Tactical Emergency Casualty Care

What is Tactical Emergency Casualty Care?

Federal and civilian tactical and emergency medical response teams now stand at the same crossroads the military special operations medical community stood at in the early 1990s. Implementing TCCC guidelines as written into civilian protocols has the same fundamental flaws as utilizing civilian ATLS principles for battlefield treatment of combat wounded. This practice is essentially basing medical care on a doctrine designed to address the specific environment and restrictions of the military battlefield, not the civilian setting.

TCCC is written for the combat medic operating in a combat theater, not for the civilian tactical medic operating in a crack house in downtown Washington, DC. There is no doubt that the weapons and wounds are similar between the two settings, and there is no doubt that federal and civilian tactical teams are indeed in combat. But, just as ATLS did not address many of the unique factors specific to the military combat environment, TCCC does not address the differences in the military setting, the federal or civilian provider, and the non-military environment.

These differences include, but are not limited to, the following:

• The scope of practice and liability

Federal and civilian medical responders must practice under State and local scope of practice and protocols, and are subject to both negligence and liability that the military provider is not.

• Patient population to include geriatrics and pediatrics

TCCC data and research was heavily based off of an 18-30-year-old population, not all age groups as represented in civilian operations.

TCCC was written primarily to address the wounded combatant and does not address high threat care for innocent non-combatants.

• Distance, the time required, resources available for evacuation to definitive care

Most civilian cities have multiple definitive medical facilities, many with Level 1 Trauma centers, within a short distance.

Ground and air medical assets are readily available in most civilian and federal settings.

• Differences in barriers to evacuation and care

In civilian settings, there is far less need for concern for secondary hits or armed resistance to evacuation. In general, once clear of the immediate scene, security in the civilian setting can be assumed.

• Baseline health of the population

The TCCC combatant population is relatively healthy and physically fit without the high incidence of chronic medical illness that exists in the civilian population.

• Wounding patterns

Although the weapons are similar between military and civilian scenarios, the wounding patterns differ given the prevalence of and differences in protective ballistic gear, as well as the use of and strength of improvised explosive devices in the military setting.

• Chronic medication use in the injured

TCCC fails to account for and address the effects of chronic medication use, such as beta blockers and especially anti-coagulants.

• Special populations including pregnant patients, mentally and physically handicapped

Special populations are prevalent in the civilian setting and the required differences in their care should not be a battlefield adjustment.

The conclusion, logically then, is that blind implementation of TCCC doctrine by federal and civilian first responders without consideration for these subtle differences will result in a practice that will not be as effective and potentially may be detrimental in some populations.

Similar to what TCCC did for the medical care in the military combat setting, civilian and federal first responders needed a new paradigm, a framework that defined the environment and resource constraints, and provided guidance that would allow best evidence-based management of patients to accomplish the life-saving mission. To address this need, a diverse group of first responder experts called the Committee for Tactical Emergency Casualty Care (C-TECC) was formed and, in May 2011, held their inaugural meeting to create the Tactical Emergency Casualty Care guidelines (TECC). The TECC guidelines are a set of best practice recommendations for casualty management during high threat civilian tactical and rescue operations.

What is our TECC training philosophy?

The training provided by our company is in full accordance with the TECC guidelines, we teach how it was meant to be taught, according to the provider skill level. We do not deviate from the curriculum nor do we teach our own "interpretation" of the guidelines.

We teach you the how's and why's, followed by the evidence-based tactical medicine research which justifies it. We show you all different kinds of gear and equipment and how they are best applied. We have numerous different types of tourniquets, bandages, hemostatic agents, stretchers, sleds, and training tools for you to evaluate.

Each course includes time for a full gear shake out, we will show you what you have that is worth keeping, what is junk, and what you need to be purchasing.

This is a "tactical medical course", not a "run-and-gun" or "edutainment" course, it is designed to enhance your medical skill set. Courses that include "tactical training" really take away from the medical didactic component. We want you to really understand the subject matter and will dedicate as long as it takes for every student to leave with the confidence needed to act during a time of crisis.

Levels of TECC courses available