TCCC Tactical Combat Casualty Care
Certification – Academic Year 2026/2027 –
Comprehensive Exam
ACTUAL QUESTIONS
Domain 1: Care Under Fire
Question 1. During Care Under Fire, what is the first priority for the combat
medic?
A. Immediate detailed assessment of all casualties
B. Gaining fire superiority and moving the casualty to cover
C. Starting intravenous fluids
D. Performing a full secondary survey
Correct Answer: B
Rationale: In Care Under Fire, the tactical situation takes precedence. The first
priorities are returning fire, gaining fire superiority, and moving the casualty to
cover or concealment before any medical intervention beyond life-threatening
hemorrhage control.
Question 2. Which hemorrhage control method is preferred for life-
threatening extremity bleeding during Care Under Fire?
A. Direct pressure with a pressure dressing
B. Application of a CoTCCC-recommended tourniquet high and tight
C. Wound packing with hemostatic gauze only
D. Elevation of the extremity
Correct Answer: B
Rationale: During Care Under Fire, a tourniquet is applied high and tight on the
extremity for life-threatening bleeding because it can be placed rapidly while the
casualty or medic remains under threat. Refinement occurs later in Tactical Field
Care.
Question 3. What is the recommended action if a casualty has a life-
threatening hemorrhage from a junctional area during Care Under Fire?
A. Apply a standard extremity tourniquet
B. Use direct pressure or a junctional tourniquet if available and feasible
,C. Ignore the bleeding until the casualty reaches a treatment facility
D. Apply only a pressure dressing
Correct Answer: B
Rationale: Junctional hemorrhage (groin, axilla, neck) cannot be controlled with a
standard limb tourniquet. Direct pressure or a CoTCCC-recommended junctional
tourniquet is used when the tactical situation permits.
Question 4. When should airway management be addressed during Care
Under Fire?
A. Immediately for every casualty
B. Only if the casualty has an obvious airway obstruction and the tactical situation
allows
C. Before any hemorrhage control
D. Never during Care Under Fire
Correct Answer: B
Rationale: Airway interventions during Care Under Fire are limited to positioning
or simple maneuvers if the casualty has an obvious obstruction and doing so does
not endanger the medic or other personnel. Full airway management is deferred to
Tactical Field Care.
Question 5. What is the primary consideration when moving a casualty during
Care Under Fire?
A. The casualty's comfort
B. The tactical situation and the safety of the rescuer and casualty
C. The mechanism of injury
D. The casualty's rank
Correct Answer: B
Rationale: During Care Under Fire, the tactical situation dictates movement. The
safety of the rescuer, the casualty, and the unit takes precedence over medical
interventions.
Question 6. Which of the following is a contraindication for applying a
tourniquet during Care Under Fire?
A. The bleeding is life-threatening
B. The tourniquet is applied over a joint
C. The casualty is in shock
D. There is no absolute contraindication when life-threatening extremity bleeding
is present
,Correct Answer: D
Rationale: There is no absolute contraindication to applying a tourniquet when life-
threatening extremity hemorrhage is present. The tourniquet should be applied high
and tight, even over clothing, to stop the bleeding.
Question 7. What is the recommended position for a casualty during Care
Under Fire if they are conscious and able to fight?
A. Prone
B. Supine
C. Return fire and take cover as directed by the tactical leader
D. Sitting upright
Correct Answer: C
Rationale: A conscious casualty who is able to fight should return fire and take
cover as directed by the tactical leader. Medical care is secondary to the tactical
mission during this phase.
Question 8. What is the primary purpose of a tourniquet during Care Under
Fire?
A. To prevent infection
B. To stop life-threatening extremity hemorrhage rapidly
C. To immobilize a fracture
D. To reduce pain
Correct Answer: B
Rationale: The primary purpose of a tourniquet during Care Under Fire is to
rapidly control life-threatening extremity hemorrhage, allowing the casualty to be
moved to safety.
Question 9. When should a medic document the time a tourniquet was
applied?
A. Immediately upon application
B. After the tactical situation is secure
C. Never
D. Only if the casualty survives
Correct Answer: A
Rationale: The time of tourniquet application should be documented immediately
(if possible) or as soon as tactically feasible, as it is critical for subsequent medical
care and determining the risk of ischemic injury.
, Question 10. What is the recommended action if a tourniquet fails to control
bleeding during Care Under Fire?
A. Remove the tourniquet and apply a new one
B. Apply a second tourniquet above the first or tighten the existing one
C. Apply direct pressure over the tourniquet
D. Ignore the bleeding
Correct Answer: B
Rationale: If a tourniquet fails to control bleeding, a second tourniquet should be
applied above the first (proximal) or the existing tourniquet should be tightened.
The goal is to stop the hemorrhage rapidly.
Question 11. What is the primary role of the combat medic during Care
Under Fire?
A. To provide definitive medical care
B. To return fire and eliminate the threat
C. To provide life-saving interventions while under threat, and to move the
casualty to safety
D. To document all injuries
Correct Answer: C
Rationale: The combat medic's role during Care Under Fire is to provide life-
saving interventions (e.g., tourniquet application) while under threat and to assist
in moving the casualty to cover.
Question 12. Which of the following is a sign of life-threatening extremity
hemorrhage?
A. Blood spurting from a wound
B. A small laceration with minor bleeding
C. A bruise
D. A superficial abrasion
Correct Answer: A
Rationale: Spurting blood, pooling blood, or a pulsatile flow indicates life-
threatening arterial hemorrhage, requiring immediate tourniquet application.
Question 13. What is the recommended method for moving a casualty during
Care Under Fire?
A. Fireman's carry
B. Drag or carry the casualty using the most expedient method available
C. Wait for a litter team
Certification – Academic Year 2026/2027 –
Comprehensive Exam
ACTUAL QUESTIONS
Domain 1: Care Under Fire
Question 1. During Care Under Fire, what is the first priority for the combat
medic?
A. Immediate detailed assessment of all casualties
B. Gaining fire superiority and moving the casualty to cover
C. Starting intravenous fluids
D. Performing a full secondary survey
Correct Answer: B
Rationale: In Care Under Fire, the tactical situation takes precedence. The first
priorities are returning fire, gaining fire superiority, and moving the casualty to
cover or concealment before any medical intervention beyond life-threatening
hemorrhage control.
Question 2. Which hemorrhage control method is preferred for life-
threatening extremity bleeding during Care Under Fire?
A. Direct pressure with a pressure dressing
B. Application of a CoTCCC-recommended tourniquet high and tight
C. Wound packing with hemostatic gauze only
D. Elevation of the extremity
Correct Answer: B
Rationale: During Care Under Fire, a tourniquet is applied high and tight on the
extremity for life-threatening bleeding because it can be placed rapidly while the
casualty or medic remains under threat. Refinement occurs later in Tactical Field
Care.
Question 3. What is the recommended action if a casualty has a life-
threatening hemorrhage from a junctional area during Care Under Fire?
A. Apply a standard extremity tourniquet
B. Use direct pressure or a junctional tourniquet if available and feasible
,C. Ignore the bleeding until the casualty reaches a treatment facility
D. Apply only a pressure dressing
Correct Answer: B
Rationale: Junctional hemorrhage (groin, axilla, neck) cannot be controlled with a
standard limb tourniquet. Direct pressure or a CoTCCC-recommended junctional
tourniquet is used when the tactical situation permits.
Question 4. When should airway management be addressed during Care
Under Fire?
A. Immediately for every casualty
B. Only if the casualty has an obvious airway obstruction and the tactical situation
allows
C. Before any hemorrhage control
D. Never during Care Under Fire
Correct Answer: B
Rationale: Airway interventions during Care Under Fire are limited to positioning
or simple maneuvers if the casualty has an obvious obstruction and doing so does
not endanger the medic or other personnel. Full airway management is deferred to
Tactical Field Care.
Question 5. What is the primary consideration when moving a casualty during
Care Under Fire?
A. The casualty's comfort
B. The tactical situation and the safety of the rescuer and casualty
C. The mechanism of injury
D. The casualty's rank
Correct Answer: B
Rationale: During Care Under Fire, the tactical situation dictates movement. The
safety of the rescuer, the casualty, and the unit takes precedence over medical
interventions.
Question 6. Which of the following is a contraindication for applying a
tourniquet during Care Under Fire?
A. The bleeding is life-threatening
B. The tourniquet is applied over a joint
C. The casualty is in shock
D. There is no absolute contraindication when life-threatening extremity bleeding
is present
,Correct Answer: D
Rationale: There is no absolute contraindication to applying a tourniquet when life-
threatening extremity hemorrhage is present. The tourniquet should be applied high
and tight, even over clothing, to stop the bleeding.
Question 7. What is the recommended position for a casualty during Care
Under Fire if they are conscious and able to fight?
A. Prone
B. Supine
C. Return fire and take cover as directed by the tactical leader
D. Sitting upright
Correct Answer: C
Rationale: A conscious casualty who is able to fight should return fire and take
cover as directed by the tactical leader. Medical care is secondary to the tactical
mission during this phase.
Question 8. What is the primary purpose of a tourniquet during Care Under
Fire?
A. To prevent infection
B. To stop life-threatening extremity hemorrhage rapidly
C. To immobilize a fracture
D. To reduce pain
Correct Answer: B
Rationale: The primary purpose of a tourniquet during Care Under Fire is to
rapidly control life-threatening extremity hemorrhage, allowing the casualty to be
moved to safety.
Question 9. When should a medic document the time a tourniquet was
applied?
A. Immediately upon application
B. After the tactical situation is secure
C. Never
D. Only if the casualty survives
Correct Answer: A
Rationale: The time of tourniquet application should be documented immediately
(if possible) or as soon as tactically feasible, as it is critical for subsequent medical
care and determining the risk of ischemic injury.
, Question 10. What is the recommended action if a tourniquet fails to control
bleeding during Care Under Fire?
A. Remove the tourniquet and apply a new one
B. Apply a second tourniquet above the first or tighten the existing one
C. Apply direct pressure over the tourniquet
D. Ignore the bleeding
Correct Answer: B
Rationale: If a tourniquet fails to control bleeding, a second tourniquet should be
applied above the first (proximal) or the existing tourniquet should be tightened.
The goal is to stop the hemorrhage rapidly.
Question 11. What is the primary role of the combat medic during Care
Under Fire?
A. To provide definitive medical care
B. To return fire and eliminate the threat
C. To provide life-saving interventions while under threat, and to move the
casualty to safety
D. To document all injuries
Correct Answer: C
Rationale: The combat medic's role during Care Under Fire is to provide life-
saving interventions (e.g., tourniquet application) while under threat and to assist
in moving the casualty to cover.
Question 12. Which of the following is a sign of life-threatening extremity
hemorrhage?
A. Blood spurting from a wound
B. A small laceration with minor bleeding
C. A bruise
D. A superficial abrasion
Correct Answer: A
Rationale: Spurting blood, pooling blood, or a pulsatile flow indicates life-
threatening arterial hemorrhage, requiring immediate tourniquet application.
Question 13. What is the recommended method for moving a casualty during
Care Under Fire?
A. Fireman's carry
B. Drag or carry the casualty using the most expedient method available
C. Wait for a litter team
