Page 187 - Journal of Special Operations Medicine - Winter 2015

Building Community Resilience to Dynamic

Mass Casualty Incidents: A Multiagency White Paper
in Support of the First Care Provider

The Committee for Tactical Emergency Casualty Care;
FirstCareProvider.Org; The Koshka Foundation for Safe Schools

“Regular people are the most important people at a disaster scene, every time.”
—Amanda Ripley, The Unthinkable: Who Survives When Disaster Strikes–and Why

mpowered and trained community members can subject matter experts, published their first guidelines
Eserve a critical role as first care providers (FCPs) discussing the FCP concept in 2011. The C-TECC pro-
during the initial moments after complex and dynamic cess and guidelines were modeled off of the successful
disasters. These FCPs often have immediate access to military Tactical Combat Casualty Care (TCCC) guide-
severely injured victims and can provide time-sensitive, lines and modified to account for the unique aspects
lifesaving interventions; the FCP is the first link in the of civilian high threat response. In the military, TCCC
trauma chain of survival. Public safety and first response was most successful at reducing mortality rates when
agencies must acknowledge this operational reality and deployed as part of a comprehensive casualty manage-
should lead the effort to integrate the FCP into whole of ment system, such as the Ranger First Responder sys-
community crisis response plans built upon the tiered tem. However, the vast differences between civilian and
application of the civilian Tactical Emergency Casualty military operational response, the unique civilian pa-
Care (TECC) medical guidelines. Utilizing TECC as the tient populations, legal restrictions, and the differences
foundation for FCP training facilitates continuity of care in logistics and resources, preclude TCCC from direct
not only for the patient but also the TECC trained pre- application into civilian operations. The TECC guide-
hospital care provider taking over care of the injured. lines account for these unique aspects of civilian high-
threat response and allow local leaders to effectively
implement “whole of community” high-threat casualty
Background
response programs.
Natural and manmade disasters are creating increasingly
complex response challenges. The current US emergency There is strong historical precedent in the United States
response model relies heavily upon the availability and and internationally for the TECC FCP concept. The
expertise of highly trained public safety agencies. Too transition of cardiopulmonary resuscitation (CPR) from
often, this leads the public and our leaders to assume a hospital-based intervention to a whole of community
that professional emergency medical care will be imme- response paradigm is perhaps the most illustrative. Dr
diately available. Unfortunately, there are often delays Elam demonstrated that CPR was scientifically “sound”
in first responders accessing victims, especially in com- in 1954. In 1957, Dr Safar described the ABCs of re-
plex high threat events (e.g., the attacks in Norway, the suscitation, and in the 1960’s national medical associa-
Aurora shootings, the Westgate Mall attack). Initiatives tions, including American Red Cross, recognized CPR
such as the Rescue Task Force model and the 3-ECHO as the standard of care. In the 1970s, the CPR principles
program are creating “warm zone/indirect threat care” made their way to the public domain and in the past few
operational paradigms for first responders and are an years has evolved to “hands-only” CPR for nonmedical
important first step in shortening the time from injury first providers. Over the decades, these bystander care
2
to first medical intervention. However, despite aggres- principles have been proven effective and have evolved
sive and expedient deployment of professional medical to include automated external defibrillators and stroke
providers, there remains a time gap from point of injury recognition. Today there are millions of trained “by-
to life saving intervention that only FCPs can address. 1 standers” across our country who can initiate cardiac
resuscitation within seconds, can recognize the need,
The Committee for Tactical Emergency Casualty Care (C- access and apply an automatic external defibrillator,
TECC), a volunteer group of civilian operational medical and can even perform a Cincinnati Stroke Scale on the

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