Tactical combat casualty care (TCCC or TC3) is the accepted battlefield prehospital standard of care. TCCC was reviewed and approved by the Committee on Tactical Combat Casualty Care (CoTCCC) which was established by the US Special Operations Command in 2002. Now, the CoTCCC operates under the Department of Defense (DoD) Joint Trauma System (JTS). The committee is formed by physicians, providers, and medical technicians across branches of the United States Army, Navy, Air Force, Marines, and Coast Guard and has 42 voting members.
TCCC originated as a Naval Special Warfare biomedical research project in the early 1990s and was first published as a Military Medicine supplement in 1996. This research was stimulated by evidence showing that tactical medicine environment and care differed substantially from typical prehospital medicine, that 90% of all combat deaths occur prior to reaching a treatment facility, and that extremity hemorrhage was a major cause of combat death. This places the wounded combatant, unit medic, or fellow soldier in the primary role of life-sustaining care. Early and effective use of the tourniquet substantially improved outcomes through evaluation from 1993 to 1996; because of this, TCCC was formed and implemented, initially in small unit group tactics and eventually becoming the basis for trauma care in the battlefield setting. Currently, TCC is a DoD course that is offered by National Association of Emergency Medical Technicians (NAEMT) in either a 2-day course for medical personnel or a 1-day course for all combatants. NAEMT also offers Tactical Emergency Casualty Care (TECC) for civilian emergency medical services (EMS).
Holcomb et al. showed that the adoption of TCCC across the United States military services substantially improved soldier fatality rates in 2006. A study of fatality rates spanning from 1941 to 2005 showed improved from 19.1% during World War II, 15.8% during the Vietnam War, down to an all-time low of 9.4% during Operation Iraqi Freedom and Operation Enduring Freedom.
In 2012, Eastridge et al. established the primary causes of death on the battlefield as hemorrhage, 91%; airway obstruction, 7.9%; and tension pneumothorax, 1.1%. Massive hemorrhage was found to include extremity wounds, 13.5%; junctional wounds, 19.2%; and truncal wounds, 67.3%. Because of this, the typical trauma primary survey has been rearranged from airway, breathing, circulation, and disability to follow the MARCH mnemonic of massive hemorrhage, airway, respiration, circulation, and hypothermia. 
The primary objectives of TCCC are to provide early, life-sustaining medical care to the casualty, limit further casualties, and achieve mission success. TCCC is divided into three phases of care: Care Under Fire (CUF), Tactical Field Care (TFC), and Tactical Evacuation Care (TACEVAC).
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