Page 79 - Journal of Special Operations Medicine - Summer 2016

domain offer several policy, operational, and tactical ad- Finally, on the tactical level, the TECC guidelines repre-
vantages for TEMS. On the policy level, it is critical to sent the most current evidence and best practice based
acknowledge that relying on specifically trained TEMS recommendations for reducing potentially preventable
providers to provide the response to high-threat and trauma mortality in the high-threat civilian environ-
hard to anticipate events is dangerous. It is the conven- ment. The guidelines are consistent with existing na-
tional prehospital medical responders that are increas- tional standards of care and represent skill sets that can
ingly called on to respond to high-threat incidents such be trained, sustained, and executed in a realistic fashion.
as ongoing acts of violence, active shooter incidents, Further, the guideline development and implementation
and dynamic terror attacks. Specialized teams of TEMS process is rooted in the principles of HROs. The inte-
personnel were not first on scene at the Fort Hood gration of the HRO principles of deference to expertise,
shooting, the Aurora massacre, the Boston bombing, sensitivity to operations, and reluctance to simplify are
or a majority of active violent incidents. In addition, a particularly important to the success of TECC and to
majority of TEMS providers are primarily conventional the future of TEMS standardization.
EMS/fire medics who are activated during high-threat
SWAT missions. Therefore, a common trauma response It is critical to recognize that the medical skills of a tacti-
framework based on TECC for EMS, fire, law enforce- cal medic extend beyond those of the TECC guidelines.
ment, and SWAT teams is critical to create more efficient Domains 2 through 10 of the NTIC address these ex-
training administration and validation, improve consis- panded training and operational competencies and are
tency across mission profiles, and reduce errors com- an important guiding framework. The JRC recommen-
monly associated with infrequently utilized protocols. dations provide the initial platform on which to con-
This realization does not diminish the role of TEMS but tinue building towards a national standard framework
rather makes it a more important and complex specialty for TEMS education, training, and operations. The po-
requiring professional standards. TEMS providers fre- litical, regulatory and operational complexity of imple-
quently have additional higher-level training, a dedi- menting a “national standard” in TEMS are well known
cated training mission, and an important role as force and include state versus federal authority, competing
multipliers. They serve as the drivers of innovation and financial interests, funding, and, sadly, individual per-
the repositories of historical knowledge. sonalities. This proposal, and the coordinated efforts of
two of the major grass-roots high-threat response orga-
Operationally, perhaps the most important advantage is nizations, offers a set of broad common sense standards
that the creation of a common language among respond- developed over many years while allowing for flexible
ers allows for more effective interagency training and implementation.
operations. Medical reports suggest that around 24%
of US military prehospital deaths during recent conflicts Limitations
in Afghanistan and Iraq were potentially preventable.
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The rate of potentially preventable deaths was found to The JRC represents a core group of individuals inti-
be approximately 15% for US Special Operation Forces mately familiar with NTIC, C-TECC, medical educa-
deaths between 2001 and 2004. However, between 2001 tion, and public policy. However, the JRC does not have
and 2010 for the 75th Ranger Regiment, the rate was the authority to speak formally for NTIC, C-TECC, or
only 3%. The Ranger First Responder (RFR) program any government agency. The recommendations in this
was a key component for achieving this significant reduc- report will be presented to the C-TECC and NTIC at
tion in combat mortality. The 75th Ranger Regiment their semiannual meetings at the Special Operations
14
has proven very successful in terms of integrating trauma Medical Association Scientific Assembly. If the commit-
care as a fundamental soldier skill. Reducing potentially tees vote to approve these recommendations, the NTIC
preventable mortality in high-threat civilian trauma re- and C-TECC will officially endorse the proposal. At
quires common operating language and principles that that point, the consolidated NTIC domains as a Na-
can be rapidly scaled in times of crisis. This approach is tional TEMS Blueprint will be debated at the Special
modeled after the RFR program for TCCC that is largely Operations Medical Association–Department of Home-
credited with the 75th Ranger Regiment achieving the land Security Office of Health Affairs Summit on TEMS
lowest rate of potentially preventable combat deaths in Standardization.
recorded military history. The analogous civilian appli-
cation of TECC employs the Chain of Survival model Conclusion
to provide leaders with an operational framework for
tiered application of TECC across skills sets. In this The NTIC competencies and training objectives are the
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model, TEMS providers are a critical link in the chain only published recommendations of their kind and offer
of survival functioning as subject matter experts, instruc- the opportunity for national standardization of TEMS
tors, operational liaisons, and force multipliers. training programs and a future accreditation process.

Integration of TECC Into the National TEMS Competency Domains 65