Module 5: Tactical Trauma Assessment

COMBAT PARAMEDIC/
PROVIDER

TACTICAL COMBAT
CASUALTY CARE COURSE
MODULE 5:
TACTICAL TRAUMA ASSESSMENT

TCCC TIER 1 TCCC TIER 2 TCCC TIER 3 TCCC TIER 4

All Service Members Combat Lifesaver Combat Medic/Corpsman Combat Paramedic/Provider
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TACTICAL COMBAT CASUALTY CARE (TCCC) ROLE-BASED TRAINING SPECTRUM

ROLE 1 CARE
NONMEDICAL MEDICAL
PERSONNEL PERSONNEL

YOU ARE HERE

STANDARDIZED JOINT CURRICULUM

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1 x TERMINAL LEARNING OBJECTIVES

05 Given a combat or non-combat scenario, perform a Tactical Trauma Assessment
in accordance with Committee on Tactical Combat Casualty Care (CoTCCC) Guidelines.

5.1 Identify the common causes of altered mental status in combat or non-combat environments.
5.2 Identify the importance of disarming and securing the communications equipment of a casualty with altered
mental status.
5.3 Identify the importance and techniques of communicating with a casualty in Tactical Field Care.
5.4 Describe the importance of body substance isolation considerations in Tactical Field Care.
5.5 Demonstrate a Tactical Trauma Assessment using the MARCH PAWS sequence to render aid and
interventions to a casualty in Tactical Field Care IAW CoTCCC Guidelines.

5 x ENABLING LEARNING OBJECTIVES

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INTRODUCTION TO
TACTICAL TRAUMA ASSESSMENT (TTA)
Standardized Approach to Assessing a Combat Casualty

RELIABLE & PROVEN METHODOLOGY

Allows seamless approach for multiple responders

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TACTICAL TRAUMA ASSESSMENT

INSTRUCTOR-LED Demonstration
(Trainer-led demonstration review of the TTA
sequence/key steps)

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CAUSES OF
ALTERED MENTAL STATUS

TRAUMATIC HYPOXEMIA HYPOVOLEMIA/SHOCK

BRAIN INJURY

HYPOTHERMIA also contributes to altered mental status

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TECHNIQUES TO ASSESS RESPONSIVENESS

ALTERED MENTAL STATUS
ASSESS THE MECHANISM OF INJURY COMMUNICATE WITH THE
CASUALTY

A lert
V erbal Stimuli
P ainful Stimuli
Blasts MVAs Direct Blow
to the Head
U nresponsive
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DISARMING CASUALTIES
AND SECURING COMM EQUIPMENT
“DON'T WORRY,
YOUR UNIT WILL REMOVE CASUALTY’S
WEAPON, unit leadership
GET THIS BACK TO
YOU ONCE YOU'RE
BETTER”
will take responsibility for it

If casualty has
communication equipment,
have the unit leadership take
control of it, as well
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COMMUNICATE WITH CASUALTIES

Frequent Communication may help the casualty feel
calmer and improve their outcome by - reducing
stress, increasing the ability to explain symptoms and
follow commands.
COMMUNICATE with the casualty, if possible
Encourage AND Reassure
Explain care each step of the way
Communicate throughout TTA to determine if the
casualty's mental status begins to change – a
potential sign that something is wrong, and they
need to be reassessed

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TRIAGE AND DIRECT

OTHER RESPONDERS
If MULTIPLE CASUALTIES
are present, you may need to
TRIAGE before starting an
individual casualty TTA

DIRECT COMBAT MEDIC

CORPSMEN, COMBAT
LIFESAVERS or other
responders to help – you
cannot do everything yourself

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BODY SUBSTANCE ISOLATION (BSI)

As a precaution, the responder should
don latex-free gloves whenever possible

In CARE UNDER FIRE or other tactical

situations, BSI may not be feasible
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TTA SEQUENCE
DURING LIFE-THREATENING AFTER MARCH AFTER PAWS

M MASSIVE BLEEDING REASSESS MARCH REASSESS

CUF or TFC #1 Priority MARCH PAWS
A AIRWAY P PAIN
PREPARATION
FOR EVACUATION
R RESPIRATION (breathing) A ANTIBIOTICS

C CIRCULATION W WOUNDS CONSIDER

DETAILED
H HYPOTHERMIA / S SPLINTING EXAMINATION
HEAD INJURIES
COMMUNICATION AND DOCUMENTATION
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TACTICAL TRAUMA
ASSESSMENT PROCESS
Assessment

M A R C H P A W S

M A R C H P A W S
Intervention(s)
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BEGIN WITH HEMORRHAGE CONTROL

AND BLOOD SWEEP
After treating obvious massive hemorrhage, do a
rapid head-to-toe check for any unrecognized life-
threatening bleeding

M
Treat any obvious massive hemorrhage with limb Check the neck, axillary, and inguinal areas
tourniquets, wound packing, pressure bandages, or Check the arms and legs
junctional tourniquets, as appropriate
CONSIDER the application of a pelvic binder in relation to the MOI

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CONTINUE TTA WITH

REST OF MARCH SEQUENCE

A R C H
Relieve any airway Treat open chest wounds Establish intravenous or Use active and passive
obstructions or pending with vented chest seals intraosseous access and measures to prevent or
airway obstructions with and tension pneumothorax treat hemorrhagic shock treat hypothermia
maneuvers, adjuncts, or with needle decompression with blood products
Assess and document head
establish a new airway of the chest
and penetrating eye injuries
surgically or via intubation
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INITIATE MEDICAL EVACUATION

PREPARE EVAC REQUEST MONITOR THE CASUALTY
Relay required MEDEVAC REASSESS all lifesaving
Request information to the tactical interventions (MARCH
leader in accordance with unit sequence) and continue with
standard operating procedures the PAWS portion if time
permits

Initiate ELECTRONIC
MONITORING, if indicated and
equipment is available

REASSESS MARCH interventions prior to

proceeding to PAWS

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COMPLETE THE TTA BY ADDRESSING PAWS

P A W S
Assess for pain and Administer antibiotics for Address additional Splint and secure
administer the appropriate all open combat wounds wounds (abdominal fractures before evacuation
pain control medications injuries, impaled objects, (if time permits)
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COMMUNICATION AND DOCUMENTATION

FRONT BACK

COMMUNICATE DOCUMENT
with tactical leadership as soon as possible on the DD Form 1380 ALL assessments and
with status and evacuation requirements treatments provided to casualties before evacuation
throughout casualty treatment as needed or handoff to other medical personnel

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SECONDARY ASSESSMENT/DETAILED EXAM

Start at the head and work your way to the toes
Reassess and Treat
1 Head 7 Thorax, all prior interventions
2 Neck Lumbar, and
Treat minor injuries as
Buttocks they are found
3 Chest 6 Upper Document any findings
Extremities on the DD Form 1380
4 Abdomen/
Pelvis, 5 Lower
Groin, Extremities
Perineum

The detailed examination takes some time, and may not be an option if evacuation is ready or
multiple casualties require attention
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REASSESS TREATMENTS
REASSESS ALL treatments following

M A R C H
Focus on MARCH if time is limited

P A W S
Reassess frequently, in particular,
after any casualty movement,
changes in casualty's symptoms or
signs, and before transitioning care
to another provider
Reassess in the same sequence as the original TTA

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PREPARE FOR EVACUATION
PREP CASUALTY PREP SITE AND EVAC SUPPORT
Prep evac equipment Establish security
Prep litter Instruct ambulatory
casualties
Pack casualty
Stage casualties
Secure loose items
(bandages, blankets, etc.)

COMMUNICATE CASUALTY STATUS

Monitor the Casualty Ensure Completion MIST Report Complete DD Form 1380
Continue to REASSESS / REASSURE M Mechanism of injury
and monitor the casualty during
evacuation preparation phase
I Injuries

S Symptoms
PREPARE EVAC REQUEST
Use MEDEVAC format T Treatment
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TACTICAL TRAUMA ASSESSMENT

INSTRUCTOR-LED Demonstration
(Trainer-led demonstration and/or student-led
review of the TTA sequence/key steps)

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SKILL STATION

TACTICAL TRAUMA ASSESSMENT

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SUMMARY
Knowledge Topics Skills and Abilities
Define Tactical Trauma Assessment Perform TTA following the MARCH
Determine common causes of and techniques PAWS sequence
to assess altered mental status
Disarm and remove communication equipment
when mental status is altered
Communicate with the casualty throughout the
TTA
Consider body substance isolation

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CHECK ON LEARNING

During which phase of care is most of the

Tactical Trauma Assessment performed?
What mnemonic is used to prioritize care
during the Tactical Trauma Assessment?
Why is it important to assess the casualty’s
mental status?
What is the importance of performing a blood
sweep?

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ANY QUESTIONS?

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REFERENCES
TCCC: Guidelines
by JTS/CoTCCC
These guidelines, updated regularly, are the result
of decisions made by CoTCCC in exploring
evidence-based research on best practices.

PHTLS: Military Edition

by NAEMT
Prehospital Trauma Life Support (PHTLS), Military
Edition, teaches and reinforces the principles of
rapidly assessing a trauma patient using an orderly
approach.

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