Tactical Medicine & Emergency Response Glossary
The definitive reference for 250+ tactical medicine, trauma care, and emergency response terms — from the battlefield to the backcountry.
Curated by Dr. Marco R. Torres, MD — Founder & CEO, MED-TAC International Corp.
Built for military medics, EMTs, paramedics, law enforcement officers, wilderness responders, Stop the Bleed participants, and prepared civilians. Whether you’re studying for TCCC certification, building your first trauma kit, or refreshing your knowledge — this glossary is your quick-reference companion.
A
ABCDE (Airway, Breathing, Circulation, Disability, Exposure/Environment) Trauma Care
A systematic primary survey framework used in trauma and emergency medicine to rapidly identify and treat life-threatening conditions in priority order. Each letter represents a step: securing the Airway, assessing Breathing, managing Circulation and hemorrhage, evaluating neurological Disability, and fully Exposing the patient while controlling the Environment to prevent hypothermia. ABCDE is foundational to both civilian emergency medicine and military trauma protocols.
Abdominal Aorta Anatomy
The largest artery in the abdominal cavity, running from the diaphragm to the pelvis where it bifurcates into the iliac arteries. In penetrating abdominal trauma, injury to the abdominal aorta is rapidly life-threatening and causes exsanguination that is not amenable to external tourniquet control. Damage control surgery is required for definitive hemorrhage management.
Absorption Dressing Equipment
A highly absorbent wound dressing designed to soak up large volumes of blood and exudate while maintaining compression over a wound, commonly used as a secondary layer over hemostatic gauze. Absorption dressings such as the Olaes and Israeli Bandage incorporate absorbent pads with integrated elastic wrapping. In tactical medicine, maximizing wound absorption reduces the need for frequent dressing changes in austere environments.
Shop Bandages & Dressings →ACE Wrap (Ace Bandage / Elastic Compression Bandage) Equipment
An elastic bandage used to apply compressive pressure over wounds, splints, or dressings to support hemorrhage control and immobilization. In tactical settings, ACE wraps are used to secure pressure dressings and hemostatic gauze in place after wound packing. They are lightweight, reusable, and a standard component of most individual first aid kits.
Shop Bandages & Dressings →ACS (American College of Surgeons) Certifications & Training
A surgical professional organization that develops and promotes evidence-based trauma care guidelines and training programs in the United States. The ACS oversees the Advanced Trauma Life Support (ATLS) program and co-sponsors the Stop the Bleed campaign. Its Committee on Trauma sets national standards for trauma center designation and verification.
AED (Automated External Defibrillator) Equipment
A portable electronic device that automatically analyzes cardiac rhythm and delivers an electrical shock to restore normal heart rhythm in cases of ventricular fibrillation or pulseless ventricular tachycardia. AEDs provide audio and visual prompts to guide users through the defibrillation process, making them usable by laypersons with minimal training. They are a critical link in the chain of survival and are widely deployed in public spaces, workplaces, and tactical medical kits.
Shop AEDs & Resuscitation →AEMT (Advanced Emergency Medical Technician) Certifications & Training
A level of EMS certification in the United States between EMT-Basic and Paramedic, allowing providers to perform advanced skills including IV/IO access, advanced airway management, and administration of a limited set of medications. AEMTs commonly serve in ground EMS systems and may be first responders in rural or semi-rural environments. Certification is regulated at the state level and recognized by the National Registry of EMTs.
Airway Adjunct Airway Management
Any device used to maintain or establish a patent (open) airway in an unconscious or compromised patient. Common airway adjuncts include the nasopharyngeal airway (NPA), oropharyngeal airway (OPA), supraglottic airways (SGAs), and surgical airways such as cricothyrotomy. Selection of the appropriate adjunct depends on the patient's level of consciousness, mechanism of injury, and provider skill level.
Shop Airway Management →ALS (Advanced Life Support) EMS Systems
A set of medical procedures and interventions performed by trained providers (typically paramedics or physicians) in response to life-threatening emergencies, including advanced airway management, cardiac monitoring, intravenous access, and drug administration. ALS protocols are designed to stabilize patients with serious medical emergencies beyond the scope of basic life support. In EMS systems, ALS units typically include at least one paramedic.
Amputation Trauma Care
The surgical or traumatic separation of a limb or appendage from the body, which constitutes a major hemorrhage emergency in the tactical and trauma setting. Traumatic amputation from blast injury or ballistic trauma requires immediate tourniquet application proximal to the amputation site to control life-threatening hemorrhage. Modern surgical care and early tourniquet application have significantly improved survival rates from combat-related amputations.
AMS (Acute Mountain Sickness) Wilderness Medicine
A collection of symptoms caused by rapid ascent to high altitude, typically above 8,000 feet, resulting from hypobaric hypoxia and reduced oxygen availability. Symptoms include headache, nausea, fatigue, dizziness, and sleep disturbance. Management includes descent, acclimatization, supplemental oxygen, and medications such as acetazolamide; failure to treat can progress to high-altitude cerebral edema (HACE) or pulmonary edema (HAPE).
Analgesia Pharmacology
Pain relief achieved through pharmacological or non-pharmacological means in a medical or tactical context. In TCCC protocols, pain management is addressed under the PAWS mnemonic and includes oral, intramuscular, and intravenous agents such as ketamine, meloxicam, and acetaminophen, titrated to the patient's condition and level of consciousness. Effective analgesia can reduce physiological stress, improve cooperation, and support recovery in combat casualties.
Anaphylaxis General First Aid
A severe, life-threatening systemic allergic reaction characterized by airway compromise, hypotension, urticaria, and shock caused by an immune-mediated release of histamine and other mediators. Immediate treatment requires intramuscular epinephrine (adrenaline), airway management, and supportive care. In austere or tactical environments, auto-injector epinephrine devices (EpiPens) are a first-line treatment.
Aorta Anatomy
The main arterial trunk arising from the left ventricle of the heart, supplying oxygenated blood to the entire body through its thoracic and abdominal branches. Traumatic aortic injury is rapidly lethal and commonly results from high-speed deceleration injuries, penetrating thoracic trauma, or blast overpressure. Management requires rapid surgical or endovascular intervention at a trauma center.
Aortic Occlusion Procedures
A hemorrhage control technique in which the aorta is occluded to limit blood flow to non-compressible truncal hemorrhage below the occlusion point, performed either through open surgery or endovascularly using a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter. Aortic occlusion is a damage control measure used in patients with exsanguinating abdominal or pelvic hemorrhage as a bridge to definitive surgical repair. REBOA requires fluoroscopy and specialized training and is available at advanced trauma centers and deployed military surgical units.
ATLS (Advanced Trauma Life Support) Certifications & Training
A standardized, evidence-based training program developed by the American College of Surgeons that teaches physicians a systematic approach to trauma assessment and management using the primary survey (ABCDE) framework. ATLS is the gold standard for in-hospital trauma care and provides the conceptual foundation for many prehospital trauma protocols. The course is taught in over 80 countries and requires periodic recertification.
ATLS Primary Survey Trauma Care
The structured initial assessment in Advanced Trauma Life Support using the ABCDE framework to identify and simultaneously treat all life-threatening conditions before conducting a thorough secondary survey. The primary survey is designed to be completed rapidly, prioritizing airway, breathing, circulation, disability, and exposure in that order. This systematic approach prevents deaths from treatable injuries that may be overlooked during unstructured assessment.
AVPU (Alert, Voice, Pain, Unresponsive) Trauma Care
A rapid neurological assessment scale used in tactical and emergency medicine to quickly categorize a patient's level of consciousness. A patient is scored as Alert (fully awake), responsive to Voice commands, responsive to Pain stimulation, or Unresponsive. AVPU is used in the H (Head Injury/Hypothermia) component of the MARCH PAWS assessment and serves as a rapid alternative to the more detailed Glasgow Coma Scale.
Axillary Artery Anatomy
A major artery of the upper extremity located in the axilla (armpit), representing the continuation of the subclavian artery distal to the first rib. Axillary artery hemorrhage is junctional bleeding that cannot be controlled with standard limb tourniquets and requires wound packing with hemostatic gauze and/or junctional tourniquets. It is a high-risk anatomical location for severe hemorrhage in penetrating trauma.
B
Ballistic Vest Equipment
Personal protective equipment worn to absorb and reduce the penetrating force of bullets, fragmentation, and shrapnel, protecting the thorax and abdomen from ballistic injury. While ballistic vests dramatically reduce lethal thoracic and abdominal wounds, they shift the pattern of combat injuries toward extremity wounds, making tourniquet training and junctional hemorrhage management even more critical. Tactical medical providers must account for the vest when conducting a rapid trauma assessment.
BAS (Battalion Aid Station) Military Medical
A forward military medical treatment facility typically located near the front line that provides first-responder and trauma stabilization care for soldiers at the battalion level. The BAS is staffed by combat medics (68W), physician assistants, and battalion surgeons and can perform limited surgical stabilization before casualties are evacuated to higher levels of care. It represents Role 1 medical care in the military health system.
Blast Injury Trauma Care
Trauma caused by an explosion, classified into four categories: primary (barotrauma from the pressure wave), secondary (fragmentation and shrapnel penetrating injury), tertiary (displacement of the body), and quaternary (burns, toxic inhalation, and miscellaneous). Primary blast injury causes unique patterns of injury including traumatic brain injury, tympanic membrane rupture, pulmonary blast injury, and bowel injury that may not be apparent externally. IED-related blast injuries are the signature wounds of the Iraq and Afghanistan conflicts.
Blood Sweep Tactical Medicine
A systematic visual and hands-on physical examination technique used in tactical medicine to identify unrecognized external hemorrhage during the MARCH assessment. The provider methodically inspects and palpates the entire body from head to toe, including the neck, axillae, groin, and back, to locate all bleeding wounds. The blood sweep is typically performed after initial tourniquet application during tactical field care.
BLS (Basic Life Support) Certifications & Training
Foundational emergency care skills including CPR, AED use, choking management, and basic hemorrhage control that can be performed by healthcare providers and trained laypersons to sustain life until advanced help arrives. BLS courses are taught by organizations such as the American Heart Association and Red Cross. BLS forms the first link in the chain of survival for cardiac arrest and is the baseline competency expected of all healthcare providers.
Shop AEDs & Resuscitation →Brachial Artery Anatomy
The primary artery of the upper arm, running along the medial aspect of the humerus from the axillary artery to its bifurcation at the elbow into the radial and ulnar arteries. It is the site most commonly used for blood pressure measurement by auscultation (auscultatory method). Penetrating or blunt trauma to the brachial artery can cause limb-threatening ischemia and is controlled with direct pressure or tourniquet application.
Buddy Aid Military Medical
The immediate self-aid or peer-to-peer medical assistance rendered by combatants to themselves or fellow soldiers prior to the arrival of trained medical personnel. Buddy aid includes tourniquet application, wound packing, and airway positioning and is taught to all service members through TCCC-ASM (All Service Members) training. Buddy aid is performed during the Care Under Fire phase and is the first line of life-saving intervention on the battlefield.
BVM (Bag-Valve-Mask) Equipment
A manual ventilation device consisting of a self-inflating bag connected to a one-way valve and a face mask, used to deliver positive pressure ventilation to patients who are not breathing adequately or who require assisted ventilation during resuscitation. The BVM can be connected to supplemental oxygen to deliver near-100% oxygen concentrations, and can be attached to an endotracheal tube or supraglottic airway for definitive ventilation. Effective BVM ventilation requires a proper mask seal, adequate bag compression, and awareness of gastric inflation risk.
Shop Airway Management →C
Capillary Refill Time Circulation
A rapid assessment of peripheral perfusion and circulatory status performed by pressing on a fingernail or the skin of the palm and measuring how quickly the color returns after pressure is released; normal is less than 2 seconds. Delayed capillary refill (>2 seconds) suggests reduced peripheral perfusion from shock, hypothermia, or arterial occlusion. CRT is a component of the circulatory assessment in the MARCH framework and is used alongside mental status and skin color/temperature assessment.
Carotid Artery Anatomy
One of the major paired arteries of the neck supplying blood to the brain, face, and neck; the common carotid artery divides into the internal and external carotid arteries at the level of the thyroid cartilage. Penetrating trauma to the carotid artery is immediately life-threatening and may cause both exsanguination and stroke. Hemorrhage control at the carotid requires wound packing and manual pressure, as tourniquets cannot be applied to the neck.
CASEVAC (Casualty Evacuation) Military Medical
The unregulated movement of casualties from the point of injury aboard non-dedicated medical vehicles, aircraft, or watercraft, typically performed when dedicated MEDEVAC assets are unavailable. CASEVAC platforms may be any available vehicle and do not require medical personnel to be present, though a trained combat medic or corpsman may accompany when available. CASEVAC is distinguished from MEDEVAC in that the transporting platform has no designated medical role.
Casualty Card Military Medical
A standardized military medical documentation form (DD Form 1380 / TCCC Casualty Card) used to record a casualty's injuries, vital signs, and treatments administered in the field. The card accompanies the casualty through the chain of evacuation to ensure continuity of care and prevent duplication of medications such as opioids or antibiotics. Accurate completion of the casualty card is a critical step in the transition of care from field to hospital.
CAT (Combat Application Tourniquet) Equipment
A widely-used, CoTCCC-approved one-handed windlass tourniquet designed for rapid application to extremities to control life-threatening hemorrhage. The CAT (Generation 7) features a self-adhering band, a windlass rod, and a time-of-application label, and can be applied in seconds by the casualty themselves using one hand. It is the most commonly issued tourniquet in the U.S. military and a standard component of individual first aid kits (IFAKs).
Shop CAT Gen 7 Tourniquet →Cervical Spine Anatomy
The uppermost seven vertebrae (C1–C7) of the spinal column located in the neck, protecting the spinal cord and supporting the skull. Cervical spine injuries from high-energy trauma can cause quadriplegia or death if the spinal cord is damaged. Spinal motion restriction (previously called spinal immobilization) may be indicated in high-risk mechanism-of-injury patients, though modern tactical guidelines emphasize selective application based on clinical assessment.
Chain of Survival EMS Systems
A conceptual framework developed by the American Heart Association describing six sequential links that maximize survival from cardiac arrest: early recognition and activation of emergency response, immediate CPR, rapid defibrillation, advanced resuscitation by EMS providers, post-cardiac arrest care, and recovery. Each link in the chain must function effectively to optimize patient outcomes. Strengthening every link through community training and rapid EMS response directly improves survival rates.
Chest Seal Equipment
A vented or non-vented occlusive dressing designed to cover open chest wounds (sucking chest wounds) caused by penetrating thoracic trauma. Vented chest seals allow trapped air to escape the pleural space during exhalation while preventing air entry on inhalation, reducing the risk of tension pneumothorax. CoTCCC-approved devices include the Hyfin Vent, Bolin, and Russell Chest Seal; they are a critical component of TCCC casualty management.
Shop Chest & Thoracic Supplies →ChitoGauze Equipment
A hemostatic dressing impregnated with chitosan, a naturally derived biopolymer from shellfish shells that promotes rapid clot formation by attracting and concentrating red blood cells and platelets at the wound site. ChitoGauze is a CoTCCC-acceptable alternative to Combat Gauze for wound packing in combat casualties. The chitosan mechanism is positive-charge based and works effectively even in anticoagulated patients by physically concentrating clotting components independent of the coagulation cascade.
Shop Hemostatic Agents →Clamshell Thoracotomy Procedures
A bilateral anterior thoracotomy that opens the entire chest cavity by cutting across both sides of the sternum to provide maximum surgical exposure for emergent cardiac and great vessel repair in traumatic cardiac arrest. The clamshell thoracotomy is reserved for the most extreme resuscitative cases and is performed in an operating room by a trauma surgeon. It allows direct cardiac massage, control of pulmonary hemorrhage, aortic cross-clamping, and release of cardiac tamponade.
Shop Chest & Thoracic Supplies →CLS (Combat Lifesaver) Military Medical
A non-medical military soldier trained to provide enhanced first aid capabilities beyond basic buddy aid, bridging the gap between untrained personnel and the combat medic. CLS training (TCCC-CLS, Tier 2) is a 40-hour program that includes tourniquet application, hemorrhage control, airway management, IV access, and needle decompression. CLS-trained soldiers are assigned throughout combat units to increase the density of trained medical responders.
Coagulopathy Circulation
A pathological condition in which the blood's ability to clot is impaired, dramatically worsening hemorrhage in trauma patients. Trauma-induced coagulopathy is exacerbated by the 'lethal triad' of hypothermia, acidosis, and hemodilution from excessive crystalloid resuscitation. Treatment includes administration of blood products, tranexamic acid (TXA), and damage control resuscitation strategies.
Combat Gauze Equipment
A kaolin-impregnated hemostatic gauze produced by Z-Medica and designated as the first-line hemostatic dressing by the Committee on TCCC (CoTCCC) for hemorrhage that cannot be controlled with a tourniquet. Kaolin activates the intrinsic clotting pathway to accelerate clot formation when the gauze is packed tightly into a wound. Combat Gauze is widely issued to U.S. military personnel and is a standard in trauma and tactical medical kits.
Shop Hemostatic Agents →Communicable Disease Military Medical
An illness caused by a pathogen (bacteria, virus, parasite, or fungus) that can be transmitted from one host to another through direct contact, respiratory droplets, vector-borne transmission, or contaminated food and water. In deployed military and wilderness medicine contexts, communicable diseases including malaria, typhoid, hepatitis, and diarrheal illnesses cause more casualties than combat injury in some environments. Standard precautions (PPE, hand hygiene) and prophylactic medications are critical preventive measures.
Compression Bandage Equipment
A pressure dressing designed to maintain direct pressure over a wound to control hemorrhage, secure hemostatic gauze in place, and absorb blood. Examples include the Israeli Bandage (Emergency Bandage) and the H&H Medical OLAES bandage. Compression bandages are used in conjunction with wound packing or as standalone pressure dressings for moderate bleeding injuries.
Shop Bandages & Dressings →Concussion Trauma Care
A mild traumatic brain injury (mTBI) caused by a blow or jolt to the head that temporarily disrupts normal brain function, resulting in symptoms such as headache, confusion, dizziness, nausea, and amnesia. In tactical settings, blast-induced concussion is the most common combat injury and can significantly impair a soldier's cognitive and physical performance. Concussed individuals must be monitored closely as repeated concussions increase the risk of chronic traumatic encephalopathy (CTE) and more severe brain injury.
CoTCCC (Committee on Tactical Combat Casualty Care) Military Medical
The U.S. military advisory body responsible for developing, reviewing, and updating the evidence-based guidelines that govern Tactical Combat Casualty Care. CoTCCC guidelines inform which medical interventions, medications, and equipment are recommended for battlefield use at each provider level. The committee's recommendations have been credited with reducing preventable combat death rates significantly since their adoption.
CPR (Cardiopulmonary Resuscitation) General First Aid
An emergency procedure combining chest compressions and rescue breaths to maintain circulation and oxygenation in a patient who has experienced cardiac arrest. Current American Heart Association guidelines recommend a compression-to-ventilation ratio of 30:2 for adults, with high-quality compressions at a rate of 100–120 per minute and a depth of at least 2 inches. CPR maintains minimal perfusion to the brain and vital organs until definitive care (defibrillation, advanced life support) can be delivered.
Shop AEDs & Resuscitation →Cricothyrotomy Airway Management
A surgical airway procedure in which an incision is made through the cricothyroid membrane to create an emergency airway when conventional methods have failed. In TCCC, surgical cricothyrotomy is the definitive airway of choice when an unconscious casualty cannot be ventilated by other means. It is faster and safer than an emergency tracheotomy and represents the last resort in a 'cannot intubate, cannot oxygenate' situation.
Shop Airway Management →CUF (Care Under Fire) Tactical Medicine
The first phase of Tactical Combat Casualty Care (TCCC), occurring when the casualty and responder are under direct and effective hostile fire. In this phase, the primary priority is fire superiority and moving the casualty to cover; the only medical intervention recommended is rapid tourniquet application to control life-threatening extremity hemorrhage. All other medical care is deferred until the tactical situation permits safer conditions during the Tactical Field Care phase.
D
Damage Control Resuscitation Circulation
A hemorrhage-focused resuscitation strategy designed to control bleeding, prevent coagulopathy, and restore perfusion in severely injured trauma patients by using blood products in a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets. DCR minimizes crystalloid fluid administration that can worsen coagulopathy and acidosis. It is the standard approach for hemorrhagic shock in military and trauma center settings.
DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling) Trauma Care
A systematic physical examination mnemonic used by EMS providers to methodically assess each body region for signs of traumatic injury during the detailed physical exam or secondary assessment. DCAP-BTLS guides providers to look and palpate for each specific sign during head-to-toe examination, improving thoroughness and reducing missed injuries. It is part of the secondary survey in both the ATLS and EMT patient assessment frameworks.
DD Form 1380 (Department of Defense Form 1380 (TCCC Casualty Card)) Military Medical
The standardized U.S. military field medical card used to record a casualty's mechanism of injury, assessed injuries, vital signs, and all treatments administered, which accompanies the casualty through the entire evacuation chain. The DD Form 1380 serves as a critical communication tool between field providers and receiving medical personnel, preventing medication duplication and providing a clinical record of prehospital care. It is a required component of the MIST report and 9-Line MEDEVAC communication.
Decompression Needle Equipment
A large-bore needle (typically 14-gauge, 3.25-inch or longer) inserted into the pleural space to relieve a tension pneumothorax by allowing trapped air to escape. Current TCCC guidelines recommend insertion at the second intercostal space, midclavicular line, or the fourth/fifth intercostal space, anterior axillary line. Needle decompression is a life-saving procedure indicated whenever tension pneumothorax is suspected in a hemodynamically deteriorating casualty.
Defibrillation Procedures
The delivery of a therapeutic electrical shock to the heart to terminate ventricular fibrillation or pulseless ventricular tachycardia and allow the heart's intrinsic pacemaker to restore an organized rhythm. Early defibrillation is the most effective treatment for ventricular fibrillation, with survival rates declining approximately 10% for every minute without defibrillation. Defibrillation is delivered by AEDs (automated external defibrillators) or manual defibrillators operated by trained providers.
Definitive Airway Airway Management
An endotracheal tube or surgical airway device that provides a secured, protected airway, preventing aspiration and ensuring reliable ventilation in an unconscious or compromised patient. Definitive airways include endotracheal intubation and surgical cricothyrotomy. In TCCC, a definitive airway is established when basic airway maneuvers and adjuncts (NPA, positioning) are insufficient to maintain a patent airway.
Shop Airway Management →Deltoid Anatomy
The triangular muscle covering the shoulder joint, commonly used as an intramuscular injection site for medications such as ketamine, morphine, and epinephrine in field and tactical medical settings. The deltoid's accessibility and predictable landmark anatomy make it a practical IM injection site even under battlefield conditions. It is one of three IM sites recommended in TCCC alongside the vastus lateralis and anterolateral thigh.
Dextrose Pharmacology
A simple sugar (glucose) administered intravenously to rapidly correct life-threatening hypoglycemia (low blood sugar), which can cause altered mental status, seizures, and death indistinguishable from other causes of unconsciousness. In tactical and wilderness medicine, a rapid glucose assessment using a point-of-care glucometer helps identify hypoglycemia as a treatable cause of unconsciousness before more invasive interventions are performed. Dextrose is part of the standard prehospital drug formulary and can be administered IV or IO.
Direct Threat Care Tactical Medicine
The civilian law enforcement tactical equivalent of TCCC's Care Under Fire phase, used in TECC (Tactical Emergency Casualty Care) protocols. During direct threat care, responders are still actively under fire or in an immediate threat environment; only the most critical, life-saving interventions (primarily tourniquet application) are performed. This phase of TECC was developed to apply battlefield medical concepts to law enforcement and civilian active-threat scenarios.
Dislocation Trauma Care
An injury in which the articulating bones of a joint are forced out of their normal anatomical alignment, causing pain, deformity, swelling, and neurovascular compromise. Common tactical and trauma-related dislocations include the shoulder, hip, and patella. Field management includes splinting in the position of comfort, neurovascular assessment, and evacuation for reduction under controlled conditions.
Distal Pulse Circulation
The palpable arterial pulse assessed at a location distal (further from the body center) to an injury, tourniquet, or splint, used to evaluate whether adequate distal perfusion is maintained in an injured extremity. Assessment of distal pulses (radial at the wrist, dorsalis pedis/posterior tibial at the foot) is a critical step after tourniquet application to confirm arterial occlusion, and after splinting or reduction of fractures/dislocations to ensure neurovascular integrity. Loss of a previously present distal pulse after splinting requires immediate reassessment and loosening.
DOTS (Deformities, Open Injuries, Tenderness, Swelling) Wilderness Medicine
A focused physical assessment mnemonic used in wilderness and remote medicine, as well as in general prehospital care, to evaluate specific body regions for signs of traumatic injury during patient palpation. DOTS directs the provider to identify Deformities (structural abnormalities), Open Injuries (wounds, fractures), Tenderness (pain on palpation), and Swelling (edema or hematoma). It is similar to DCAP-BTLS and guides systematic trauma assessment in field environments.
Drowning Marine Medicine
A process of respiratory impairment resulting from submersion or immersion in a liquid medium, which can be fatal or non-fatal (previously called 'near-drowning'). In military and maritime contexts, drowning management prioritizes restoring oxygenation above all other interventions, including compressions — rescue breaths are delivered first for submersion cardiac arrest. Water temperature significantly affects survival time, with cold water providing some cerebral protection due to the diving reflex.
Drowning Management Marine Medicine
The specialized resuscitation approach for submersion victims that prioritizes airway management and rescue breathing before chest compressions, differing from standard cardiac arrest protocols because drowning cardiac arrest is primarily hypoxic in origin. Key priorities include early rescue from the water, removing wet clothing, providing supplemental oxygen, and delivering rescue breathing or CPR as indicated. In cold-water drowning, resuscitation should continue until the patient is rewarmed to at least 30°C/86°F before declaring death, as the hypothermia provides some cerebral protection.
Duress Dressing General First Aid
An informal term sometimes used for an emergency or improvised pressure dressing constructed from available materials when standard trauma dressings are unavailable. In austere or resource-limited environments, clothing, bandanas, and other absorbent materials can be used to control hemorrhage through direct pressure until proper dressings are obtained. Improvised dressings do not perform as effectively as commercial hemostatic products but are preferable to no intervention.
E
EMS (Emergency Medical Services) EMS Systems
A system of coordinated out-of-hospital emergency care including dispatch, first responder, EMT, and paramedic response to medical emergencies and trauma. EMS systems are organized to provide rapid prehospital assessment, stabilization, and transport to definitive care, and vary significantly in training levels, protocols, and resources by region. In the United States, EMS is regulated primarily at the state level with national standardization provided by NHTSA guidelines and NREMT certification.
EMT (Emergency Medical Technician) Certifications & Training
The foundational level of prehospital emergency medical certification in the United States, trained to provide basic life support including CPR, airway management, hemorrhage control, splinting, and patient assessment. EMTs typically complete approximately 150 hours of training and are essential members of emergency response teams, ambulance crews, and tactical medical units. Certification is maintained through the National Registry of Emergency Medical Technicians (NREMT).
Endotracheal Intubation Airway Management
The placement of a flexible plastic tube (endotracheal tube or ETT) through the mouth or nose, past the vocal cords, and into the trachea to establish a secured, definitive airway for ventilation and airway protection. Intubation is performed using laryngoscopy and may be facilitated by rapid sequence induction (RSI) medications in the clinical setting. In TCCC, surgical cricothyrotomy is often preferred over intubation in the field due to the difficulty and equipment requirements of laryngoscopy in austere environments.
Shop Airway Management →Epaulette Tourniquet Hemorrhage Control
An improvised tourniquet technique using a belt, cravat, or piece of clothing applied to control junctional hemorrhage at the shoulder or hip when commercial junctional tourniquets are unavailable. While not as effective as CoTCCC-approved devices, improvised junctional tourniquets provide a life-saving stopgap in austere environments. Training in improvised tourniquets is part of extended first aid and TCCC supplemental curricula.
Shop Tourniquets →Epinephrine Pharmacology
A naturally occurring catecholamine hormone and medication used as the first-line treatment for anaphylaxis, cardiac arrest, and severe bronchospasm. In anaphylaxis, intramuscular epinephrine (0.3 mg for adults) is administered into the anterolateral thigh to reverse airway compromise, bronchospasm, and hypotension. Auto-injectors (EpiPen) allow lay responders and tactical personnel to administer epinephrine quickly in the field.
Escharotomy Procedures
A surgical procedure that involves incising the eschar (hardened, dead skin) of a circumferential burn to release the constrictive tissue and restore distal circulation or chest wall compliance for ventilation. Circumferential burns to extremities can cause compartment syndrome and limb ischemia, while circumferential chest burns can restrict breathing. Escharotomy is typically performed at a burn center or by an advanced medical provider in an austere setting when evacuation is significantly delayed.
Evacuation Care Tactical Medicine
The TECC (Tactical Emergency Casualty Care) phase equivalent to TACEVAC in TCCC, encompassing care delivered to a casualty during transport from the scene of injury to a medical treatment facility or definitive care center. During evacuation care, more advanced monitoring and interventions become possible as the immediate threat is removed. Providers reassess all injuries and previous interventions, manage pain, and prepare the patient for handoff to receiving providers.
Evacuation Priority Military Medical
The urgency classification assigned to a military casualty to determine the timeline for evacuation to a higher level of medical care: Urgent (within 2 hours, life-threatening injury), Urgent Surgical (within 2 hours, requires immediate surgery), Priority (within 4 hours, will deteriorate without evacuation), Routine (within 24 hours), and Convenience (administrative movement). Evacuation priority is transmitted as part of the 9-Line MEDEVAC request and directly drives the allocation of evacuation assets. Misclassification of evacuation priority can delay life-saving care or unnecessarily divert resources.
Exsanguination Hemorrhage Control
Severe or total loss of blood volume resulting in death or near-death; the most common cause of preventable combat death. Exsanguination from extremity wounds is addressed by tourniquet application, while junctional and non-compressible hemorrhage (truncal, thoracic, abdominal) is managed with hemostatic dressings, wound packing, and damage control surgery. The concept of the 'golden hour' emphasizes the critical importance of rapid hemorrhage control and surgical intervention to prevent death from exsanguination.
Shop Hemorrhage Control →EZ-IO Equipment
A battery-powered intraosseous vascular access device manufactured by Teleflex that uses a drill to insert a special needle through the cortex of the bone (typically the proximal tibia or humerus) and into the medullary cavity, allowing rapid vascular access when IV insertion has failed or is impractical. EZ-IO access can be established in approximately 30–60 seconds and allows for the infusion of fluids, blood products, and emergency medications. It is approved for use across the lifespan and is standard equipment on many advanced life support units and in military medical kits.
F
Femoral Artery Anatomy
The largest artery of the lower extremity, running through the femoral triangle in the groin (inguinal region) and continuing down the thigh. Hemorrhage from the femoral artery is a leading cause of preventable death in both combat and civilian trauma and is classified as junctional bleeding that may require a junctional tourniquet, wound packing, and direct pressure. Femoral artery pulse assessment is also used to evaluate lower extremity perfusion and shock severity.
Femur Fracture Trauma Care
A fracture of the femur (thigh bone), the largest and strongest bone in the body, which carries a life-threatening risk of hemorrhage of up to 1–2 liters of blood into the thigh from associated vessel damage. Femur fractures typically result from high-energy trauma and present with pain, deformity, swelling, and inability to bear weight. Traction splints are the preferred field treatment to reduce fracture displacement, decrease pain, and limit internal hemorrhage by restoring femoral length.
Fentanyl Pharmacology
A synthetic opioid analgesic 50–100 times more potent than morphine, used in tactical and military medicine for rapid pain management in combat casualties. Oral transmucosal fentanyl citrate (OTFC), also known as the 'fentanyl lollipop,' allows self-administration for mildly injured, conscious casualties in TCCC protocols. As a potent respiratory depressant, fentanyl requires careful monitoring and access to naloxone for reversal in cases of overdose.
Field Amputation Procedures
An emergency surgical amputation of a limb performed in the field or in an austere environment when the limb is non-viable, severely damaged, or preventing the extraction of a trapped casualty with other life-threatening injuries. Field amputations are extremely rare, high-risk procedures reserved for the most dire circumstances such as entrapment scenarios and are performed by surgeons or advanced medical providers using damage control principles. Post-operative hemorrhage control, infection prevention, and rapid evacuation are critical considerations.
Field Dressing Equipment
A sterile, absorbent bandage issued to military personnel and first responders for the initial treatment of wounds, cuts, and abrasions in the field. Field dressings provide basic wound coverage and direct pressure but are not hemostatic and should be augmented with wound packing and hemostatic agents for significant hemorrhage. The basic military field dressing (BFD) has largely been replaced in tactical kits by more advanced hemostatic gauze and pressure dressings.
Flail Chest Trauma Care
A life-threatening chest injury in which three or more consecutive ribs are fractured in two or more places, creating a free-floating segment that moves paradoxically opposite to the rest of the chest wall during respiration. Flail chest impairs ventilation and is almost always associated with underlying pulmonary contusion. Management includes adequate analgesia, positive pressure ventilation if indicated, and monitoring for the development of pneumothorax or hemothorax.
Fluid Resuscitation Circulation
The intravenous or intraosseous administration of fluids to replace lost blood volume in hemorrhagic shock, guided by the principles of damage control resuscitation and permissive hypotension. Current TCCC guidelines recommend blood products (whole blood or component therapy) over crystalloids, as crystalloids worsen coagulopathy. Permissive hypotension targets a systolic blood pressure of 80–90 mmHg in hemorrhagic shock to prevent clot disruption while maintaining brain perfusion.
Forward Surgical Team Military Medical
A small, mobile military surgical unit (FST) capable of performing emergency damage control surgery close to the front line, consisting of approximately 20 personnel including surgeons, anesthesiologists, nurses, and operating room technicians. FSTs provide the first surgical capability in the chain of care for combat casualties and can perform hemorrhage control surgery within the 'golden hour' of injury. They represent Role 2 medical capability in the military health system taxonomy.
Frostbite Wilderness Medicine
A cold-induced tissue injury caused by the freezing of skin and underlying tissues, most commonly affecting the extremities, ears, nose, and cheeks during prolonged exposure to sub-freezing temperatures. Frostbite is classified as superficial (frostnip, first- and second-degree) or deep (third- and fourth-degree), with deep frostbite potentially resulting in tissue loss and amputation. Field management includes passive rewarming, protection from refreezing, and evacuation; active rewarming should only be initiated if refreezing can be reliably prevented.
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GCS (Glasgow Coma Scale) Trauma Care
A standardized neurological assessment tool that evaluates a patient's level of consciousness based on three parameters: eye opening (1–4), verbal response (1–5), and motor response (1–6), with scores ranging from 3 (deep coma) to 15 (fully alert). GCS scores guide triage decisions, monitor injury severity over time, and communicate neurological status between providers. A GCS score of ≤8 generally indicates the need for airway protection through endotracheal intubation.
Glasgow Coma Scale Trauma Care
See GCS (Glasgow Coma Scale). A standardized 15-point neurological assessment tool used to evaluate level of consciousness based on eye opening, verbal response, and motor response, with scores below 8 generally indicating severe brain injury requiring airway protection. The GCS was developed in 1974 by Teasdale and Jennett and is the most widely used neurological assessment scale in emergency and critical care medicine.
Golden Hour Trauma Care
The critical time window — originally conceptualized as the first 60 minutes after severe trauma — during which definitive surgical intervention and hemorrhage control can most dramatically improve survival outcomes. Coined by trauma surgeon R Adams Cowley, the concept underscores the importance of rapid prehospital care, triage, and transport to a trauma center. In modern tactical medicine, the 'platinum ten minutes' further emphasizes the most critical early interventions, recognizing that hemorrhage control in the first minutes is even more impactful.
Guedel Airway Airway Management
A rigid, curved oropharyngeal airway device (OPA) designed to maintain airway patency in unconscious patients by preventing the tongue from occluding the pharynx, named after its inventor Arthur Guedel. Guedel airways are color-coded by size (with size 3 for average adults) and are one of the most commonly used airway adjuncts in emergency and resuscitation care. They must only be used in patients without a gag reflex to avoid aspiration.
Shop Airway Management →H
HACE (High Altitude Cerebral Edema) Wilderness Medicine
A severe, life-threatening form of altitude illness in which fluid accumulates in the brain due to hypoxia at high altitude, typically above 12,000 feet. Symptoms progress from severe headache and ataxia to altered consciousness, seizures, and coma if untreated. Immediate descent of at least 1,000–1,500 feet is the definitive treatment, supplemented by supplemental oxygen and dexamethasone when available.
HAPE (High Altitude Pulmonary Edema) Wilderness Medicine
A non-cardiogenic pulmonary edema that develops at high altitude due to hypoxia-induced pulmonary vasoconstriction and abnormal capillary leakage into the alveoli, the leading cause of high-altitude death. Clinical features include dyspnea at rest, cough with pink frothy sputum, tachycardia, and cyanosis. Immediate descent, supplemental oxygen, and the medication nifedipine are the primary treatments; HAPE is reversible if treated promptly.
Hartford Consensus EMS Systems
A joint policy statement issued by the American College of Surgeons and law enforcement leadership following the Sandy Hook Elementary School shooting (2012), establishing the THREAT protocol (Threat suppression, Hemorrhage control, Rapid Extrication, Assessment by medical providers, Transport) and recommending immediate bystander hemorrhage control as a national priority. The Hartford Consensus drove expansion of Stop the Bleed training, TECC adoption by law enforcement, and placement of bleeding control kits in public spaces. It fundamentally changed the civilian response framework for mass casualty events.
Head-Tilt Chin-Lift Airway Management
A basic manual airway maneuver performed by tilting the head backward and lifting the chin forward to displace the tongue from the posterior pharynx and open the airway in an unconscious patient without suspected cervical spine injury. The head-tilt chin-lift is the primary airway maneuver taught in BLS and CPR courses and is the first step in managing an unconscious patient's airway before using airway adjuncts. In patients with suspected cervical spine injury, the jaw thrust is preferred.
Shop Airway Management →HEEDS (Helicopter Emergency Egress Device System) Marine Medicine
A compact, emergency underwater breathing device used by military helicopter crews and maritime personnel to provide several minutes of compressed air during underwater helicopter egress after ditching in water. HEEDS bottles provide approximately 5–7 breaths at the surface but less at depth due to increasing air consumption under pressure. Regular training in helicopter underwater escape techniques (HUET) combined with HEEDS significantly improves survival in helicopter ditching scenarios.
Heimlich Maneuver General First Aid
An abdominal thrust technique used to dislodge a foreign body obstructing the airway of a conscious, choking victim. Performed by standing behind the victim and delivering rapid inward-and-upward thrusts with both hands positioned between the navel and the lower ribcage. The technique is not recommended for infants, pregnant women, or unconscious individuals, for whom alternative airway clearance methods are used.
Hemorrhagic Shock Trauma Care
A form of hypovolemic shock caused by acute blood loss that results in inadequate tissue perfusion, classified into four classes based on estimated blood loss: Class I (<750 mL, minimal symptoms), Class II (750–1500 mL, anxiety, tachycardia), Class III (1500–2000 mL, confusion, hypotension, tachycardia), and Class IV (>2000 mL, lethargy, severe hypotension, potentially fatal). Treatment priorities follow the MARCH algorithm: immediate hemorrhage control, fluid resuscitation (blood products preferred in severe cases), and surgical or definitive hemorrhage control. The triad of hypothermia, acidosis, and coagulopathy—the 'lethal triad'—dramatically worsens outcomes in hemorrhagic shock.
Hemostasis Hemorrhage Control
The physiological process by which bleeding is stopped through a combination of vascular constriction, platelet aggregation, and coagulation cascade activation to form a stable blood clot. In trauma care, external hemostasis is achieved through tourniquets, wound packing, direct pressure, and hemostatic agents, while internal hemostasis may require surgery or embolization. Impaired hemostasis (coagulopathy) dramatically worsens outcomes in traumatic hemorrhage.
Shop Hemostatic Agents →Hemostatic Agent Hemorrhage Control
A substance or dressing that promotes blood clotting and stops hemorrhage through physical or biochemical mechanisms, used when direct pressure alone is insufficient. Current CoTCCC-recommended hemostatic dressings include Combat Gauze (kaolin-impregnated) for wound packing, with ChitoGauze (chitosan) as an acceptable alternative. Hemostatic agents are indicated for junctional wounds, truncal wounds, and extremity wounds where tourniquets cannot be applied.
Shop Hemostatic Agents →Hemothorax Trauma Care
An accumulation of blood in the pleural space between the lung and chest wall, most commonly caused by penetrating or blunt thoracic trauma lacerating pulmonary or intercostal vessels. Unlike tension pneumothorax, hemothorax presents with dull percussion of the affected side, flat neck veins (due to volume depletion), and decreased breath sounds. Definitive treatment is tube thoracostomy to drain the blood and re-expand the lung; a massive hemothorax (>1,500 mL) requires immediate surgical exploration.
High-and-Tight Hemorrhage Control
A tourniquet application technique in which the device is placed as proximally as possible on a limb (high) and tightened until bleeding stops (tight), without regard for the precise location of the wound. The high-and-tight method is recommended when the exact wound location is unknown, when wounds are in proximity to the groin or axilla, and in the rapid, one-handed self-application scenario during Care Under Fire. This technique minimizes time while maximizing effectiveness.
Shop Hemorrhage Control →High-Flow Oxygen Procedures
Supplemental oxygen delivered at flow rates of 10–15 liters per minute via a non-rebreather mask, providing oxygen concentrations of approximately 60–90%, used for patients with significant hypoxemia, respiratory distress, or major trauma. High-flow oxygen is indicated in TCCC for casualties with traumatic brain injury, oxygen saturation below 90%, or significant respiratory compromise. It is also a component of treatment for diving-related injuries (decompression illness, arterial gas embolism) and carbon monoxide poisoning.
Hypothermia Wilderness Medicine
A dangerous reduction in core body temperature below 35°C (95°F), caused by cold environmental exposure, wet clothing, immersion, and blood loss, which impairs coagulation, cardiac function, and cognitive performance. Hypothermia is one component of the 'lethal triad' (along with acidosis and coagulopathy) that dramatically increases mortality in trauma patients. Prevention and treatment involve removing wet clothing, applying insulating blankets and vapor barriers, administering warm IV fluids when possible, and avoiding unnecessary patient exposure.
Hypovolemic Shock Circulation
A life-threatening state of circulatory failure resulting from significant blood or fluid loss that reduces cardiac output and tissue oxygen delivery below metabolic requirements. In trauma, hemorrhagic shock is the most common form of hypovolemic shock and is classified into four classes based on estimated blood loss (Class I–IV). Management follows the principles of damage control resuscitation: control hemorrhage first, then restore volume with blood products.
I
ICS (Incident Command System) EMS Systems
A standardized, on-scene emergency management system designed to allow different agencies and disciplines to work together effectively during multi-agency emergency responses, including mass casualty incidents. ICS establishes a clear chain of command, defined roles (Incident Commander, Operations, Logistics, Finance, Planning), and common terminology to reduce confusion. It is mandated for use in all FEMA/NIMS-guided responses in the United States and is integral to EMS MCI management.
IFAK (Individual First Aid Kit) Equipment
A compact, standardized medical kit issued to individual military personnel or carried by law enforcement officers and civilians for immediate self-aid or buddy aid, typically containing a tourniquet, hemostatic dressing, chest seal, NPA, pressure bandage, and trauma shears. IFAK contents are designed to address the most common preventable causes of combat death identified in the Hartford Consensus and TCCC data. Proper training in the use of IFAK contents is essential, as equipment alone without competency does not improve outcomes.
Shop IFAK Kits →Immersion Hypothermia Marine Medicine
Rapid body heat loss caused by cold water immersion, which extracts heat from the body approximately 25 times faster than air at the same temperature. In maritime emergencies, survival time in cold water is measured in minutes to hours depending on water temperature, and loss of meaningful motor function typically precedes loss of consciousness. Management includes rapid extraction from the water, removal of wet clothing, and active rewarming while preventing 'post-rescue collapse' from sudden circulatory changes.
Improvised Explosive Device Military Medical
A homemade explosive weapon assembled from commercial, military, or improvised components, responsible for the majority of combat casualties in the Iraq and Afghanistan conflicts. IED blast injuries produce unique multi-system injury patterns including traumatic amputations, blast lung injury, traumatic brain injury, and penetrating fragment wounds, challenging medical providers with simultaneous hemorrhage, airway, and neurological emergencies. Understanding IED injury patterns is critical for tactical medical providers planning equipment loadouts and training.
Indirect Threat Tactical Medicine
In TECC terminology, a threat situation where the immediate active threat has been suppressed but the scene remains potentially unsafe, corresponding to the Tactical Field Care phase of TCCC. During indirect threat care, providers can begin a more systematic MARCH PAWS assessment while maintaining situational awareness for renewed threats. The transition from direct to indirect threat care is based on operational intelligence, not the completion of medical care.
Indirect Threat Care Tactical Medicine
The TECC phase occurring after the immediate threat has been suppressed but the scene is not yet fully secure, equivalent to the Tactical Field Care phase of TCCC. During indirect threat care, responders can perform a more thorough assessment and implement a wider range of interventions, including airway management, IV access, and chest decompression. This phase transitions to evacuation care once the patient is being transported from the scene.
Intubation Airway Management
The process of inserting a tube into the trachea (endotracheal intubation) or other body passage to maintain an open airway, facilitate mechanical ventilation, or administer anesthetic gases. In emergency and tactical medicine, orotracheal intubation using direct laryngoscopy or video laryngoscopy is the most common method for securing a definitive airway. RSI (Rapid Sequence Intubation) with sedation and neuromuscular blockade is the preferred technique for emergency intubation in patients who are not in cardiac arrest.
Shop Airway Management →IO (Intraosseous) Circulation
A vascular access route in which a needle is inserted through the cortex of a bone and into the medullary (bone marrow) cavity, providing rapid venous access equivalent to a central venous line for the delivery of fluids, blood products, and medications. IO access is recommended when peripheral IV access cannot be established quickly in critically ill or injured patients, particularly in pediatric resuscitation and hemorrhagic shock. Common IO sites include the proximal tibia, proximal humerus, and distal femur; insertion devices such as the EZ-IO drill make placement rapid and reliable.
Shop IV/IO & Transfusion Supplies →Ischemia Anatomy
Insufficient blood flow to a tissue or organ resulting in oxygen and nutrient deprivation and, if prolonged, irreversible tissue death (necrosis). In extremity trauma, ischemia distal to a tourniquet, vascular injury, or compartment syndrome causes progressive muscle and nerve damage, with irreversible injury occurring after approximately 4–6 hours of complete ischemia. Rapid hemorrhage control, vascular repair, and tourniquet time management are essential to minimize ischemic injury.
ITLS (International Trauma Life Support) Certifications & Training
A prehospital trauma care training program designed for EMTs, paramedics, and other emergency providers that focuses on rapid systematic assessment and life-saving interventions for trauma patients. ITLS teaches a structured rapid trauma survey, spinal motion restriction, hemorrhage control, airway management, and shock treatment using a priority-based approach. The ITLS curriculum is evidence-based and continually updated to reflect current trauma research.
IV (Intravenous) Circulation
The direct delivery of fluids, blood products, or medications into a peripheral or central vein via a catheter or needle, providing immediate systemic distribution. IV access is a critical skill in emergency, tactical, and hospital medicine for hemorrhage control, fluid resuscitation, and drug administration. In tactical medicine, a saline lock (IV catheter with a capped port rather than running fluid) is the preferred method of maintaining IV access in the field to allow medication delivery without continuous fluid administration.
Shop IV/IO & Transfusion Supplies →J
Jaw Thrust Airway Management
An airway maneuver performed by placing the fingers behind the angles of the mandible and pushing the jaw forward to displace the tongue from the posterior pharynx and open the airway without extending the neck. The jaw thrust is preferred over the head-tilt chin-lift in patients with suspected cervical spine injury, as it minimizes neck movement. In TCCC, the jaw thrust is a primary airway intervention for unconscious casualties during Tactical Field Care.
Shop Airway Management →JETT (Junctional Emergency Treatment Tool) Equipment
A CoTCCC-approved junctional tourniquet device designed to apply targeted pressure over the femoral vessels in the inguinal region to control otherwise uncontrollable junctional hemorrhage in the groin. The JETT consists of a belt with an inflatable balloon bladder that is positioned over the femoral triangle and inflated to compress the femoral artery and vein against the underlying bone. It can be applied by a single provider and is approved for both femoral and abdominal aortic compression.
JTS (Joint Trauma System) Military Medical
The U.S. Department of Defense organization responsible for continuously improving trauma care outcomes for military personnel by collecting data, developing clinical practice guidelines, and overseeing the implementation of evidence-based trauma care across the military health system. The JTS maintains the DoD Trauma Registry and collaborates with the Committee on TCCC (CoTCCC) to update prehospital care guidelines. It is the primary driving force behind military trauma care innovation.
Jugular Vein Distension Anatomy
Visible engorgement of the external jugular veins in the neck, indicating elevated central venous pressure caused by obstruction of venous return to the heart. In trauma, JVD combined with hypotension and absent breath sounds on one side is a classic sign of tension pneumothorax; JVD with muffled heart sounds and hypotension suggests cardiac tamponade. The absence of JVD in hemorrhagic shock is notable as a sign of volume depletion.
JumpSTART EMS Systems
A pediatric modification of the START triage algorithm designed for children up to approximately 8 years of age in mass casualty incidents, accounting for developmental differences in vital signs and breathing patterns. JumpSTART was developed in 1995 and incorporates rescue breathing for children who are apneic but have a palpable pulse, recognizing that respiratory arrest precedes cardiac arrest in pediatric patients more commonly than in adults. It uses the same color-coding system (Red, Yellow, Green, Black) as START.
Junctional Hemorrhage Hemorrhage Control
Life-threatening bleeding at anatomical junctions where standard limb tourniquets cannot be applied, specifically the groin, axilla (armpit), neck, and junctional zones between the torso and extremities. Junctional hemorrhage is a leading cause of preventable combat death and requires specialized management including wound packing with hemostatic gauze, junctional tourniquets (such as the JETT or SAM JT), and manual pressure. It is addressed in the 'M' (Massive Hemorrhage) phase of the MARCH assessment.
Shop Hemorrhage Control →Junctional Tourniquet Equipment
A specialized device designed to control junctional hemorrhage in the groin or axilla where standard limb tourniquets cannot be placed, using targeted compression over arterial pressure points. CoTCCC-approved devices include the Combat Ready Clamp (CRoC), the Junctional Emergency Treatment Tool (JETT), and the SAM Junctional Tourniquet. These devices apply pneumatic or mechanical pressure directly over the femoral or subclavian vasculature to occlude arterial flow.
Shop Tourniquets →K
Ketamine Pharmacology
A dissociative anesthetic agent used in tactical and military medicine as a first-line analgesic and procedural sedative for combat casualties due to its ability to provide pain relief and sedation while maintaining airway reflexes and hemodynamic stability. TCCC protocols recommend ketamine 50 mg IM or 20 mg slow IV for moderate-to-severe pain management. Ketamine is also used at sub-anesthetic doses for field analgesia, with the 'ketamine endpoint' being cessation of pain or onset of nystagmus.
Ketamine Analgesia Pharmacology
The use of sub-anesthetic doses of ketamine for pain management in the field, providing dissociative analgesia while preserving airway reflexes, respiratory drive, and hemodynamic stability — properties that make it ideally suited for use in hemorrhagic shock and head injury patients. TCCC protocols recommend ketamine 50 mg IM or 20 mg slow IV/IO for moderate-to-severe pain, titrating to pain relief with the endpoint being nystagmus (involuntary eye movement). Ketamine's sympathomimetic properties may actually improve blood pressure in hypotensive casualties.
L
Lactated Ringer's Pharmacology
A balanced isotonic crystalloid solution closely resembling plasma electrolyte composition, containing sodium chloride, potassium, calcium, and sodium lactate, used for intravenous fluid resuscitation in trauma and surgical patients. Lactated Ringer's (LR) is preferred over normal saline for large-volume resuscitation in trauma because it causes less hyperchloremic acidosis. In TCCC, LR (or normal saline) is used when blood products are unavailable for resuscitation of casualties in hemorrhagic shock.
Shop IV/IO & Transfusion Supplies →Laryngeal Mask Airway Airway Management
A supraglottic airway device consisting of an inflatable mask that seals around the laryngeal inlet to provide a non-invasive, semi-definitive airway without endotracheal intubation. The LMA is less invasive than intubation but does not protect against aspiration as effectively as an endotracheal tube with an inflated cuff. It is used as a rescue airway when intubation fails and as a primary airway adjunct in certain emergency and anesthetic settings.
Shop Airway Management →Laryngospasm Airway Management
A sudden, involuntary spastic closure of the vocal cords causing complete airway obstruction, most commonly triggered by aspiration, intubation attempts, or pharyngeal stimulation in a partially anesthetized or drowning patient. Laryngospasm presents as high-pitched stridor or complete silence despite respiratory effort and can rapidly progress to hypoxia and cardiac arrest if untreated. Management includes jaw thrust, positive pressure ventilation, succinylcholine administration if laryngospasm is refractory, and emergency intubation or surgical airway.
Shop Airway Management →Lateral Recumbent Position General First Aid
See Recovery Position. The lateral recumbent (left or right lateral) position places an unconscious breathing patient on their side to maintain airway patency, facilitate drainage of oral secretions, and prevent aspiration. In TCCC, unconscious casualties without airway obstruction are placed in the recovery position when no airway adjunct has been placed and the casualty cannot be continuously monitored.
Lethal Triad Trauma Care
The combination of hypothermia, acidosis, and coagulopathy that synergistically worsens trauma outcomes and dramatically increases mortality in severely injured patients. Each element of the triad exacerbates the others: hypothermia impairs clotting enzyme function, acidosis reduces cardiac output and platelet aggregation, and coagulopathy prevents effective hemorrhage control. Damage control resuscitation is specifically designed to interrupt the lethal triad through blood product administration, hemorrhage control, and temperature management.
Lifesaving Intervention Trauma Care
Any immediate medical action that directly addresses a life-threatening condition and prevents death in the critical early minutes of trauma care, including tourniquet application, needle decompression, airway management, chest seal application, and hemorrhage control by wound packing. In mass casualty triage (SALT), brief lifesaving interventions are performed during the individual assessment phase before categorizing patients. The ability to perform lifesaving interventions quickly and correctly is the central objective of all TCCC and TECC training.
Ligation Procedures
A surgical procedure in which a vessel or anatomical structure is tied off to control hemorrhage, typically performed in the operating room as a component of damage control surgery. In the field, temporary vessel ligation or clamping may be performed as a life-saving last resort by advanced providers when conventional hemorrhage control fails. Field ligation requires careful technique to avoid permanent limb ischemia.
Litter Equipment
A rigid or flexible stretcher used to transport injured or incapacitated patients in tactical, military, and wilderness settings, allowing for safe movement over rough terrain with multiple carriers. Military litters include the NATO folding litter, the SKED rescue system, and improvised litters constructed from poles and materials. Proper litter carries preserve patient immobilization, prevent further injury, and are a critical component of casualty extraction from the point of injury to the casualty collection point.
LMA (Laryngeal Mask Airway) Airway Management
See Laryngeal Mask Airway. An LMA is a supraglottic airway device used to maintain an open airway in unconscious patients or as a rescue device when endotracheal intubation fails. It requires less training to insert than an endotracheal tube and can be placed without direct visualization of the vocal cords, making it valuable in difficult airway scenarios.
Shop Airway Management →Low-Blow Hemorrhage Control
Military slang for a traumatic inguinal or genital injury — a significant category of combat wound because of the proximity to major vascular structures (femoral artery) and the challenges of hemorrhage control at the perineum and groin junction. These wounds involve the most complex junctional anatomy and often require junctional tourniquets, extensive wound packing, and urgent surgical management due to the risk of femoral vessel injury and exsanguination. Tactical providers must be trained specifically in managing genital and perineal hemorrhage in combat settings.
Shop Hemorrhage Control →M
Man Overboard Marine Medicine
A maritime emergency procedure activated when a person falls into the water from a vessel, requiring immediate announcement, vessel maneuvering to return to the victim, and recovery operations. The primary medical priorities in man overboard recovery are prevention and treatment of immersion hypothermia, management of near-drowning, and trauma assessment for injuries sustained during the fall. HEEDS breathing devices, immersion suits, and crew rescue swimmer training all improve survival in man overboard incidents.
Mannitol Pharmacology
An osmotic diuretic agent administered intravenously to reduce intracranial pressure (ICP) in patients with traumatic brain injury by drawing water out of brain tissue and reducing cerebral edema. Mannitol is typically used at a dose of 0.25–1 g/kg IV when signs of elevated ICP (deteriorating neurological status, Cushing's triad) are present. Its use in the prehospital and tactical environment is limited but may be considered by advanced providers in prolonged casualty care scenarios with extended evacuation timelines.
Manual Pressure Hemorrhage Control
The application of direct physical force with gloved hands over a wound to compress bleeding vessels and promote clot formation, representing the most basic and universal form of hemorrhage control. Manual pressure is the first step in hemorrhage management and should be applied immediately to any externally bleeding wound while more definitive interventions (tourniquet, wound packing, hemostatic dressings) are prepared. Sustained direct pressure for at least 3–5 minutes is required when using hemostatic gauze to allow clot formation.
Shop Hemorrhage Control →MARCH (Massive Hemorrhage, Airway, Respirations, Circulation, Hypothermia/Head Injury) Tactical Medicine
The primary tactical trauma assessment mnemonic used in TCCC and many prehospital trauma systems to prioritize life-saving interventions in the order most likely to prevent death. Unlike the ABCDE framework used in hospital medicine, MARCH places hemorrhage control first because uncontrolled bleeding is the leading cause of preventable battlefield death. Each letter guides the responder through a systematic assessment and treatment sequence during the Tactical Field Care phase.
MARCH PAWS (Massive Hemorrhage, Airway, Respirations, Circulation, Hypothermia/Head Injury, Pain, Antibiotics, Wounds, Splinting) Tactical Medicine
The expanded TCCC assessment mnemonic that adds secondary assessment priorities (Pain management, Antibiotics, Wound care, Splinting) to the primary MARCH sequence. PAWS addresses non-life-threatening but clinically important interventions that reduce long-term morbidity once the primary life threats have been managed. The full MARCH PAWS sequence is performed during the Tactical Field Care phase when the tactical situation permits a thorough head-to-toe assessment.
MARCH-E (Massive Hemorrhage, Airway, Respirations, Circulation, Hypothermia/Head Injury, Evacuation) Tactical Medicine
An expanded version of the MARCH mnemonic that adds 'Evacuation' as a final step, emphasizing that preparing and executing patient evacuation is a critical and distinct element of the tactical trauma care sequence. MARCH-E is used by some training organizations and military units to ensure that evacuation planning, 9-Line MEDEVAC requests, and patient packaging are systematically included in the casualty care process. The evacuation step includes reassessment of all interventions and preparation of MIST reports.
MARCH-PAWS (Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia, Pain, Antibiotics, Wounds, Splinting) Military Medical
An expanded version of the MARCH algorithm used in prolonged field care scenarios, adding management of Pain (analgesics, ketamine), Antibiotics (prophylactic antibiotics for open wounds to prevent infection), Wound care (reassessment, irrigation, dressing changes), and Splinting for fracture stabilization. The PAWS additions are particularly relevant when evacuation is delayed beyond one hour, as infection prevention and long-term wound management become increasingly important. MARCH-PAWS represents the full scope of prehospital combat trauma care from point of injury through extended field stabilization.
Marine Medicine Marine Medicine
A subspecialty of emergency and operational medicine focused on medical care in maritime environments including ships, submarines, offshore platforms, and amphibious military operations. Marine medicine addresses unique challenges including limited resources, prolonged time to definitive care, immersion injuries, decompression illness, and environmental hazards specific to the sea. Military maritime medicine integrates TCCC principles with shipboard medical capabilities and naval operational medicine.
Mass Shooting Protocol EMS Systems
A coordinated response framework integrating law enforcement, fire, and EMS activities during an active-threat mass casualty event, emphasizing rapid neutralization of the threat, creation of casualty collection points in warm zones, and immediate life-saving interventions in the Hartford Consensus THREAT framework. Modern active shooter protocols use the THREAT mnemonic (Threat suppression, Hemorrhage control, Rapid Extrication, Assessment by medical providers, Transport to definitive care). Integration of TECC training into law enforcement equips officers to begin hemorrhage control before EMS can access the scene.
MCI (Mass Casualty Incident) EMS Systems
Any event in which the number of patients exceeds the immediate capacity of available medical resources, requiring triage to prioritize care for those most likely to survive with the available interventions. MCIs include natural disasters, terrorist attacks, transportation accidents, and mass shooting events. Management of MCIs requires activation of the Incident Command System (ICS) and systematic triage using START, SALT, or other recognized systems.
Shop Mass Casualty Kits →Mechanism of Action Pharmacology
The specific biochemical or physiological process by which a drug or medical intervention produces its therapeutic effect, essential knowledge for tactical and emergency medical providers selecting and administering medications. Understanding the mechanism of action allows providers to predict drug effects, anticipate side effects, recognize contraindications, and make rational treatment decisions under time pressure. For hemostatic agents, mechanisms include clotting factor concentration (chitosan), intrinsic pathway activation (kaolin), and fibrin sealants.
MEDEVAC (Medical Evacuation) Military Medical
The regulated movement of casualties by dedicated medical platforms (aircraft, vehicles, or watercraft) staffed with medical personnel that are protected under the Geneva Convention and identified by the Red Cross emblem. MEDEVAC differs from CASEVAC in that the platform is designated for medical use, carries medical equipment and trained personnel, and is a non-combatant asset under international law. The 9-Line MEDEVAC request is the standardized format for requesting evacuation and transmits critical patient and site information.
Medic Military Medical
An informal term for a military combat medic (U.S. Army Military Occupational Specialty 68W) or a general prehospital emergency medical provider. U.S. Army combat medics receive approximately 16 weeks of advanced medical training including trauma management, IV therapy, medication administration, and emergency procedures. Combat medics serve as the primary tactical medical providers at the squad and platoon level and operate under the TCCC framework.
Medical Intelligence Military Medical
Pre-mission planning information that includes the location of the nearest medical treatment facilities, expected trauma patterns for the operational environment, medical threats (infectious diseases, environmental hazards), blood product availability, and evacuation timelines. Tactical medical personnel use medical intelligence to pre-position resources, plan evacuation routes, and ensure that the appropriate medical equipment and medications are available for anticipated casualty types. Inadequate medical intelligence is a significant risk factor for poor outcomes in military and tactical operations.
Meloxicam Pharmacology
A nonsteroidal anti-inflammatory drug (NSAID) used in TCCC protocols for mild-to-moderate pain management in combat casualties who are fully alert, can protect their own airway, and are not at risk for bleeding complications. Meloxicam (15 mg oral) is a component of the TCCC analgesia ladder alongside acetaminophen and is part of the Combat Wound Medication Pack (CWMP). Unlike opioids, meloxicam does not cause respiratory depression or altered mental status.
Midline Catheter Circulation
A peripheral venous catheter approximately 8–20 cm long, inserted into the basilic, cephalic, or brachial vein in the upper arm and advanced to the axillary vein, providing intermediate-term venous access between a short peripheral IV and a central venous catheter. Midline catheters are not appropriate for rapid large-volume resuscitation due to their length, which limits flow rates, but provide reliable access for medication administration and moderate fluid therapy. They are used in extended or prolonged field care (PFC) scenarios where longer IV access is needed.
Military Tourniquet Equipment
Any CoTCCC-approved windlass-type tourniquet designed specifically for rapid, one-handed application on the battlefield to control extremity hemorrhage, including the Combat Application Tourniquet (CAT), SOF-T Wide, and SAM XT. Military tourniquets are rigorously tested by the U.S. Army Institute of Surgical Research (USAISR) for efficacy at achieving arterial occlusion and are required equipment for all deployed U.S. military personnel. They are designed to be applied over clothing in the Care Under Fire phase and adjusted directly on skin in the Tactical Field Care phase.
Shop Tourniquets →MIST Report (Mechanism, Injuries, Signs/Symptoms, Treatment) Military Medical
A structured verbal or written handoff communication format used in TCCC and emergency medicine to transfer critical patient information from prehospital providers to receiving medical personnel. The MIST report concisely conveys the Mechanism of injury, all Injuries identified, current Signs and symptoms including vital signs, and all Treatments administered. MIST reports are typically transmitted as part of or following the 9-Line MEDEVAC request to prepare receiving providers for the incoming casualty.
MOI (Mechanism of Injury) Trauma Care
The forces and circumstances that caused a patient's traumatic injuries, used to predict injury patterns and guide the clinical assessment. High-energy mechanisms such as high-speed motor vehicle collisions, falls from significant height, blast injuries, and gunshot wounds increase suspicion for multi-system trauma and occult injury. Understanding the MOI is critical in tactical medicine for anticipating life-threatening injuries that may not be immediately visible.
Morphine Pharmacology
An opioid analgesic used for moderate-to-severe pain management in medical and tactical settings, delivered intramuscularly or intravenously for rapid effect. In TCCC, morphine has been largely supplanted by ketamine and oral transmucosal fentanyl due to concerns about respiratory depression and cardiovascular side effects in hypotensive combat casualties. When used, morphine requires monitoring for respiratory depression and availability of naloxone for reversal.
Moxifloxacin Pharmacology
A broad-spectrum fluoroquinolone antibiotic recommended in TCCC protocols as a prophylactic antibiotic for combat wounds to prevent infection, particularly in open soft tissue injuries. TCCC guidelines recommend a 400 mg oral dose for casualties with penetrating wounds who can tolerate oral medications. It is included in the Combat Wound Medication Pack (CWMP) along with meloxicam and acetaminophen.
Multitrauma Trauma Care
The simultaneous presence of two or more significant traumatic injuries involving multiple body systems (polytrauma), which collectively create a greater physiological burden than any single injury in isolation. Multitrauma patients are at highest risk for the lethal triad, coagulopathy, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome. Management requires prioritization using the MARCH PAWS or ABCDE framework to address the most immediately life-threatening injuries first while simultaneously preparing for evacuation.
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Naloxone (Naloxone Hydrochloride (brand: Narcan)) Pharmacology
An opioid antagonist medication that rapidly reverses opioid overdose by binding to opioid receptors and blocking their effects, restoring normal breathing within 2–3 minutes. It is available as a nasal spray, intramuscular injection, or IV formulation, and is now FDA-approved over-the-counter. Because naloxone's effects last only 30–90 minutes—shorter than most opioids—repeated dosing and continued monitoring are essential.
Narcan (Brand name for Naloxone) Pharmacology
Narcan is the original brand name for naloxone hydrochloride, an opioid reversal agent widely carried by EMS providers, law enforcement, and trained civilians. The name has become colloquially synonymous with naloxone itself. First-responders administer Narcan intranasally or intramuscularly to reverse life-threatening respiratory depression from opioid overdose, including fentanyl and heroin.
NCD (Needle Chest Decompression) Procedures
An emergency life-saving procedure used to treat tension pneumothorax by inserting a large-bore needle or catheter (14-gauge or 10-gauge, at least 3.25 inches long) into the pleural space to release trapped air. Current TCCC guidelines recommend placement at the second intercostal space at the midclavicular line or the fourth/fifth intercostal space at the anterior axillary line. A rush of air and rapid improvement in respiratory distress confirms successful decompression.
Neurogenic Shock Trauma Care
A form of distributive shock caused by spinal cord injury (particularly at or above T6) that disrupts descending sympathetic nervous system signals, resulting in massive peripheral vasodilation, relative hypovolemia, and paradoxical bradycardia despite hypotension. Unlike other forms of shock, neurogenic shock presents with a triad of hypotension, bradycardia, and warm/flushed skin due to loss of sympathetic vasoconstriction. Treatment involves careful volume resuscitation, vasopressors (norepinephrine or phenylephrine) to restore vascular tone, and spinal immobilization.
Non-Vented Chest Seal Equipment
An occlusive dressing that completely seals an open chest wound without any valve mechanism, preventing air movement in either direction. While effective for small, stable penetrating chest wounds, non-vented seals carry the risk of converting an open pneumothorax into a tension pneumothorax if the lung continues to leak air into the pleural space. If a patient deteriorates after non-vented chest seal application, the seal should be 'burped' (lifted at one corner) to allow trapped air to escape before reassessing.
Shop Chest & Thoracic Supplies →Normal Saline (0.9% Sodium Chloride Solution) Pharmacology
An isotonic intravenous crystalloid fluid containing 9 grams of sodium chloride per liter, used for volume resuscitation, medication dilution, and wound irrigation in emergency and prehospital medicine. In hemorrhagic shock, large-volume normal saline resuscitation has been associated with hyperchloremic metabolic acidosis and is increasingly replaced by balanced crystalloid solutions (Ringer's Lactate) or blood products in major trauma. Normal saline remains the preferred resuscitation fluid for patients with traumatic brain injury, where isotonic environment is critical to prevent cerebral edema.
NPA (Nasopharyngeal Airway) Airway Management
A flexible rubber or silicone tube inserted through the nostril to maintain an open airway in a semi-conscious or unconscious patient by displacing the posterior tongue and soft palate. NPAs are preferred over oropharyngeal airways in tactical settings because they are better tolerated by patients with an intact gag reflex and can be used in conscious patients. Sizing is based on the diameter of the patient's little finger or nostril, and the device is lubricated before insertion.
Shop Airway Management →NREMT (National Registry of Emergency Medical Technicians) Certifications & Training
The national credentialing organization for EMS professionals in the United States, responsible for administering cognitive and psychomotor examinations for EMR, EMT, AEMT, and Paramedic certifications. NREMT certification is required for licensure in most states and must be renewed every two years through continuing education or re-examination. As of 2025, updated versions of the EMR and EMT certification exams were launched to reflect evolving clinical standards.
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Obstructive Shock Trauma Care
A life-threatening form of shock in which a mechanical obstruction prevents adequate cardiac output, most commonly caused by tension pneumothorax, cardiac tamponade, massive pulmonary embolism, or tension pneumoperitoneum. In the prehospital trauma setting, tension pneumothorax and pericardial tamponade are the most common causes of obstructive shock, both requiring immediate procedural intervention (needle decompression or pericardiocentesis). Recognition relies on clinical findings—absent breath sounds, distended neck veins, hypotension—rather than imaging in austere environments.
Occlusive Dressing Hemorrhage Control
An airtight, waterproof covering applied to seal open wounds—particularly penetrating chest wounds (sucking chest wounds)—to prevent air from entering the pleural space. Occlusive dressings may be vented (with a one-way valve to allow air to escape during exhalation) or non-vented (completely sealed). In the absence of a commercial chest seal, petroleum gauze, plastic wrap, or the inner packaging of bandages can be improvised as an occlusive dressing.
Shop Chest & Thoracic Supplies →OLAES (Olaes Modular Bandage) Equipment
A multi-functional trauma bandage designed with direct input from combat medics, combining a pressure dressing, wound packing gauze (3 meters), and a removable occlusive plastic sheet in a single compact package. The transparent pressure cup focuses force directly on the wound site and can double as a rigid eye shield for ocular injuries per CoTCCC guidelines. Available in 4-inch and 6-inch sizes, the OLAES eliminates the need to carry separate pressure dressings and packing gauze.
Shop OLAES Bandage →Ondansetron (Ondansetron (brand: Zofran)) Pharmacology
A serotonin-3 (5-HT3) receptor antagonist antiemetic used prehospitally by paramedics to treat and prevent nausea and vomiting from various causes including trauma, head injury, and medication side effects. It is listed on the WHO List of Essential Medicines and is administered intravenously, intramuscularly, or as an oral dissolving tablet (ODT) at 4 mg doses. Ondansetron carries a rare risk of QT prolongation and should be withheld if a QT interval greater than 500 ms is documented.
Open Pneumothorax Trauma Care
A life-threatening chest wound in which a penetrating injury creates a communication between the outside air and the pleural space, allowing air to rush into the chest with each breath. Also called a sucking chest wound, this injury impairs ventilation on the affected side and can progress to tension pneumothorax if the wound is sealed without venting. Treatment involves immediate application of a vented chest seal and evacuation to definitive care.
Shop Chest & Thoracic Supplies →OPQRST (Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time) Procedures
A mnemonic used by EMS providers to systematically assess a patient's pain complaint by exploring each dimension of the symptom. Onset asks what the patient was doing when symptoms started; Provocation/Palliation identifies what makes it better or worse; Quality describes the character of pain (sharp, dull, crushing); Region/Radiation determines location and spread; Severity uses a 0–10 pain scale; and Time asks about duration and changes over time. OPQRST is typically used in conjunction with SAMPLE history.
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PEARRL (Pupils Equal And Round, Reactive to Light) Procedures
A neurological assessment acronym used to evaluate pupillary response as an indicator of brain function and intracranial pressure. Normal findings include pupils of equal size, circular shape, and brisk constriction in response to direct light. Abnormal findings such as unequal pupils (anisocoria), fixed and dilated pupils, or sluggish response may indicate traumatic brain injury, herniation, or certain drug effects.
Permissive Hypotension Trauma Care
A deliberate damage control resuscitation strategy that allows systolic blood pressure to remain below normal levels (typically 80–90 mmHg for blunt trauma, 60–70 mmHg for penetrating trauma) in actively hemorrhaging patients prior to surgical hemorrhage control. The goal is to maintain minimal organ perfusion while avoiding fluid overload that can disrupt clot formation, worsen coagulopathy, and increase bleeding. Permissive hypotension is contraindicated in patients with traumatic brain injury, where higher blood pressure targets are required to maintain cerebral perfusion.
PERRLA (Pupils Equal, Round, Reactive to Light and Accommodation) Procedures
An expanded pupillary assessment acronym that includes testing the accommodation reflex in addition to direct light reactivity. Healthcare providers use PERRLA during both routine neurological exams and trauma assessments to document normal eye function. Deviation from PERRLA findings—such as unequal pupils or failure to constrict—warrants immediate further neurological evaluation.
PFC (Prolonged Field Care) Military Medical
Field medical care applied beyond doctrinal planning timelines—typically defined as care required when evacuation to a higher level of medical treatment is delayed beyond one hour. PFC was developed primarily within Special Operations medicine and encompasses advanced skills including diagnostics, airway management, IV access, telemedicine consultation, and nursing care. The concept recognizes that in austere or contested environments, care may need to be sustained for hours to days before evacuation is possible.
Shop Prolonged Field Care Kits →PHTLS (Prehospital Trauma Life Support) Certifications & Training
An internationally recognized continuing education program developed by NAEMT in partnership with the American College of Surgeons Committee on Trauma, covering the assessment and management of trauma patients in the prehospital environment. The 16-hour provider course is available to EMTs, paramedics, nurses, physicians, and military medical personnel, and is updated regularly to reflect current evidence-based practice. PHTLS training emphasizes the pathophysiology of trauma, shock management, airway control, hemorrhage control, and spinal motion restriction.
Pneumothorax Trauma Care
An accumulation of air in the pleural space between the chest wall and the lung, causing partial or complete lung collapse on the affected side. Simple pneumothorax results from blunt or penetrating trauma, while tension pneumothorax occurs when a one-way valve effect causes progressive air accumulation that compresses the heart and great vessels, leading to cardiovascular collapse. Treatment ranges from observation (small simple pneumothorax) to immediate needle decompression (tension pneumothorax) or chest tube insertion.
Shop Chest & Thoracic Supplies →POI (Point of Injury) Military Medical
The immediate location and time at which a casualty sustains an injury on the battlefield or at a tactical incident. Care at the POI is governed by the Care Under Fire phase of TCCC, which prioritizes returning fire, moving to cover, and applying a tourniquet to control life-threatening extremity hemorrhage. All other medical interventions are deferred until the Tactical Field Care phase once the immediate threat is neutralized.
Point of Injury Military Medical
The exact location on the body or the geographic location on the battlefield where a casualty sustains their wound or injury. In TCCC, the point of injury (POI) represents the starting point of the medical care chain, where Care Under Fire interventions—primarily tourniquet application—are initiated. Accurate documentation of point of injury time and initial interventions is essential for continuity of care as the casualty moves through the evacuation chain.
Popliteal Artery Anatomy
A major artery of the lower extremity, formed as the continuation of the femoral artery as it passes through the popliteal fossa (the hollow behind the knee joint). Injury to the popliteal artery from penetrating trauma or severe knee dislocation can rapidly cause limb-threatening ischemia due to its limited collateral circulation. Absent pedal pulses after a knee injury should raise immediate suspicion for popliteal artery damage requiring vascular surgical intervention.
Pressure Bandage Hemorrhage Control
A dressing applied with sufficient circumferential compression to maintain hemostasis and secure wound packing in place after direct pressure or hemostatic gauze application. Pressure bandages such as the Israeli Bandage (Emergency Bandage) use an integrated bar or pressure applicator to focus force at the wound site rather than simply providing general circumferential compression. In tactical settings, a pressure bandage is typically the final step after tourniquet application and wound packing for junctional or non-extremity hemorrhage.
Shop Bandages & Dressings →Q
QRF (Quick Reaction Force) Military Medical
A designated military or law enforcement unit held at immediate readiness to respond rapidly to a developing threat, to reinforce a unit in contact, or to respond to a casualty collection point requiring additional security and extraction support. In tactical medicine contexts, the QRF may include combat medical personnel who augment care during mass casualty events or complex evacuations. The QRF concept is also applied in tactical EMS operations where a medical team stands by to deploy into a warm or cold zone during active threat incidents.
QuikClot (QuikClot Combat Gauze) Hemorrhage Control
A hemostatic dressing consisting of sterile non-woven rayon/polyester gauze impregnated with kaolin, an inorganic mineral that activates Factor XII and accelerates the body's natural clotting cascade. QuikClot Combat Gauze has been the U.S. Department of Defense's primary hemostatic agent and the CoTCCC hemostatic dressing of choice since 2008, indicated for life-threatening hemorrhage not controllable by tourniquet. The gauze is packed directly into the wound with sustained direct pressure for at least three minutes to achieve hemostasis.
Shop Hemostatic Agents →R
Radial Artery Anatomy
A major artery of the forearm that runs along the radius bone from the antecubital fossa to the wrist, where it is palpable just lateral to the flexor carpi radialis tendon at the base of the thumb. The radial pulse is one of the primary assessment points for circulation in trauma patients—its presence at the wrist indicates a systolic blood pressure of at least 70–80 mmHg, while its absence suggests severe hemorrhagic shock. The radial artery is also the preferred site for arterial line placement in critical care settings.
Rapid Extrication Procedures
An emergency technique for quickly removing a trauma patient from a vehicle or confined space when the scene is unstable or the patient's condition deteriorates and waiting for proper equipment or stabilization is not feasible. The technique sacrifices ideal spinal precautions in favor of speed, using a coordinated team approach with manual in-line stabilization of the cervical spine to move the patient as a unit onto a backboard or directly to a stretcher. Rapid extrication is preferable to standard extrication when delaying removal would result in greater harm than the theoretical risk of spinal movement.
Rapid Sequence Intubation Airway Management
An advanced airway management technique used by paramedics, physicians, and flight nurses in which a sedative induction agent and a neuromuscular blocking agent are administered in rapid succession to facilitate endotracheal intubation while minimizing the risk of aspiration and patient injury. RSI is indicated in patients who require definitive airway management but have an intact gag reflex or are combative. Medications commonly used include etomidate or ketamine for induction and succinylcholine or rocuronium for paralysis.
Shop Airway Management →Recovery Position General First Aid
A lateral recumbent patient positioning technique used for unresponsive patients who are breathing and have no suspected spinal injury, placing them on their side with the airway open and dependent to prevent aspiration of vomit or secretions. The position involves extending the lower arm, bending the upper knee forward as a stabilizer, and tilting the head slightly back to maintain airway patency. Patients in the recovery position must be monitored continuously until EMS arrives, as their condition may deteriorate.
Rescue Swimmer Marine Medicine
A highly trained military or Coast Guard swimmer deployed from helicopters or vessels to rescue incapacitated personnel in open water, capable of reaching victims in sea conditions that preclude other rescue methods. Rescue swimmers receive training in emergency medical care, water survival, SCUBA, and helicopter rescue techniques, enabling them to stabilize patients in the water before hoisting or towing them to safety. U.S. Navy Search and Rescue (SAR) swimmers and Coast Guard Aviation Survival Technicians (AST) represent the elite end of this specialty.
Ringer's Lactate Pharmacology
A balanced isotonic crystalloid intravenous solution containing sodium, chloride, potassium, calcium, and lactate in concentrations close to physiological plasma, used as a resuscitation fluid in trauma and hemorrhagic shock. Ringer's Lactate (also called Lactated Ringer's or LR) is preferred over normal saline in hemorrhagic trauma because it minimizes hyperchloremic acidosis and is more physiologically compatible for large-volume infusion. It is widely used in both civilian and military prehospital care protocols and is a component of damage control resuscitation strategies.
RTF (Rescue Task Force) EMS Systems
An integrated response team pairing law enforcement officers with fire/EMS paramedics to provide immediate medical care in warm zones during active threat or active shooter incidents. RTF members operate under the security umbrella of dedicated law enforcement escorts, triaging and treating casualties without entering the hot zone where active threats remain. The concept has been endorsed by the Department of Homeland Security, the Hartford Consensus, and major public safety organizations as the standard model for mass casualty active shooter response.
Rule of Nines Trauma Care
A rapid assessment tool first described by Pulaski and Tennison in 1947 and formalized by Alexander Wallace in 1951, used to estimate the total body surface area (TBSA) affected by burns in adult patients by assigning 9% increments to major body regions. The head and neck equal 9%; each arm equals 9%; the anterior trunk equals 18%; the posterior trunk equals 18%; each leg equals 18%; and the perineum equals 1%. The TBSA burn percentage guides fluid resuscitation calculations using formulas such as the Parkland formula (4 mL × kg × %TBSA burned over 24 hours).
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SALT Triage (Sort, Assess, Lifesaving Interventions, Treatment/Transport) EMS Systems
A CDC-sponsored national mass casualty triage standard developed to create uniformity across jurisdictions and improve upon the limitations of the START system. SALT begins with global sorting (walk, wave, or still), followed by individual assessment with immediate lifesaving interventions (hemorrhage control, two rescue breaths for apneic patients, needle decompression) before assigning one of five categories: Immediate (Red), Delayed (Yellow), Minimal (Green), Expectant (Gray), or Dead (Black). SALT's addition of a 'Gray' (expectant) category—distinct from Black/deceased—reduces confusion when encountering a patient who is dying but not yet dead.
SAM Splint (Structural Aluminum Malleable Splint) Equipment
A lightweight, reusable, aluminum-core splint covered in closed-cell foam padding that can be bent into a variety of shapes to immobilize fractures and sprains of the extremities, spine, and digits. SAM Splints are a staple of wilderness medicine, military aid bags, and EMS kits because they are compact, radiolucent, and can be custom-molded to any limb in seconds. When bent into a C-curve or T-curve, the structural geometry significantly increases rigidity, providing effective immobilization without the need for plaster or fiberglass.
Shop Immobilization Equipment →SAM XT (SAM Extremity Tourniquet) Hemorrhage Control
A CoTCCC-recommended windlass-style limb tourniquet featuring the proprietary TRUFORCE Buckle, which auto-locks at a predetermined circumferential force to eliminate tourniquet slack—the primary cause of failed applications. The SAM XT requires fewer windlass turns than traditional tourniquets due to its mechanical efficiency, enabling faster and more intuitive application under stress. It is approved by the U.S. Department of Defense and rated to MIL-STD-810G standards for durability in extreme environments.
Shop SAM XT Tourniquet →SAMPLE History (Signs/Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, Events) Procedures
A standardized patient history mnemonic used by EMS providers to rapidly gather essential clinical information during patient assessment. Signs/Symptoms captures objective and subjective findings; Allergies documents drug and environmental sensitivities; Medications lists current prescriptions, over-the-counter drugs, and supplements; Past Medical History identifies relevant prior illnesses or surgeries; Last Oral Intake notes the most recent food and fluid consumption (important before surgical procedures); Events describes the circumstances leading to the current emergency. SAMPLE is typically used alongside OPQRST for comprehensive pain evaluation.
SAR (Search and Rescue) Wilderness Medicine
Organized emergency operations designed to locate, access, stabilize, and evacuate persons in distress in wilderness, maritime, or disaster environments where standard EMS resources are unavailable or inadequate. SAR teams may include ground searchers, technical rescue specialists, canine units, and helicopter crews, all of which may have medical personnel capable of providing prehospital care in austere conditions. The Wilderness Medical Society recommends that SAR teams maintain jurisdictional authority, proper training, and operational protocols to optimize patient outcomes in remote environments.
Scene Safety General First Aid
The initial and ongoing assessment of a rescue or treatment environment to identify hazards that could injure first responders or additional victims before any patient care is initiated. Scene safety evaluation includes identification of environmental hazards (fire, gas, electricity, structural instability), mechanism of injury, threat assessment (weapons, violence), and traffic control needs. The principle is encapsulated in the EMS adage: 'You cannot help the patient if you become a patient yourself.'
Scope of Practice EMS Systems
The legally and regulatorily defined set of procedures, treatments, and interventions that a licensed EMS or healthcare provider is authorized to perform based on their level of training and certification. Scope of practice in EMS is defined at the national level by the NHTSA National EMS Scope of Practice Model (2019) and implemented at the state level, creating variation between jurisdictions. Providers who exceed their scope of practice—performing interventions not authorized by their certification and medical direction—may face license revocation, civil liability, and criminal charges.
SCUBA (Self-Contained Underwater Breathing Apparatus) Marine Medicine
A system allowing divers to breathe underwater by carrying a supply of compressed gas (typically air or a nitrox mixture) in tanks worn on the back, regulated by a demand regulator that delivers gas at ambient pressure. Medical emergencies in SCUBA divers include arterial gas embolism (AGE), decompression sickness (DCS/'the bends'), nitrogen narcosis, oxygen toxicity, and near-drowning. Emergency management focuses on immediate 100% oxygen administration, patient positioning, hydration, and urgent transfer to a hyperbaric chamber.
Shelter-in-Place EMS Systems
An emergency protective action directing individuals to remain in their current indoor location and seal openings to reduce exposure to an external hazard such as a chemical release, nuclear event, severe weather, or active shooter incident. In tactical medicine contexts, shelter-in-place may be ordered during a warm zone operation when threats prevent evacuation, requiring medical personnel to continue treating casualties within a secured location. Shelter-in-place protocols include sealing ventilation, rationing resources, and communicating status to incident command.
Shock Trauma Care
A life-threatening state of circulatory failure resulting in inadequate oxygen delivery to tissues, leading to cellular dysfunction, organ failure, and death if untreated. The major types are: Hypovolemic (blood or fluid loss), Hemorrhagic (blood loss specifically), Cardiogenic (pump failure), Distributive (maldistribution of blood flow—includes Septic, Neurogenic, and Anaphylactic subtypes), and Obstructive (mechanical obstruction to flow, as in tension pneumothorax or cardiac tamponade). Hemorrhagic shock is the most common type encountered in tactical and trauma medicine, classified into four classes based on estimated blood loss and physiological response.
SITREP (Situation Report) Military Medical
A concise, structured communication tool originating in military operations that provides decision-makers with an accurate picture of the current situation, actions taken, planned next steps, and key decisions required. In tactical medicine, a SITREP is transmitted from the point of injury or casualty collection point to command elements to request resources, report casualty counts, and coordinate evacuation. An effective SITREP prioritizes critical information first and eliminates ambiguity that could delay life-saving responses.
Snakebite Protocol Wilderness Medicine
Evidence-based first-aid and clinical management guidelines for venomous snakebite, which emphasize immobilizing the affected limb, keeping the victim calm, removing constricting jewelry, and rapidly transporting to a facility capable of administering antivenom. Current guidelines strictly contraindicate incision, suction, tourniquets, ice, and electric shock—all traditional remedies that delay transport and cause additional harm. Pressure immobilization bandaging (PIM) is recommended only for neurotoxic elapid bites (e.g., coral snakes) and is contraindicated for viper bites due to the risk of concentrating cytotoxic venom.
SOF-T Wide (Special Operations Forces Tourniquet Wide) Hemorrhage Control
A 1.5-inch wide windlass tourniquet designed by Tactical Medical Solutions for prehospital use, featuring a quick-connect buckle for rapid one-handed or two-handed application over an arm or leg. The wider constricting band distributes pressure over a greater area compared to narrow-band designs, increasing patient comfort and effectiveness while reducing the risk of tissue damage. The SOF-T Wide is on the CoTCCC recommended list and is widely used by U.S. and allied military forces, law enforcement, and tactical EMS teams.
Shop Tourniquets →Spinal Motion Restriction Trauma Care
The selective application of cervical collar and/or long backboard/vacuum mattress to trauma patients based on clinical criteria suggesting possible spinal injury, replacing the previous dogmatic full spinal immobilization of all trauma patients. Modern evidence and updated NAEMSP guidelines recognize that routine spinal immobilization of penetrating trauma patients is contraindicated and may increase mortality by delaying evacuation. Indicators for spinal motion restriction include blunt mechanism with altered mental status, midline spinal tenderness, neurological deficit, or significant distracting injuries.
START Triage (Simple Triage and Rapid Treatment) EMS Systems
The most widely used mass casualty triage system in the United States, designed for rapid application by first responders with minimal training to classify victims of a mass casualty incident in under 60 seconds per patient. START assesses three parameters—respirations, perfusion (radial pulse or capillary refill), and mental status—to assign patients to one of four categories: Immediate (Red), Delayed (Yellow), Minor (Green), or Deceased/Expectant (Black). Ambulatory patients are directed to move to a designated area as the initial sorting step, identifying the walking wounded.
Shop Mass Casualty Kits →Stop the Bleed Certifications & Training
A national public awareness and skills training campaign launched by the American College of Surgeons in 2015, designed to train bystanders in the three core bleeding control techniques: applying direct pressure, packing a wound, and applying a tourniquet. The campaign was developed in response to the Hartford Consensus, which identified hemorrhage as the leading cause of preventable death from trauma. Stop the Bleed courses are widely taught to teachers, law enforcement, corporate employees, and the general public, with the goal of turning bystanders into immediate responders.
Subclavian Artery Anatomy
A major artery arising from the aortic arch (left subclavian) or brachiocephalic trunk (right subclavian) that supplies blood to the upper extremity, neck, and parts of the brain via branches including the vertebral artery and internal thoracic artery. Subclavian artery injuries from penetrating or blunt trauma can cause massive hemorrhage that is difficult to control externally due to the artery's protected location beneath the clavicle. Hard signs of subclavian injury include absent upper extremity pulses, expanding hematoma, bruit, or active hemorrhage from the axilla or neck.
Subcutaneous Emphysema Trauma Care
The abnormal presence of air or gas trapped within the subcutaneous tissue beneath the skin, causing a characteristic crackling or crunching sensation (crepitus) on palpation and visible puffiness, most commonly resulting from pneumothorax, tracheal injury, or penetrating chest trauma. In the tactical setting, subcutaneous emphysema around the chest wall or neck is a clinical sign prompting immediate evaluation for tension pneumothorax and consideration of needle decompression. Extensive subcutaneous emphysema following a penetrating chest injury should be treated as tension pneumothorax until proven otherwise.
Sucking Chest Wound Trauma Care
A colloquial term for an open pneumothorax in which a penetrating chest injury creates a wound large enough (typically greater than two-thirds the diameter of the trachea) for air to enter the pleural space through the wound rather than via the trachea during inspiration, producing an audible sucking sound. The condition impairs ventilation on the affected side and can rapidly deteriorate into tension pneumothorax if the wound is covered without a vented seal. Immediate treatment involves applying a vented chest seal or three-sided occlusive dressing and monitoring for tension pneumothorax development.
Shop Chest & Thoracic Supplies →Surface-Supplied Diving Marine Medicine
An underwater diving method in which the diver's breathing gas is supplied from the surface via a hose (umbilical) rather than carried in scuba tanks, providing continuous communication, breathing gas, and a safety line between the diver and the surface team. Medical emergencies unique to surface-supplied diving include decompression sickness, arterial gas embolism, contaminated gas supply, and entrapment. Rescue swimmer and dive team medics must be trained in hyperbaric injury management, 100% oxygen administration, and hyperbaric chamber referral protocols.
Surgical Airway Airway Management
An emergency airway technique that creates a direct opening into the trachea through the cricothyroid membrane (cricothyrotomy) when standard airway management methods—jaw thrust, NPA, OPA, bag-valve-mask, and endotracheal intubation—have failed or are impossible due to anatomy, injury, or obstruction. Surgical airways include needle cricothyrotomy (using a large-bore catheter for temporary oxygenation) and surgical cricothyrotomy (incision with tube insertion for definitive airway). In TCCC, the surgical airway is the definitive intervention for 'can't intubate, can't oxygenate' scenarios and is a required skill for combat medics and tactical paramedics.
Shop Airway Management →T
TACEVAC (Tactical Evacuation Care) Military Medical
The third and final phase of Tactical Combat Casualty Care (TCCC), encompassing the medical care provided from the point of evacuation to delivery at a medical treatment facility, whether by ground vehicle or aircraft. During TACEVAC, providers can perform a more thorough assessment and initiate interventions not possible during active engagement, including IV access, reassessment of hemorrhage control, hypothermia prevention, and monitoring. Both CASEVAC (non-dedicated medical vehicles) and MEDEVAC (dedicated medical platforms with Geneva Convention protection) fall under the TACEVAC umbrella.
Tachycardia Circulation
A heart rate exceeding 100 beats per minute in an adult, which in the trauma context is a critical compensatory response to hemorrhage, pain, or anxiety, as the heart attempts to maintain cardiac output despite reduced blood volume. In hemorrhagic shock, tachycardia is one of the earliest objective signs of hemodynamic instability (Class II shock begins at approximately 100–120 bpm), preceding hypotension in most patients. Trauma providers must recognize tachycardia as a red flag requiring immediate hemorrhage assessment even in patients who appear relatively well-compensated.
Tachypnea Circulation
An abnormally rapid breathing rate exceeding 20 breaths per minute in adults, which in trauma patients may signal hemorrhagic shock, tension pneumothorax, pain, anxiety, or metabolic acidosis. Severe tachypnea (respiratory rate >30 breaths/min) in a trauma patient is associated with life-threatening physiological compromise and is classified as an Immediate (Red) category in START triage. In TCCC, tachypnea following torso trauma with significant respiratory distress warrants assessment for tension pneumothorax and consideration of needle decompression.
Tactical Combat Casualty Care Phases Military Medical
The three operationally distinct phases of TCCC that govern what care is rendered based on the tactical situation. Care Under Fire (Phase 1) restricts interventions to tourniquet application for extremity hemorrhage while under direct fire. Tactical Field Care (Phase 2) allows comprehensive trauma care once the immediate threat is controlled. Tactical Evacuation Care (Phase 3) encompasses continued care and monitoring during transport to a medical treatment facility. Each phase reflects a deliberate balance between tactical necessity and medical capability.
Tactical Evacuation Military Medical
The organized movement of casualties from the point of injury or tactical field care location to a higher level of medical care, encompassing both Casualty Evacuation (CASEVAC) and Medical Evacuation (MEDEVAC). TACEVAC is the third phase of TCCC, during which providers continue assessment and interventions while managing the patient en route. Evacuation priorities are classified as Urgent (within 2 hours, life- or limb-threatening), Priority (within 4 hours, deteriorating condition), Routine (within 24 hours), or Convenience.
Tactical Field Care Military Medical
The second phase of TCCC, initiated when the immediate threat to the medical provider has been sufficiently suppressed to allow comprehensive patient assessment and treatment beyond simple tourniquet application. During TFC, providers follow the MARCH or MARCH-PAWS algorithm: Massive hemorrhage control, Airway, Respiration (chest decompression, chest seal), Circulation (IV access, fluids, TXA), Hypothermia/Head injury prevention, and monitoring. This phase represents the primary opportunity for life-saving interventions including needle decompression, wound packing, airway adjuncts, and pain management.
TBI (Traumatic Brain Injury) Trauma Care
An injury to the brain caused by an external mechanical force—such as a blast, blunt impact, or penetrating projectile—resulting in temporary or permanent changes in brain function. TBI is classified as mild (concussion), moderate, or severe based on duration of loss of consciousness, post-traumatic amnesia, and Glasgow Coma Scale score. In military populations, blast-related TBI from improvised explosive devices (IEDs) is the signature wound of modern warfare, and the VA estimates 15–20% of veterans from Iraq and Afghanistan experienced at least one TBI.
TCCC (Tactical Combat Casualty Care) Military Medical
A set of evidence-based guidelines developed by the U.S. military for trauma management in prehospital combat environments, divided into three operational phases: Care Under Fire (CUF), Tactical Field Care (TFC), and Tactical Evacuation Care (TACEVAC). TCCC guidelines are maintained by the Committee on Tactical Combat Casualty Care (CoTCCC) under the Joint Trauma System and are updated regularly based on combat injury data. The TCCC framework has saved thousands of lives and its principles have been adapted for civilian tactical and mass casualty settings through programs such as TECC (Tactical Emergency Casualty Care).
TCCC Casualty Card Military Medical
A standardized field documentation card (TCCC form DD-1380) completed at the point of care to record a casualty's injuries, vital signs, treatments administered, time of tourniquet application, medications given, and evacuation priority for handoff to the next echelon of care. Accurate and timely completion of the casualty card is a critical element of TCCC, as it enables receiving medical personnel to understand what has been done and make appropriate treatment decisions without starting from scratch. The card is typically attached to the casualty's body or clothing for immediate visibility.
TCCC Phases (The Three Phases of Tactical Combat Casualty Care) Military Medical
TCCC care is structured in three sequential phases tied to the tactical environment. Phase 1, Care Under Fire (CUF), allows only tourniquet application for life-threatening extremity hemorrhage while under direct enemy fire. Phase 2, Tactical Field Care (TFC), permits comprehensive assessment and treatment—airway management, hemorrhage control, chest decompression, IV access, hypothermia prevention—once the immediate threat is suppressed. Phase 3, Tactical Evacuation Care (TACEVAC), involves continued and expanded care during transport to a medical treatment facility.
TECC (Tactical Emergency Casualty Care) Tactical Medicine
The civilian and law enforcement adaptation of TCCC guidelines, developed for application during high-threat civilian incidents such as active shooter events, terrorism responses, and civil unrest. TECC mirrors the three-phase structure of TCCC—Direct Threat Care (equivalent to Care Under Fire), Indirect Threat Care (equivalent to Tactical Field Care), and Evacuation Care (equivalent to TACEVAC). The curriculum has been adopted by many law enforcement agencies, SWAT teams, and tactical EMS programs across the United States.
Tension Hemothorax Trauma Care
A rare but immediately life-threatening accumulation of blood under pressure in the pleural space following thoracic trauma, causing mediastinal shift and compressive cardiovascular collapse similar to tension pneumothorax. Unlike tension pneumothorax, needle decompression will not resolve the condition; treatment requires immediate tube thoracostomy (chest tube) or surgical thoracotomy to evacuate the blood. Tension hemothorax should be considered when a patient with chest trauma deteriorates despite a previously placed chest tube or needle decompression.
Tension Pneumothorax Trauma Care
A rapidly lethal condition in which air progressively accumulates in the pleural space through a one-way valve mechanism—often from a lung laceration or chest wound—causing increasing pressure that collapses the ipsilateral lung, shifts the mediastinum, compresses the heart and great vessels, and ultimately causes obstructive shock and cardiac arrest if untreated. Classic signs include progressive respiratory distress, hypotension, absent breath sounds on the affected side, tracheal deviation (a late finding), and distended neck veins. Treatment is immediate needle chest decompression followed by tube thoracostomy.
Shop Chest & Thoracic Supplies →Thermal Protection Military Medical
The preventive and therapeutic measures used to maintain core body temperature in trauma patients, who are at high risk for hypothermia due to blood loss, wet clothing, environmental exposure, and the administration of cold IV fluids. The Hypothermia Prevention and Management Kit (HPMK) is the U.S. military's primary thermal management system, incorporating the Ready-Heat chemical blanket and a heat-reflective shell. Prevention of hypothermia is a priority in TCCC Tactical Field Care, as the combination of hypothermia, acidosis, and coagulopathy—the 'lethal triad'—dramatically increases trauma mortality.
Thermal Protection (Marine) Marine Medicine
The use of immersion suits, dry suits, thermal hoods, and hypothermia wraps to prevent or treat life-threatening heat loss in marine emergencies where cold water immersion can cause incapacitation in minutes and death in under an hour in water temperatures below 10°C (50°F). Survival time in cold water is governed by water temperature, body composition, protective clothing, and whether the victim can maintain the Heat Escape Lessening Posture (HELP) or huddling position. Rescue teams managing cold water immersion casualties must handle patients gently to prevent cardiac arrhythmia during rescue and rewarming.
Thoracic Cavity Anatomy
The chest cavity enclosed by the rib cage, sternum, thoracic vertebrae, and diaphragm, containing the lungs, heart, great vessels (aorta, superior and inferior vena cava), trachea, esophagus, and thoracic duct. Penetrating or blunt trauma to the thoracic cavity can cause pneumothorax, hemothorax, cardiac tamponade, aortic injury, or tension pneumothorax—all of which are immediately life-threatening. The thoracic cavity is divided into the right and left pleural spaces and the mediastinum, with injuries to any of these compartments requiring prompt recognition and intervention.
Shop Chest & Thoracic Supplies →Tourniquet Hemorrhage Control
A circumferential device applied proximal to a life-threatening extremity hemorrhage to compress the soft tissues and occlude arterial blood flow, preventing exsanguination until definitive surgical hemorrhage control can be achieved. CoTCCC-recommended tourniquets include the CAT, SOF-T Wide, SAM XT, and SOFT-W, all of which use a windlass mechanism to achieve sufficient occlusion pressure. Tourniquets should be applied 2–3 inches above the wound, as high and tight on the limb as possible in austere conditions, and time of application recorded; conversion to wound packing at the first safe opportunity reduces ischemic complications.
Shop Tourniquets →Tourniquet Conversion Hemorrhage Control
The process of transitioning from tourniquet-controlled hemorrhage to wound packing with a hemostatic dressing when the tactical situation permits, to preserve limb viability by reducing prolonged ischemic time. Tourniquet conversion is performed during Tactical Field Care by exposing the wound, packing it with hemostatic gauze, applying a pressure dressing, and cautiously releasing the tourniquet while monitoring for renewed hemorrhage. If bleeding cannot be controlled after conversion, the tourniquet is re-tightened and left in place for surgical management.
Shop Tourniquets →Tourniquet Note Time Procedures
The documentation of the exact time a tourniquet was applied, written directly on the tourniquet strap or on the TCCC casualty card, enabling all subsequent providers in the care chain to calculate ischemic time and make decisions about conversion or limb viability. TCCC guidelines mandate recording tourniquet time (abbreviated as 'TK time' or 'T/K time') and communicating it during patient handoff at every echelon of care. Delays in recording tourniquet time are associated with increased rates of under-recognized prolonged ischemia and avoidable amputation.
Shop Tourniquets →Tourniquet Time Procedures
The duration from tourniquet application to surgical removal or conversion, which is a critical prognostic factor for limb salvage and nerve function in casualties with extremity hemorrhage. Current evidence suggests that complications from tourniquet use are minimal when total application time is under 2 hours, acceptable up to 4–6 hours in life-threatening situations, and increase significantly beyond 6 hours, including compartment syndrome, nerve palsy, and rhabdomyolysis. Recording and communicating tourniquet application time on the TCCC casualty card is a mandatory step at all echelons of care.
Shop Tourniquets →Tourniquet Windlass Equipment
The rigid rod mechanism in a windlass-style tourniquet (CAT, SOF-T Wide, SAM XT) that is twisted to tighten the constricting band and increase occlusion pressure, and is then locked in place with a securing strap or clip to maintain tension. Windlass tourniquets can be applied one-handed by the casualty themselves through a series of gross motor movements, making them suitable for self-aid in care under fire situations. Failure to lock the windlass is a common error that allows the tourniquet to loosen and bleed restarting.
Shop Tourniquets →TPAK (Tourniquet and Pressure bandage Accessory Kit) Equipment
A modular accessory pouch or kit designed to carry and provide immediate access to a tourniquet, pressure bandage, and other hemorrhage control essentials in a standardized, MOLLE-compatible format for military and tactical use. TPAK configurations vary by manufacturer but typically include holders for CoTCCC-recommended tourniquets such as the CAT or SOF-T Wide, ensuring the life-saving device is immediately accessible rather than buried in a larger aid bag. The kit concept supports the TCCC principle of keeping hemorrhage control tools staged for one-handed self-application.
Shop TPAK Decompression Needle →Trachea Anatomy
The cartilaginous and fibromuscular tube extending from the larynx at the C6 vertebral level to the carina (bifurcation at T4–T5), where it divides into the left and right mainstem bronchi, serving as the primary conduit for air to enter the lungs. In trauma patients, tracheal injuries from penetrating neck wounds, severe blunt force, or tension pneumothorax (tracheal deviation is a late sign) constitute surgical emergencies. Emergency airway management techniques including cricothyrotomy and surgical airway placement target the trachea when standard airway maneuvers fail.
Tracheal Deviation Anatomy
A late and unreliable sign of tension pneumothorax in which the trachea shifts away from the affected side due to mediastinal displacement caused by massive air accumulation in the pleural space. Because tracheal deviation requires significant pressure buildup to become detectable by palpation, providers should not wait for this finding before performing needle decompression when other signs of tension pneumothorax (severe respiratory distress, absent breath sounds, hemodynamic instability) are present. Tracheal deviation may also occur in large hemothorax, thyroid mass, or mediastinal tumor.
Trench Foot Wilderness Medicine
A non-freezing cold injury caused by prolonged exposure of the feet to cold, wet conditions (typically temperatures 0–16°C/32–61°F for more than 12 hours), leading to damage of nerves, muscles, and blood vessels from moisture maceration and reduced circulation. Initial symptoms include numbness, tingling, and pallor; rewarming causes intense pain, hyperemia, and blistering, progressing to ulceration and potential tissue loss in severe cases. Prevention involves keeping feet dry, changing socks regularly, and removing wet footwear; treatment focuses on gentle drying, rewarming, and wound care.
Triage EMS Systems
The systematic process of sorting and prioritizing multiple patients according to the severity of their injuries and the resources available, to do the greatest good for the greatest number of patients. Triage assigns patients to categories—typically Immediate (Red), Delayed (Yellow), Minor (Green), and Expectant/Deceased (Black)—based on survivability and resource intensity of required treatment. Triage is a dynamic process requiring continuous reassessment as patient conditions change and additional resources arrive.
Triage Categories EMS Systems
The standardized color-coded priority classifications used in mass casualty triage to communicate injury severity and resource allocation urgency across responding agencies. Red (Immediate): life-threatening injuries with high survival potential requiring urgent treatment. Yellow (Delayed): serious but stable injuries that can tolerate a delay in care. Green (Minimal): walking wounded with minor injuries. Black (Expectant/Deceased): fatal injuries or deceased patients. SALT triage adds Gray for patients expected to die despite intervention, clarifying what was previously an ambiguous Black category.
TXA (Tranexamic Acid) Pharmacology
An antifibrinolytic drug that prevents clot breakdown by competitively blocking plasminogen binding sites, thereby inhibiting the conversion of plasminogen to plasmin and preserving blood clots formed at injury sites. The landmark CRASH-2 trial and MATTERs military study both demonstrated significantly reduced mortality when TXA was administered within 3 hours of injury to patients with significant hemorrhage, and it now costs approximately $30 per dose. Current TCCC guidelines recommend TXA administration in the prehospital setting for casualties with significant hemorrhage who are at risk of hemorrhagic shock.
U
Universal Precautions General First Aid
An infection control approach in which all patients' blood and certain body fluids are treated as if they are infected with HIV, hepatitis B, hepatitis C, or other bloodborne pathogens, regardless of known diagnosis. Standard precautions require the use of personal protective equipment (gloves, mask, eye protection, gown) when exposure to blood or body fluids is anticipated, as well as proper hand hygiene and safe handling of sharps. Universal precautions were introduced by the CDC in the 1980s and are foundational to all prehospital and clinical healthcare provider practice.
V
Vagal Response Circulation
Sudden, transient loss of vascular tone and heart rate mediated by parasympathetic (vagus nerve) stimulation, typically triggered by pain, fear, emotional stress, bearing down, or medical procedures, resulting in bradycardia, hypotension, pallor, nausea, and syncope. In the tactical setting, a vagal response following a traumatic injury (vasovagal syncope) can be mistaken for hemorrhagic shock; the distinguishing feature is rapid spontaneous recovery when the patient is supine and the stimulus is removed. Vagal responses do not require fluid resuscitation but do require removal of the triggering stimulus and patient monitoring.
Vasopressor Pharmacology
A class of medications that cause vasoconstriction to raise blood pressure in patients with distributive or neurogenic shock where volume resuscitation alone is insufficient to restore adequate perfusion pressure. Common vasopressors used in austere and prehospital settings include epinephrine (also a vasopressor at high doses), norepinephrine, and phenylephrine; ketamine and vasopressin also have vasopressor properties. In prolonged field care, vasopressors may be indicated when standard fluid resuscitation fails to maintain adequate mean arterial pressure.
Venous Tourniquet Procedures
A venous tourniquet applied with light pressure to distend veins for IV access procedures, distinct from an arterial tourniquet used to occlude arterial flow for hemorrhage control. In prehospital care, venous tourniquets—typically a simple rubber band or blood pressure cuff inflated below diastolic pressure—are standard for peripheral IV catheter placement. Applying a venous tourniquet with insufficient pressure (not achieving arterial occlusion) at an active hemorrhage site would be a critical error; all hemorrhage control tourniquets must achieve arterial occlusion.
Shop Tourniquets →Vented Chest Seal Equipment
An occlusive chest dressing incorporating a one-way valve mechanism that prevents air from entering the pleural space through an open chest wound while allowing trapped air and blood to escape during exhalation, preventing tension pneumothorax development. Research comparing vented and non-vented chest seals in penetrating thoracic trauma models demonstrates that vented seals prevent tension pneumothorax in the presence of ongoing intrapleural air accumulation, whereas non-vented seals can lead to progressive tension and respiratory arrest. CoTCCC guidelines recommend vented chest seals as the preferred treatment for open pneumothorax.
Shop Chest & Thoracic Supplies →Vital Signs Procedures
The four core physiological measurements used to rapidly assess a patient's baseline health status and monitor response to treatment: heart rate (60–100 bpm in adults), blood pressure (90/60–120/80 mmHg), respiratory rate (12–18 breaths/min), and body temperature (97.8–99.1°F / 36.5–37.3°C). In trauma patients, abnormal vital signs—particularly hypotension (SBP < 90 mmHg), tachycardia (HR > 100 bpm), and tachypnea (RR > 20 breaths/min)—suggest hemorrhagic shock and mandate aggressive intervention. Pulse oximetry (SpO2) and Glasgow Coma Scale (GCS) are often documented alongside traditional vital signs in prehospital trauma assessments.
W
Warm Zone Tactical Medicine
In the incident command zone model used during active threat events, the warm zone is the area adjacent to the hot zone (where active threat exists) that has been partially secured by law enforcement but where residual hazards remain. Rescue Task Forces (RTF) consisting of medical and law enforcement personnel operate in the warm zone to provide hemorrhage control and initial stabilization to casualties who cannot be safely reached by standard EMS in the cold zone. Medical personnel in the warm zone focus on life-threatening hemorrhage control and rapid extraction rather than comprehensive assessment.
WEMT (Wilderness Emergency Medical Technician) Certifications & Training
An advanced wilderness medicine certification combining the full National Registry EMT curriculum with wilderness-specific medical training focused on extended patient care when evacuation is delayed by 24 hours or more. The WEMT course (typically 170+ hours over 18 days) is the flagship medical program of organizations such as NOLS and SOLO, and graduates earn both EMT and Wilderness EMT certifications. WEMT certification is preferred by professional SAR teams, top-tier ski patrols, wildland fire crews, and disaster relief agencies requiring personnel who can function in both urban and remote medical environments.
Wet Dressing General First Aid
A moist wound covering used in the field management of burns, abrasions, and avulsions to protect exposed tissue, reduce pain, and prevent desiccation during transport to definitive care. For burns, cool (not cold) wet dressings are applied to small and moderate burns to reduce tissue temperature and relieve pain, but are contraindicated over large TBSA burns due to the risk of hypothermia. Commercial saline-moistened dressings or clean cloths moistened with water are appropriate field expedient options.
WFR (Wilderness First Responder) Certifications & Training
The industry-standard wilderness medicine certification for outdoor professionals—including backcountry guides, camp counselors, ski patrollers, and expedition leaders—requiring approximately 70–80 hours of training in remote patient assessment, trauma management, environmental emergencies, and evacuation decision-making. WFR certification is granted by organizations such as NOLS, SOLO, and WEMS, is valid for two years, and emphasizes the management of medical emergencies when definitive care is hours to days away. Skills covered include improvised splinting, dislocations reduction, spinal injury assessment, altitude illness, anaphylaxis treatment, and patient packaging.
Wilderness First Aid Certifications & Training
A foundational level of wilderness medical training (typically 16–20 hours) covering patient assessment, basic trauma and medical care, and evacuation decision-making for recreational outdoor participants and trip leaders who may be more than 30 minutes from definitive care. Wilderness First Aid is a step below the Wilderness First Responder (WFR) certification and provides the minimum recommended training for leaders of outdoor programs, scouts, and camping staff. It covers bleeding control, fracture splinting, shock management, allergic reaction treatment, and environmental emergency recognition.
Wilderness Medicine Wilderness Medicine
A medical subspecialty focused on the prevention, recognition, and treatment of illness and injury in austere or remote environments where standard medical resources and evacuation timelines are dramatically extended. Core competencies include trauma management, environmental injury (heat, cold, altitude, lightning, envenomation), extended patient care, improvised equipment use, and evacuation decision-making. The Wilderness Medical Society (WMS) publishes clinical practice guidelines and sets educational standards for wilderness medicine providers at all certification levels.
Windlass Tourniquet Hemorrhage Control
A self-tightening tourniquet design using a rigid rod (windlass) that is rotated to progressively tighten a band of material around a limb until arterial blood flow is occluded, then locked in place with a securing mechanism. The windlass design allows both one-handed self-application and two-handed buddy application and generates sufficient mechanical advantage to achieve arterial occlusion even on large-diameter limbs. All CoTCCC-recommended limb tourniquets—including the CAT, SOF-T Wide, and SAM XT—use windlass mechanisms.
Shop Tourniquets →Wound Packing Hemorrhage Control
A hemorrhage control technique used for deep junctional or cavitary wounds not amenable to tourniquet application, in which gauze (ideally hemostatic gauze such as QuikClot) is tightly packed directly into the wound cavity onto the source of bleeding, followed by sustained direct pressure for a minimum of three minutes. Packing is performed by feeding gauze into the wound with one hand while maintaining pressure with the other, filling the wound completely above the skin level before applying a pressure dressing to maintain compression. Proper wound packing followed by a pressure dressing is the standard of care for inguinal, axillary, and neck hemorrhage in both military and civilian trauma contexts.
Shop Bandages & Dressings →Wrist Tourniquet Hemorrhage Control
Application of a tourniquet to the distal forearm or wrist, which is non-standard and generally discouraged in TCCC guidelines because the anatomy at the wrist contains multiple small bones, tendons, and nerves that prevent adequate arterial compression. Standard tourniquet placement is 2–3 inches proximal to the wound or, for austere conditions, as high and tight on the limb as practical. However, in cases where a single artery (such as the radial or ulnar artery) is injured with minimal wound involvement, direct pressure and wound packing are preferred over distal tourniquet placement.
Shop Tourniquets →X
X-STAT Hemorrhage Control
A hemostatic device consisting of a syringe-like applicator loaded with small compressed sponge pellets impregnated with chitosan, designed to rapidly fill a wound tract in junctional or narrow-entry wounds and expand upon contact with blood to create mechanical tamponade within 20 seconds. X-STAT was developed in response to combat casualties from narrow-channel gunshot wounds to the groin, axilla, and neck where traditional wound packing is difficult. It received FDA approval and CoTCCC recommendation for use in penetrating extremity and junctional wounds where other hemorrhage control measures have failed.
Shop Hemorrhage Control →Y
Yaw Trauma Care
The tumbling or sideways rotational motion of a projectile as it passes through tissue, which dramatically increases the wound cavity size and energy transfer compared to a stably flying bullet. High-velocity rifle rounds with significant yaw create temporary and permanent wound cavities that can extend far beyond the bullet's direct path, causing injuries to structures anatomically remote from the bullet track. Understanding yaw and wound ballistics is essential for tactical medical providers assessing penetrating trauma to anticipate injury patterns that may not be obvious from the wound entry and exit locations.
Z
Zofran (Brand name for Ondansetron) Pharmacology
Zofran is the original brand name for ondansetron, a 5-HT3 serotonin receptor antagonist antiemetic widely used in prehospital and emergency medicine for the treatment of nausea and vomiting from trauma, medication, or medical illness. Available in intravenous, intramuscular, and orally dissolving tablet (ODT) formulations, Zofran/ondansetron is the preferred antiemetic in most EMS protocols and is included on the WHO List of Essential Medicines. It is generally safe but should be used with caution in patients with prolonged QT syndrome.
Zone of Care Tactical Medicine
The geographic operational zones—Hot, Warm, and Cold—defined during tactical and mass casualty incidents to delineate areas of active threat and regulate the movement of medical personnel. The Hot Zone contains the active threat where no medical care is rendered; only law enforcement and military personnel operate here. The Warm Zone has been partially secured and is where Rescue Task Forces provide immediate hemorrhage control and extraction. The Cold Zone is fully secured and serves as the casualty collection and treatment area where EMS operates freely.
Zoned Response Tactical Medicine
The structured tactical and medical response model that divides an active threat scene into hot, warm, and cold zones, with specific personnel and interventions assigned to each zone based on threat level and capability. Implementing a zoned response prevents medical personnel from being drawn into life-threatening areas prematurely and ensures that care is delivered efficiently once the situation permits. The zoned response model is a cornerstone of the Hartford Consensus and TECC frameworks for active shooter and mass casualty incident management.
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About This Glossary: Maintained by Dr. Marco R. Torres, MD and the MED-TAC International team. Updated regularly to reflect the latest TCCC, TECC, and emergency medicine terminology.