First Aid (TCCC)

Care Under Fire

This is the care rendered at the scene of the injury while still under hostile fire. The best medicine on any battlefield is fire superiority.

Priorities:
1. Return fire and take cover
2. Direct the casualty to return fire, take cover, and apply self-aid if able
3. Try to keep the casualty from sustaining additional wounds
4. If the casualty is unable to move — provide tactical movement to cover
5. Stop life-threatening hemorrhage with a hasty tourniquet (high and tight over clothing)

MARCH Algorithm

M – Massive hemorrhage: Apply tourniquet to life-threatening extremity bleeding
A – Airway: Establish and maintain an airway (head-tilt chin-lift, NPA)
R – Respiration: Treat chest injuries (chest seal for sucking chest wound)
C – Circulation: Establish IV/IO access, treat for shock
H – Hypothermia/Head injuries: Prevent heat loss, monitor for TBI

Tourniquet Application

• There are two types of tourniquet applications based on the phase of care:
• Hasty Tourniquet (Care Under Fire): Applied 'High and Tight' over the uniform. Used when under fire and speed is critical.
• Deliberate Tourniquet (Tactical Field Care): Applied 2-3 inches above the wound, directly on the skin (NOT on a joint). Used when no longer under direct fire.

• Key Steps:
• Pull the band tight and twist the windlass until bleeding stops
• Lock the windlass, secure the band
• Mark a 'T' on the casualty's forehead with the time of application
• Do NOT remove a tourniquet once applied — only medical personnel should do so

9-Line MEDEVAC Request

Line 1: Location (grid coordinate)
Line 2: Radio frequency and call sign
Line 3: Number of patients by precedence (A-Urgent, B-Priority, C-Routine)
Line 4: Special equipment required
Line 5: Number of patients by type (Litter or Ambulatory)
Line 6: Security of pickup site (Wartime) / Number and type of wound, injury, or illness (Peacetime)
Line 7: Method of marking pickup site
Line 8: Patient nationality and status
Line 9: CBRN contamination (Wartime) / Terrain description (Peacetime)

Board Tips

Know the MARCH algorithm and tourniquet application steps. The board will try to trick you on tourniquet placement: remember 'High and Tight' is for Care Under Fire, and '2-3 inches above the wound' is for Tactical Field Care. The 9-Line MEDEVAC is a classic board question. Practice it until you can recite it from memory, and be ready to answer what Lines 6 and 9 are during peacetime.