Medical Lane
M2

CARE UNDER FIRE / MOVE CASUALTY

3 min (care under fire) 9 min (transport & transfer)

Conditions: You witness a teammate receive a gunshot wound to the leg while under sporadic small arms fire. Bright red arterial bleeding visible. No spinal injury, non-CBRNE.

Understanding This Task

This is the most physically demanding medical task. You must return fire, move the casualty to cover, apply a CAT tourniquet, load them into a Sked litter, drag 50 meters to a CCP, and complete a TCCC card.

Sequence matters: Return fire FIRST. Then treat. Then move.

Three-fingertip test: If three fingertips slide under the tourniquet band, it is not tight enough — retighten.

Common NO-GO Mistakes

  • Tourniquet not HIGH and TIGHT — must be as high as possible on extremity
  • Three fingertips slide under band = retighten
  • Forgetting to timestamp the tourniquet
  • Not reassessing CAT after movement
  • Attaching TCCC card to body armor (gets separated at MTF)

Starting Configuration

Casualty: 160-200 lb mannequin/Soldier with simulated extremity wound, 10m from cover. Full combat uniform with IFAK and CAT.

Candidate: Full ESB uniform, carrying Sked litter, magazine of blanks loaded. Starts 10m from first covered position.

Task Basis: 081-COM-1001, 081-COM-0048, 081-COM-1046, 081-000-0013

Video Resources

ESB 2022: Care Under Fire — 1-2 SBCT
Care under fire and casualty movement demonstration
TCCC Tourniquet Application
Proper CAT tourniquet application technique
Care Under Fire Timer: 3 Minutes
3:00
Critical Notes
  • Return fire FIRST. Then treat. Then move.
  • Tourniquet: HIGH and TIGHT. Timestamp it.
  • Do NOT attach TCCC card to body armor — it gets separated at MTF.

PERFORMANCE MEASURES

0/5 GO
  1. 1

    Suppress enemy fire

    • Return fire, move to cover. Yell direction, distance, description.
    • Direct casualty to return fire, move to cover, self-aid.
    • State "Cover me." Grader replies "Got you covered."
  2. 2

    Move casualty and equipment to cover

    • Use cradle-drop drag or appropriate technique without causing further injury.
    • Kneel at head, slide hands (palms up) under shoulders, get firm hold under armpits.
    • Rise, support head on forearm. Drag backwards to covered position.
  3. 3

    Administer life-saving aid (CAT tourniquet) CRITICAL

    • Place tourniquet over clothing as HIGH as possible on bleeding extremity (not capturing shoulder/buttocks).
    • Route band around limb ABOVE the wound.
    • Pass red tip through inside slit in buckle. Pull band as tight as possible.
    • Three-fingertip test: If three fingertips slide under band, retighten.
    • Twist windlass until bleeding stops.
    • Lock windlass in windlass clip. Route self-adhering band. Secure with windlass strap.
    • Mark "T" and time of application on casualty (forehead or label).
    • Secure CAT with tape.
  4. 4

    Move casualty using Sked litter

    • Prepare Sked: unroll, back roll to flatten, lay flat. Pull out handholds and straps.
    • Place next to casualty (head end at head). Log roll casualty onto non-CAT side, slide litter under.
    • Fasten four cross straps and foot straps. Check casualty is secure.
    • Reassess CAT. Suppress enemy if needed ("Cover me").
    • Drag casualty 50 meters to CCP. Reassess CAT.
  5. 5

    Document on TCCC card and transfer

    • Front: EVAC priority, date (DD-MMM-YY), time (24hr L/Z), mechanism of injury, injury site on body picture, tourniquet info (type, time).
    • Back: EVAC priority, circulation interventions (TQ category, name), first responder name and last 4 SSN.
    • Attach card to casualty per SOP — do NOT attach to body armor.
Transport & Transfer Timer: 9 Minutes
9:00

From the Ranger Handbook (TC 3-21.76)

Supplementary context — not tested directly, but builds deeper understanding.

Care Under Fire — Ranger Priorities (Ch. 15):

When still under fire, the Ranger Handbook prescribes five immediate actions: (1) maintain situational awareness; (2) return fire and determine if the casualty is dead or alive — have the casualty render self-aid; (3) protect the casualty; (4) move the casualty to cover; and (5) identify and control severe bleeding with a bandage or tourniquet. Make sure any sensitive equipment is secured.

Tourniquet application: Apply a tourniquet to arterial bleeding of the extremities 2-3 inches above the elbow or knee. If this does not control the bleeding, apply a second tourniquet above the first and apply a pressure dressing. Control all other bleeding with a pressure dressing. Check dressings often (Ch. 15, para 15-6).

ABCs of First Aid (Table 15-1):

  • Airway: Open with patient position or airway adjuncts.
  • Breathing: Identify and seal open chest wounds with occlusive dressing.
  • Circulation: Identify uncontrolled bleeding; control with pressure or tourniquet.
  • Disability: Determine level of consciousness.
  • Exposure: Fully expose patient (environment dependent).

Source: TC 3-21.76, Chapter 15 — First Aid, April 2017

M1: MEDEVAC 9-Line M3: Restore Breathing / CPR