The 3 Preventable
Causes of Death.
Twenty years of Tactical Combat Casualty Care data identified three injury patterns that kill people who would otherwise survive. These same patterns appear in civilian emergencies: car accidents, workplace incidents, school violence, kitchen and workshop injuries.
The bystander who knows the difference between these three is the difference between an outcome and a statistic. EMS response averages 7 to 14 minutes nationally. The injuries below can kill in 3.
1
Massive
Hemorrhage
Hemorrhage
Extremity arterial bleeding
KILLS IN
3-5 MINUTES
WHAT IT IS
A severed femoral artery loses enough blood in three minutes to cause death. Brachial, axillary, and large peripheral wounds follow the same timeline.
WHAT IT LOOKS LIKE
Pulsating or spurting bright red blood. Soaked clothing. A pool forming faster than you can wipe it. The casualty going pale and altered.
M
In MARCH:
Massive hemorrhage
2
Tension
Pneumothorax
Pneumothorax
Penetrating chest injury
KILLS IN
MINUTES
WHAT IT IS
Air enters the chest cavity through a penetrating wound. Pressure builds, collapses the lung, compresses the heart, blocks venous return. The casualty suffocates.
WHAT IT LOOKS LIKE
A chest wound that bubbles, sucks, or hisses. Increasing difficulty breathing. Distended neck veins. Casualty rapidly deteriorating despite obvious injury.
R
In MARCH:
Respiration
3
Airway
Obstruction
Obstruction
Unconscious casualty, blocked airway
KILLS IN
4-6 MINUTES
WHAT IT IS
An unconscious casualty's tongue, blood, vomit, or facial trauma can occlude the airway. Without oxygen reaching the brain, irreversible damage begins in 4 minutes.
WHAT IT LOOKS LIKE
Unconscious casualty making snoring, gurgling, or no sounds. Visible facial trauma. No chest rise. Lips and skin turning blue.
A
In MARCH:
Airway
↓ Scroll for what to do ↓
Source: Committee on Tactical Combat Casualty Care (CoTCCC) preventable-death analysis · tactical-medicine.com/pages/brief
Source: Committee on Tactical Combat Casualty Care (CoTCCC) preventable-death analysis · tactical-medicine.com/pages/brief
What To Do.
For each cause, the bystander action that closes the gap until EMS arrives.
1
FOR MASSIVE HEMORRHAGE
TOURNIQUET
- Apply HIGH AND TIGHT, 2-3 in. above wound.
- NEVER over a joint.
- Tighten until bleeding stops.
- Note time of application.
- DO NOT REMOVE until ER.
For wounds where a tourniquet cannot be used (neck, groin, armpit, torso): PACK with hemostatic gauze and apply firm pressure for 3 minutes.
2
FOR TENSION PNEUMOTHORAX
CHEST SEAL
- Wipe wound clean and dry.
- Apply VENTED chest seal over the wound.
- CHECK BACK for exit wound. Seal both holes.
- Position on injured side.
- Monitor breathing.
A vented seal lets air escape but not enter. Improvised seals work in extremis but are inferior to a real one.
3
FOR AIRWAY OBSTRUCTION
RECOVERY POS.
- Check responsiveness.
- If unresponsive but breathing: ROLL to recovery position.
- Clear visible obstructions.
- Insert NPA if trained.
- Monitor breathing every 30 sec.
Recovery position alone saves lives. Gravity keeps the tongue and fluids from blocking the airway in an unconscious casualty.
WHAT YOU NEED TO CARRY
The minimum kit for civilian bystander response.
TOURNIQUET
CoTCCC-recommended: CAT Gen 7, SOF-T Wide, or SAM XT.
HEMOSTATIC GAUZE
For wound packing where tourniquet won't work (QuikClot, Combat Gauze).
VENTED CHEST SEAL
Twin-pack — penetrating wounds often exit. Seal both holes.
NPA + THERMAL BLANKET
Airway adjunct + hypothermia prevention. Hypothermia kills bleeders.
PRINT · LAMINATE · CARRY
Download this reference card.
High-resolution PDF, sized for US Letter. Print at home, laminate, and keep one in your vehicle, kitchen, range bag, or workplace first aid kit.
GO DEEPER
The Trauma Brief — 31-page doctrine reference.
From the same MARCH framework on this card, expanded into the full doctrine: hemorrhage control, airway management, respiration, circulation, hypothermia, and the decision logic behind each. Free PDF.
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