TP-C cheat sheet

Tactical emergency casualty care (TECC) phases: direct threat care (care under fire), indirect threat care (tactical field care), evacuation care (tactical evacuation care); priorities shift as threat level changes.

Care under fire priorities: return fire/suppress threat, move patient to cover, apply tourniquet for life-threatening extremity hemorrhage, then evacuate; airway and breathing interventions are deferred until in cover.

Tourniquet application: place 2-3 inches proximal to wound, not over a joint; tighten until bleeding stops and distal pulse is absent; document time; do not loosen once applied in the tactical setting.

Junctional hemorrhage (neck, axilla, groin) is not amenable to tourniquet; use wound packing with hemostatic gauze and direct pressure for at least 3 minutes, then apply a junctional pressure device.

MARCH PAWS sequence: Massive hemorrhage, Airway, Respiration, Circulation, Head injury/hypothermia, then Pain, Antibiotics, Wounds, Splinting during tactical evacuation care.

Tension pneumothorax in the tactical setting: progressive respiratory distress, unilateral absent breath sounds, hypotension, tracheal deviation (late); treat with needle decompression at 2nd intercostal space midclavicular line or 4th/5th ICS anterior axillary line.

Casualty evacuation priority categories under TECC: urgent (life-threatening, needs surgery within 2 hours), priority (within 4 hours), routine; use the same triage color scheme as TCCC (red/yellow/green/black).

Hypothermia prevention is a continuous tactical priority: remove wet clothing, apply passive insulation and active warming, and use a hypothermia prevention kit even in warm climates because hemorrhage and shock accelerate heat loss.

Analgesia in the tactical setting: ketamine is preferred for hemodynamically unstable casualties; oral transmucosal fentanyl or ketamine can be used when IV access is unavailable and the airway is secure.

Tactical emergency casualty care (TECC) phases: direct threat care (care under fire), indirect threat care (tactical field care), evacuation care (tactical evacuation care); priorities shift as threat level changes.

Care under fire priorities: return fire/suppress threat, move patient to cover, apply tourniquet for life-threatening extremity hemorrhage, then evacuate; airway and breathing interventions are deferred until in cover.

Tourniquet application: place 2-3 inches proximal to wound, not over a joint; tighten until bleeding stops and distal pulse is absent; document time; do not loosen once applied in the tactical setting.

Junctional hemorrhage (neck, axilla, groin) is not amenable to tourniquet; use wound packing with hemostatic gauze and direct pressure for at least 3 minutes, then apply a junctional pressure device.

MARCH PAWS sequence: Massive hemorrhage, Airway, Respiration, Circulation, Head injury/hypothermia, then Pain, Antibiotics, Wounds, Splinting during tactical evacuation care.

Tension pneumothorax in the tactical setting: progressive respiratory distress, unilateral absent breath sounds, hypotension, tracheal deviation (late); treat with needle decompression at 2nd intercostal space midclavicular line or 4th/5th ICS anterior axillary line.

Casualty evacuation priority categories under TECC: urgent (life-threatening, needs surgery within 2 hours), priority (within 4 hours), routine; use the same triage color scheme as TCCC (red/yellow/green/black).

Hypothermia prevention is a continuous tactical priority: remove wet clothing, apply passive insulation and active warming, and use a hypothermia prevention kit even in warm climates because hemorrhage and shock accelerate heat loss.

Analgesia in the tactical setting: ketamine is preferred for hemodynamically unstable casualties; oral transmucosal fentanyl or ketamine can be used when IV access is unavailable and the airway is secure.