EVAC CATEGORY: ______________________ BATTLE ROSTER #

#: ____________

T A C T I C A L C O MB A T C A S UA L T Y C A R E ( T C C C ) C A R D

NAME (Last, First): _________________________ LAST 4: ___________

DATE (DD-MMM-YY): _____________________________ TIME: ________________

UNIT: _________________________________ ALLERGIES: _______________

Mechanism of Injury: (X all that apply)

Artillery Burn Fall Grenade GSW IED
Landmine MVC RPG Other: _____________________

Injury: (Mark injuries with an X)

TQ: R Arm TQ: L Arm
TYPE: ________ TYPE: ________
TIME: ________ TIME: ________

TQ: R Leg TQ: L Leg

TYPE: ________ TYPE: ________
TIME: ________ TIME: ________

Signs & Symptoms: (Fill in the blank)

Time
Pulse (Rate & Location)
Blood Pressure
Respiratory Rate
Pulse Ox % O2 Sat
AVPU
Pain Scale (0-10)
DD FORM (NUM), (DATE) Page 1 of 2
EVAC CATEGORY: ______________________ BATTLE ROSTER #: ____________

Treatments: (X all that apply, and fill in the blank)

C: Extremity-TQ Junctional-TQ Pressure-Dressing
Hemostatic-Dressing Type: _______________________________
A: Intact NPA CRIC ET-Tube SGA Type: __________
B: O2 Needle-D Chest-Tube Chest-Seal Type: _________

C: Name Volume Route Time

Fluid

Blood
Product

MEDS: Name Dose Route Time

Analgesic
(e.g. Ketamine,
Fentanyl,
Morphine)

Antibiotic
(e.g. Moxifloxacin,
Ertapenem)

Other
(e.g. TXA)

OTHER: Combat-Pill-Pack Eye-Shield ( R L) Splint

Hypothermia-Prevention Type: ______________________

NOTES: _________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
FIRST RESPONDER
NAME (Last, First): ____________________________ LAST 4: ________
DD FORM (NUM), (DATE) Page 2 of 2