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Phases of Care

2 min read

A defining feature of TCCC is that it treats context as clinically determinative. The same wound is not the same problem when you are under direct threat as when you have cover, time, light, and help.

TCCC is often taught in three phases (names vary by doctrine and update cycle):

1. Care Under Fire / direct threat

Characteristics:

  • The casualty, responder, and unit may still be exposed to lethal threat.
  • Time and dexterity are limited; prolonged clinical decision-making is not realistic.
  • The primary goal is to end or escape the threat and move to a position where care is possible.

Clinical implication:

  • Interventions are restricted to those that are both immediately life-saving and realistically performable under threat.

2. Tactical Field Care

Characteristics:

  • The immediate threat is reduced enough that focused care is possible.
  • Resources may still be limited, but assessment and reassessment become feasible.
  • This phase is often where most structured evaluation and treatment occurs.

Clinical implication:

  • Priority-ordered assessment (often MARCH/PAWS) guides what is treated first and what can wait.

3. Tactical Evacuation Care

Characteristics:

  • Care occurs during movement to higher capability (vehicle, aircraft, or a more resourced casualty collection point).
  • Noise, vibration, cramped conditions, and competing tasks (navigation, security) can degrade care quality.
  • New resources may appear (higher trained personnel, oxygen, monitoring), and new risks appear (loss of access, hypothermia, delayed recognition of deterioration).

Clinical implication:

  • The focus shifts to preventing deterioration during transport, maintaining previously achieved control, and communicating clearly to the next team.

Terminology variants

Different curricula use different names for similar constraint-sets.

  • In many TCCC materials, the three phases are Care Under Fire, Tactical Field Care, and Tactical Evacuation Care.
  • In some civilian tactical emergency care curricula, you may see direct threat / indirect threat / evacuation language, or “hot / warm / cold” zones.

The practical point is the same: the tactical situation changes what is possible, and it changes what is prioritized.

Boundary management

The phase boundary is not a clock. It is a change in constraints. Good TCCC practice includes deliberately recognizing phase transitions and revisiting priorities when constraints change.

See also: MARCH and PAWS and Documentation and Handoff.

References

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