CARE UNDER FIRE / MOVE CASUALTY
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
ATP 4-02.11 Doctrine
From Army Techniques Publication 4-02.11, 23 March 2026 — Chapter 3: Fundamentals of TCCC; Chapter 4: Massive Bleeding Control
CUF defined (para 3-37): Care Under Fire is the first phase of TCCC where very limited care is provided while the enemy threat is still active. The primary focus is providing immediate life-saving care while still under enemy fire — returning fire, moving the casualty to cover, and controlling severe bleeding using tourniquets. Available medical equipment is limited to what is carried by individual responders; the only medical priority is addressing massive extremity bleeding.
Priority of actions (para 3-40): In CUF, early control of severe bleeding is the number one medical priority, as extremity hemorrhage is the most frequent cause of preventable battlefield deaths. Major vessel injuries can quickly lead to shock and death in as little as three minutes. Only massive bleeding warrants intervention during CUF — treatment of non-life-threatening bleeding is deferred to the TFC phase.
Hasty TQ — high and tight (para 4-9, 4-11, 4-39): During CUF, apply a hasty tourniquet "high and tight" on the wounded extremity when the bleeding source is ambiguous or under fire. This should be accomplished in less than one minute. Do not apply over the knee or elbow, over a holster, or over a cargo pocket containing bulky items. A TQ applied in CUF must be re-evaluated in TFC — moved to 2–3 inches above the wound, directly on skin, not over clothing.
CLS role in CUF (para 3-47 to 3-50): The CLS prioritizes suppressing hostile fire. Wounded Service members are directed to seek cover, perform self-aid if possible, and continue returning fire while moving to safety. Signs of massive bleeding — pulsing or steady bleeding, traumatic amputation — must be promptly addressed. Prompt TQ application also enables injured Service members to continue fighting while awaiting evacuation.
Source: ATP 4-02.11, Chapter 3, para 3-37 through 3-50; Chapter 4, para 4-7 through 4-11
- 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
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."
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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
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.
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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
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.
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
Go Deeper — ATP 4-02.11 Reference
Detailed doctrine from the Army Techniques Publication: