Understanding the three phases of Tactical Combat Casualty Care: Care Under Fire, Tactical Field Care, and Tactical Evacuation Care.

Three Phases, One Mission: Keep Survivors Alive

Picture a medic moving through a dusty field, the air tight with urgency. A casualty is down, danger still lingers, but lives are at stake. Tactical Combat Casualty Care breaks this chaos into three clear phases. Each phase has its own job, its own tools, and its own timing. The result is a structured approach that helps medics act fast, stay safe, and keep blood loss and shock from winning the day.

Here’s the thing: you don’t treat everything at once. You triage what’s most urgent, then move through stages that let you do more as the environment allows. Let me walk you through the three phases and what each one demands from the team on the ground.

Care Under Fire: Stop the Bleed, Stay Alive

In the moment of injury, danger is not a backdrop—it’s the main obstacle. Care Under Fire (CUF) happens while there’s still a real risk from bullets, shells, or other threats. The medic’s goal is simple and brutal: prevent the immediate threats to life while keeping everyone safe enough to move forward.

What happens in CUF

• Quick assessment of life threats, with first priority being massive hemorrhage.

• Use of rapid bleeding control tactics, most notably a tourniquet on a limb bleed. If the bleeding is through a limb, a tourniquet can be life-saving.

• If the casualty is still in a dangerous zone, you don’t linger for checks that can wait. You do what you must, then you move to safer ground.

• Minimal interventions, focused on stopping the single biggest killer right now: hemorrhage. Airway, breathing, and other concerns stay on the backburner until it’s safe to address them.

Why this order matters

• Time is a weapon inCUF—both for the casualty and for the medic. The priority is to buy time and still keep everyone safe.

• A secure environment is the platform for everything that comes next. Without safety, more elaborate care can become dangerous or impossible.

Tactical Field Care: Full Assessment, Comprehensive Intervention

Once the scene is secure, the medic can transition to Tactical Field Care (TFC). Now they have space to assess more thoroughly and fix a wider range of problems. This is where the MARCH approach (Massive hemorrhage, Airway, Respirations, Circulation, Hypothermia) helps organize thinking so nothing slips through the cracks.

What happens in TFC

• A careful head-to-toe assessment of the casualty’s condition, with continuous reassessment as the situation evolves.

• Airway management: airway maneuvers such as jaw-thrust or suction, and, if needed, more advanced steps performed by trained personnel.

• Breathing checks and interventions: ensuring the casualty is ventilating adequately; identifying chest injuries; treating difficulty breathing or chest wounds with appropriate seals or supportive measures.

• Hemorrhage control continues, but with more options: wound packing with gauze, additional dressings, and the possibility of longer-term bleeding control devices if applicable.

• Circulation and shock management: establishing IV access if feasible, fluids as needed, keeping the casualty warm to prevent hypothermia, and monitoring responsiveness and vital signs.

• Pain management and comfort measures, when appropriate and safe in the field.

Why TFC matters

• This phase bridges the gap between urgent life-saving actions and the longer trek to definitive care. It buys time and stabilizes the casualty so they can survive transport.

• The medic gains a better understanding of what’s really going on. Is the chest wound healing? Is the airway secure? Are there internal injuries that require different attention later?

Tactical Evacuation Care: Safe Transport, Ongoing Vigilance

The final stage is Tactical Evacuation Care (TEC). This is the care you provide during the actual movement to a higher level of medical care. Transport doesn’t mean “pause this,” but rather “keep caring as you move.” TEC is about vigilance, continuity, and preventing deterioration during the ride to safety.

What happens in TEC

• Ongoing monitoring of breathing, circulation, and consciousness throughout the evacuation.

• Continuation of initial treatments, plus adjustments as the casualty’s condition evolves in transit.

• Airway and breathing safeguards maintained during movement; cervical spine protection if there’s concern for neck injury.

• IV access maintained, medications administered as appropriate for pain and stabilization, and feverish red flags addressed before arrival.

• Coordination with receiving medical teams to ensure a smooth handoff and a quick transition to definitive care once the casualty reaches a higher level of medical capability.

Why TEC matters

• Transport is a high-stress phase all by itself. Any slip in monitoring or signaling can turn a survivable injury into a life-threatening one.

• The goal here is continuity—the same standard of care you started with in the field continues, even as you’re moving through unfamiliar terrain or crowded routes.

Connecting the Dots: Why these phases work together

Think of it like reading a map while driving a rough road. You don’t try every turn at once; you follow the plan, adjusting as you go. CUF buys you the time you need by stopping the bleed fast and staying focused on safety. TFC then lets you address the bigger problems with a clear, systematic approach. TEC keeps the momentum going, ensuring the casualty remains stable during transport and arrives at the next level of care in as good shape as possible.

The practical takeaway is simple: control the bleeding first, then secure the airway and breathing, then take care of circulation and temperature, all while staying mindful of scene safety. The exact steps may vary with the tools at hand and the casualty’s injuries, but the order and logic hold steady.

A quick mental model you can carry

• Phase 1 (Care Under Fire): Stop the bleeding, stay alive, stay safe.

• Phase 2 (Tactical Field Care): Thorough assessment, fix life threats, prepare for transport.

• Phase 3 (Tactical Evacuation Care): Monitor and maintain during movement, hand off with a clear status to the next care team.

A small, practical digression you might relate to

In the field, teams often reuse a preference for simple, reliable tools. A Cat tourniquet on a limb bleed, compact gauze packs for rapid packing, a chest seal for a suspected chest wound, and a way to keep the patient warm—all these pieces are chosen for reliability under stress. The exact brand names vary, but the principle is consistent: you want tools that work when you need them most.

A scenario to picture it clearly

Imagine a roadside incident. A casualty has a severe leg bleed and is in obvious distress, but cover and concealment are present, and the team must move to safer ground quickly. The medic applies a tourniquet in the CUF phase, halting the hemorrhage. Once the area is secured, they shift to TFC: they reassess, secure an airway if needed, monitor breathing, and continue to manage bleeding with wound packing and dressings. Finally, as they prepare to evacuate, TEC kicks in: IV access maintained, oxygen as needed, pain relief considerations weighed, and a clear handoff to the receiving hospital team as the casualty is moved to higher care.

Common questions, clear answers

• Do I always start with a tourniquet? In the CUF phase, yes—if there’s a life-threatening limb bleed, a tourniquet is a primary tool to save a life. The goal is to stop the bleed fast, then transition to more thorough care when it’s safe.

• When do we switch from CUF to TFC? As soon as the scene is secure and there’s no immediate danger to the medic or casualty from ongoing threats.

• What about the chest injuries? In TFC, you’ll address respiratory and chest issues. If you suspect a chest wound, you’ll apply appropriate dressings or seals and support breathing as needed.

• Is transport part of the care? Yes—TEC ensures that care continues during evacuation, with ongoing monitoring and adjustments until the casualty reaches higher medical care.

A few tips that stick

• Always have scene safety at the front. A secure environment makes everything else possible.

• Keep hemorrhage control as the priority inCUF; you can’t overemphasize controlling bleeding early.

• Use a structured approach in TFC to avoid missing a hidden problem. MARCH is a handy guide, but adapt to what you see.

• In TEC, maintain a calm, continuous handoff to the next care providers. It’s how you ensure no detail gets dropped.

Closing thoughts: why this framework remains vital

The phases of care in Tactical Combat Casualty Care aren’t abstract concepts. They are a living, breathing framework designed to save lives when every second counts. When medics move through Care Under Fire, Tactical Field Care, and Tactical Evacuation Care, they’re choosing a path that prioritizes immediate threats, followed by comprehensive stabilization, then safe transport. It’s a rhythm that makes sense on the ground and shines through in real-world outcomes.

If you’re learning this material, keep the three-phase sequence in your head as a simple mental map. Every clinical decision, every action in the field, gets weighed against the timing and the safety of everyone involved. In practice, this is not about memorizing a ladder of steps; it’s about internalizing a mindset: act decisively to stop life-threatening bleeding first, then build a stable platform for ongoing care, and finally ensure a clean handoff as the casualty moves toward definitive treatment.

That’s the heart of TCCC’s phased care. Three phases, one mission: give the casualty the best chance to survive and recover, no matter how tough the environment gets.