TCCC Tactical Combat Casualty Care Certification -
Academic Year 2026/2027 - Comprehensive Examination with
Verified Questions and Correct Answer Rationales - 150
Questions with Answers
Page 1
,Q1. During Care Under Fire (CUF), a casualty with a severe extremity hemorrhage
cannot be moved to cover. Which action is most appropriate?
A. Apply a hemostatic dressing and direct pressure while returning fire.
B. Apply a tourniquet high and tight over the clothing, then move to cover.
C. Drag the casualty to cover before any hemorrhage control.
D. Apply pressure dressing and continue the mission.
Correct Answer: B. Apply a tourniquet high and tight over the clothing, then move to
cover.
Rationale: In CUF, the primary goal is to stop life-threatening hemorrhage and prevent
further casualties. A tourniquet can be applied quickly without exposing the wound, and it
is the only intervention that can be effectively applied while under fire. Moving to cover is
secondary to hemorrhage control. Hemostatic dressings require direct wound contact and
pressure, which is not feasible during active fire. Dragging the casualty first delays
hemorrhage control and may be impossible under fire.
Why Wrong:
A - Applying a hemostatic dressing requires exposing the wound and maintaining
pressure, which is not feasible during active fire and delays movement to cover.
C - Delaying hemorrhage control to move to cover increases the risk of
exsanguination; hemorrhage control should be initiated immediately if possible.
D - A pressure dressing is not sufficient for severe extremity hemorrhage and does not
meet the CUF priority of rapid tourniquet application.
Reference: TCCC Guidelines 2026, Care Under Fire, Hemorrhage Control.
Q2. In Tactical Field Care (TFC), which finding would most likely prompt a casualty
to be placed in the recovery position?
A. Unconscious with a pulse and no suspected spinal injury.
B. Conscious with a penetrating chest wound and respiratory distress.
C. Unconscious with signs of tension pneumothorax.
D. Conscious with a severe head injury and vomiting.
Correct Answer: A. Unconscious with a pulse and no suspected spinal injury.
Rationale: The recovery position is indicated for unconscious casualties who are
breathing and have no suspected spinal injury, to maintain a patent airway and prevent
aspiration. In TFC, airway management is prioritized, and the recovery position is a key
intervention for such casualties. The other options require different interventions: chest
wound and respiratory distress may require a chest seal, tension pneumothorax requires
needle decompression, and head injury with vomiting may require spinal precautions.
Why Wrong:
B - A conscious casualty with a chest wound requires a chest seal and monitoring, not
the recovery position.
C - Unconsciousness with tension pneumothorax requires immediate needle
Page 2
, decompression, not just positioning.
D - A conscious casualty with head injury and vomiting may require spinal
immobilization and airway protection, not the recovery position.
Reference: TCCC Guidelines 2026, Tactical Field Care, Airway Management.
Q3. Which medication is the preferred analgesic for a casualty with moderate to
severe pain and no contraindications in Tactical Field Care?
A. Morphine sulfate 5 mg IM
B. Oral acetaminophen 650 mg
C. Oral transmucosal fentanyl citrate (OTFC) 800 mcg
D. Ketorolac 30 mg IV
Correct Answer: C. Oral transmucosal fentanyl citrate (OTFC) 800 mcg
Rationale: Oral transmucosal fentanyl citrate (OTFC) is the preferred analgesic for
moderate to severe pain in TFC because it is rapidly absorbed, has a fast onset, and can
be administered without IV access. Morphine IM has a slower onset and may be less
reliable in hypovolemic casualties due to poor perfusion. Acetaminophen is only for mild
pain. Ketorolac is an NSAID and not recommended for severe pain in tactical settings.
Why Wrong:
A - Morphine IM has a slower onset and its absorption is unpredictable in casualties
with shock.
B - Acetaminophen is too weak for moderate to severe pain.
D - Ketorolac is an NSAID and not appropriate for severe pain in this context.
Reference: TCCC Guidelines 2026, Analgesia.
Q4. A casualty has a tension pneumothorax in Tactical Field Care. Which procedure
is the immediate intervention of choice?
A. Needle decompression with a 14-gauge, 3.25-inch catheter at the second intercostal
space, midclavicular line.
B. Finger thoracostomy at the fourth intercostal space, anterior axillary line.
C. Application of a three-sided occlusive dressing.
D. Immediate evacuation to the next echelon of care.
Correct Answer: A. Needle decompression with a 14-gauge, 3.25-inch catheter at the
second intercostal space, midclavicular line.
Rationale: Needle decompression is the immediate intervention for tension pneumothorax
in TFC when performed by trained medics. The preferred site is the second intercostal
space, midclavicular line, using a 14-gauge catheter of sufficient length (3.25 inches) to
penetrate the chest wall. Finger thoracostomy is a more advanced procedure that may be
performed by physicians or advanced providers if trained, but it is not the immediate
first-line intervention. An occlusive dressing is for open pneumothorax, not tension
pneumothorax. Evacuation is important but not the immediate life-saving intervention.
Page 3
, Why Wrong:
B - Finger thoracostomy is a definitive procedure but is not the immediate first-line
intervention for tension pneumothorax in TCCC; needle decompression is faster.
C - A three-sided occlusive dressing is used for open pneumothorax, not tension
pneumothorax.
D - Evacuation is important but should not delay needle decompression.
Reference: TCCC Guidelines 2026, Respiratory Management.
Q5. Which statement accurately differentiates between the use of tranexamic acid
(TXA) in Tactical Field Care versus Tactical Evacuation Care?
A. TXA is given in TFC for all casualties with suspected hemorrhage, while in
TACEVAC it is only for those with hemorrhagic shock.
B. TXA is administered in TFC if the casualty has hemorrhagic shock, while in
TACEVAC it is given if the casualty is at risk for hemorrhage.
C. TXA is not used in TFC, only in TACEVAC.
D. TXA is used in both TFC and TACEVAC for casualties with severe hemorrhage, but
the dose is higher in TACEVAC.
Correct Answer: B. TXA is administered in TFC if the casualty has hemorrhagic
shock, while in TACEVAC it is given if the casualty is at risk for hemorrhage.
Rationale: According to TCCC guidelines, TXA is indicated in TFC for casualties with
hemorrhagic shock (e.g., weak radial pulse, altered mental status). In TACEVAC, TXA is
considered for casualties who are at significant risk for hemorrhage, including those with
moderate to severe injury, even if not in shock. The dose is the same (1g in 100 mL over 10
minutes). Thus, the difference lies in the threshold for administration, with TACEVAC
allowing broader use.
Why Wrong:
A - This reverses the indications: TFC requires shock, TACEVAC allows risk-based
use.
C - TXA is used in both TFC and TACEVAC.
D - The dose is the same in both phases.
Reference: TCCC Guidelines 2026, TXA Administration.
Q6. During Tactical Evacuation Care (TACEVAC), a casualty with a penetrating eye
injury requires intervention. Which action is most appropriate?
A. Apply a rigid eye shield and do not apply pressure.
B. Irrigate the eye with saline and apply a loose dressing.
C. Apply an occlusive dressing to the affected eye.
D. Have the casualty close the eye and cover with a patch.
Correct Answer: A. Apply a rigid eye shield and do not apply pressure.
Page 4
Academic Year 2026/2027 - Comprehensive Examination with
Verified Questions and Correct Answer Rationales - 150
Questions with Answers
Page 1
,Q1. During Care Under Fire (CUF), a casualty with a severe extremity hemorrhage
cannot be moved to cover. Which action is most appropriate?
A. Apply a hemostatic dressing and direct pressure while returning fire.
B. Apply a tourniquet high and tight over the clothing, then move to cover.
C. Drag the casualty to cover before any hemorrhage control.
D. Apply pressure dressing and continue the mission.
Correct Answer: B. Apply a tourniquet high and tight over the clothing, then move to
cover.
Rationale: In CUF, the primary goal is to stop life-threatening hemorrhage and prevent
further casualties. A tourniquet can be applied quickly without exposing the wound, and it
is the only intervention that can be effectively applied while under fire. Moving to cover is
secondary to hemorrhage control. Hemostatic dressings require direct wound contact and
pressure, which is not feasible during active fire. Dragging the casualty first delays
hemorrhage control and may be impossible under fire.
Why Wrong:
A - Applying a hemostatic dressing requires exposing the wound and maintaining
pressure, which is not feasible during active fire and delays movement to cover.
C - Delaying hemorrhage control to move to cover increases the risk of
exsanguination; hemorrhage control should be initiated immediately if possible.
D - A pressure dressing is not sufficient for severe extremity hemorrhage and does not
meet the CUF priority of rapid tourniquet application.
Reference: TCCC Guidelines 2026, Care Under Fire, Hemorrhage Control.
Q2. In Tactical Field Care (TFC), which finding would most likely prompt a casualty
to be placed in the recovery position?
A. Unconscious with a pulse and no suspected spinal injury.
B. Conscious with a penetrating chest wound and respiratory distress.
C. Unconscious with signs of tension pneumothorax.
D. Conscious with a severe head injury and vomiting.
Correct Answer: A. Unconscious with a pulse and no suspected spinal injury.
Rationale: The recovery position is indicated for unconscious casualties who are
breathing and have no suspected spinal injury, to maintain a patent airway and prevent
aspiration. In TFC, airway management is prioritized, and the recovery position is a key
intervention for such casualties. The other options require different interventions: chest
wound and respiratory distress may require a chest seal, tension pneumothorax requires
needle decompression, and head injury with vomiting may require spinal precautions.
Why Wrong:
B - A conscious casualty with a chest wound requires a chest seal and monitoring, not
the recovery position.
C - Unconsciousness with tension pneumothorax requires immediate needle
Page 2
, decompression, not just positioning.
D - A conscious casualty with head injury and vomiting may require spinal
immobilization and airway protection, not the recovery position.
Reference: TCCC Guidelines 2026, Tactical Field Care, Airway Management.
Q3. Which medication is the preferred analgesic for a casualty with moderate to
severe pain and no contraindications in Tactical Field Care?
A. Morphine sulfate 5 mg IM
B. Oral acetaminophen 650 mg
C. Oral transmucosal fentanyl citrate (OTFC) 800 mcg
D. Ketorolac 30 mg IV
Correct Answer: C. Oral transmucosal fentanyl citrate (OTFC) 800 mcg
Rationale: Oral transmucosal fentanyl citrate (OTFC) is the preferred analgesic for
moderate to severe pain in TFC because it is rapidly absorbed, has a fast onset, and can
be administered without IV access. Morphine IM has a slower onset and may be less
reliable in hypovolemic casualties due to poor perfusion. Acetaminophen is only for mild
pain. Ketorolac is an NSAID and not recommended for severe pain in tactical settings.
Why Wrong:
A - Morphine IM has a slower onset and its absorption is unpredictable in casualties
with shock.
B - Acetaminophen is too weak for moderate to severe pain.
D - Ketorolac is an NSAID and not appropriate for severe pain in this context.
Reference: TCCC Guidelines 2026, Analgesia.
Q4. A casualty has a tension pneumothorax in Tactical Field Care. Which procedure
is the immediate intervention of choice?
A. Needle decompression with a 14-gauge, 3.25-inch catheter at the second intercostal
space, midclavicular line.
B. Finger thoracostomy at the fourth intercostal space, anterior axillary line.
C. Application of a three-sided occlusive dressing.
D. Immediate evacuation to the next echelon of care.
Correct Answer: A. Needle decompression with a 14-gauge, 3.25-inch catheter at the
second intercostal space, midclavicular line.
Rationale: Needle decompression is the immediate intervention for tension pneumothorax
in TFC when performed by trained medics. The preferred site is the second intercostal
space, midclavicular line, using a 14-gauge catheter of sufficient length (3.25 inches) to
penetrate the chest wall. Finger thoracostomy is a more advanced procedure that may be
performed by physicians or advanced providers if trained, but it is not the immediate
first-line intervention. An occlusive dressing is for open pneumothorax, not tension
pneumothorax. Evacuation is important but not the immediate life-saving intervention.
Page 3
, Why Wrong:
B - Finger thoracostomy is a definitive procedure but is not the immediate first-line
intervention for tension pneumothorax in TCCC; needle decompression is faster.
C - A three-sided occlusive dressing is used for open pneumothorax, not tension
pneumothorax.
D - Evacuation is important but should not delay needle decompression.
Reference: TCCC Guidelines 2026, Respiratory Management.
Q5. Which statement accurately differentiates between the use of tranexamic acid
(TXA) in Tactical Field Care versus Tactical Evacuation Care?
A. TXA is given in TFC for all casualties with suspected hemorrhage, while in
TACEVAC it is only for those with hemorrhagic shock.
B. TXA is administered in TFC if the casualty has hemorrhagic shock, while in
TACEVAC it is given if the casualty is at risk for hemorrhage.
C. TXA is not used in TFC, only in TACEVAC.
D. TXA is used in both TFC and TACEVAC for casualties with severe hemorrhage, but
the dose is higher in TACEVAC.
Correct Answer: B. TXA is administered in TFC if the casualty has hemorrhagic
shock, while in TACEVAC it is given if the casualty is at risk for hemorrhage.
Rationale: According to TCCC guidelines, TXA is indicated in TFC for casualties with
hemorrhagic shock (e.g., weak radial pulse, altered mental status). In TACEVAC, TXA is
considered for casualties who are at significant risk for hemorrhage, including those with
moderate to severe injury, even if not in shock. The dose is the same (1g in 100 mL over 10
minutes). Thus, the difference lies in the threshold for administration, with TACEVAC
allowing broader use.
Why Wrong:
A - This reverses the indications: TFC requires shock, TACEVAC allows risk-based
use.
C - TXA is used in both TFC and TACEVAC.
D - The dose is the same in both phases.
Reference: TCCC Guidelines 2026, TXA Administration.
Q6. During Tactical Evacuation Care (TACEVAC), a casualty with a penetrating eye
injury requires intervention. Which action is most appropriate?
A. Apply a rigid eye shield and do not apply pressure.
B. Irrigate the eye with saline and apply a loose dressing.
C. Apply an occlusive dressing to the affected eye.
D. Have the casualty close the eye and cover with a patch.
Correct Answer: A. Apply a rigid eye shield and do not apply pressure.
Page 4
