TCCC (Tactical Combat Casualty Care): What It Is, Why It Matters, and How Mixed Reality Training Offers a Force Multiplier

In high-threat and austere environments, the first minutes after injury are often the decisive ones. Tactical Combat Casualty Care (TCCC) exists to reduce preventable deaths by giving teams a simple, repeatable sequence of priorities that fits high risk environments.

TCCC is best understood as a framework for decision-making under constraint: limited time, limited resources, and an evolving threat. Many civilian tactical frameworks (including TECC-style models) draw from TCCC’s logic, adapting it to non-military contexts and responder safety realities.

What is TCCC?

TCCC is a set of evidence-informed guidelines for trauma care in combat and tactical settings, designed around the reality that the environment dictates what is safe and feasible at any moment. In practical terms, TCCC teaches teams to:

• prioritise the most preventable causes of death first

• deliver care in phases based on threat level

• standardise communication and documentation for evacuation and handover

TCCC is commonly taught in three phases.

The 3 phases of TCCC

1) Care Under Fire (CUF)

This is the “still under threat” phase. The priority is tactical survival + rapid actions that prevent immediate death, while moving toward cover and control.

2) Tactical Field Care (TFC)

This phase begins when the casualty and team are in relative safety (even if the scene isn’t fully secure). Care becomes more systematic — typically aligned to MARCH  or DRSCABCD priorities.

3) Tactical Evacuation Care (TEC)

This phase focuses on monitoring, reassessment, packaging, and transport often with variable evacuation delays and changing platform constraints (ground/air/boat).

Tactical medical kit ready for emergency use

The MARCH(-E) algorithm: the core TCCC mental model

One of the reasons TCCC is so teachable (and searchable) is the mnemonic MARCH (often taught as MARCH-E).

MARCH-E

• M — Massive haemorrhage: control life-threatening bleeding

• A — Airway: establish/maintain airway

• R — Respirations: address breathing problems (e.g., chest injury management)

• C — Circulation: perfusion/shock priorities and reassessment

• H — Hypothermia / Head injury: temperature and brain-injury considerations

• E — Everything else: evacuation, meds (per protocol), documentation, ongoing tasks

Why TCCC focuses on preventable causes of death?

TCCC’s sequencing is built around the pattern that certain problems repeatedly drive preventable fatalities in tactical trauma, especially when evacuation is delayed or care is constrained. That is why the framework puts heavy emphasis on early haemorrhage control, airway/breathing threats, and hypothermia mitigation.

What “good” TCCC training looks like

Teams don’t fail because they “don’t know the theory.” They fail because real incidents are messy:

• threat changes what you can safely do

• fine motor skills degrade under stress

• communication breaks down

• reassessment and documentation get skipped

• evacuation introduces new failure modes

That’s why effective TCCC programs lean hard into repetition, scenario realism, and after-action review, not just classroom slides.

Tourniquet application during tactical medical training

Where Mixed Reality (MR) fits (and why it’s a force multiplier)

Well-designed MR training can compress years of “rare but critical” exposure into repeatable reps by combining:

• realistic casualty cues and time pressure

• decision points that force MARCH sequencing

• team communication and role clarity

• measurable performance (time-to-intervention, missed steps, handover quality)

For BlueRoom Simulations, this is the core idea: make TCCC decision-making trainable at scale, with consistent scenarios, objective scoring, and a structured debrief so teams build the habits that hold under stress.

FAQs

Is TCCC only for military?

TCCC is the military-focused framework, but its logic is widely taught and often adapted into civilian tactical models depending on setting, responder scope, and threat profile.

What’s the difference between TCCC and TECC?

In simple terms: TCCC is built for combat, while TECC-style approaches adapt the same trauma priorities to civilian-centric, dynamic environments and responder safety constraints.  

What does MARCH stand for in TCCC?

Massive haemorrhage, Airway, Respirations, Circulation, Hypothermia/Head injury (often with “E” for Everything Else).

What are the phases of TCCC care?

Care Under Fire, Tactical Field Care, Tactical Evacuation Care.

How often should teams refresh TCCC skills?

High-stakes skills decay quickly. Many units treat TCCC as a recurrent competency supported by short, frequent scenario reps rather than infrequent, long courses.