Tactical Combat Casualty Care Guidelines – 18 August 2010
* All changes to the guidelines made since those published in the 2006 Sixth Edition of the PHTLS Manual are shown in bold text. The new material on hypothermia prevention is shown in red text.
Basic Management Plan for Care Under Fire
Return fire and take cover.
Direct or expect casualty to remain engaged as a combatant if appropriate.
Direct casualty to move to cover and apply self-aid if able.
Try to keep the casualty from sustaining additional wounds.
Casualties should be extricated from burning vehicles or buildings and moved to places of relative safety. Do what is necessary to stop the burning process. Airway management is generally best deferred until the Tactical Field Care phase. Stop life-threatening external hemorrhage if tactically feasible:
- Direct casualty to control hemorrhage by self-aid if able.- Use a CoTCCC-recommended tourniquet for hemorrhage that is anatomically amenable to tourniquet application.
- Apply the tourniquet proximal to the bleeding site, over the uniform, tighten, and move the casualty to cover.
Basic Management Plan for Tactical Field Care
Casualties with an altered mental status should be disarmed immediately.
a. Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a CoTCCC-recommended tourniquet to control life-threatening external hemorrhage
that is anatomically amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound...