Page 134 - Journal of Special Operations Medicine - Summer 2014

7
Results on the battlefields of Afghanistan and Iraq. Although
initially developed for the Special Operations Commu-
Two face-to-face meetings were convened. At the first nity, TCCC has been adopted throughout all U.S. and
meeting, the panel reviewed each of the original compe- other military medical services. Due to similarities to
tency domains and determined that slight modifications many other missions requiring specialized responses,
were needed. The panel modified the original compe- TCCC has been used by many nonmilitary agencies as
tency domains to a list of 17 as shown in Table 2. Most a framework for providing TEMS to teams working
of the changes were made to combine or separate con- in a wide variety of hazardous settings. More recently,
tent and to remove redundancy. The four most signifi- TECC was developed to adapt TCCC for civilian use
cant changes were the additions of Tactical Emergency and increase use of the TCCC principles in nonmilitary
Casualty Care (TECC), Tactical Familiarization, Legal tactical environments. The TCCC and TECC guide-
5,8
Aspects of TEMS, and Mass Casualty Triage to the com- lines are freely available through the Internet and up-
petency domains.
4,5
dated as the respective committees modify them. The
National TEMS Council and the Committee on TECC
have both voted to encourage organizations requiring
Inclusion of TECC in the Competency Domains
TEMS to use either TCCC or TECC methodologies and
One of the key modifications was the incorporation of to use whichever best suits their needs.
TECC. In 1996, Butler et al. proposed an evidence-based
and consensus-driven system of out-of-hospital care in TCCC and TECC use similar terminologies for different
high-threat, resource-constrained environments called situations in which specialized operators and medical
TCCC. These clinical guidelines have evolved under providers may provide care. TCCC, being more ori-
6
the stewardship of a multidisciplinary committee, and ented toward combat environments of various intensi-
TCCC has been credited with saving thousands of lives ties, describes three operational “phases”:

Table 2 Final Competency Domains
2009 Competency Domains Updated Competency Domains
Tactical Combat Casualty Care (TCCC)/Tactical Emergency
Tactical Combat Casualty Care (TCCC) Methodology
Casualty Care (TECC) Methodology
Remote Assessment and Rescue/Extraction Remote Assessment and Surrogate Care
Rescue/Extraction
Hemostasis Hemostasis
Airway Airway
Breathing Breathing
Circulation Circulation
Vascular Access
Medication Administration Medication Administration
Casualty Immobilization Casualty Immobilization
Medical Planning Medical Planning
Human Performance Factors\Health Surveillance Force Health Protection
Environmental Factors Environmental Factors
Explosions and Blast Injuries
Injury Patterns and Evidence Preservation Mechanisms and Patterns of Injury
Legal Aspects of TEMS
Hazardous Materials Management Hazardous Materials Management
Remote Surrogate Treatment
Less-Lethal Injuries
Special Populations
Mass Casualty Triage
Tactical Familiarization

124 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014