Page 77 - Journal of Special Operations Medicine - Summer 2016

tactical team commanders, and TEMS medical directors Figure 1 Existing NTIC Core Competencies.
identified 18 critical competency domains required to 1. Tactical Combat Casualty Care Methodology
provide successful TEMS (Figure 1). The study group
additionally identified the medical knowledge and skills 2. Remote Assessment and Rescue/Extraction
(i.e., domains) within each domain that applied to four 3. Hemostasis
categories of personnel involved with TEMS during law 4. Airway
enforcement tactical operations (operator, medical pro- 5. Breathing
vider, team commander, and TEMS medical director).
Working group consensus on this matrix was developed 6. Circulation
through a modified Delphi method, which is a widely 7. Vascular Access
used and accepted means of incorporating cycles of 8. Medication Administration
structured group face-to-face and/or electronic feedback 9. Casualty Immobilization
to achieve a convergence of expert opinion. 2
10. Medical Planning
In 2011, the Centers for Disease Control and Prevention– 11. Human Performance Factors/Health Surveillance
Terrorism Injuries Information, Dissemination, and 12. Environmental Factors
Exchange (CDC-TIIDE) Project funded a collabora- 13. Explosion and Blast Injuries
tive workshop led by the National Association of EMS
Physicians (NAEMSP) and the COM, titled “Finalizing 14. Injury Patterns and Evidence Preservation
a National TEMS Curriculum.” Participants included 15. Hazardous Materials Management
representatives of the Department of Justice (DOJ), 16. Remote/Surrogate Agreement
Department of Health and Human Services (DHHS), 17. Less Lethal Injuries
Department of State (DOS), Department of Defense
(DOD), Committee on Tactical Combat Casualty Care Figure 2 Proposed Updated NTIC Core Competency
(CoTCCC), National Association of State EMS Of- Domains (2016).
ficials (NASEMSO), National Association of EMTs
(NAEMT), NAEMSP, ACEP, and law enforcement, fire, 1. TECC methodology and TECC threat-based trauma
interventions
and EMS agencies of various local, state, and federal ju-
risdictions. The diverse workshop participants reviewed a. Hemostasis
and discussed the original 18 critical competency do- b. Airway
mains before modifying them into 17 domains. One key c. Respiration/breathing
change was the incorporation of the best practice TECC d. Circulation
methodology in recognition that the tactical combat
casualty care (TCCC) guidelines designed for military e. Vascular access
combat operations did not adequately meet the needs f. Medication administration
of the civilian law enforcement community. This expert g. Casualty immobilization and packaging
3
group evolved to become the NTIC (Figure 2). 2 2. Medical planning

Concurrently, in 2010, the C-TECC formed as a best 3. Remote medical assessment and surrogate treatment
practice development group for the provision of trauma 4. Force health protection
care in high-threat, civilian prehospital environments. 5. Legal aspects of TEMS
A core C-TECC mission was, and continues to be, the 6. Hazardous materials management
effective and appropriate translation of combat lessons
learned to civilian high-threat trauma response. High re- 7. Environmental factors
4
liability organizations (HROs), which excel in complex, 8. Mass casualty triage
high-risk environments such as TEMS, are characterized 9. Tactical familiarization
by a preoccupation with failure, reluctance to simplify 10. Operational rescue and casualty extraction
interpretations, sensitivity to operations, commitment
to resilience, and deference to experience. Using HRO
principles, C-TECC brought together a diverse group based on the successful military TCCC guidelines. A
of policy, education, and operational leaders to craft a core constituency of C-TECC members remains actively
set of operationally sensitive, TEMS-specific, evidence- engaged in the CoTCCC to ensure expeditious analysis
based guidelines. TECC accounts for the operational of military lessons learned. A modified Delphi technique
and threat situation as it relates to the need for life- was used to create the initial guidelines. The C-TECC
saving interventions and focuses on expeditious point working groups review emerging data and propose revi-
of wounding care. The initial TECC guidelines were sions to the 24-member C-TECC Guidelines Committee

Integration of TECC Into the National TEMS Competency Domains 63