordance with DHA-PI 6040.01, 20 JAN 2017

The DD Form 1380, TCCC card, will serve as the record of trauma care rendered at the point-of-injury (POI) and during tactical field care and prehospital evacuation to be imported into the Service member’s electronic health record (EHR). First responders, to include clinical providers, will document treatment provided according to their skill level or scope of practice using the current TCCC guidelines in accordance with Reference (e) and Service policy.

The DD Form 1380, TCCC card, at Enclosure 3, with accompanying instructions located in Enclosure 4, should be disseminated to the widest extent possible within each of the Military Departments. The instructions at Enclosure 4 for completing the DD Form 1380, TCCC card, are officially maintained on the DoD Forms Management Program website at http://www.dtic.mil/whs/directives/forms/eforms/dd1380inst.pdf.

The DD Form 1380, TCCC card, should be stocked in applicable organizational medical equipment sets, kits, and outfits to include, but not limited to, Combat Lifesaver bags, Individual and Joint First Aid Kits (IFAKs, JFAKs), and Unit First Aid Kits located on all operational platforms (e.g., vehicle, aviation, and shipboard assets). This change should occur with expediency to make the revised cards available for use to support the appropriate documentation of care in all contingencies.

Background

Pre-Hospital or Pre-Medical Treatment Facility (pre-MTF) documentation of medical interventions by first responders at the POI is critical to ensuring continuity of care and providing meaningful analyses of medical interventions, techniques, tactics, and procedures rendered at the POI.

In a deployed, combat, or training setting, all personnel have the potential to be casualties, and all personnel have the potential to be first responders.  First responder care capability is also known as tactical combat casualty care. Tactical combat casualty care [or TCCC] occurs during a combat mission and is the military counterpart to prehospital trauma life support. Prehospital trauma care in the military is most commonly provided by enlisted personnel and includes self-aid and buddy aid and combat lifesavers. TCCC focuses on the most likely threats, injuries, and conditions encountered in combat and on a strictly limited range of interventions directed at the most serious of these threats and conditions.

DD Form 1380 promotes DoD goals of capturing documentation of pre-MTF medical interventions at the POI using a MIST format (Mechanisms of injury; Injuries; Signs & Symptoms; and Treatments). It is designed for use by all first responders, including non-medical personnel. 

Commanders will ensure that all first responders carry and use DD Form 1380 to document pre-MTF care at the POI. Such care relates to both battle and non-battle injuries.

Once completed, the DD Form 1380, TCCC must be visibly attached to the patient. Upon arrival at a Role 2 or Role 3 MTF, the DD Form 1380 will be included with the paper medical record, then scanned and entered into both the patient’s EHR and the trauma system’s trauma registry. Role 2 and Role 3 MTF Commanders must establish a clear process to ensure entry of the medical information recorded on DD Form 1380 into both the EHR and the trauma registry.

The DD Form 1380 will be a component of the IFAK, JFAK, and other first aid kits utilized. Corpsmen, combat medics, and tactical evacuation personnel should carry multiple blank versions of the form.

First responders will complete all entries as fully as possible on the DD Form 1380 unless under extreme conditions whereby the casualty and/or provider’s safety may be at additional risk.

All abbreviations authorized for use in DoD health records or DoD trauma registries may also be used on DD Form 1380.

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.

FRONT OF CARD

Battle Roster # - Write first letter of casualty’s first name, then first letter of casualty’s last name, then write the last four numbers of casualty’s Social Security number. For example, John Doe 123-12-1234 is Battle Roster # “JD1234”. 

Evacuation (EVAC) - Mark an “X” on the casualty’s evacuation priority/precedence (Urgent; Priority; or Routine). 

Name - Write casualty’s name (Last, First).

Last 4 - Write last four numbers of casualty’s Social Security number.

Gender - Mark an “X” on the casualty’s gender (Male (M) or Female (F)).

Date - Write date of injury in DD-MMM-YR format. For example, “29-JUN-13”. 

Time - Write 24-hour time of injury, and indicate whether local (L) or zulu (Z) time. For example, “1300Z”.

Service - Write casualty’s branch of service (USA, USAF, USCG, USN, USMC). For U.S. civilians, write “US CIV”. For non-U.S. personnel, write “NON US” or a standard abbreviation for casualty’s nationality. 

Unit - Write casualty’s unit name.

Allergies - Write casualty’s known drug allergies. If no drug allergies, write “NKDA” (no known drug allergies). 

Mechanism of Injury (MOI) - Mark an “X” on the mechanism or cause of injury (artillery, blunt, burn, fall, grenade, gunshot wound (GSW), improvised explosive device (IED), landmine, motor vehicle crash/collision (MVC), rocket-propelled grenade (RPG), other (specify)). Mark all that apply. 

Injury - Mark an “X” at the site of the injury(ies) on the body picture. For burn injuries, circle the burn percentage(s) on the figure. If multiple mechanisms of injury and multiple injuries, draw a line between the mechanism of injury and the anatomical site of the injury. 

TQ: R Arm (tourniquet, right arm) - If a tourniquet is applied to the right arm, write type of tourniquet used and the time of tourniquet application. 

TQ: L Arm (tourniquet, left arm) - If a tourniquet is applied to the left arm, write type of tourniquet used and the time of tourniquet application. 

TQ: R Leg (tourniquet, right leg) - If a tourniquet is applied to the right leg, write type of tourniquet used and the time of tourniquet application. 

TQ: L Leg (tourniquet, left leg) - If a tourniquet is applied to the left leg, write type of tourniquet used and the time of tourniquet application. 

Time, Pulse (rate & location), Blood Pressure, Respiratory Rate, Pulse Ox % O2 Sat, AVPU, Pain Scale (0-10) - Record vital signs (pulse rate and location, blood pressure, respiratory rate, oxygen saturation), level of consciousness (AVPU: Alert, responds to Verbal stimulus, responds to Pain stimulus, Unresponsive), and level of pain (on numeric rating scale of 0 to 10, with 0 being no pain and 10 being the worst pain) with time.  

BACK OF CARD

Battle Roster # - Write first letter of casualty’s first name, then first letter of casualty’s last name, and then write the last four numbers of casualty’s Social Security number. For example, John Doe 123-12-1234 is Battle Roster # “JD1234” .

Evacuation (EVAC) - Mark an “X” on the casualty’s evacuation priority/precedence (Urgent; Priority; or Routine). 

C - Mark an “X” for all Circulation hemorrhage control interventions. For tourniquets (TQ), mark category (Extremity, Junctional and/or Truncal) and write name of TQ(s) used. For dressings, mark category (Hemostatic, Pressure, and/or Other) and write name of dressing(s) used. 

A - Mark an “X” for all Airway interventions (Intact, NPA (nasopharyngeal airway), CRIC (cricothyroidotomy), ET Tube (endotracheal tube), SGA (supraglottic airway) and write type of device(s) used. 

B - Mark an “X” for all Breathing interventions (O2 (oxygen), Needle D (needle decompression), Chest Tube, Chest Seal) and write type of device(s) used. 

C: Fluid - Circulation resuscitation interventions. Write name, volume, route, and time of any fluids given. 

C: Blood Product - Circulation resuscitation interventions. Write name, volume, route, and time of any blood products given. 

Meds: Analgesic - Medications. Write name, dose, route, and time of any analgesics given. 

Meds: Antibiotic - Medications. Write name, dose, route, and time of any antibiotics given. 

Meds: Other - Medications. Write name, dose, route, and time of any other administered medications. 

Other - Mark an “X” for other treatments administered (combat pill pack, eye shield (mark right (R) or left (L)), splint, hypothermia prevention) and type of device(s) used. 

Notes - Use this space to record any other pertinent information and/or clarifications. 

First Responder Name - Print the first responder’s name (Last, First).

First Responder Last 4 - Write last four numbers of first responder’s Social Security number

ABBREVIATIONS & DEFINITIONS

AVPU - alert, verbal, pain, unresponsive

CRIC - cricothyroidotomy

IFAK - individual first aid kit 

JFAK - joint first aid kit 

MTF - medical treatment facility 

O2 - oxygen

POI - point of injury 

TCCC - Tactical Combat Casualty Care 

TQ - tourniquet

area of responsibility. The geographical area associated with a combatant command within which a geographic combatant commander has authority to plan and conduct operations.

clinical provider. Any individual permitted by law and Service regulations to provide care, treatment, and services, without direction or supervision, within the scope of the individual’s license and consistent with individually granted clinical privileges. This term is equivalent to healthcare provider.

first responder. Medical or non-medical personnel who provide initial and/or immediate self-aid, buddy aid, POI care, and/or tactical field care and stabilization for evacuation to the next health service support capability in the roles of care, and treats Service members for common minor illnesses.

roles of care. A characteristic of health service support is the distribution of medical resources and capabilities. Role 1 is the first medical care military personnel receive, also referred to as unit-level medical care; Role 2 provides advanced trauma management and emergency medical treatment, including continuation of resuscitation started in Role 1; Role 3 is care provided in an MTF that is staffed and equipped to provide care to all categories of patients, to include resuscitation, initial wound surgery, and post-operative treatment; and Role 4 medical care is found in U.S. base hospitals and robust overseas facilities. 

TCCC. A set of trauma management guidelines customized for use in the operational setting that maintains a focus on the most common causes of preventable deaths resulting from combat.

The DoD, Federal Agencies, and authorized contractors may establish accounts and obtain DD Form 1380, form number 0102LF0137602 (100 Ea) or 0102LF0137603 (10 Ea), from the Defense Logistics Agency Document Services, “Navy Forms Online” website, at1. The DoD, Federal Agencies, and authorized contractors may establish accounts and obtain DD Form 1380, form number 0102LF0137602 (100 Ea) or 0102LF0137603 (10 Ea), from the Defense Logistics Agency Document Services, “Navy Forms Online” website, at https://navalforms.documentservices.dla.mil/web/public/home.

Customers WITH an existing Defense Automated Printing Services (DAPS) account complete the following steps to obtain DD Form 1380:

     (1) On the “Naval Forms Online” website, click on the “Forms” tab and then click on “Keyword Search”.

     (2) After clicking on “Keyword Search”, a “Search Criteria” text box will open. In the “Search Criteria” text box, type in “DD 1380” and click on “Search”.

     (3) After clicking on “Search”, the DD Form 1380 will be listed in two available quantities, either 10 per pack or 100 per pack. Click on the “brown warehouse box” next to the quantity desired to connect to the “Checkout” window and complete the transaction through DAPS.

Customers without a DAPS account must first establish an account prior to ordering the DD Form 1380:

     (1) Instructions for establishing a DAPS account are detailed in the Customer Assistance Handbook located on the “Navy Forms Online” Website, https://forms.documentservices.dla.mil/public/Naval%20Forms%20OnLine%20website%20instructions.pdf.

     (2) If further assistance is required, contact the Navy Forms Help Desk at 1-866-736-7010.

In the rare event customers are unable to use Defense Logistics Agency Document Services to order the DD Form 1380, the TCCC card may be procured using NSN 7540-01-647-6165 (100 Ea), or NSN 7540-01-651-8602 (10 Ea). Contact DHA Medical Logistics Division at (301) 619-8538 if additional assistance is required.