IBSC TP-C Certified Tactical Paramedic

Which of the following best describes the three phases of Tactical Combat Casualty Care (TCCC)?

• ATriage, Treatment, Transport
• BCare Under Fire, Tactical Field Care, Tactical Evacuation Care
• CPrimary Survey, Secondary Survey, Definitive Care
• DHot Zone, Warm Zone, Cold Zone Care

What does the 'M' in the MARCH-PAWS algorithm stand for?

• AMechanism of injury
• BMental status
• CMassive hemorrhage
• DMedication review

During the Care Under Fire phase, what is the only medical intervention typically performed before moving to cover?

• AFull airway management with surgical cricothyrotomy
• BApplication of a tourniquet for life-threatening extremity hemorrhage
• CNeedle decompression of a tension pneumothorax
• DIV fluid resuscitation

What does TECC stand for, and how does it differ from TCCC?

• ATactical Emergency Casualty Care - civilian adaptation of TCCC for high-threat civilian i…
• BTactical Emergency Combat Care - identical to TCCC but for federal teams only
• CTrauma Emergency Critical Care - hospital-based critical care
• DThreat Evaluation and Combat Casualty - threat assessment doctrine

Which TECC phase corresponds to the TCCC phase of Tactical Field Care?

• ADirect Threat Care
• BIndirect Threat Care
• CEvacuation Care
• DDefinitive Care

In the MARCH-PAWS algorithm, what does the 'C' represent?

• ACervical spine immobilization
• BCapnography
• CCirculation (perfusion, IV/IO access, TXA, pelvic stabilization)
• DCombat lifesaver status

What is the purpose of the 'H' in MARCH-PAWS?

• AHyperventilation for head injury
• BHypothermia prevention and Head injury management
• CHemorrhage reassessment
• DHelmet removal

Which of the following best describes a Casualty Collection Point (CCP)?

• AA predetermined location where wounded are gathered for triage, treatment, and prepared f…
• BThe exact location where a casualty was injured
• CAn ambulance staging area outside the inner perimeter
• DOnly the helicopter landing zone

A SWAT operator is wounded by gunfire to the upper thigh during dynamic entry. Hostiles are still actively engaging the team. What is the operator's first priority?

• AApply a pressure dressing while exposed to fire
• BMove to cover and return fire if able; self-apply a tourniquet if hemorrhage is life-thre…
• CWait for the medic to crawl forward and treat them
• DBegin IV fluid resuscitation immediately

What is the recommended sequence of MARCH-PAWS?

• AMassive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head, Pain, Antibiotics…
• BMental status, Airway, Respiration, Circulation, Hemorrhage, Pain, Antibiotics, Wounds, S…
• CMechanism, Assessment, Resuscitation, Communication, Hypothermia, Pain, Airway, Wounds, S…
• DMassive hemorrhage, Airway, Respiration, Cervical spine, Hypothermia, Position, Antibioti…

Which of the following is true about cervical spine immobilization in TCCC for penetrating trauma?

• ARequired for all penetrating neck wounds
• BRoutine c-spine immobilization is not recommended for penetrating trauma; it is depriorit…
• CMandatory for all gunshot wounds regardless of location
• DRequired if the casualty fell after being shot

The 'P' in PAWS within MARCH-PAWS most appropriately stands for what?

• APosition of comfort
• BPain control / analgesia
• CPenetration depth
• DPulse oximetry

Per current TCCC, which oral pain medication combination is included in the Combat Wound Medication Pack (CWMP)?

• AMeloxicam 15 mg + acetaminophen 1000 mg
• BAspirin 325 mg + ibuprofen 800 mg
• CNaproxen 500 mg + tramadol 50 mg
• DAcetaminophen 500 mg + diphenhydramine 25 mg

A casualty in shock following a penetrating chest wound requires analgesia. According to TCCC guidance, which agent is preferred?

• AKetamine IV/IM/IO
• BMorphine 10 mg IV
• CHydromorphone 1 mg IV
• DFentanyl OTFC lozenge alone

What is the recommended TCCC antibiotic for an ambulatory penetrating trauma casualty unable to take oral medication?

• ACefoxitin 2 g IV/IM
• BErtapenem 1 g IV/IM
• CVancomycin 1 g IV
• DCiprofloxacin 400 mg IV

A conscious casualty is in Tactical Field Care after a maxillofacial gunshot wound. They are sitting upright, leaning forward, with adequate ventilation. What is the most appropriate airway intervention?

• AImmediate surgical cricothyrotomy
• BNasopharyngeal airway
• CAllow position of comfort (sit up, lean forward) and continuously reassess
• DEndotracheal intubation

Which of the following does TCCC consider the leading preventable cause of death on the battlefield?

• ATension pneumothorax
• BAirway obstruction
• CExtremity hemorrhage
• DHypothermia

In Tactical Evacuation Care (TACEVAC), which of the following may be appropriate that is NOT typically part of Tactical Field Care?

• AApplication of a tourniquet
• BInitiation of advanced cardiac monitoring and packed red blood cell or whole blood transf…
• CWound packing with hemostatic gauze
• DSelf-aid by the casualty

Which of the following is the highest priority during Tactical Field Care assessment of an unresponsive casualty?

• ACheck pupils and GCS
• BStop massive hemorrhage and confirm airway is patent
• CEstablish IV access and start fluids
• DPerform a head-to-toe trauma exam

What is the primary rationale for prioritizing fire superiority over medical care during Care Under Fire?

• AMedical interventions are not effective on the battlefield
• BMore casualties are produced by an active threat than can be saved by individual medical…
• CTourniquets cannot be applied while exposed to fire
• DThe medic is not allowed to provide care during gunfights

Which of the following best describes the difference between TCCC and conventional civilian EMS trauma care priorities?

• ATCCC prioritizes airway over hemorrhage
• BTCCC prioritizes massive hemorrhage control before airway and explicitly accepts permissi…
• CTCCC requires full c-spine precautions for all trauma
• DTCCC eliminates the need for triage

Per current TCCC guidance, what is the target systolic blood pressure during fluid resuscitation in a casualty with uncontrolled internal hemorrhage and altered mental status?

• AMaintain SBP greater than 120 mmHg
• BPermissive hypotension targeting palpable radial pulse or SBP roughly 80-90 mmHg
• CMaintain SBP greater than 140 mmHg
• DAggressive crystalloid bolus until SBP is 110 mmHg

When should buddy aid take priority over self-aid in TCCC?

• AAlways - the buddy is always faster
• BWhen the casualty is unresponsive or otherwise unable to perform self-aid effectively
• COnly after the medic has arrived
• DNever - buddy aid is not part of TCCC

A casualty with a moderate gunshot wound to the leg has been given oral moxifloxacin from the CWMP. Approximately how soon does TCCC recommend antibiotic administration after wounding?

• AWithin 1 hour of wounding when possible
• BWithin 24 hours of wounding
• COnly after surgical washout
• DAntibiotics are not indicated in TCCC

Which TCCC card / form is used to document care delivered to a casualty in the tactical environment?

• APCR (Patient Care Report)
• BDD Form 1380 (TCCC Casualty Card)
• CSOAP note
• DTrauma Activation Form

What is the correct placement for a CAT or SOFTT-W tourniquet under TCCC guidelines when the wound location is not directly visible (e.g., bleeding through a pant leg under fire)?

• ADirectly over the wound regardless of clothing
• BHigh and tight on the affected limb, 2-3 inches above the wound when visible, or as high…
• CBelow the joint nearest to the wound
• DAround the torso to compress the abdominal aorta

A casualty has a tourniquet applied at 0945. According to TCCC documentation standards, what should be marked on the tourniquet itself?

• ACasualty's name only
• BThe time of application (e.g., '0945') in clear, contrasting marker
• CLocation of injury
• DNothing - documentation is on the casualty card only

What is the recommended TCCC action if a single tourniquet does not control extremity hemorrhage?

• ALoosen and reposition the same tourniquet
• BApply a second tourniquet directly above the first, side by side
• CReplace it with a pressure dressing only
• DApply ice to the limb

Which hemostatic agent is currently CoTCCC-approved as a first-line option for wound packing?

• ACombat Gauze (kaolin-impregnated)
• BQuikClot ACS+ (zeolite granules)
• CHemCon bandage only
• DPlain Kerlix gauze

After packing a junctional wound with Combat Gauze, how long should direct pressure be held continuously?

• A30 seconds
• B1 minute
• CAt least 3 minutes of uninterrupted firm pressure
• D10 minutes

Which of the following anatomic regions is NOT amenable to standard limb tourniquet application and instead requires a junctional tourniquet or wound packing?

• AMid-thigh
• BInguinal/groin (proximal femoral artery)
• CMid-upper arm
• DForearm

Which device is specifically designed to control bleeding from inguinal, axillary, and pelvic junctional zones?

• ACAT (Combat Application Tourniquet)
• BSOFTT-W (Special Operations Forces Tactical Tourniquet - Wide)
• CSAM Junctional Tourniquet (SJT)
• DIsraeli emergency bandage

TCCC recommends tranexamic acid (TXA) in casualties at significant risk of hemorrhage. What is the standard dose and time window?

• A1 g IV/IO bolus given as soon as possible, ideally within 3 hours of injury
• B5 g IV bolus given within 12 hours
• C10 mg/kg PO given within 24 hours
• DTXA is no longer used in TCCC

Which clinical scenario most clearly indicates the need for a pelvic binder?

• AIsolated knee pain after a fall
• BSuspected unstable pelvic fracture in a casualty with hypotension after blunt trauma or h…
• CFemur fracture without pelvic involvement
• DPenetrating abdominal trauma with stable vital signs

Where should a SAM Pelvic Sling be positioned on the casualty?

• AOver the iliac crests
• BOver the umbilicus
• CCentered over the greater trochanters
• DUnder the lumbar spine

A casualty develops hypotension and altered mental status 25 minutes after a tourniquet was applied for a partial-amputation injury. The wound is no longer bleeding actively. What is the most appropriate action?

• ARemove the tourniquet immediately to restore perfusion
• BLeave the tourniquet in place, treat shock with appropriate resuscitation, expedite evacu…
• CLoosen the tourniquet by half to allow some flow
• DReplace it with a pressure dressing alone

Which of the following is a key contraindication or limitation to tourniquet conversion in the field?

• ATourniquet has been in place greater than 6 hours, casualty is in shock, or distal hemorr…
• BTourniquet is the wrong color
• CThe casualty refuses conversion
• DConversion can always be attempted regardless of time

A casualty has bilateral lower extremity amputations with two tourniquets in place. Vital signs: HR 130, BP 70/40, GCS 13. Which fluid is preferred per current TCCC for resuscitation if available?

• ANormal saline 0.9% in 2-liter boluses
• BLactated Ringer's 1-liter rapid infusion
• CCold-stored low-titer O whole blood (CLT-OWB) or balanced blood products (1:1:1 PRBC:plas…
• D5% dextrose in water

What is the primary rationale for limiting crystalloid infusion in tactical trauma resuscitation?

• ACrystalloids are too expensive to carry
• BAggressive crystalloid infusion dilutes clotting factors, worsens coagulopathy, and disru…
• CCrystalloids cannot be infused through IO access
• DCrystalloids cause anaphylaxis in trauma

A casualty is bleeding from the right axilla after a stab wound. A standard limb tourniquet is unable to stop the bleeding. What is the best next step?

• AApply a second limb tourniquet around the chest
• BPack the wound aggressively with hemostatic gauze and hold pressure for at least 3 minutes
• CPlace a pelvic binder
• DApply ice to the area

A conscious casualty with severe maxillofacial trauma is breathing spontaneously but has copious oral bleeding. What is the most appropriate initial airway intervention in Tactical Field Care?

• AImmediate orotracheal intubation
• BAllow position of comfort (sit up, lean forward) and consider a nasopharyngeal airway if…
• CCricothyrotomy regardless of patency
• DPlace supine in recovery position

Which of the following is the preferred technique for emergency surgical airway in current TCCC guidance?

• ANeedle cricothyrotomy with jet ventilation
• BScalpel-Bougie-Tube (SBT) cricothyrotomy
• CTracheostomy through the second tracheal ring
• DNasal intubation

Which anatomic landmark is identified before performing a surgical cricothyrotomy?

• ASuprasternal notch
• BCricothyroid membrane between thyroid cartilage and cricoid cartilage
• CHyoid bone
• DSecond tracheal ring

What size endotracheal tube is typically used for an adult emergency surgical cricothyrotomy?

• A8.0 or 8.5 cuffed ETT
• B6.0 or 6.5 cuffed ETT
• C4.0 uncuffed ETT
• DAny size will do

A casualty has snoring respirations with adequate chest rise after a head injury. The casualty has an intact gag reflex. What is the most appropriate initial airway adjunct?

• AOropharyngeal airway
• BNasopharyngeal airway lubricated and inserted along the floor of the nostril
• CSupraglottic airway (i-gel)
• DEndotracheal intubation

Which of the following is the strongest contraindication to nasopharyngeal airway placement?

• ASuspected basilar skull fracture (raccoon eyes, battle sign, CSF leak)
• BAnterior epistaxis
• CNasal septal deviation
• DRecent rhinoplasty