Tactical Combat Casualty Care (TCCC) and Combat Lifesaver (CLS) Fundamentals, Philosophies, and Guidance

1. PURPOSE. TO PROMULGATE TCCC FUNDAMENTALS AND 
PHILOSOPHIES AND PROVIDE GUIDANCE TO COMMANDERS IN THE 
IMPLEMENTATION OF TCCC WITHIN THE FULL SPECTRUM OF THE USMC HEALTH 
SERVICE TRAINING CONTINUUM. 
2. BACKGROUND. 
A. IN 1996, THE NAVAL SPECIAL WARFARE COMMAND DEVELOPED A NEW 
SET OF TACTICALLY APPROPRIATE BATTLEFIELD TRAUMA CARE GUIDELINES 
NAMED TCCC. THE TCCC GUIDELINES WERE ADOPTED BY THE U.S. SPECIAL 
OPERATIONS COMMAND (USSOCOM) AND APPROVED BY THE AMERICAN COLLEGE OF 
SURGEONS (ACS) AND THE NATIONAL ASSOCIATION OF EMERGENCY MEDICAL 
TECHNICIANS. THE GUIDELINES ARE PUBLISHED IN THE PREHOSPITAL TRAUMA 
LIFE SUPPORT (PHTLS) MANUAL. THE COMMITTEE ON TACTICAL COMBAT 
CASUALTY CARE (COTCCC), UNDER THE EXECUTIVE AGENCY OF THE NAVAL 
OPERATIONAL MEDICINE INSTITUTE (NOMI), IS CHARGED WITH THE PERIODIC 
REVIEW AND UPDATE OF TCCC GUIDELINES. IN RESPONSE TO NEEDS 
ARTICULATED BY THE MARFOR AND LESSONS LEARNED, TECOM CHARTERED AN 
SME CONFERENCE TO DETERMINE APPLICABILITY OF TCCC AS SUSTAINMENT 
TRAINING FOR MEDICAL PERSONNEL ASSIGNED TO MARFOR UNITS AND AS THE 
BASELINE PHILOSOPHY FOR HEALTH CARE IN THE TACTICAL ENVIRONMENT AND 
STANDARDIZATION OF A COMBAT LIFE SAVER PROGRAM. 
B. REF (A) RECOMMENDED IMPLEMENTATION OF THE TCCC COURSE FOR 
USE AS SUSTAINMENT CASUALTY CARE TRAINING ACROSS THE MARINE CORPS 
FOR MEDICAL PERSONNEL AND THE DEVELOPMENT OF A CLS PROGRAM FOR 
SELECTED MARINES. 
C. BETWEEN JUN AND NOV 2005, CLS AND TCCC COURSES FOR USE BY 
CERTIFIED TRAINERS, CLS TRAINERS (CLS-T) AND TCCC TRAINER (TCCC-T) 
COURSES WERE DEVELOPED AND BETA TESTED BY FIELD MEDICAL SERVICE 
SCHOOLS (FMSS) WEST AND EAST. DATA COLLECTED FROM BETA TESTING WAS 
USED TO REFINE COURSES RESULTING IN APPROVAL OF CLS-T COURSE AND 
TCCC-T COURSE. 
3. GOAL. ELIMINATE PREVENTABLE LOSS OF LIFE ON THE BATTLEFIELD. 
IN ACCOMPLISHING THIS GOAL, TCCC AND CLS PROGRAMS ARE BEING DIRECTED 
AS A MEANS OF IMPROVING FIRST RESPONDER CARE AT THE POINT OF WOUND. 
4. IMPLEMENTATION. 
A. TCCC. 
(1) TRAINING IN TCCC IS INTENDED FOR MEDICAL PERSONNEL AS 
SUSTAINMENT TRAINING IN COMBAT CASUALTY CARE. TCCC HAS THREE 
PHASES: CARE UNDER FIRE, TACTICAL FIELD CARE AND CASEVAC CARE. 
THE INTENT IS FOR ALL MEDICAL PERSONNEL TO BE TRAINED IN TCCC PRIOR 
TO DEPLOYMENT INTO A POTENTIAL COMBAT AREA. 
(2) THE TCCC-T PROGRAM FOR MEDICAL PERSONNEL ASSIGNED TO 
MARINE CORPS OPERATING FORCES IS READY FOR EXECUTION. 
(3) IN MAY 2006, FMSS EAST AND WEST BEGAN TCCC-T COURSES 
TO PROVIDE TCCC TRAINERS TO THE OPERATING FORCES. FMSS EAST AND 
WEST WILL EACH CONDUCT TWO COURSES PER YEAR WITH A TOTAL OF 30 
CLASS SEATS PER COURSE. THIS WILL PRODUCE 120 TRAINERS PER YEAR 
FOR THE OPERATING FORCES AND MILITARY TREATMENT FACILITY READINESS 
AND TRAINING DEPARTMENTS. TCCC-T STUDENTS WILL COME FROM STUDENTS 
ATTENDING FMSS [UNITS MAY SEND AND FUND ADDITIONAL CORPSMEN TO 
ATTEND THE TCCC-T COURSE ON SPACE AVAILABLE BASIS]. 
(4) TCCC TRAINERS WILL RECEIVE THE STANDARDIZED TRAINING 
MATERIAL(S) UPON COMPLETION OF THE FMSS TCCC-T. 
(5) FMSS WILL DEVELOP AND MAINTAIN ALL LESSON PLANS, MEDIA 
AND EXAMINATIONS AND DISSEMINATE UPDATES TO UNIT TCCC TRAINERS AS 
REQUIRED. 
(6) TCCC TRAINING WILL BE A UNIT TRAINING RESPONSIBILITY 
WITHIN THE MEFS AND MARFORRES USING THE TRAINERS WHO HAVE COMPLETED 
THE TCCC-T COURSE GIVEN AT THE FMSS. 
(7) OPERATIONAL COMMANDERS WILL DEVELOP POLICY TO ENSURE ALL 
INCOMING MEDICAL PERSONNEL HAVE BEEN, OR WILL BE, TRAINED IN TCCC 
AFTER REPORTING TO THEIR RESPECTIVE COMMANDS. 
(8) TRAINING WILL INCLUDE, AT A MINIMUM, THE TCCC CURRICULUM 
DEVELOPED BY FMSS AND HANDS ON TRAINING IN THE ADEQUATE USE OF 
COMBAT TRAUMA MEDICAL EQUIPMENT IDENTIFIED WITHIN THE CURRICULUM. 
B. CLS 
(1) TRAINING IN CLS IS INTENDED FOR SELECTED MARINES TO 
PROVIDE ADVANCE LIFE SAVING SKILLS TO INCLUDE: HEMORRHAGE CONTROL; 
AIRWAY MANAGEMENT; AND SHOCK MANAGEMENT. TRAINING IS ACCOMPLISHED 
THROUGH A COMBINATION OF CLASSROOM AND PRACTICAL APPLICATION BY 
CORPSMEN TRAINED AS CLS TRAINERS. 
(2) THE CLS-T COURSE IS FOR MEDICAL PERSONNEL ASSIGNED TO 
MARINE CORPS OPERATING FORCES, AND IS READY FOR EXECUTION. 
(3) IN MAY 2006, FMSS EAST AND WEST BEGAN CLS-T COURSES TO 
PROVIDE CLS TRAINERS TO THE OPERATING FORCES. FMSS EAST AND WEST 
WILL EACH CONDUCT THREE COURSES PER YEAR WITH A TOTAL OF 30 CLASS 
SEATS PER COURSE. THIS WILL PRODUCE 180 TRAINERS PER YEAR FOR THE 
OPERATING FORCES AND MILITARY TREATMENT FACILITY READINESS AND 
TRAINING DEPARTMENTS. CLS-T STUDENTS WILL COME FROM STUDENTS 
ATTENDING FMSS [UNITS MAY SEND AND FUND ADDITIONAL CORPSMEN TO 
ATTEND THE CLS-T COURSE ON SPACE AVAILABLE BASIS]. 
(4) FMSS DESIGNATED CLS-T HOSPITAL CORPSMEN ARE THE ONLY 
TRAINERS AUTHORIZED TO CONDUCT CLS TRAINING. 
(5) CLS-T WILL RECEIVE THE STANDARDIZED TRAINING MATERIAL(S) 
UPON COMPLETION OF THE FMSS CLS-T COURSE. 
(6) FMSS WILL DEVELOP AND MAINTAIN ALL LESSON PLANS, MEDIA 
AND EXAMINATIONS, AND DISSEMINATE UPDATES TO UNIT CLS TRAINERS AS 
REQUIRED. 
(7) CLS TRAINING FOR SELECTED MARINES WILL BE A UNIT 
TRAINING RESPONSIBILITY WITHIN THE MEFS AND MARFORRES USING THE 
TRAINERS WHO HAVE COMPLETED THE CLS-T COURSE GIVEN AT THE FMSS. 
(8) PER REF (A), OPERATIONAL COMMANDERS WILL DEVELOP POLICY 
TO TRAIN AT LEAST TWO CLS TRAINED MARINES PER T/O UNIT CORPSMEN 
PRIOR TO DEPLOYING. 
C. REFRESHER/SUSTAINMENT TRAINING FOR CLS AND TCCC MUST BE 
COMPLETED EVERY TWO YEARS OR WITHIN THREE MONTHS OF DEPLOYMENTS. 
D. UNIT COMMANDERS MUST ENSURE THAT CASUALTY CARE TRAINING 
BECOMES AN INTEGRAL PART OF SUSTAINING SPECIFIED COMBAT MEDICAL 
SKILLS AND CAPABILITIES [INCLUDING ENHANCED FIRST AID AND COMBAT 
LIVESAVER] IOT ENSURE THAT MORTALITY AMONG CASUALTIES WILL BE 
MINIMIZED. 
E. HEALTH SERVICES TRAINING AND EDUCATION CENTER OF EXCELLENCE 
(HSTECOE) AT FMSS EAST WILL WORK WITH USMC ENTRY LEVEL SCHOOLS TO 
ENSURE THAT FIRST AID AND BUDDY AID PROGRAMS ARE IN COMPLIANCE WITH 
TCCC GUIDELINES. 
F. THE DIRECTOR, HEALTH SERVICES TRAINING AND EDUCATION CENTER 
OF EXCELLENCE (HSTECOE)FMSS EAST, IN COORDINATION WITH TECOM, GROUND 
TRAINING BRANCH AND MARINE CORPS CENTER FOR LESSONS LEARNED WILL 
DEVELOP A MECHANISM TO OBTAIN PERIODIC FEEDBACK FROM RETURNING 
COMBAT MEDICAL PERSONNEL REGARDING THE STRENGTHS AND WEAKNESSES OF 
CURRENTLY RECOMMENDED TECHNIQUES AND EQUIPMENT. THIS FEEDBACK WILL 
BE PROVIDED TO THE COTCCC VIA FMSS EAST TO BE INCORPORATED INTO 
FUTURE REVISIONS 
OF THE TCCC GUIDELINES. 
G. NAVY PERSONNEL TRAINING WILL BE TRACKED IN CETARS. MARINES 
RECEIVING CLS TRAINING WILL BE TRACKED IN THE SHORT TERM VIA UNIT 
INDIVIDUAL TRAINING RECORDS AND LONG TERM VIA AN ELECTRONIC TRAINING 
RECORD WHEN DEVELOPED. 
H. COURSE QUOTAS FOR EACH COURSE WILL BE MANAGED LOCALLY BY THE 
FIELD MEDICAL SERVICE SCHOOLS. 
5. THIS MARADMIN IS APPLICABLE TO THE MARINE CORPS TOTAL FORCE.