The Field Care Chain
nA Practical Guide to Tactical Combat Casualty Care, MARCH Assessment, Hemorrhage Control, Evacuation, and Handoff

By Manalo Dubois

Trauma care under pressure is rarely lost because someone forgot that bleeding matters. It is lost in the gaps: the wound that was never reassessed after movement, the change in breathing nobody said out loud, the tourniquet time that vanished during handoff, the casualty who became cold while everyone focused on the dramatic injury, or the evacuation plan that existed only in someone's head.

The Field Care Chain turns Tactical Combat Casualty Care into a practical system for those gaps.

Built around the current TCCC framework and the MARCH sequence, this field-oriented guide explains how casualty care changes from active threat to Tactical Field Care and evacuation. It keeps invasive procedures inside proper provider boundaries while concentrating on the skills every strong casualty-care system depends on: prioritization, reassessment, communication, documentation, team roles, movement, thermal protection, and disciplined handoff.

Inside, you'll learn how to:
n- Use MARCH as a working-memory tool instead of a rigid checklist.
n- Recognize why massive hemorrhage gets first attention and why reassessment matters after every move.
n- Separate airway problems from respiratory problems and communicate deterioration without guessing at diagnoses.
n- Read shock as a changing pattern rather than betting everything on one sign.
n- Prevent trauma-related hypothermia early, including in environments that do not feel cold.
n- Deliver a concise MIST handoff that tells the next provider what happened, what changed, and what still needs attention.
n- Give non-medics clear, useful jobs that strengthen the casualty-care chain.
n- Integrate triage, evacuation, documentation, and logistics when there is more than one casualty.
n- Train under pressure without confusing noise and shouting with good instruction.
n- Prepare for delayed evacuation, provider fatigue, equipment limits, and the quiet system failures that surface after the first hour.

The book also includes five composite training scenarios, a 30-day practice plan, a one-page field-care map, a team training scorecard, a glossary, and references to current Joint Trauma System and CoTCCC guidance.

The tone is direct because the subject deserves clarity, but it is not written like a stack of laminated cards. You will find realistic examples, sharp reminders, and enough dry humor to keep the material human without making light of the stakes.

For readers who want to understand how TCCC works as a chain of decisions, people, movement, and information, not merely a collection of procedures, The Field Care Chain provides a practical place to start and a better way to structure training.

Medical and training note: This book is an educational supplement. It does not replace hands-on TCCC instruction, current official guidelines, medical licensure, standing orders, or organization-specific protocols. Readers should perform only interventions for which they are trained, equipped, authorized, and competent.

The Field Care Chain

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