TCCC Tier-3
A casualty has a penetrating chest wound, worsening respiratory distress, and absent breath sounds on one side. What treatment should be performed, and at what two preferred anatomical locations may it be performed?
Needle decompression at the 5th ICS AAL or 2nd ICS MCL.
You have finished removing your gloves after caring for a patient with no known infectious disease. Before touching any equipment or another patient, what action must you take?
Perform hand hygiene.
A casualty has an isolated extremity injury with severe pain, is alert, has a normal mental status, and is not in shock. According to the Pain Management protocol, what medication, dose, and route should a Skill Level 3 provider administer, and what is the medication's purpose?
Ketamine 20 mg IV slow push (or 50 mg IM/IN if no IV). It provides analgesia while helping preserve airway reflexes and respiratory drive.
You arrive at a motor vehicle accident involving a tanker truck displaying a red placard with a flame symbol. Before approaching, what type of hazard should you immediately suspect?
Flammable material.
What is Lt. Zepeda's civilian job when he isn't serving in the Air National Guard? (be specific)
Emergency Department Clinical Nurse Coordinator.
A tourniquet was applied high and tight during Care Under Fire. During Tactical Field Care, what conditions must be present before considering conversion to a pressure or hemostatic dressing?
Casualty is stable, bleeding is controlled, and the wound can be monitored.
You are preparing to assist with wound care on a patient with a draining surgical incision. Based on standard precautions, what minimum PPE should you wear?
Gloves (accept additional PPE if they justify splash risk).
A casualty has an open femur fracture, and evacuation is expected to take several hours. According to the trauma protocols, what medication, dose, and route should be administered, and why?
Ertapenem 1 g IV/IM. It is a broad-spectrum antibiotic used to reduce the risk of infection in open wounds.
A railcar has a green placard with a gas cylinder symbol. What general hazard does this indicate?
Non-flammable compressed gas.
Before commissioning into the Air Force Nurse Corps, what enlisted AFSC did Lt. Zepeda serve as? (Be specific w/ upgrade training)
4N071 – Aerospace Medical Service.
A casualty in hemorrhagic shock needs fluid resuscitation. Place these products in preferred TCCC order: crystalloids, whole blood, plasma and red blood cells, dried plasma, and red blood cells alone.
Whole blood → Plasma + RBCs (1:1) → Dried plasma → RBCs alone → Crystalloids
During your assessment, a patient rates their pain as 8/10, but they are smiling and talking comfortably. Should you document the pain score, your observation, or both?
Both
A patient develops severe airway swelling, hypotension, and respiratory distress after a bee sting. According to the Anaphylaxis protocol, what medication, dose, concentration, and route should be given, and what does it do?
Epinephrine 0.3 mg IM (1 mg/mL). It reverses anaphylaxis by opening the airways, improving blood pressure, and reducing swelling.
During a warehouse response, several victims complain of burning eyes, coughing, and difficulty breathing after an unknown chemical release. As a HazMat Operations responder, what is your first priority?
Protect yourself, isolate the area, and identify the hazard before treating patients.
If Lt. Zepeda isn't at the hospital or drill weekend, where is he most likely to be?
Golf Course
After receiving blood products, a casualty has a palpable radial pulse, improved mental status, and a systolic blood pressure of 105 mmHg. The casualty also has a suspected traumatic brain injury. Is resuscitation adequate, and what blood-pressure target should guide continued treatment?
Maintain SBP ≥100–110 mmHg with suspected TBI.
While preparing to transfer a patient with a suspected cervical spine injury from a gurney to a hospital bed, what is the most important action to prevent further injury?
Maintain spinal alignment throughout the transfer.
A patient with a severe traumatic brain injury begins showing signs of increased intracranial pressure. According to the Head Injury protocol, what medication, concentration, dose, and route should be administered, and what is its purpose?
3% Hypertonic Saline, 250 mL IV. It reduces cerebral edema and helps lower intracranial pressure.
You arrive at a highway accident involving a tanker truck. The trailer is carrying a four-digit UN number. What information can that number help you determine?
The product being transported and its associated hazards.
What is one thing Lt. Zepeda is almost guaranteed to ask you about during patient care?
But Why?
A casualty has an altered mental status, weak radial pulse, severe pelvic pain after a blast, no obvious external hemorrhage, and a distended abdomen. Explain your treatment and evacuation priorities.
Treat hemorrhagic shock, apply a pelvic binder if indicated, prevent hypothermia, and evacuate urgently.
You are preparing a patient for transport on a fixed-wing aircraft. Before movement begins, what are the two most important safety checks that should be completed?
Secure the patient and ensure all equipment/lines are secured.
A patient has a painful corneal abrasion after debris entered their eye. According to the Eye Injury protocol, what medication, dose, and route should be administered before further assessment, and what is its purpose?
Tetracaine 0.5%, 1–2 drops in the affected eye. It provides topical anesthesia to relieve pain and facilitate the eye examination.
You arrive at a chemical spill involving an unknown substance. The driver is unconscious and no one knows what the product is. Name three resources or clues you can use to identify the material before patient contact.
Lt. Zepeda has worked in emergency medicine for approximately how many years?
About 10 years.