Free IBSC TP-C practice questions with answers

Twenty-five original, source-verified IBSC TP-C questions with full answers and rationale below, free to read, no account required. A new set every day.

1. Question 1

   You are holding a casualty for a prolonged period in a remote hide site. How often does prolonged casualty care guidance schedule a hygiene bath, and what is the best-resourced way to perform it?

   • Every 24 hours, using chlorhexidine-impregnated cleansing wipesCorrect
   • Every 72 hours, using povidone-iodine solution and dry gauze
   • Every 48 hours, using an alcohol-based hand rub on the skin
   • Every 12 hours, using warm water with soap and a gauze roll

   Why: The prolonged casualty care nursing schedule sets hygiene at every 24 hours and grades the method: warm water, soap and a gauze roll to the face, armpits and groin as the minimum, baby wipes or a wash cloth as better, and chlorhexidine-impregnated cleansing wipes as best. The twelve-hourly option misstates the interval and pairs it with the minimum method, and the 48- and 72-hour options both stretch the interval and name agents the guideline does not use for a bath. Primary reference: Prolonged Casualty Care Guidelines (JTS CPG ID:91), Wound Care and Nursing, p. 44.

2. Question 2

   A wounded officer with a holstered pistol is being treated in the warm zone and has become confused. Under the 2025 TECC Indirect Threat Care guidelines, what should be done with the weapon?

   • It stays with him because it is agency property
   • It should be made safe and securedCorrect
   • It should be unloaded but left in the holster
   • It should be handed to the nearest bystander to hold

   Why: TECC's first Indirect Threat Care instruction is that any injured person, including law enforcement with a weapon, should have that weapon made safe or secured once the threat is neutralised or if mental status is altered. Both triggers are present here. Leaving a loaded weapon with a confused patient endangers the treatment team, unloading it but leaving it holstered does not remove it from his reach, and handing a firearm to a bystander creates a chain-of-custody and safety problem of its own. Primary reference: TECC Guidelines for BLS/ALS Clinicians (C-TECC, Final 2025-1-2), Indirect Threat Care/Warm Zone, p. 5.

3. Question 3

   A casualty with a sucking chest wound had a vented chest seal applied twenty minutes ago and is now in severe respiratory distress with a saturation of 84 per cent. Under the 2026 TCCC guidelines, what is the first step in treating the suspected tension pneumothorax?

   • Decompress the chest with a 14-gauge 3.25-inch needle at the fifth space
   • Burp or remove the chest sealCorrect
   • Sit the casualty fully upright and begin assisted bag-valve-mask ventilation
   • Place a second vented chest seal over the first to improve the seal integrity

   Why: The initial treatment list for suspected tension pneumothorax begins with a step that costs nothing: if the casualty has a chest seal in place, burp or remove it. A dressing that has become occluded by blood or by tissue apposition converts an open pneumothorax into a tension pneumothorax, and lifting it can resolve the physiology instantly without breaching the chest wall. Needle decompression follows if that fails. Sitting the casualty up and bagging him does not relieve the intrapleural pressure, and adding a second seal makes the trapped air worse. Primary reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Tactical Field Care, Respiration/Breathing, p. 4. Cross-reference: TECC Guidelines for BLS/ALS Clinicians (C-TECC, 2025), Indirect Threat Care/Warm Zone, printed p. 7.

4. Question 4

   Operators in chemical protective overgarments are doing hard work on a decontamination line. What adjustment to the measured wet bulb globe temperature index does doctrine direct for that combination of garment and workload?

   • Add 20 degrees F (10.2 degrees C)Correct
   • Add 10 degrees F (5.6 degrees C)
   • No adjustment is applied
   • Add 5 degrees F (2.8 degrees C)

   Why: Wearing protective overgarments alone adds 10 degrees F to the index, but doctrine doubles that to 20 degrees F once the wearer is doing moderate or hard work, because the sweat the garment traps can no longer evaporate at that metabolic rate. Five degrees is the separate body-armour correction, and leaving the index unadjusted would place workers in a work/rest cycle far too generous for their real heat strain. Primary reference: Multi-Service Tactics, Techniques, and Procedures for Health Service Support in a Chemical, Biological, Radiological, and Nuclear Environment (ATP 4-02.7 / MCRP 4-11.1F / NTTP 4-02.7 / AFTTP 3-42.3, 15 March 2016), Patient Decontamination, caution following Table 5-6, p. 5-20.

5. Question 5

   The 2025 TECC Evacuation Care operational principles include a statement about situational awareness during dynamic events. What is it?

   • The cold zone is free of threat once it has been declared
   • In dynamic events there are no threat-free areasCorrect
   • Situational awareness becomes the incident commander's task alone
   • Threat assessment ends once the last casualty has been extracted

   Why: TECC's Evacuation Care operational principles direct the clinician to maintain situational awareness and state plainly that in dynamic events there are no threat-free areas. That statement is the operational counterpart to the guidelines' position that the phases correlate with threat level rather than geography: a cold-zone label describes a moment, not a guarantee. Handing situational awareness entirely to incident command or closing threat assessment at the last extraction both contradict the principle. Primary reference: TECC Guidelines for BLS/ALS Clinicians (C-TECC, Final 2025-1-2), Evacuation Care/Cold Zone, p. 12.

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7. Question 6

   The 2023 K9TCCC guidelines give a specific caution for hydromorphone in working dogs. What is it?

   • It reliably produces profound hypotension in dogs
   • It causes seizures at doses above 0.05 mg per kilogram
   • It cannot be reversed by naloxone in this species
   • It causes excessive panting, so use caution with head injuryCorrect

   Why: K9TCCC states that hydromorphone causes excessive panting and directs caution in dogs with head injuries and respiratory disease, because panting alters ventilation and carbon dioxide and can confound assessment in exactly the casualty whose intracranial pressure you are trying to manage. The drug is otherwise a listed option at 0.1 mg per kilogram by intravenous, intraosseous or intramuscular route across all three pain categories. Naloxone is required to be available whenever opioids are given, so reversibility is assumed rather than denied. Primary reference: Canine Tactical Combat Casualty Care (K9TCCC) Guidelines, 01 May 2023, Analgesia and Sedation, p. 11.

8. Question 7

   Where is the vapour control line placed relative to the hot line at a patient decontamination site, and what does crossing it permit?

   • Directly on the hot line; masks are removed as each patient crosses the hot line
   • About 50 metres downwind of the hot line; masks may be removed once it is crossed
   • About 10 metres upwind of the hot line; masks may be removed once it is crossedCorrect
   • About 10 metres downwind of the drop-off point; masks are removed at the triage area

   Why: The hot line separates the warm zone from the clean side and no liquid or solid contamination crosses it, but vapour can, so a separate vapour control line is established typically about ten metres upwind of the hot line, and patients and team members stay masked until they cross it. Chemical vapour detectors are used to establish that line. Doctrine adds that a vapour control line is not needed for a radiological or biological hazard, because those agents produce no hazardous vapour. Placing the line downwind, or on the hot line itself, would unmask people while vapour is still present. Primary reference: Multi-Service Tactics, Techniques, and Procedures for Health Service Support in a Chemical, Biological, Radiological, and Nuclear Environment (ATP 4-02.7 / MCRP 4-11.1F / NTTP 4-02.7 / AFTTP 3-42.3, 15 March 2016), Patient Decontamination, pp. 5-25 to 5-26.

9. Question 8

   A person is decontaminated after exposure to dispersed radioactive material and the responders must decide what to do with the removed clothing. What does response guidance direct?

   • Return the clothing to the patient once surface readings have fallen to twice background.
   • Place it in a clearly marked and sealed receptacle so that it can be tested later on.Correct
   • Bag the clothing with other scene refuse, since contaminated textiles carry no further value.
   • Launder the clothing on scene, which removes contamination without generating a waste stream.

   Why: For people contaminated with radioactive material the guidance directs minimising the spread of contamination, moving the person to a low-radiation area if that can be done safely, and removing their clothing and placing it in a clearly marked and sealed receptacle, such as a plastic bag, for later testing. Decontamination then proceeds by the methods described for chemical and biological agents while avoiding breaking the skin, for example by vigorous brushing. Sealing and marking the clothing serves two purposes at once: it contains the contamination, and it preserves the item as a testable article, which matters when an intentional release is suspected and the clothing may be the best available record of what the person was exposed to. Discarding, returning or laundering the clothing destroys both the containment and the record. Primary reference: Emergency Response Guidebook 2024, Decontamination Measures, p. 364.

10. Question 9

    An initial needle decompression on a working dog fails to relieve the signs of tension pneumothorax. What do the 2023 K9TCCC guidelines direct next?

    • Proceed immediately to an open thoracotomy
    • Apply a second chest seal over the first dressing
    • Accept the finding and move on to circulation assessment
    • Reposition and decompress again, considering the opposite sideCorrect

    Why: K9TCCC directs that if the first attempt fails, a dog in sternal recumbency be repositioned into lateral recumbency and decompressed again on the same side with a new needle and catheter, that decompression then be attempted on the opposite chest wall with another new unit, and that the opposite side be considered on the basis of mechanism and findings. The guidelines specifically advise considering both sides in working dogs because of anatomical differences. Only after a failed second attempt does the sequence move on to circulation, and thoracostomy is reserved for refractory shock by a provider authorised to perform it. Primary reference: Canine Tactical Combat Casualty Care (K9TCCC) Guidelines, 01 May 2023, Respiration/Breathing, p. 6.

11. Question 10

    The 2023 K9TCCC guidelines direct how the K9TCCC Card is used for a working-dog casualty. What do they require?

    • The card is retained by the treating medic for the unit record
    • The card is completed only for casualties evacuated by air
    • The card is transmitted by radio and the paper copy destroyed
    • The card is completed, secured to the casualty and forwarded onCorrect

    Why: K9TCCC directs that clinical assessments, treatments and changes in status be documented on a K9TCCC card, DD Form 3073, that the information be forwarded with the casualty to the next level of care, and that the completed card be secured to the dog when preparing for evacuation. It also directs that tourniquet application, reapplication, conversion and removal times be marked in permanent ink on both the tourniquet and the card. Retaining, destroying or selectively completing the card all break the continuity of care the form exists to provide. Primary reference: Canine Tactical Combat Casualty Care (K9TCCC) Guidelines, 01 May 2023, Documentation of Care, p. 14.

12. Question 11

    A casualty with a fragment wound to the forearm is in pain but remains mission capable. Under the 2026 TCCC analgesia guidance, which three oral medications make up the TCCC Combat Wound Medication Pack?

    • Meloxicam, moxifloxacin and acetaminophen with an antiemetic tablet
    • Acetaminophen, ibuprofen and oral transmucosal fentanyl citrate
    • Acetaminophen, meloxicam and suzetrigineCorrect
    • Acetaminophen, celecoxib and oral ketamine at an analgesic dose

    Why: The 2026 Combat Wound Medication Pack contains acetaminophen 1000 to 1300 mg every eight hours, meloxicam 15 mg once daily, and suzetrigine 100 mg once followed by 50 mg every twelve hours. All three are oral, none is sedating, and none meaningfully impairs platelet function, so the casualty can stay in the fight. Ibuprofen is a traditional non-steroidal drug that TECC advises against in trauma for that reason, transmucosal fentanyl is an opioid rather than a pack component, and moxifloxacin is an antibiotic. Primary reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Tactical Field Care, Analgesia, p. 10. Cross-reference: TECC Guidelines for BLS/ALS Clinicians (C-TECC, 2025), Indirect Threat Care/Warm Zone, printed p. 10.

13. Question 12

    A tactical paramedic is asked to contribute the medical portion of a mission analysis. Which set of variables is the framework that analysis is built on?

    • The five phases of a raid: infiltration, isolation, assault, task accomplished, and withdrawal.
    • The five military aspects of terrain: observation, cover, obstacles, key terrain, avenues of approach.
    • The mission variables: mission, enemy, terrain and weather, troops, time and civil considerations.Correct
    • The five paragraphs of the operation order: situation, mission, execution, sustainment, and command.

    Why: Leaders filter relevant information into the categories of the mission variables, which the current edition lists as mission, enemy, terrain and weather, troops and support available, time available, civil considerations and informational considerations, the last added to the familiar mnemonic because information is now used to generate cognitive effects and must be assessed continuously as a component of each other variable. These variables are what leaders use to analyse and understand a situation in relation to the unit's mission, and a medical estimate is built inside them rather than beside them. The five-paragraph order is the product of planning, not the analytical framework; the aspects of terrain are a subset of one variable; and the phases listed describe the conduct of a raid rather than an analysis. Primary reference: ATP 3-21.8, Infantry Rifle Platoon and Squad, 11 January 2024, p. 2-9.

14. Question 13

    A casualty has extensive facial burns with an airway obstruction that positioning and suction have not relieved. Under the 2026 TCCC guidelines, what are the specified dimensions of the airway cannula used for surgical cricothyroidotomy?

    • Exactly 10 mm outer diameter with an uncuffed 8 mm internal lumen
    • At least 12 mm outer diameter to guarantee adequate minute ventilation
    • Whatever endotracheal tube is to hand, cut to approximately 12 cm length
    • Less than 10 mm outer diameter, 6-7 mm inner, 5-8 cm intratrachealCorrect

    Why: The 2026 guidelines describe the device as well as the technique: a flanged and cuffed airway cannula of less than 10 mm outer diameter, 6 to 7 mm internal diameter, and 5 to 8 cm of intratracheal length, placed by either a bougie-aided or a standard open surgical approach. The outer-diameter ceiling reflects the size of the cricothyroid membrane, the internal diameter preserves adequate flow, and the length limit keeps the tip above the carina. A larger cannula will not pass reliably. Improvising with an uncut or arbitrarily cut tube risks a tip in the right main bronchus or an uncuffed, unsecured airway. Primary reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Tactical Field Care, Airway Management, p. 3. Cross-reference: Prolonged Casualty Care Guidelines (JTS CPG ID:91), Respiration and Ventilation, p. 15.

15. Question 14

    A casualty in prolonged care with a severe head injury begins seizing. Under the Prolonged Casualty Care guidelines, what is the immediate treatment, and what is used for refractory seizures?

    • A benzodiazepine first, with ketamine considered for refractory seizuresCorrect
    • Propofol infusion first, with a barbiturate coma for refractory seizures
    • Hypertonic saline first, on the basis that the seizure indicates herniation
    • Levetiracetam 1 gram first, with phenytoin loading for refractory seizures

    Why: The PCC head injury table places immediate seizure treatment with benzodiazepines at Role 1c, and directs the provider to consider ketamine for refractory seizures. Levetiracetam appears in the same table but as seizure prophylaxis at 1 gram where available, which is a different indication from an active seizure. Propofol and barbiturates are not offered anywhere in these guidelines as field agents, and hypertonic saline is reserved for signs of raised intracranial pressure rather than used as an anticonvulsant. Primary reference: Prolonged Casualty Care Guidelines (JTS CPG ID:91), Head Injury/TBI, pp. 28–29. Cross-reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Tactical Field Care, Analgesia and sedation notes, p. 11.

16. Question 15

    The Prolonged Casualty Care guidelines define roles of care by the time a casualty is held. Which role corresponds to a mission support site where care extends beyond four hours?

    • Role 1d
    • Role 1a
    • Role 1b
    • Role 1cCorrect

    Why: The PCC roles of care table pairs each role with a place and a time band: Role 1a is carried at the point of need for under an hour, Role 1b is a mission-specific transport platform for one to four hours, Role 1c is a mission support site beyond four hours, and Role 1d is an evacuation platform with no fixed timeframe. The distinction matters because several PCC interventions, including Foley placement, type-specific blood conversion and continuous core temperature monitoring, are keyed to Role 1c. Primary reference: Prolonged Casualty Care Guidelines (JTS CPG ID:91), Guideline User Notes, Table 1 Roles of Care, p. 8. Cross-reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Traumatic Brain Injury, p. 9.

17. Question 16

    According to the TCCC skill sets by responder level, which respiration skills are marked for the Combat Paramedic/Provider only?

    • Automated ventilation, simple finger thoracostomy and tube thoracostomyCorrect
    • Oxygen administration and assessment of respirations in TCCC
    • Treatment of a sucking chest wound and treatment of respiratory dysfunction
    • Needle thoracostomy and vented chest seal application together

    Why: In the respiration block of the master list, three skills carry a single mark in the combat paramedic and provider column: automated ventilation, simple finger thoracostomy and tube thoracostomy. Needle thoracostomy and sucking chest wound treatment extend down to the combat lifesaver, oxygen administration is shared with the combat medic, and respiratory assessment sits at every level. The pattern is why the TCCC refractory-shock paragraph qualifies finger thoracostomy and chest tube insertion by the skills, experience and authorisations of the treating provider. Primary reference: Tactical Combat Casualty Care Skill Sets by Responder Level (master list, 25 Jan 2024), Respiration/Breathing, sheet 2. Cross-reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Tactical Field Care, Refractory Shock, p. 7.

18. Question 17

    Your team finds numerous dead goats and birds within a small area, with no obvious cause and no recent severe weather. Under multi-service doctrine, what is the significance of that finding and what action follows?

    • It indicates a radiological release only, so begin an immediate radiation survey
    • Animal deaths carry no CBRN significance, so document and continue the task
    • It indicates a toxic industrial spill only, so notify the supporting engineer officer
    • Animals can be sentinels of CBRN exposure, so report to veterinary supportCorrect

    Why: Doctrine states that animals can serve as sentinels of CBRN contamination or exposure and directs that unexpected death or illness in wild or indigenous animals be reported to the supporting veterinary unit, particularly where onset is sudden and large numbers are affected quickly. It stresses that this is especially true for biological agents, because many produce similar signs in animals and people. Dismissing the finding forfeits an early warning, and neither the radiological nor the toxic-industrial interpretation is the only one available. Primary reference: Multi-Service Tactics, Techniques, and Procedures for Health Service Support in a Chemical, Biological, Radiological, and Nuclear Environment (ATP 4-02.7 / MCRP 4-11.1F / NTTP 4-02.7 / AFTTP 3-42.3, 15 March 2016), Veterinary Service Support, Veterinary Public Health, p. 6-3.

19. Question 18

    Under the 2026 TCCC guidelines, what must be documented before ketamine is administered, and on which form?

    • The casualty verbal consent and last oral intake, in the medic patient notebook
    • A pain score out of ten, recorded on the unit casualty tracking log
    • A mental status examination using the AVPU method, on the DD Form 1380 cardCorrect
    • A full Glasgow Coma Scale score, on the DD Form 3019 resuscitation record

    Why: TCCC requires that a mental status examination using the AVPU method be documented on the DD Form 1380 TCCC card before ketamine is given. The reason is diagnostic rather than administrative: once a casualty is dissociated, no later examiner can tell whether an abnormal mental status reflects the drug or an evolving brain injury, so the pre-drug baseline is the only reference point that will exist. A Glasgow Coma Scale on the resuscitation record is a prolonged-care practice, and consent is not the stated requirement. Primary reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Tactical Field Care, Analgesia and sedation notes, p. 11. Cross-reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Documentation of Care, p. 14.

20. Question 19

    Under the Prolonged Casualty Care guidelines, what eye care is required for a casualty with facial burns?

    • Perform a thorough eye examination early, before oedema beginsCorrect
    • Tape both eyelids closed immediately to prevent exposure keratopathy
    • Defer any eye examination until the casualty reaches a burn centre
    • Irrigate both eyes continuously for thirty minutes regardless of findings

    Why: The PCC wound care row states that every patient with facial burns should have a thorough eye examination conducted early, before oedema begins, because within hours the lids will be too swollen to open and an injury will go undetected until the eye is lost. If a corneal injury is identified, the guidance directs a rigid shield to cover the eye and ophthalmic erythromycin or neomycin ointment every two hours. Continuous irrigation is a chemical-exposure measure, and taping the lids without first examining them conceals the very injury being looked for. Primary reference: Prolonged Casualty Care Guidelines (JTS CPG ID:91), Burn Treatment, p. 49. Cross-reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Penetrating Eye Trauma, p. 10.

21. Question 20

    Under the 2026 TCCC guidelines, up to what burn size may oral fluids be considered in a conscious casualty who can swallow?

    • Up to 10 per cent total body surface area
    • Up to 20 per cent
    • Up to 30 per centCorrect
    • Up to 50 per cent

    Why: TCCC permits consideration of oral fluids for burns up to 30 per cent total body surface area if the casualty is conscious and able to swallow. The allowance matters operationally because it covers a substantial burn without committing a line, a warmer and a bag of crystalloid in a setting where those may be scarce. The 20 per cent figure in the distractors is the threshold at which intravenous resuscitation begins, so the two overlap between 20 and 30 per cent, and confusing them is the trap this item tests. Primary reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Tactical Field Care, Burns, p. 13. Cross-reference: Prolonged Casualty Care Guidelines (JTS CPG ID:91), Burn Treatment, p. 48.

22. Question 21

    An exfiltration plan must move a time-critical casualty from a rural objective where the nearest hospital is a 50 minute drive. What does clinical guidance advise?

    • Request air transport only after ground transport has begun and the patient has deteriorated.
    • Ground transport is always preferable, because air assets introduce additional delay on scene.
    • Consider air transport when ground transport time exceeds 30 minutes for a critical patient.Correct
    • Use lights and sirens routinely on the ground leg, which offsets the additional transport time.

    Why: The universal patient-safety considerations direct considering air medical transport, if available, for patients with time-critical conditions where ground transport time exceeds 30 minutes. The same list makes the companion point that routine use of lights and sirens is not warranted and that even when they are in use speed must stay safe for the vehicle and road conditions, so lights and sirens are not a substitute for choosing the right platform. Making the decision during exfiltration planning rather than at the moment of injury is what makes a landing zone available when it is needed. Waiting for deterioration before requesting a platform forfeits the launch and transit time that made air transport worth considering, and a blanket preference for ground transport ignores the threshold the guidance sets. Primary reference: National Model EMS Clinical Guidelines (NASEMSO), Version 3.0, March 2022, Universal Care Guideline, p. 13.

23. Question 22

    The 2023 K9TCCC guidelines describe hypothermia prevention for a working-dog casualty. Where is an active heating blanket placed?

    • Wrapped circumferentially around the torso and secured
    • Over the head and neck so that inspired air is warmed
    • Beneath the dog, directly between it and the cold ground
    • On the torso, not directly on haired skin and not wrapped aroundCorrect

    Why: K9TCCC directs placing an active heating blanket on the torso and specifically warns against putting an active heat source directly on haired skin or wrapping it around the torso, because a sedated or shocked dog cannot move away from a burn. Insulation goes between the dog and any cold surface, wet gear is removed and wet tissue gently patted dry, and the dog is then enclosed in an impermeable bag and upgraded to an insulated system when possible. Warming inspired air is not part of the canine plan. Primary reference: Canine Tactical Combat Casualty Care (K9TCCC) Guidelines, 01 May 2023, Hypothermia Prevention, p. 9.

24. Question 23

    Under the 2026 TCCC guidelines, how often should neurological status be reassessed in a casualty with a suspected moderate or severe traumatic brain injury?

    • Every five to ten minutesCorrect
    • Every fifteen minutes until evacuation
    • Hourly, or on any change reported by the casualty or another responder
    • Every minute for the first ten minutes, then every thirty minutes

    Why: TCCC closes the brain injury section with an instruction to reassess neurological status every five to ten minutes to evaluate for worsening status. The short interval exists because the deterioration this section is written to catch, an expanding intracranial haematoma, can progress from a following-commands casualty to a herniating one inside that window, and the medic has interventions that only work if the change is caught. Hourly checks are the prolonged-care standard for a casualty already held for many hours, not the acute field interval. Primary reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Traumatic Brain Injury, p. 10. Cross-reference: Prolonged Casualty Care Guidelines (JTS CPG ID:91), Head Injury/TBI, p. 27.

25. Question 24

    Under the 2026 TCCC guidelines, a tension pneumothorax should be suspected and treated when a casualty has significant torso trauma or primary blast injury plus at least one further finding. Which of the following is on that list?

    • Traumatic cardiac arrest without obviously fatal woundsCorrect
    • Subcutaneous emphysema palpable over the chest wall or supraclavicular fossa
    • Tracheal deviation away from the affected side on palpation
    • Distended neck veins with a narrowed pulse pressure

    Why: The 2026 list is deliberately short and field-usable: severe or progressive respiratory distress, severe or progressive tachypnoea, absent or markedly decreased breath sounds on one side, saturation below 90 per cent, shock, and traumatic cardiac arrest without obviously fatal wounds. The classical late signs in the distractors, tracheal deviation, distended neck veins and subcutaneous emphysema, are real findings but appear nowhere in the criteria, because they are unreliable, appear late, and cannot be assessed in a casualty wearing body armour in poor light. Primary reference: Tactical Combat Casualty Care (TCCC) Guidelines, 01 May 2026, Tactical Field Care, Respiration/Breathing, p. 3. Cross-reference: TECC Guidelines for BLS/ALS Clinicians (C-TECC, 2025), Indirect Threat Care/Warm Zone, printed p. 7.

26. Question 25

    Samples awaiting processing are held in a field laboratory refrigerator. Beyond biosafety, what does doctrine require of that storage, and why?

    • Samples must be split on arrival so that a duplicate is always held at a separate location.
    • Samples must be relabelled on entry so that collector identifiers are replaced by laboratory numbers.
    • Storage containers must be physically secured to control access, maintaining chain of custody.Correct
    • Samples must be stored at ambient temperature so that condensation does not degrade labels.

    Why: The storage guidance directs that samples be kept at temperatures appropriate for the sample type, usually refrigerated at about 4 degrees Celsius for a short period until processing, and that the unused portion be refrigerated after aliquoting. It then adds the security requirement that carries the legal weight: because of the potentially hazardous nature of these samples, good physical security must be maintained on the storage area, and storage containers are to be physically secured to control access so as to maintain chain of custody and assure biosafety. Accessioning preserves rather than replaces the collector's identifying number, since the laboratory must record the number assigned by the collector where one exists. Splitting is done for parallel identification rather than as an access control, and ambient storage is contrary to the guidance. Primary reference: ATP 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3, Health Service Support in a CBRN Environment, 15 March 2016, pp. 8-4 to 8-5.