TCCC PHASES OVERVIEW
Source: ATP 4-02.11, Chapter 3 — Tactical Combat Casualty Care, 23 March 2026
Key Points
- TCCC has 3 phases: CUF, TFC, TACEVAC
- TCCC has 4 tiers from All Service Members to Providers
- MARCH-PAWS is the treatment priority sequence
- In CUF, only massive bleeding from extremities is treated
- Airway and breathing are not addressed until TFC
- CLS performs Tier 2 skills (needle chest decompression, NPA)
- All Service Members must recertify TCCC annually (Active) or biannually (Reserve/Guard)
Common Mistakes
- Treating airway before stopping massive bleeding
- Performing junctional wound hemostatics during CUF (wait for TFC)
- Not reassessing tourniquet when transitioning phases
- Forgetting MARCH-PAWS is not a linear checklist — return to M if bleeding restarts
MARCH-PAWS
- M — Massive bleeding
- A — Airway
- R — Respiration
- C — Circulation/Shock
- H — Hypothermia
- P — Pain management
- A — Antibiotics
- W — Wounds (secondary)
- S — Splinting
Treatment priorities should follow MARCH-PAWS, with massive bleeding (M) always being the most important. The treatment priorities are not a linear process — if at any time massive bleeding is not controlled, go back to M. (ATP 4-02.11, para 4-3)
The Three Phases of TCCC
Phase 1: Care Under Fire (CUF)
Care rendered at the point of injury while both the responder and casualty are exposed to hostile fire. The primary focus is suppressing hostile fire and gaining fire superiority to protect both personnel and casualties.
Who treats: The casualty themselves (self-aid), buddy aid, and Tier 1 trained Service Members.
What is treated in CUF:
- Massive life-threatening bleeding from extremities — apply a hasty tourniquet HIGH and TIGHT in less than one minute
- Direct the casualty to return fire and self-apply tourniquet if able
- Move casualty to cover
What is NOT treated in CUF: Airway, breathing, junctional wounds (neck, axilla, groin), and all other injuries. These wait until TFC.
Phase 2: Tactical Field Care (TFC)
Care provided once the threat has been neutralized, the scene is safe, or the casualty has moved out of the immediate threat situation. This phase permits more extensive medical interventions.
Who treats: CLS (Tier 2), Combat Medic (Tier 3), or Combat Paramedic/Provider (Tier 4).
TFC interventions include:
- Reassess all CUF hemorrhage control (tourniquet adequacy, junctional wounds)
- Airway management — NPA insertion if needed
- Respiration — chest seal for open wounds, needle decompression for tension pneumothorax
- Circulation — reassess shock, establish IV/IO access if indicated
- Hypothermia prevention — wet clothing removal, heat-reflective blanket
- Pain management, antibiotics (CWMP)
- Secondary wound management, eye shields, splinting
- DD Form 1380 documentation and MIST handoff prep
Phase 3: Tactical Evacuation Care (TACEVAC)
Care rendered during casualty evacuation — either ground (CASEVAC) or air (MEDEVAC). The TACEVAC phase begins when the casualty is loaded onto the evacuation platform and continues until delivered to a medical treatment facility (MTF).
TACEVAC care is typically performed by combat medics and may include continued monitoring, IV/IO therapy, advanced airway management, and medication administration. Anticipate environmental challenges: vibration, noise, cold from altitude, and propeller wash.
TCCC Tier Structure
TCCC skills are categorized into four tiers, with each tier building upon the skills of the preceding one. (ATP 4-02.11, paras 3-5 through 3-9)
| Tier | Personnel | Focus | Key Skills |
|---|---|---|---|
| Tier 1 | All Service Members | Basic hemorrhage control and serious injury recognition | Tourniquet application, direct pressure, casualty movement, TCCC card |
| Tier 2 | Combat Lifesavers (CLS) | Most common causes of battlefield fatalities; advanced stabilization | NPA insertion, needle chest decompression, hemostatic dressings, IV access |
| Tier 3 | Combat Medics / Corpsmen | Invasive care; significantly more medical knowledge required | IO access, splinting, advanced airway, medication administration |
| Tier 4 | Combat Paramedics / Providers | Most sophisticated care; keep casualties alive for definitive care | Surgical airways, blood transfusion, advanced pharmacology |
Causes of Preventable Battlefield Death
TCCC is designed to address the three leading causes of preventable battlefield deaths:
-
1
Massive hemorrhage — Extremity wounds with arterial bleeding are the #1 preventable cause. Death can occur in as few as 3 minutes from femoral or brachial artery injury.
-
2
Airway obstruction — Facial trauma, blood, or relaxed tongue in unconscious casualties. Brain cells can die within 5 minutes without oxygen.
-
3
Tension pneumothorax — Air trapped in pleural space compresses the lung and eventually shifts the mediastinum; treated with needle chest decompression.
ATP 4-02.11 Source
Chapter 3: Tactical Combat Casualty Care — Army Techniques Publication 4-02.11, Casualty Response, Tactical Combat Casualty Care, and First Aid. Headquarters, Department of the Army, 23 March 2026.
See It in Practice — ESB Tasks
These ESB Medical Lane tasks apply this doctrine directly: