DD Form XXXX, 25 Feb 2020 v2.0 Page of

TACTICAL COMBAT CASUALTY CARE AFTER ACTION REPORT (TCCC AAR)Complete within 72hrs after mission and submit to the Joint Trauma System via email: DHA.JBSA.j-3.List.JTS-Prehospital@mail.mil

Annotate Injuries

Event Date: Time: Country: TheaterBattle Injury (BI): WIA KIA DOW Non-Battle Injury (NBI): DeadAlive Injury

Evacuation Category URG PRI ROULitterGround VehicleAircraft

Type:Type:

Time of Pick Up:

Local ZULU

Watercraft Type:Type:

Time of Pick Up:Time of Pick Up:Time of Pick Up:

BR#:Unit:

Rank:

SSN/DoD ID: DOB:

Casualty Demographics (mini. requirement:last name & last 4 SS# Last Name: First Name:

Mission #Gender M F

Point-of-Injury (POI) Provider Info

Non-Medic (NM) First Responder Last Name: First Name: Rank/Title:

Other POI Provider (OP) Last Name: First Name: Rank/Title:

Medic (M) Last Name: First Name: Rank/Title:

Airborne OperationAircraft CrashBlast – Dismounted IED or Mine Blast – Mounted IED or MineBlast – RPG or GrenadeBlast – Indirect Fire (Mortar/Artillery/Missile) Blast – Other Collapse/Crush/ Compartment from StructureFire/ExplosionFall, Height: ft

Fragmentation / Shrapnel GSW – Gunshot WoundVehicle Accident/Collision

Other:Environmental:

M - Mechanism of Injury

S - Signs Initial Check

A V P U GCS: /15 (E

V /5, M /6) RR: HR: BP:

pOx (%): Pain level (_/10): EtCO2 (mmHG):

A UPV GCS: /15 (E

V /5, M /6) BP:HR:RR:

pOx (%): Pain level (_/10): EtCO2 (mmHG):

Last Check

Eye Opening - 4: spontaneous, 3: to speech, 2: to pain, 1: no response

Motor Response - 6: follows commands, 5: localizes pain, 4: withdraws from pain, 3: decorticate flexion, 2: decerebrate extension, 1: no response

Verbal Response - 5: alert and oriented, 4: disoriented conversation, 3: speaking but nonsensical, 2: moans, unintelligible sounds, 1: no response

Time Time

/4 /4

(A)mputation(B)leeding(Bu)rn, TBSA: %(C)repitus(D)eformity

(FX)Fracture(E)cchymosis

(H)ematoma(GSW) Gun Shot Wound

(DG)Degloving

(P)ain(LAC)eration

(PW)Puncture Wound(PP)Peppering

I - Injuries

T - Treatments Massive Hemorrhage Control (TQ/Hemostatic Adjunct)

TypeLocationTime

LocationTime

LocationTime

LocationTime

Time off

Time off

Time off

Time off

Type

Type

Type

Airway

TypeTime Size Depth @

Type Size Depth @

Type Size Depth @

TypeTime Size Depth @

Time

Time

Type:MNM Chest SealOP

OP

OP

NM Needle Decompression Location 2ICS/MCL 5ICS/AAL # of attempts Cath/Needle sizeM

NM

AssistedLaboredSpontaneous Respiration/Breathing Assisted with BVM

Chest Tube

Time

Output Air Blood (ml)Finger ThoracostomyM

DD Form XXXX, 25 Feb 2020 v2.0 Page of

TACTICAL COMBAT CASUALTY CARE AFTER ACTION REPORT (TCCC AAR)Complete within 72hrs after mission and submit to the Joint Trauma System via email: DHA.JBSA.j-3.List.JTS-Prehospital@mail.mil

OPMNM Saline Lock

OPMNM IO-Intraosseous Device, Type

OPMNM TXA-Tranexamic Acid Dose

OPMNM Blood products Type Volume

OPMNM IV Fluids Type Volume

Time Circulation - Resuscitation

OPMNM Pelvic Binder Type Outcome:NoYesSuccessful?

OPMNM Hypothermia Prev. Type Outcome:NoYesSuccessful?

OPMNM Eye Shield Left Right Outcome:YesSuccessful? No

OPMNM C-Collar Spine Board Outcome:NoYesSuccessful?

Interventions - Other Time

OPMNM Splint Type Outcome:NoYesSuccessful?

OPMNM Tourniquet Conversion Outcome:Location NoYesSuccessful?

OPMNM Antibiotic Name: Route:Dose: Outcome:

OPMNM Antibiotic Name: Route:Dose: Outcome:

OPMNM Analgesic Name: Route:Dose: Outcome:

OPMNM Analgesic Name: Route:Dose: Outcome:

OPMNM Analgesic Name: Route:Dose: Outcome:

OPMNM Analgesic Dose: Route:Name: Outcome:OPMNM Combat Wound Medication Pack Outcome:

OPMNM Other Med Name: Route:Dose: Outcome:

OPMNM Other Med Name: Route:Dose: Outcome:

Medications - Pain, Infection, Other Time

Sustains (Treatment, Equipment, Evacuation, Operations):

Improves (Treatment, Equipment, Evacuation, Operations):

Comments-Additional Treatment

SSN/DoD ID: Last Name: