Page 78 - Journal of Special Operations Medicine - Summer 2016

on a semiannual basis. A two-thirds majority vote from adoption and support of TECC guidelines by the DHS
the Guidelines Committee is required to approve any Office of Health Affairs, the Federal Emergency Man-
changes to the existing TECC guidelines. 4 agement Agency (FEMA), the National Association of
EMTs (NAEMT), the IAB, the JCTAWS, the NTOA, the
Since the first publication of the guidelines, over 150,000 IAFF, and dozens of other agencies at the federal, re-
law enforcement, fire department, EMS, physicians, gional and local levels. 7–9
nurses, and laypersons have been trained in TECC. A
5
variety of government and professional organizations The JRC also recognized that although the existing
including the Department of Homeland Security (DHS), NTIC domains were valid and the trauma care recom-
the InterAgency Board (IAB), the Joint Counterterror- mendations are consistent with TECC, the presence
ism Awareness Workshop (JCTAWS), the NTOA, the of 17 domains likely created unnecessary redundancy
Special Operations Medical Association (SOMA), the and barriers to broad implementation. The JRC recom-
International Association of Fire Fighters (IAFF), the In- mended consolidation of the medical/trauma care do-
ternational Association of Fire Chiefs (IAFC), and the mains into a single domain titled Tactical Emergency
International Association of Chiefs of Police (IACP) sup- Casualty Care. Within this domain, the specific trauma
port, endorse, or incorporate TECC. This broad support care competencies and learning objectives would remain
has resulted in wide dissemination of the guidelines at unchanged (e.g., hemorrhage control, management of
the local, state, regional, and national levels. Because respiratory and airway emergencies, etc.); however, cer-
the TECC principles are the civilian translation of the tain key civilian-specific considerations would be em-
military TCCC guidelines, they have become a critical phasized. For example, though hemorrhage remains the
component of modern TEMS. Importantly, however, the major cause of potentially preventable death in trauma,
TECC principles apply beyond the traditional “tactical” emerging evidence suggests that civilian and combat
environment and as such have laid the foundation for the mortality patterns differ even in high-threat scenarios.
10
development of a more consistent, integrated prehospital This naturally impacts recommendations. Additionally,
response. certain TCCC recommendations such as Hextend for
resuscitation were removed given US Food and Drug
Administration black box warning against its use in crit-
Methods
ically ill patients or those with potential coagulopathy.
11
From January 2015 through January 2016, a JRC of sub- Finally, the JRC also recommended that the C-TECC
ject matter experts (SMEs) from the NTIC and C-TECC become the primary source for recommended updates to
executive teams convened to review existing NTIC do- the NTIC training standards related to Domain 1.
mains and determine feasibility of domain consolidation.
The group reviewed existing NTIC competencies and Discussion
C-TECC recommendations, evaluated emerging scientific
evidence regarding prehospital trauma interventions, ex- TEMS providers historically have a variety of operational
amined existing practice patterns, and solicited feedback roles and distinct functional responsibilities. Certainly
12
from a variety of professional organizations. The group the most visible and easily recognizable role is the provi-
also evaluated both organizational procedures for devel- sion of lifesaving interventions to the casualties resulting
oping and updating recommendations. The SME group from operations in a high-threat environment. Less vis-
consisted of national leaders with backgrounds in emer- ible, but no less important, roles include the provision of
gency medicine, critical care, trauma surgery, EMS medi- preventive medicine services to tactical teams and other
cal direction, TEMS, law enforcement, and public policy. responders in order to limit personnel degradation sec-
ondary to operational factors such as heat, cold, dehy-
dration, and exhaustion. TEMS providers are expected
Results
to provide medical planning and advocacy for complex
The JRC determined that the TECC guidelines represent operations to ensure seamless continuity of care and ex-
the existing best practice for the provision of trauma pedited extraction and transport of casualties from the
care in civilian high-threat and dynamic environments point of injury to trauma centers with definitive care
for several reasons. First, the JRC recognized that the capabilities. They are also repositories of operational
TECC recommendations incorporate the most realistic and tactical medicine knowledge that can be relied on to
balance of evidence-based and expert consensus avail- provide initial and sustainment training in casualty care
able. Second, the JRC supports the academically and to tactical responders, such as law enforcement officers,
6
professionally rigorous process that C-TECC and NTIC who do not have a primary medical mission.
use for updating their guidelines. Finally, the JRC con-
cluded that TECC is now the de facto national standard The consolidation of the NTIC domains from 17 to
in civilian high-threat trauma care given the widespread 10 and the inclusion of TECC as the core trauma care

64 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016