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Quizzes > Health & Medicine

TCCC Practice Test: MARCH Algorithm and Combat Lifesaver Skills

Quick, free combat lifesaver test to check your MARCH skills. Instant results.

Editorial: Review CompletedCreated By: Magma KatUpdated Aug 26, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration of combat lifesaver gear and quiz title on dark blue background

This quiz helps you practice the MARCH algorithm in TCCC and make clear, safe choices under pressure. Work through short prompts on bleeding, airway, chest, circulation, hypothermia, and evacuation, then strengthen support skills with 9 line medevac scenarios, tune up basics with a free first aid quiz, and expand readiness with a cbrn practice test.

What is the first step in the TCCC MARCH sequence for battlefield casualty care?
Assess airway
Manage massive hemorrhage
Ensure adequate respiration
Prevent hypothermia
The MARCH sequence prioritizes stopping life-threatening hemorrhage before airway, breathing, circulation, and hypothermia prevention. Controlling massive bleeding prevents rapid exsanguination, which is the leading preventable cause of death on the battlefield.
During Care Under Fire, the recommended method for controlling severe extremity bleeding is:
Direct pressure with a dressing
Use of hemostatic gauze
Application of a tourniquet
Elevation of the limb
In the Care Under Fire phase, the casualty and rescuer are still under hostile fire. A tourniquet can be applied rapidly and without prolonged exposure, making it the preferred method to control life-threatening extremity hemorrhage.
What target systolic blood pressure is recommended for permissive hypotension during Tactical Field Care when hemorrhage is not yet controlled?
90 mmHg
110 mmHg
120 mmHg
70 mmHg
Permissive hypotension aims to maintain a systolic pressure around 80 - 90 mmHg until hemorrhage control, balancing perfusion and bleeding risk. This reduces dislodgement of clots and ongoing bleeding.
Which airway adjunct is indicated first in a TCCC casualty who is unconscious with no gag reflex?
Cricothyroidotomy
Endotracheal tube
Oropharyngeal airway
Nasopharyngeal airway
In an unconscious casualty without a gag reflex, an oropharyngeal airway (OPA) is the first-line adjunct to maintain patency. It is simple to insert and requires no specialized equipment.
In the MARCH algorithm, what does the 'H' represent?
Hypovolemic shock
Hypothermia prevention
Head injury management
Hemostatic dressings
The 'H' in MARCH stands for hypothermia prevention. Hypothermia worsens coagulopathy and increases mortality, so active prevention is essential throughout casualty care.
In Tactical Field Care, what is the preferred anatomical site for needle thoracostomy in a suspected tension pneumothorax?
4th intercostal space at the anterior axillary line
6th intercostal space at the posterior axillary line
5th intercostal space at the midaxillary line
2nd intercostal space at the midclavicular line
TCCC guidelines recommend needle decompression at the 4th or 5th intercostal space in the anterior axillary line to reduce failure rates associated with chest wall thickness and better access in combat gear.
Which analgesic is recommended in Tactical Field Care when evacuation is delayed?
Oral ibuprofen
Intranasal fentanyl lozenge
Intravenous or intramuscular ketamine
Intramuscular morphine
Ketamine is recommended for battlefield analgesia due to its safety profile, minimal respiratory depression, and ability to provide both pain relief and dissociative sedation when evacuation is delayed.
What is the maximum recommended time to apply a combat tourniquet before it must be evaluated or loosened?
Within 10 minutes
Within 1 minute
Within 5 minutes
Less than 30 seconds
TCCC recommends that tourniquets be applied swiftly - preferably in under one minute - to rapidly control life-threatening hemorrhage, as delays significantly increase the risk of exsanguination.
Which hemostatic dressing is specifically approved by TCCC for junctional hemorrhage when a tourniquet cannot be used?
HemCon Bandage
Celox Granules
Combat Gauze (QuikClot)
ChitoGauze
Combat Gauze, impregnated with kaolin, is the only hemostatic dressing TCCC specifically approves for adjunctive use in junctional or non-tourniquet areas to control severe bleeding.
What is the recommended compression-to-ventilation ratio for single-rescuer CPR per TCCC standards?
5 compressions to 1 ventilation
100 compressions uninterrupted
30 compressions to 2 ventilations
15 compressions to 2 ventilations
TCCC follows the standard 30:2 compression-to-ventilation ratio for single rescuers to maximize perfusion while ensuring adequate oxygenation. This approach balances care quality and simplicity in austere settings.
In Care Under Fire, if a casualty sustains a chest wound and stops breathing, what intervention should you perform first?
Place the casualty in recovery position
Start chest compressions
Needle decompression
Apply an occlusive chest seal
Under fire, the priority is to rapidly seal open chest wounds with an occlusive dressing to prevent external air entry. Needle decompression is deferred until Tactical Field Care when the scene is more secure.
What is the minimum recommended depth of chest compressions for adults according to TCCC?
At least one-third of chest depth
Exactly 4 cm
At least 1.5 inches
At least 2 inches (5 cm)
Effective chest compressions require a depth of at least 5 cm (about 2 inches) in adults to generate adequate cardiac output and perfusion during resuscitation.
When evaluating a casualty's respiratory rate during Tactical Field Care, which rate range is considered normal?
12 - 20 breaths per minute
5 - 15 breaths per minute
8 - 10 breaths per minute
20 - 30 breaths per minute
The normal adult respiratory rate is 12 - 20 breaths per minute. Rates outside this range may indicate respiratory compromise that needs further intervention.
Which statement best defines permissive hypotension in TCCC guidelines?
Use large-volume crystalloid to rapidly restore normal BP
Maintain SBP above 100 mmHg to ensure perfusion
Target SBP of 80 - 90 mmHg until hemorrhage control
Restrict fluids until SBP is below 70 mmHg
Permissive hypotension targets a lower systolic pressure (80 - 90 mmHg) to minimize bleeding until definitive hemorrhage control is achieved, reducing the risk of clot disruption.
In Tactical Evacuation Care, if whole blood is not available, what is the preferred resuscitation fluid?
0.9% Normal saline
Hextend (6% hetastarch)
Lactated Ringer's solution
Plasma-only transfusion
When whole blood cannot be obtained, Hextend is the preferred colloid in TCCC because it maintains circulating volume without worsening coagulopathy as crystalloids might.
Select the correct sequence for managing a suspected tension pneumothorax in TCCC from initial identification to evacuation preparation.
Perform needle decompression ? apply occlusive chest seal ? identify tension signs ? monitor vital signs ? prepare for evacuation
Apply chest seal ? monitor respiratory rate ? do CPR if needed ? perform decompression ? plan evacuation
Identify tension signs ? apply occlusive chest seal ? perform needle decompression at 4th ICS anterior axillary line ? re-seal and monitor ? prepare for evacuation
Identify tension signs ? start IV fluids ? apply chest seal ? then perform decompression at 2nd ICS midclavicular line
TCCC dictates first recognizing tension pneumothorax signs, then applying an occlusive seal, followed by needle decompression at the 4th - 5th ICS AAL in Field Care, re-sealing if needed, and preparing casualty for evacuation. This protects the airway, restores ventilation, and prevents re-accumulation.
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Study Outcomes

  1. Apply TCCC Protocols -

    Use knowledge of Tactical Combat Casualty Care phases to select appropriate interventions during care under fire and tactical field care.

  2. Perform Hemorrhage Control -

    Demonstrate life-saving techniques such as tourniquet application and wound packing to manage severe bleeding in combat settings.

  3. Assess Airway and Breathing -

    Evaluate and address airway obstructions and respiratory compromise using TCCC best practices taught in the quiz.

  4. Prioritize Tactical Evacuation -

    Make informed decisions on casualty evacuation timelines and methods to optimize patient survival under hostile conditions.

  5. Interpret Shock and Trauma Signs -

    Identify early indicators of shock and other critical injuries to initiate timely interventions and improve outcomes.

  6. Self-Evaluate Combat Lifesaver Test Performance -

    Analyze your results from the combat lifesaver test quiz to highlight strengths and target areas for further skill development.

Cheat Sheet

  1. MARCH Mnemonic for Prioritizing Care -

    Before taking the combat lifesaver test, master the MARCH sequence (Massive hemorrhage, Airway, Respiration, Circulation, Head) to rapidly assess and treat casualties under fire following TCCC guidelines. This memory aid from the Defense Health Agency directs you to address life-threatening injuries in the correct order and keeps interventions systematic under stress.

  2. Rapid Tourniquet Application -

    In a tactical combat casualty care quiz scenario, apply a tourniquet 2 - 3 inches above the wound and tighten until the distal pulse disappears, following Joint Trauma System protocols. Use the "High and Tight" mnemonic to remember placement and always note the time of application on the tourniquet strap.

  3. Airway Management with NPA -

    During a combat lifesaver quiz, be ready to insert a nasopharyngeal airway (NPA) in unconscious patients with an intact gag reflex, using water-based lubricant to minimize trauma and ensure patency. Verifying placement with bilateral breath sounds on auscultation prevents airway obstruction, as recommended by the Journal of Special Operations Medicine.

  4. Needle Decompression for Tension Pneumothorax -

    Identify tension pneumothorax by tracheal deviation, jugular venous distension, and unilateral chest rise, then perform needle decompression in the 5th intercostal space at the anterior axillary line per Trauma Anesthesiology Society standards. Practicing on simulation manikins improves landmark recognition and speed during high-pressure scenarios.

  5. Fluid Resuscitation and Permissive Hypotension -

    Follow the 1:1:1 ratio for plasma, platelets, and red blood cells or administer 500 mL of balanced crystalloids while targeting a systolic BP of 90 mm Hg, based on TCCC protocols from the Armed Forces Journal. Use the "TIP" mnemonic (Tiny Infusion Press) to recall permissive hypotension steps and prevent dilutional coagulopathy.

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