Page 86 - Journal of Special Operations Medicine - Fall 2014

Hot, Warm, and Cold Zones
Applying Existing National Incident Management System Terminology
to Enhance Tactical Emergency Medical Support Interoperability

Andre Pennardt, MD, FACEP; Richard Schwartz, MD, FACEP

A key component of an interoperable response is the equate to the TECC Indirect Threat Care or the TCCC
use of common terminology and language. Ideally, tacti- Tactical Field Care. Warm Zone Care includes the other
cal casualty care guidelines should use existing incident life-saving interventions associated with applying the
management language where possible in order to facili- MARCH algorithm (Massive hemorrhage, Airway, Res-
tate understanding and widespread adoption by law en- piration, Circulation, and Hypothermia) in the tactical
forcement, fire, and emergency medical services (EMS) environment. Casualty collection points and Rescue
agencies. Task Forces are typically employed within the Warm
Zone. Finally, the Cold Zone is the area where no sig-
The Tactical Emergency Casualty Care (TECC) and nificant threat is reasonably anticipated and additional
the Tactical Combat Casualty Care (TCCC) guidelines medical/transport resources may be staged. Cold Zone
are widely accepted as the standard guidelines for care Care equates to Evacuation Care and generally falls un-
in the civilian and military communities, respectively. der established local, regional, or state protocols rather
TECC currently uses the terms “Direct Threat Care,” than national tactical casualty care guidelines in the ci-
“Indirect Threat Care,” and “Evacuation Care,” while vilian setting.
TCCC uses the terms “Care Under Fire,” “Tactical Field
Care,” and “Tactical Evacuation Care” to denote the The TECC guidelines are being established nationally
phases of casualty care in a tactical environment based as the tactical medicine standard for the civilian TEMS
on the level of threat. While the guidelines use differ- community; however, many providers have previously
ent terminology, they could be easily applied to existing received TCCC training in either the military or civilian
National Incident Management System (NIMS) termi- communities. We believe that the use of accepted NIMS
nology, namely Hot, Warm, and Cold Zones, which terminology (Hot Zone, Warm Zone, and Cold Zone)
denote the level of threat within an area. Public safety to describe the phases of care would help bridge the lan-
agencies and personnel throughout the United States guage gap between TEMS personnel trained in TECC
are already typically familiar with these NIMS terms. versus TCCC and thereby enhance interoperability. It
Various Tactical Emergency Medical Support (TEMS) would also facilitate the learning process for person-
operational planning guides use the terms “Hot Zone,” nel undergoing training by associating tactical casualty
“Warm Zone,” and “Cold Zone” or recommend an un- care principles and phases of care with standard NIMS
derstanding thereof in the setting of active shooter/mass threat zone terms already well established in the civilian
1–4
casualty/TEMS incidents, as well as link terms such as responder community.
“Warm Zone” and “Indirect Threat Care.” 1,3
Disclosures
The Hot Zone is the area where a direct and immediate
threat exists. Hot Zone Care would therefore equate to The authors have nothing to disclose.
the TECC Direct Threat Care or the TCCC Care Un-
der Fire. The emphasis in this zone is on threat suppres- References
sion, preventing further casualties, extracting casualties 1. US Fire Administration. Fire/emergency services department
from the high-threat area, and implementing control of operational considerations and guide for active shooter
life-threatening extremity hemorrhage. The Warm Zone and mass casualty incidents. FEMA. September 2013:9–
is the area where a potential threat exists, but there is 10. http://www.usfa.fema.gov/downloads/pdf/publications
no direct or immediate threat. Warm Zone Care would /active_shooter_guide.pdf.

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