Is Tactical Emergency Casualty Care enough for first repsonders?....Do we need more?

The core of  Tactical Combat Casualty Care("TCCC") training and later civilian Tactical Emergency Casualty Care ("TECC") training is to provide the front line responder with the knowledge and skill to save their own life or their buddy when death is less then 3 minutes away. TCCC was never designed or intended to replace the need for a highly skilled battle medic.  In the past month, there have been several great discussions among emergency first responder groups on the topic of the civilian TECC and the military TCCC programs respectively. TECC training is a modified version that takes into the account the unique needs of the civilian world injuries while TCCC is focused on the different landscapes of battlefield injuries. Regardless of the modifications and continued improvement to meet the needs of our civilian population, TECC training fundamentally mirrors the foundation of TCCC training which is the recognition and treatment of the top three causes of death after a survivable injury. Uncontrolled bleeding, penetrating injury to the chest, and loss of airway account for ninety percent (90%) of the deaths that occur before reaching an acute care medical facility. TCCC training was developed after the recognition that many soldiers in the field died from survivable injuries because medical care was not started soon enough. Despite the presence of well trained and equipped battle medics, it was realized that the victim was often not reachable by the platoon or team medic in the critical minutes. The injured soldier was either alone or with a buddy. Though a soldier first with the capability of providing superior firepower to the fight, military combat medics are typically equipped and trained to handle a full spectrum of injuries on the battlefield. From a sprained ankle to performing a surgical airway in the middle of a firefight, combat medics rise to almost any challenge except when they cannot reach the wounded soldier or superior firepower is the priority.

The civilian world differs significantly than the military battlefield.  Regardless of the event, school shootings, explosions or natural disasters, in civilian life, large numbers of emergency medical service (EMS) responders are deployed immediately. Evacuations can occur by land , air or sea and arrival time at an acute care medical facility is typically measured in minutes compared to combat where hours to days may elapse. However, the most striking difference is the inability of civilian EMS to work in a hostile environment. The lack of medical personnel in the hot zone makes TECC  training that much more important to the civilian front line responders. Historically, TECC training has resulted in numerous lives saved with examples coming from all regions of the United States. As significant and cutting edge TECC training is, it does not replace or duplicate the education and training of our EMS partners. TECC training provides a time bridge for the critically injured to allow them to be removed from the area of direct fire or danger and be delivered to the EMS personnel for immediate treatment and care throughout the entire evacuation process


 Though bleeding and penetrating chest trauma seem self explanatory, the loss of the airway does not. The airway is defined as the open passages that allow us to take a breath in and expel it out. When the structures of the face, mouth or neck are damaged this can result in the obstruction of these "air" passages that then prevents the injured from breathing.  The education and training of TECC is aimed at extending the critical time the injured has before medical providers can start treatment. Battle tourniquets. pressure bandages, and chest seals make up the tools of TECC training. Education on body positions to maximize the best and easiest breathing patterns rounds out the skill set. No specific skill set of TECC training needs any prior medical knowledge to make a front line responder successful in saving a life. Placing a tourniquet when significant bleeding is occurring, or a chest seal when an obvious chest wound is present requires no special license or government mandated credentialing. Like basic first-aid, TECC training teaches simple skills and these skills  can make the difference between life and death of the injured. There is no confusion that TECC is not a form of paramedic or emergency medical technician training. Its goal rather is to take the professionals who make a career of tactics and operating in hostile environments and give them some life saving skills in the danger zone. TECC emphasizes that tactics, resolution of the mission and individual safety are always first priority.

Given the numerous acts of  war like violence occurring in the civilian environment, does the civilian world also need its version of the combat medic along with TECC?? The civilian version tactical medic is gaining ground throughout the United States. Numerous SWAT teams have embedded paramedics into their tactical teams.  Back in 1982, the San Diego Police and Fire departments joined forces to create the STAR program. Firefighter/paramedics were trained to operate in tactical environment of the San Diego SWAT team and provide immediate advanced medical care in the middle of the hot zone. The California Fire Authority now has several tactical medics deployed on their fire engines. They train independently and are outfitted with ballistic helmets and rifle body armor. The gold standard for the tactical medics has been set by the New York Police Emergency Service unit and the Los Angeles County Sheriff Department Special Enforcement Bureau's Emergency Service Detail (LASD ESD). All members are sworn law enforcement officers who have received additional certified accredited training as paramedics and or emergency medical technicians who are equipped accordingly.. The members of LASD ESD are, traditionally, experienced SWAT operators who apply for and compete for the coveted positions on the ESD team. They are educated in both civilian and military paramedic programs. They mobilize in full ambulance equipped Lenco Bearcats. Like the military medic, they are fully armed SWAT operators with advanced medical training. ESD deploys with every SWAT call out as one of their many other medical responsibilities.

Those in the civilian medical community don't always parallel military medicine success in the general population. Uniform standards of care, credentials, and licenses can be markedly different for these two communities, whereas scope of practice of a paramedic or EMT in the United States is highly regulated. All training is accredited and certified by license exams with input at the county, state and federal levels. Though some individuals may not see the relationship between the needs of an injured soldier and that of a critically injured civilian, TECC training is not enough. The combination of TECC training for front line responders and the embedding of tactical medics is the best model present for our modern world.