IBSC TR-C Certified Tactical Responder

During Care Under Fire (CUF) in a tactical engagement, what is the FIRST priority intervention for a casualty with a life-threatening extremity hemorrhage?

• AReturn effective fire and direct/expect the casualty to apply self-aid if able
• BPerform a comprehensive MARCH assessment
• CEstablish IV access and begin fluid resuscitation
• DInitiate hypothermia prevention with an HPMK

Which TECC phase is characterized by the responder operating in the warm zone with the threat suppressed but not eliminated?

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

The MARCH-PAWS algorithm is used in Tactical Field Care. What does the 'M' represent?

• AMechanism of injury
• BMassive hemorrhage
• CMental status
• DMonitoring vitals

Where on an extremity should a Combat Application Tourniquet (CAT) be initially placed during Care Under Fire?

• ATwo inches above the wound site
• BDirectly over the wound
• CHigh and tight on the extremity, over clothing
• DAt the joint nearest the bleeding

After applying a tourniquet, what MUST be documented and visible on the casualty?

• ACasualty's name and DOB
• BTime of application
• CType of weapon used
• DEstimated blood loss

An extremity hemorrhage continues despite a properly applied tourniquet. What is the next BEST action?

• ALoosen the first tourniquet and reposition
• BApply a second tourniquet immediately proximal (above) the first
• CReplace with a pressure dressing
• DElevate the limb and wait 5 minutes

Which type of wound is most appropriate for treatment with hemostatic gauze (Combat Gauze) and wound packing?

• AAn open mid-thigh hemorrhage amenable to tourniquet
• BA junctional groin wound where a tourniquet cannot be applied
• CA small superficial laceration of the forearm
• DAn eye penetrating injury

After packing a wound with hemostatic gauze, for how long must firm direct pressure be maintained?

• A30 seconds
• B1 minute
• CAt least 3 minutes
• D10 minutes

Tranexamic acid (TXA) for severe trauma hemorrhage should ideally be administered within what time window from injury?

• A30 minutes
• B1 hour
• C3 hours
• D12 hours

What is the standard initial dose of tranexamic acid (TXA) in tactical trauma per TCCC guidelines?

• A100 mg IV slow push
• B500 mg IV bolus
• C1 g IV/IO over 10 minutes
• D5 g IV over 1 hour

Which of the following is the PREFERRED airway adjunct for a conscious tactical casualty with airway compromise?

• AOropharyngeal airway (OPA)
• BNasopharyngeal airway (NPA)
• CKing LT supraglottic airway
• DEndotracheal tube

What anatomical landmark is used for surgical cricothyrotomy?

• ABetween the hyoid bone and thyroid cartilage
• BBetween the thyroid cartilage and cricoid cartilage (cricothyroid membrane)
• CBetween the cricoid cartilage and first tracheal ring
• DThe suprasternal notch

A casualty has a penetrating chest wound with audible air movement and increasing dyspnea. What is the immediate intervention?

• AApply a vented chest seal over the wound
• BPerform endotracheal intubation
• CPlace the casualty supine and elevate the legs
• DBegin chest compressions

What are the classic clinical findings of a tension pneumothorax?

• ABradycardia, hypertension, warm extremities
• BTracheal deviation away from the affected side, JVD, absent breath sounds, hypotension
• CBilateral wheezing and stridor
• DSubcutaneous emphysema with normal vitals

What is the preferred site for needle decompression of a tension pneumothorax per current TCCC guidelines?

• A2nd intercostal space, midclavicular line, with a 14-gauge 3.25-inch catheter
• B5th intercostal space, anterior axillary line, with a 14-gauge 3.25-inch catheter
• CEither 2nd ICS midclavicular OR 5th ICS anterior axillary line, with a 14-gauge 3.25-inch…
• D4th intercostal space, posterior axillary line, with an 18-gauge 1-inch catheter

What is the goal systolic blood pressure (permissive hypotension) for a non-head-injured trauma casualty in tactical care?

• A60-70 mmHg
• B80-90 mmHg
• C100-110 mmHg
• D120-130 mmHg

What is the PREFERRED IO (intraosseous) site in a tactical casualty with extremity injuries?

• AProximal tibia
• BSternum
• CProximal humerus
• DDistal femur

What is the FIRST-line resuscitation fluid for hemorrhagic shock per current TCCC guidelines?

• A0.9% normal saline
• BLactated Ringer's
• CWhole blood (cold-stored low-titer O+)
• D5% dextrose in water

Why is calcium administration important during massive transfusion?

• ATo increase blood pressure directly
• BCitrate in stored blood chelates calcium, leading to hypocalcemia and coagulopathy
• CTo reverse opioid effects
• DTo treat hyperkalemia from stored blood

What is the most important hypothermia prevention measure to apply to a trauma casualty in TFC?

• ARemoving all wet clothing and exposing the casualty
• BHypothermia Prevention Management Kit (HPMK) with active warming
• CCold IV fluids to slow metabolism
• DImmersion in cool water

In SALT triage, what is the FIRST step?

• AIndividual primary survey
• BGlobal sorting (instructing those who can walk to one area, then those who can wave)
• CTagging by color
• DDefinitive treatment

What does the THREAT acronym from the Hartford Consensus stand for?

• AThreat suppression, Hemorrhage control, Rapid extrication, Assessment, Transport
• BTactical, Hostile, Rescue, Evacuate, Assess, Triage
• CThorough, Hemorrhage, Response, Effective, Action, Trauma
• DThreat, Hemorrhage, Recovery, Equipment, Airway, Time

A Rescue Task Force (RTF) operates in which zone during an active shooter event?

• AHot zone (active threat)
• BWarm zone (threat suppressed but not eliminated)
• CCold zone (no threat)
• DOutside the perimeter only

A blast injury causes tympanic membrane rupture and pulmonary contusion. This represents which type of blast injury?

• APrimary blast injury (barotrauma)
• BSecondary blast injury (penetrating fragments)
• CTertiary blast injury (blunt from being thrown)
• DQuaternary blast injury (burns/inhalation)

The antidote pair for organophosphate (nerve agent) exposure is:

• ANaloxone and flumazenil
• BAtropine and pralidoxime (2-PAM)
• CHydroxocobalamin and sodium nitrite
• DCalcium gluconate and magnesium

The cyanide antidote of choice in a tactical/mass casualty environment is:

• AAtropine
• BPralidoxime
• CHydroxocobalamin (Cyanokit)
• DActivated charcoal

What level of PPE provides the highest level of skin and respiratory protection (fully encapsulating, SCBA)?

• ALevel A
• BLevel B
• CLevel C
• DLevel D

What is the normal rectal temperature range for a healthy adult working K9?

• A97.0-99.0°F
• B100.5-102.5°F
• C103.0-105.0°F
• D98.6°F (same as humans)

What does the MIST report stand for in tactical casualty handover?

• AMechanism, Injuries, Signs/symptoms, Treatment given
• BMedic, Identify, Sort, Transport
• CMassive bleed, IV, Shock, Treatment
• DMark, Immobilize, Splint, Transport

What is the FIRST line of a 9-line MEDEVAC request?

• ANumber of patients by precedence
• BLocation of the pickup site (grid coordinates)
• CRadio frequency and call sign
• DType of equipment required

TEMS stands for what in the tactical environment?

• ATactical Emergency Medical Support
• BTactical Equipment Management System
• CTrauma Evaluation and Management Standards
• DTactical Evacuation Management Service

During Care Under Fire, when should you check for a pulse on an unconscious casualty?

• AImmediately upon reaching the casualty
• BAfter applying a tourniquet to the obvious bleed
• CPulse checks are deferred — focus on threat suppression and hemorrhage control
• DOnly after CPR has been initiated

A casualty is breathing 8 times per minute, has a pulse of 130, SBP 80, and altered mental status. This represents:

• ACompensated shock
• BDecompensated (Class III/IV) hemorrhagic shock
• CNeurogenic shock
• DAnaphylactic shock

What is the recommended pain medication regimen for a tactical casualty with severe pain who can fight (mild-moderate pain) per TCCC?

• AIV morphine 10 mg
• BOral combat wound medication pack: meloxicam, acetaminophen (Tylenol)
• CIV ketamine 100 mg push
• DIM fentanyl 200 mcg

TCCC recommends what dose of ketamine for moderate-severe pain in a casualty unable to continue mission?

• A10 mg IV/IO push
• B20-30 mg slow IV/IO push or 50-100 mg IM/IN
• C200 mg IV bolus
• D500 mg IM

When converting a tourniquet during TFC, the new tourniquet should be placed:

• ADirectly over the wound
• B2-3 inches above the wound, not over a joint
• CAt the most proximal joint
• DBelow the wound to assess refilling

Tourniquet conversion to a pressure dressing should NOT be attempted if:

• AThe casualty is in shock, the limb has been amputated, or evacuation will arrive within 2…
• BThe wound has stopped bleeding
• CThe casualty is conscious and walking
• DThe TQ has been on less than 30 minutes

Which is an example of a junctional tourniquet?

• ACombat Application Tourniquet (CAT)
• BCombat Ready Clamp (CRoC), JETT, or SAM Junctional
• CIsraeli Emergency Bandage
• DOLAES Modular Bandage

A casualty has a deep neck wound with brisk venous bleeding. What is the appropriate tactical intervention?

• AApply a tourniquet around the neck
• BPack the wound with hemostatic gauze and apply firm direct pressure
• CUse a junctional tourniquet (CRoC) on the neck
• DCover with a sterile dressing without pressure

After packing a junctional wound, what additional intervention is needed for hemorrhage from a high femoral or pelvic source?

• AApply a junctional tourniquet (e.g., SAM Junctional, JETT) for sustained proximal compres…
• BPelvic binder only
• CElevate both lower extremities
• DNo further intervention is needed

Which of the following is a vented chest seal designed to prevent tension pneumothorax?

• AKerlix gauze
• BHyFin Vent or HALO Vent chest seal
• CIsraeli bandage
• DSterile occlusive dressing taped on three sides

After placing a chest seal, the casualty develops increasing dyspnea, hypotension, and unilateral absent breath sounds. What is the next action?

• AApply a second chest seal on top
• BBurp the chest seal (lift one edge) or perform needle decompression
• CBegin CPR
• DAdminister high-dose epinephrine

The recovery position for an unconscious casualty with a maintained airway in TFC is:

• ASupine, head flat
• BTrendelenburg
• CRecovery (lateral) position
• DReverse Trendelenburg

Which of the following is an indication for surgical cricothyrotomy in tactical care?

• AConscious patient with snoring respirations
• BSevere maxillofacial trauma with airway obstruction unable to be managed with NPA/positio…
• CTension pneumothorax
• DHemorrhagic shock

What is the appropriate size of NPA to choose for an adult casualty?

• ALength from earlobe to corner of mouth
• BLength from earlobe to tip of the nose; diameter approximately the size of the patient's…
• CAlways use the largest available
• DLength from chin to xiphoid

A relative contraindication to NPA placement is:

• AConscious patient with gag reflex
• BSuspected basilar skull fracture or significant midface trauma
• CPediatric patient
• DSnoring respirations

The most common preventable cause of death on the battlefield (and in tactical operations) is:

• ATension pneumothorax
• BAirway obstruction
• CExtremity hemorrhage
• DHypothermia