Page 110 - JSOM Winter 2025

Casualty Care (TECC) program, which takes TCCC concepts and Jacobs LM, Wade DS, McSwain NE, et al. The Hartford Consensus:
tailors them to better meet the tactical considerations that are THREAT, a medical disaster preparedness concept. J Am Coll Surg.
encountered by law enforcement and firefighters in civilian high 2013;217(5):947–953. doi:10.1016/j.jamcollsurg.2013.07.002
threat scenarios (Callaway 2017, Callaway 2011). In addition, Jacobs LM, McSwain NE Jr, Rotondo MF, et al. Improving survival from
the educational leadership displayed by The National Association active shooter events: the Hartford Consensus. J Trauma Acute Care
of Emergency Medical Technicians (NAEMT) in offering courses Surg. 2013;74(6):1399–1400. doi:10.1097/TA.0b013e318296b237
in Prehospital Trauma Life Support, TCCC, and TECC around Jerome JE, Pons PT, Haukoos JS, Manson J, Gravitz S. Tourniquet Appli-
the world have made tactical medicine training widely available cation by Urban Police Officers: The Aurora, Colorado Experience.
for organization that seek it (Butler 2017 – TCCC LLL). These J Spec Oper Med. 2021;21(1):71–76. doi:10.55460/9YEC-A5CE
initiatives and many other local, state, and regional efforts have Kragh JF Jr, Walters TJ, Westmoreland T, et al. Tragedy into drama: an
American history of tourniquet use in the current war. J Spec Oper
ensured that the advances in prehospital trauma care pioneered by Med. 2013;13(3):5–25. doi:10.55460/QN66-A9MG
TCCC, the Joint Trauma System, and military medicine are being Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emergency tour-
used to save lives in civilian trauma care practice with increasing niquet use to stop bleeding in major limb trauma. Ann Surg. 2009;
frequency, notably by the law enforcement officers and firefight- 249(1):1–7. doi:10.1097/SLA.0b013e31818842ba
ers that the Hartford Consensus Group identified as a previously Kragh JF Jr, Walters TJ, Baer DG, et al. Practical use of emergency
underutilized source of lifesaving first responder care for trauma tourniquets to stop bleeding in major limb trauma. J Trauma.
victims (Jerome 2021, Reed 2018, Callaway 2015, Pons 2015). 2008;64(2 Suppl):S38-S50. doi:10.1097/TA.0b013e31816086b1
The impact of TCCC on civilian first responder trauma care and Levy MJ, Jacobs LM. A Call to Action to Develop Programs for Bystand-
its subsequent incorporation into the Hartford Consensus and the ers to Control Severe Bleeding. JAMA Surg. 2016;151(12):1103–
1104. doi:10.1001/jamasurg.2016.2789
White House/ACS Stop the Bleed program was summed up by Pons PT, Jerome J, McMullen J, Manson J, Robinson J, Chapleau
Hawk (Hawk 2018): W. The Hartford Consensus on Active Shooters: Implementing
Tactical Combat Casualty Care has revolutionized prehospi- the Continuum of Prehospital Trauma Response. J Emerg Med.
tal care, dramatically reduced the incidence of preventable 2015;49(6):878–885. doi:10.1016/j.jemermed.2015.09.013
battlefield death, and spurred development of novel devices Reed JR, Carman MJ, Titch FJ, Kotwal RS. Implementation and eval-
to arrest hemorrhage, such as junctional tourniquets and uation of a first-responder bleeding-control training program in
the X-Stat hemostatic device. The application of the les- a rural police department. J Spec Oper Med. 2018;18(3):57–61.
doi:10.55460/DN8P-L4EL
sons learned has transitioned to civilian practice. The Amer-
ican College of Surgeons convened senior leaders from the TCCC in Civilian Trauma Systems
military medical, law enforcement, and emergency medical There is a common perception that military forces make signifi-
services communities to explore the civilian application of cant advances in trauma care during times of war and that these
Tactical Combat Casualty Care in response to active-shooter advances will be translated as a matter of course to the civilian
mass casualty incidents. Those leaders generated the Hart- sector. While that may be a true statement in general, the transla-
ford Consensus, which described a series of critical actions tion process may be a prolonged one.
with the acronym THREAT. The second action was hemor-
rhage control. Launched in October 2015 by the White TCCC has acknowledged from its beginning that decisions about
House, “Stop the Bleed” is a national awareness campaign battlefield trauma care would usually need to be made on the ba-
managed through the Department of Homeland Security. sis of imperfect evidence. Few decisions in combat are based on
information that approaches the level of a randomized controlled
References trial and medical decisions are no exception. In approaching a
Bulger EM, Snyder D, Schoelles K, et al. An evidence-based prehospi- clinical decision, the Committee on TCCC generally responds to
tal guideline for external hemorrhage control: American College of new information by determining a specific question that needs to
Surgeons Committee on Trauma. Prehosp Emerg Care. 2014;18 be answered, weighing the best evidence available when a deci-
(2):163–173. doi:10.3109/10903127.2014.896962 sion is called for, making the requisite decision, and then revisiting
Butler FK. Stop the bleed. Strategies to enhance survival in active that decision whenever important new evidence comes to light.
shooter and intentional mass casualty events. The Hartford Con- Importantly, from the beginning of the TCCC process, existing
sensus. A major step forward in translating battlefield trauma recommendations have been subjected to the same best-evidence
care advances to the civilian sector. J Spec Oper Med. 2015;15(4): scrutiny that proposed new ones receive.
133–135.
Butler FK, Carmona R. Tactical combat casualty care: from the bat- Civilian Medical Organizations and TCCC
tlefields of Afghanistan and Iraq to the streets of America. The In 1996, the nascent TCCC effort benefitted from an interaction
Tactical Edge. Winter 2012 between Rear Admiral Mike Cowan, Commander of the Defense
Callaway DW. Translating tactical combat casualty care lessons Medical Readiness Training Institute, and Dr. Norman McSwain,
learned to the high-threat civilian setting: tactical emergency ca- founder and medical director of the Prehospital Trauma Life
sualty care and the Hartford Consensus. Wilderness Environ Med. Support (PHTLS) program. These two leaders agreed that there
2017;28(2S):S140–S145. doi:10.1016/j.wem.2016.11.008 should be a military medicine section in the Fourth Edition of the
Callaway D, Robertson J, Sztajnkrycer M. Law enforcement-applied PHTLS textbook. TCCC concepts were included in that edition
tourniquets: a case series of life-saving interventions. Prehosp and have been included in every subsequent edition. This has been
Emerg Care.2015;19(2):320–327. doi:10.3109/10903127.2014.9
64893 most helpful in translating TCCC concepts into use in the civilian
Callaway DW, Smith ER, Cain J, et al. Tactical emergency casualty care sector in that the PHTLS textbook carries the endorsement of the
(TECC): guidelines for the provision of prehospital trauma care in American College of Surgeons and the NAEMT. This could well
high threat environments. J Spec Oper Med. 2011;11(3):104–122. be considered the first step towards the mainstreaming of TCCC
doi:10.55460/8BUM-KREB (Butler 2017 – TCCC Turns 20, Butler 2017 – TCCC Beginnings).
Hawk AJ. How hemorrhage control became common sense. J Trauma Beginning with this initial interaction, a robust and ongoing di-
Acute Care Surg. 2018;85(1S Suppl 2):S13–S17. doi:10.1097/TA. alogue developed between TCCC, PHTLS, and NAEMT. The
0000000000001862 strong partnership between NAEMT, PHTLS, the American Col-
Jacobs LM Jr; Joint Committee to Create a National Policy to Enhance lege of Surgeons Committee on Trauma, and TCCC has endured
Survivability From Intentional Mass Casualty Shooting Events. and these groups have adopted a number of the recommendations
The Hartford Consensus IV: a call for increased national resilience. made by the CoTCCC regarding prehospital trauma care (Stuke
Conn Med. 2016;80(4):239–244. 2011, Bulger 2014). TCCC, in turn, has benefitted greatly from

108 | JSOM Volume 25, Edition 4 / Winter 2025