Studying for your TCCC certification, recert, or just trying to stay current? Here are 50 practice questions covering the core domains. Every answer includes the rationale. All content reflects the current CoTCCC guidelines including Change 24-1 (airway) and Change 25-1 (antibiotics).
These are not trick questions. They test whether you know the material well enough to apply it under pressure.
Hemorrhage Control
1. The #1 cause of preventable combat death is:
Hemorrhage. Over 90% of potentially survivable combat deaths are from bleeding that could have been stopped with a tourniquet, wound packing, or junctional device.
2. A tourniquet should be placed:
2-3 inches above the wound during TFC (deliberate application). During CUF, go high and tight over the uniform for speed.
3. Your tourniquet fails to stop bleeding. Next action:
Apply a second tourniquet proximal to and touching the first. Never remove a failed tourniquet.
4. Minimum direct pressure time after wound packing:
3 minutes. Time it. Don't release to check early. You'll disrupt the forming clot.
5. Hemostatic gauze should NOT be packed into:
Chest wounds. Packing can interfere with lung re-expansion. Chest wounds get sealed, not packed.
6. Bleeding soaks through a pressure dressing. You should:
Add more material on top. Never remove the original dressing. Removal disrupts the clot underneath.
7. TQ conversion requires ALL of the following:
Tactical situation permits monitoring, tourniquet on less than 6 hours, casualty not in shock. Missing any one means the TQ stays.
8. After 6 hours of tourniquet time, the biggest risk of conversion is:
Reperfusion injury. Ischemic tissue releases potassium, lactate, and myoglobin. Sudden release can cause hyperkalemia and cardiac arrest. Consult telemedicine.
Airway Management (Updated for Change 24-1)
9. Per Change 24-1, the TFC airway sequence is:
Positioning/suction, then surgical cricothyrotomy if needed. No intermediate devices. NPA, SGAs, and jaw thrust are no longer in the TFC airway algorithm.
10. Jaw thrust is:
No longer recommended in TCCC. Removed by Change 24-1.
11. Supraglottic airways (i-gel, KingLT-D) in TFC are:
Removed from the TFC algorithm by Change 24-1. Evidence showed no survival benefit over BVM in battlefield trauma and very high mortality when placed without RSI sedation.
12. NPA is now indicated only when:
The casualty has impaired ventilation with SpO2 dropping below 90%. It has been moved from the Airway section to Respiration/Breathing.
13. The updated recovery position is:
Head tilted back, chin away from the chest. This is the primary TFC intervention for unconscious casualties without traumatic airway obstruction.
14. After a surgical cricothyrotomy, what monitoring is now mandatory?
Continuous capnography. This was upgraded from recommended to mandatory by Change 24-1.
15. NPA is contraindicated in:
Suspected basilar skull fracture. Signs: raccoon eyes, Battle's sign, CSF rhinorrhea or otorrhea.
16. Cric tube size for adults:
6.0 cuffed. Larger risks tracheal damage, smaller has excessive resistance.
Respiration
17. Tension pneumothorax is the ___ leading cause of preventable combat death:
Third, after hemorrhage and airway obstruction.
18. Primary needle decompression site:
2nd intercostal space, midclavicular line. Insert above the 3rd rib to avoid the neurovascular bundle.
19. Minimum needle length for chest decompression:
3.25 inches. Standard 1.5-inch needles frequently fail due to chest wall thickness.
20. After applying a chest seal, the casualty worsens. First action:
Burp the seal. Lift one corner, release trapped air, reseal. If no improvement, then needle decompression.
21. You must seal:
Both entry and exit wounds. Always check the back.
Circulation
22. Radial pulse present means SBP is approximately:
80+ mmHg. Femoral = 70+. Carotid only = 60+.
23. Resuscitation endpoint per 01 May 2026 TCCC Guidelines:
Palpable radial pulse, improved mental status, OR systolic BP of 100 mmHg. Same target for TBI casualties. The older permissive hypotension SBP 80-90 has been replaced.
24. Fluid resuscitation preference order per 2026 TCCC Guidelines:
Cold-stored low-titer O whole blood, pre-screened low-titer O fresh whole blood, 1:1:1 components, plasma plus RBCs 1:1, plasma or RBCs alone. Crystalloid is no longer in the 2026 hemorrhagic shock fluid hierarchy.
25. Calcium 1g IV/IO is given:
After the FIRST transfused blood product per 01 May 2026 TCCC Guidelines. 30ml of 10% calcium gluconate or 10ml of 10% calcium chloride. Citrate in stored blood binds ionized calcium, impairing cardiac function and coagulation. The older "every 4 units" threshold has been replaced.
26. TXA dose and timing per 2026 TCCC Guidelines:
2g IV/IO slow push as a single dose. ASAP after wounding but NOT later than 3 hours after injury. Indications: anticipated need for blood products OR significant TBI OR altered mental status from blast or blunt trauma.
Antibiotics (Updated for Change 25-1)
27. First-line oral antibiotic for open combat wounds:
Cefadroxil 1g PO daily (preferred) or Cephalexin 500mg PO (alternative). Moxifloxacin is no longer recommended per Change 25-1.
28. First-line parenteral antibiotic:
Ceftriaxone 2g IV/IO/IM once daily. Ertapenem is no longer recommended due to carbapenem resistance concerns.
29. Ceftriaxone must be reconstituted in:
Normal saline only. Not LR or any calcium-containing solution. Calcium causes precipitation.
30. Why was ertapenem removed?
Data from GWOT showed 86% of hospital-acquired MDR organisms were Acinetobacter baumannii, with 91% being carbapenem-resistant. Field use of carbapenems was driving resistance.
31. When to add Metronidazole:
Penetrating abdominal or pelvic wounds. 500mg IV every 8 hours for anaerobic coverage.
Hypothermia and TBI
32. The lethal triad is:
Hypothermia, acidosis, and coagulopathy. Each worsens the others.
33. The single most important hypothermia prevention step:
Insulate from the ground. Ground conduction is the fastest route of heat loss.
34. Mental status standard per 2026 TCCC Guidelines:
AVPU on the DD 1380 is the TCCC standard, including prior to ketamine administration. Moderate or severe TBI is defined as unable to follow simple instructions (thumbs up, two fingers, blink) beyond 10 minutes post-injury with suspected head injury and no alternative cause.
35. Herniation treatment per 2026 TCCC Guidelines:
250ml of 3% or 5% hypertonic saline OR 30ml of 23.4% hypertonic saline IV/IO over at least 10 minutes, followed by saline flush. Repeat in 20 minutes if no response, max 2 doses. Head up 30 degrees if not in shock and tactically feasible. Immediate MEDEVAC. Hyperventilation is not in the 2026 herniation algorithm.
36. Seizure prophylaxis for TBI:
Levetiracetam (Keppra) 1500mg IV.
Pain Management
37. Preferred analgesic for hemodynamically unstable patients per 2026 TCCC Guidelines:
Ketamine. Fixed dosing: 100mg IM, OR 50mg IN, OR 25mg (or 0.2-0.3 mg/kg) IV/IO over 1 minute. Repeat q30 min PRN. Esketamine 14 or 28mg IN is also an option in 2026. AVPU on DD 1380 prior to administration. TBI and eye injury do NOT preclude use.
38. CWMP contents per 2026 TCCC Guidelines:
Acetaminophen 1000-1300mg PO every 8 hours, Meloxicam 15mg PO once daily, and Suzetrigine 100mg PO once (loading) then 50mg PO every 12 hours. Suzetrigine is a NaV1.8 blocker, not an opioid, no respiratory depression. For the casualty who can stay in the fight.
39. OTFC status per 2026 TCCC Guidelines:
Not in the 01 May 2026 analgesia algorithm. The "casualty can stay in the fight" track uses CWMP (acetaminophen + meloxicam + suzetrigine). The "cannot stay in the fight" track uses ketamine or esketamine. OTFC may remain in some legacy stocks; verify unit SOP and command guidance before using.
PFC and Shock
40. RAVINES stands for:
Resuscitate/Reduce tourniquets, Airway care, Ventilate, Initiate telemedicine, Nursing (HITMAN), Environmental, Surgical procedures.
41. HITMAN stands for:
Head-to-toe assessment, Infection control, Tubes, Medications, Administration, Nursing fundamentals.
42. PFC vital signs should be trended every:
30 minutes. The trend tells you if the patient is improving or deteriorating. A single set means nothing.
43. Class III hemorrhagic shock involves:
1500-2000ml blood loss (30-40% volume). HR 120-140, BP dropping, confusion.
44. Beck's triad indicates:
Cardiac tamponade. Hypotension + JVD + muffled heart sounds.
45. The most sensitive early indicator of shock:
Mental status change. A casualty who was talking and is now confused has lost significant volume.
Walking Blood Bank
46. Low-titer O is defined as:
Anti-A and anti-B titers both less than 256 by immediate spin.
47. LTOWB can be transfused to:
Any blood type. That's the purpose of screening for low titer.
48. Dog tags are wrong for blood type approximately:
4% of the time. Always confirm with Eldon card.
49. Fresh whole blood at room temperature must be used within:
8 hours. If refrigerated within 8 hours, it becomes stored WBB blood good for up to 35 days in CPDA-1.
50. Most dangerous transfusion reaction:
Acute hemolytic reaction from ABO mismatch. Stop transfusion immediately, NS bolus, save the blood bag.
How to use this
These 50 questions cover the core TCCC domains tested on certification exams. If you want to practice interactively with scoring and detailed rationales for every answer, the free quiz modules at medeor.app cover all of these topics and more. No login, works on your phone, works offline.
All content reflects the 01 May 2026 TCCC Guidelines, including Change 24-1 (airway management), Change 25-1 (antibiotic replacement), the 2026 TBI section update, and the new CWMP including suzetrigine.