In 2011, the Committee for Tactical Emergency Casualty
Care (C-TECC) published guidelines of care for
law enforcement and EMS, based on the successful
US Military’s Tactical Combat Casualty Care (TCCC)
program, adapted for high threat incidents in a
civilian setting. C-TECC recognized that the civilian
environment could benefit from the same simple skills
applied in mass casualty incidents, where injuries are
similar to those sustained on the battlefield.
Adding “Tactical” to the title of these skills is not a marketing ploy or just to sound “tacti-cool.” C-TECC defines “Tactical” as “of or pertaining to a maneuver or plan of action designed as an expedient toward gaining a desired end or temporary advantage.”
These skills and techniques are a structured plan of action with one goal in mind, to save lives from traumatic injuries before advanced medical care can be provided.
The guidelines of Tactical Emergency Casualty Care define three distinct phases of care during emergency medical responses, whether terrorist, intentional, accidental, or disaster related mass casualty accidents.
These three phases are:
Direct Threat Care – A current active threat exists, goal is neutralization of
threat and rapid care of immediate life-threatening injuries.
Indirect Threat Care – Threat may be near, or situation is unstable, goal is
swift assessment and management of life-threatening injuries
in preparation for transport to a trauma hospital.
Evacuation Care – Threat is neutralized or contained, goal is rapid
transport to a trauma hospital.
According to TECC, injuries are assessed, treated, and managed using the MARCHe acronym:
M – Massive Hemorrhage
A – Airway
R – Respirations
C – Circulation
H – Hypothermia / Head Injury
e – Everything else
The skills of TECC are simple.
- Stop rapid, severe bleeding using tourniquets and hemostatic gauze.
- Keep the airway open using proper victim positioning.
- Manage lung compromise from penetrating wounds using chest seals.
- Treat lesser bleeding using pressure bandages.
- Prevent hypothermia by keeping the victim insulated and warm.
- Manage head injuries by assessing mental status and using proper victim
The tools of TECC are simple.
- A quality commercial tourniquet, such as TacMed Solutions' SOFTT-W or
North American Rescue's CAT tourniquets
- Approved hemostatic gauze, such as MedTrade Products' Celox Rapid
Gauze or Z-Medica's Quikclot Combat Gauze
- Chest seals such as MedTrade Products' FoxSeal Chest Seals,
North American Rescue's Hyfin Chest Seals, or PMI's Halo Chest Seals
- All-in-one pressure dressings, such as TacMed Solutions' Olaes Modular
Bandage or North American Rescue's Emergency Trauma Dressing
- Emergency "Space" Radiant Heat Blanket
CAPOST and CAEMSA approved the use of tactical tourniquets, the application of hemostatic gauze, the use combat chest seals, and the use of trauma pressure bandages in April 2015, including these skills into the scope of practice for Law Enforcement Officers. These skills became required, mandated skills for CA Law Enforcement in April 2017.