I'm not sure if
D-Dey Response Group is still offering Tactical Combat Casualty Care (or if they are even still offering classes in Florida, period), but I definitely learned a lot when I took TCCC in August 2022 with instructor Dan Hudnet.
Day 1 consisted of lecture and demos at D-Dey's indoor facility in Stuart, FL, and Day 2 featured live-fire shooting and simulated casualty care at
OK Corral Gun Club.
DAY 1 NOTES
First Care Under Fire
- Can they walk? Have them apply stopgap treatment on themselves
- Don't get shot applying care to someone else - may only be able to apply critical items like a tourniquet (TQ)
Then Tactical Field Care (not actively under fire)
Then Tactical Evac Care (get to higher level of care)
MARCH algorithm - Massive bleeding, Airway, Respiratory, Circulation, Head/Hypothermia
Massive Bleeding
Old protocol was to put fluids (IV) into people - that has changed
Video example
Traffic stop where a cop is shot and his partner applies TQ to his arm
Takeaways
- Use cover! often the casualty can get up and relocate.
- Neutralize the threat first
TQ comparison
CAT is good, but needs 5" minimum limb
SOF-T is good, but less convenient for self-application
Other (worse) options: RATs, SWAT-T, improvised
1) Stopgap - apply direct pressure however you can
2) Apply TQ "high and tight"
Video example
officer shoots suspect, applies TQ to suspect's leg
Video example
hotel lobby - victim bleeding out
Self-application practice drill on arms and legs
CAT Tip - Trace the velcro all the way around - if it fails, the TQ needs to be reapplied
Internal bleeding can swell the appendage
Watch for both entrance and exit wounds
Junctional Bleeding / Woundpacking tips
Celox Rapid Z fold gauze
1) Start the "powerball" - a wad of gauze - helps protect your hands from sharp bones
2) Pack the wound - "Which way is the blood flowing?" - Got to kill the source
3) MAINTAIN PRESSURE
ETB - use the clips - do not trust the velcro
Airways
- head tilt, jaw thrust
- NPA - be sure to lubricate
- If you hear snoring, etc., don't force it
- If resistance is met, use a back and forth motion - rotate/saw
- To size airway - measure from nostrils to the bottom of jawline/earlobes
- DO NOT USE IF they're bleeding from back of the head, or if there's facial trauma
- Lube can dry out - can use spit or blood to lube
- Just need to lube the tip
- Apply beveled edge to septum
- Work it in little by little
- No force
- Make sure curve is the right way
- If you do one side, might as well do two
Recovery Position
- Only if you have to leave someone
- Turn patient to their left side
Respiration (the "box")
- Chest seal- pull half off - do not let it stick to itself
Video Example - Afghanistan SF soldier shot - chest seal applied to back
Circulation
- Shock is from inadequate blood to the body
- leads to altered mental state
- alertness/attentiveness down
- body will compensate for a little while...until it doesn't
Head injury/Hypothermia
- Head injury is beyond the scope of the course - even fire rescue can't do much
- Passive warming/thermal blanket
- Active warming/ready heat
- Hypothermia directly affects clotting ability
For bowel hit - wet pack with abdominal bandage - do not use Celox
Trach demo
Burns/splints/bandage demo
Burns
- liquid - hose it off
- dry - wipe off as much as possible (water might make it worse)
- Irrigate
- Burntec dressing
- Burn is gonna be wet and oozing
Impaled objects - leave in unless airway affected
DAY 2 NOTES
My Equipment - P365 in PHLster Skeleton with single mag pouch and LTC TQ holder
Safety briefing
Pork butt demo
- Tiny exit wound from ball ammo (entrance would may be small and not bleeding much)
- JHP - bigger hole
- bone hit - fragments
Shooting - 2-shot warmup plus TQ
2 shots -> TQ -> 2 shots
1 handed manipulations
- Still push into it
- Arms first
- can use shoe to rack
Shooting from back
- TQs on legs
- now being interrupted
Drag the body drill
- simple commands
- watch for exit wounds
- wounds are not always "front and back"