TACTICAL COMBAT CASUALTY CARE – CLS:
TRAIN-THE-TRAINER (INSTRUCTOR) FINAL
EXAMINATION - TCCC CLS Instructor Certification
Assessment with Evidence-Based Rationales
SECTION 1: INSTRUCTOR METHODOLOGY & ERROR CORRECTION
Questions 1–8
Q1. During the hemorrhage control skill station, a CLS student applies a CAT Gen 7
tourniquet high on the thigh over the patient's BDU pants. The student achieves bleeding
cessation and documents "TQ placed." As the instructor candidate, what is your
PRIMARY teaching point?
A. "You applied the TQ correctly. Good work."
B. "Next time, apply it directly to bare skin to improve effectiveness."
C. "You achieved hemorrhage control, but you must document the time of application
and reassess for distal pulses."
D. "The CAT Gen 7 should be applied 2-3 inches above the wound, not high and tight."
Correct Answer: C
Rationale (Instructor Focus): The student performed the skill correctly (high-and-tight is
acceptable per current guidelines; direct skin contact is preferred but not mandatory).
,HOWEVER, the critical instructor teaching point is DOCUMENTATION – TCCC guidelines
require TQ time notation and reassessment for continued necessity. This is the MOST
common CLS documentation error. B: "Preferred" not "required" – presenting as
absolute is incorrect teaching. D: Current guidelines do not mandate 2-3 inches;
high-and-tight is acceptable for femoral hemorrhage.
Instructor Competency: Error recognition + documentation emphasis + absolute
language avoidance
Q2. During the needle decompression station, a student identifies the 2nd intercostal
space, midclavicular line, and prepares a 14-gauge, 3.25-inch angiocatheter. The student
states, "I'll insert the needle perpendicular to the chest wall until I feel a pop." What is the
CORRECT instructor intervention?
A. "That is correct. Proceed with the skill."
B. "The correct site is the 4th/5th intercostal space, anterior axillary line."
C. "Insert the needle at a 45-degree angle, not perpendicular."
D. "You have the correct site and equipment, but the angle should be slightly superior to
avoid the neurovascular bundle."
Correct Answer: D
Rationale (Instructor Focus): This is a HIGH-YIELD teaching point. Per current TCCC
guidelines, needle decompression should be performed with the needle inserted at a
slight SUPERIOR angle to avoid the intercostal artery/vein running along the inferior rib.
Perpendicular insertion risks laceration. A: Incorrect; this perpetuates a dangerous error.
B: Describes the lateral approach (4th/5th ICS, AAL) – this is acceptable but student
,correctly identified 2nd ICS. The question tests teaching the ANGLE correction. C: 45° is
excessive; "slightly superior" is correct.
Instructor Competency: Technique nuance + anatomical hazard identification +
correction delivery
Q3. A CLS student demonstrates the Combat Gauze wound packing technique, inserting
gauze with forceps and packing the wound loosely. The student holds pressure for 2
minutes and reports, "The wound is packed." What is the PRIMARY instructor
correction?
A. "You packed correctly; 2 minutes is adequate pressure time."
B. "You must pack the wound tightly to the point of resistance, not loosely, and hold
pressure for 3 minutes minimum."
C. "Combat Gauze is no longer recommended; switch to ChitoGauze."
D. "You should pack from the bottom up in layers, not insert all at once."
Correct Answer: B
Rationale (Instructor Focus): The CRITICAL teaching point is TIGHT PACKING to the
point of resistance – loose packing allows continued bleeding around the gauze.
Current guidelines specify 3 minutes minimum pressure time. A: Perpetuates two errors
(loose packing, insufficient time). C: Incorrect; Combat Gauze remains recommended.
D: Layering technique is preferred but secondary to tight packing; the student's method
is acceptable if packing is tight.
Instructor Competency: Technique precision + pressure duration emphasis + priority
teaching
, Q4. During the MARCH assessment station, a student spends 4 minutes applying a
tourniquet to a simulated arm amputation while the casualty has gurgling respirations.
The student states, "I need to stop the bleeding first." What is the CORRECT instructor
feedback?
A. "You correctly prioritized hemorrhage control over airway."
B. "In this scenario, the airway compromise is immediately life-threatening. MARCH
prioritizes massive hemorrhage, but airway takes precedence when patency is
compromised."
C. "You should have called for help before starting the TQ."
D. "The tourniquet application was too slow; you must complete it in under 90 seconds."
Correct Answer: B
Rationale (Instructor Focus): This tests understanding of MARCH as a FLEXIBLE
algorithm. While "M" comes first, an immediately compromised airway (gurgling =
obstruction) requires simultaneous or prioritized intervention. The instructor must teach
CRITICAL THINKING, not rigid sequence adherence. A: Incorrect; airway obstruction is
immediately lethal. C: Not the primary teaching point. D: Speed is important but not the
core issue.
Instructor Competency: Algorithm flexibility + clinical judgment teaching + lethal triage
understanding
Q5. A student performing the i-gel insertion achieves placement but ventilates with
difficulty and notes gastric distension. The student asks, "Is this normal?" What is the
instructor's PRIORITY action?
TRAIN-THE-TRAINER (INSTRUCTOR) FINAL
EXAMINATION - TCCC CLS Instructor Certification
Assessment with Evidence-Based Rationales
SECTION 1: INSTRUCTOR METHODOLOGY & ERROR CORRECTION
Questions 1–8
Q1. During the hemorrhage control skill station, a CLS student applies a CAT Gen 7
tourniquet high on the thigh over the patient's BDU pants. The student achieves bleeding
cessation and documents "TQ placed." As the instructor candidate, what is your
PRIMARY teaching point?
A. "You applied the TQ correctly. Good work."
B. "Next time, apply it directly to bare skin to improve effectiveness."
C. "You achieved hemorrhage control, but you must document the time of application
and reassess for distal pulses."
D. "The CAT Gen 7 should be applied 2-3 inches above the wound, not high and tight."
Correct Answer: C
Rationale (Instructor Focus): The student performed the skill correctly (high-and-tight is
acceptable per current guidelines; direct skin contact is preferred but not mandatory).
,HOWEVER, the critical instructor teaching point is DOCUMENTATION – TCCC guidelines
require TQ time notation and reassessment for continued necessity. This is the MOST
common CLS documentation error. B: "Preferred" not "required" – presenting as
absolute is incorrect teaching. D: Current guidelines do not mandate 2-3 inches;
high-and-tight is acceptable for femoral hemorrhage.
Instructor Competency: Error recognition + documentation emphasis + absolute
language avoidance
Q2. During the needle decompression station, a student identifies the 2nd intercostal
space, midclavicular line, and prepares a 14-gauge, 3.25-inch angiocatheter. The student
states, "I'll insert the needle perpendicular to the chest wall until I feel a pop." What is the
CORRECT instructor intervention?
A. "That is correct. Proceed with the skill."
B. "The correct site is the 4th/5th intercostal space, anterior axillary line."
C. "Insert the needle at a 45-degree angle, not perpendicular."
D. "You have the correct site and equipment, but the angle should be slightly superior to
avoid the neurovascular bundle."
Correct Answer: D
Rationale (Instructor Focus): This is a HIGH-YIELD teaching point. Per current TCCC
guidelines, needle decompression should be performed with the needle inserted at a
slight SUPERIOR angle to avoid the intercostal artery/vein running along the inferior rib.
Perpendicular insertion risks laceration. A: Incorrect; this perpetuates a dangerous error.
B: Describes the lateral approach (4th/5th ICS, AAL) – this is acceptable but student
,correctly identified 2nd ICS. The question tests teaching the ANGLE correction. C: 45° is
excessive; "slightly superior" is correct.
Instructor Competency: Technique nuance + anatomical hazard identification +
correction delivery
Q3. A CLS student demonstrates the Combat Gauze wound packing technique, inserting
gauze with forceps and packing the wound loosely. The student holds pressure for 2
minutes and reports, "The wound is packed." What is the PRIMARY instructor
correction?
A. "You packed correctly; 2 minutes is adequate pressure time."
B. "You must pack the wound tightly to the point of resistance, not loosely, and hold
pressure for 3 minutes minimum."
C. "Combat Gauze is no longer recommended; switch to ChitoGauze."
D. "You should pack from the bottom up in layers, not insert all at once."
Correct Answer: B
Rationale (Instructor Focus): The CRITICAL teaching point is TIGHT PACKING to the
point of resistance – loose packing allows continued bleeding around the gauze.
Current guidelines specify 3 minutes minimum pressure time. A: Perpetuates two errors
(loose packing, insufficient time). C: Incorrect; Combat Gauze remains recommended.
D: Layering technique is preferred but secondary to tight packing; the student's method
is acceptable if packing is tight.
Instructor Competency: Technique precision + pressure duration emphasis + priority
teaching
, Q4. During the MARCH assessment station, a student spends 4 minutes applying a
tourniquet to a simulated arm amputation while the casualty has gurgling respirations.
The student states, "I need to stop the bleeding first." What is the CORRECT instructor
feedback?
A. "You correctly prioritized hemorrhage control over airway."
B. "In this scenario, the airway compromise is immediately life-threatening. MARCH
prioritizes massive hemorrhage, but airway takes precedence when patency is
compromised."
C. "You should have called for help before starting the TQ."
D. "The tourniquet application was too slow; you must complete it in under 90 seconds."
Correct Answer: B
Rationale (Instructor Focus): This tests understanding of MARCH as a FLEXIBLE
algorithm. While "M" comes first, an immediately compromised airway (gurgling =
obstruction) requires simultaneous or prioritized intervention. The instructor must teach
CRITICAL THINKING, not rigid sequence adherence. A: Incorrect; airway obstruction is
immediately lethal. C: Not the primary teaching point. D: Speed is important but not the
core issue.
Instructor Competency: Algorithm flexibility + clinical judgment teaching + lethal triage
understanding
Q5. A student performing the i-gel insertion achieves placement but ventilates with
difficulty and notes gastric distension. The student asks, "Is this normal?" What is the
instructor's PRIORITY action?
