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Conclusion 2. Butler FK Jr, Holcomb JB, Giebner SD, et al. Tactical combat
casualty care 2007: evolving concepts and battlefield experi-
Agencies across the nation have used the principles of ence. Mil Med. 2007;172(11 Suppl):1–19.
TECC to successfully develop multiagency response 3. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battle-
protocols for high-threat prehospital response. 44,46,47 field (2001–2011): implications for the future of combat ca-
The C-TECC guidelines provide recommendations for sualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):
S431–437.
life-saving interventions (i.e., the “what”) in high-threat 4. Butler FK Jr, Blackbourne LH. Battlefield trauma care then
civilian environments and the science supporting the and now: a decade of Tactical Combat Casualty Care. J
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cessful, they must be accompanied by effective strategies 5. Committee on Tactical Combat Casualty Care. Meeting
for training and execution (i.e., the “how”). The RFR minutes, 4–5 February 2014. https://www.naemt.org/docs/
default-source/phtls-tccc/10-29-14-tccc-updates/cotccc-meeting-
program is a military combat tested and validated casu- minutes-1402-final.pdf?sfvrsn=2. Accessed February 2, 2015.
alty-response training program that can be used to stan- 6. US Fire Administration. Fire/Emergency Medical Services
dardize TECC training programs and translated into Department operational considerations and guide for active
civilian practice at the local, regional, and federal levels. shooter and mass casualty incidents. 2013. https://www.usfa.
fema.gov/downloads/pdf/publications/active_shooter_guide.
pdf. Accessed February 9, 2015.
Though AVIs may drive the public discourse around ci- 7. National Tactical Officers Association. TEMS position state-
vilian first response, they are just the tip of the iceberg in ment. n.d. https://ntoa.org/sections/tems/tems-position-state
terms of civilian violent trauma. A study by Cuellar et ment/. Accessed February 9, 2015.
al. reported that in 2009, gunshot wound (GSW)-related 8. International Association of Fire Fighters. IAFF position
injuries accounted for 76,100 emergency department statement: rescue task force training. n.d. http://www.iaff.
org/Comm/PDFs/IAFF_RTF_Training_Position_Statement.
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48
linked to assaults, of which 54% resulted in hospitaliza- 9. Vernon A. George Washington University receives grant
tions. Additionally, 32,240 of GSW-related injuries (42%) to teach tactical emergency casualty care. 2015. http://
48
were to an extremity (arm or leg). National Trauma Da- www.emergencymgmt.com/emergency-blogs/incident-
tabank figures revealed that nearly 9,000 trauma patients management/13-million-grant-to-teach-Tactical-Emergency-
Casualty-Care-and-escorted-warm-zone-care.html. Accessed
between 2000 and 2004 suffered an extremity amputa- April 30, 2015
tion, an injury with a high rate of mortality if not quickly 10. Blair JP, Schweit KW. A study of active shooter incidents in
49
addressed in the field. A better-trained populace and the United States between 2000 and 2013. Washington, DC:
nonmedical first responder cadre will have significant im- Texas State University, Federal Bureau of Investigation, US
pacts in these “routine” environments as well. Department of Justice; 2014.
11. Bellamy R. The causes of death in conventional land war-
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Figure 4 outlines the proposed skill sets and level of knowl- 1984;149:55–62.
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TECC training. Successful whole-community AVI re- and causes of death from Operation Iraqi Freedom and Oper-
sponse programs should be based on the TECC prin- ation Enduring Freedom: 2003–2004 versus 2006. J Trauma.
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ciples and the TECC Trauma Chain of Survival. The US 13. Holcomb JB, McMullin NR, Pearse L, et al. Causes of death
Army RFR Program offers a validated model for imple- in U.S. Special Operations Forces in the global war on terror-
mentation and supports the concept of a whole-com- ism: 2001–2004. Ann Surg. 2007;245:986–991.
munity approach to reducing mortality in AVIs. As the 14. Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminat-
Rangers demonstrated, FCPs and nonmedical first re- ing preventable death on the battlefield. Arch Surg. 2011;146:
1350–1358.
sponders are critical early links in the Chain of Survival. 15. Veliz CE, Montgomery HR, Kotwal RS. Ranger first re-
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Disclaimer 16. Kotwal RS, Montgomery HR, Mechler KK. A prehospital
The opinions in this article are those of the authors only. trauma registry for Tactical Combat Casualty Care. US Army
Med Dep J. 2011;Apr–Jun:15–17.
17. Wound Data and Munitions Effectiveness Team. The WD-
Disclosure MET study. Bethesda, MD: Uniformed University of the
Health Sciences; 1970.
The authors have nothing to disclose. 18. McPherson JJ, Feigin DS, Bellamy RF. Prevalence of ten-
sion pneumothorax in fatally wounded combat casualties. J
Trauma. 2006;60:573–578.
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