Tactical Combat Casualty Care (TCCC) is developed by the U.S. Department of Defense Defense Health Agency (DHA) Joint Trauma System to teach evidence-based, life-saving techniques and strategies for providing the best trauma care on the battlefield.
Tactical Emergency Casualty Care (TECC) is a set of evidenced-based and best practice trauma care guidelines for civilian high-threat pre-hospital environments. The TECC guidelines are built upon the critical medical lessons learned by US and allied military forces over the past 15 years of conflict and codified in the doctrine of Tactical Combat Casualty Care (TCCC). Using the military TCCC guidelines as a starting point, the Committee creates the civilian high threat medical guidelines through a process of literature research, evidence evaluation, expert discussion, and civilian best practices review. The TECC guidelines are built upon the foundations of TCCC but are different to meet the unique needs of the civilian medical and operational environments. The differences address civilian specific language, provider scope of practice, population, civilian liability, civilian mission and operational constraints, logistics, and resource acquisition.
Tactical Emergency Casualty Care is a set of civilian medical guidelines for high threat operations. Tactical Combat Casualty Care is a set of military medical guidelines for care of the wounded during military combat operations. The two sets of guidelines are naturally related, but each with a necessary difference in language, scope, applicability and flexibility.
There are two key unifying principles of TCCC and TECC. First is the process of guideline development. Both Committees are comprised of medics, physicians, academics and operational leaders. Both Committees began with prior operational and medical lessons learned- for CoTCCC this was Vietnam and Somalia, for C-TECC this was TCCC and OIF/OEF- and rapidly evolved their recommendations based on immediate lessons learned. Second is an understanding that success requires developing and deploying a SYSTEM of care. In the military, TCCC’s success fundamentally lies in the fact that all personnel deploying to a combat theater were trained in the principles of TCCC. The operational and trauma care systems were built around this training.
This second fact is also the main limiting factor for the deployment of TCCC in the civilian setting. As a system, TCCC cannot be deployed in the civilian setting because many recommendations run counter to civilian scope of practice and medical standards (e.g. use of hextend for resuscitation, pre-hospital antibiotics, needle decompression practiced by non medical personnel, etc.).
Tactical Emergency Casualty Care is the civilian evolution and application of the military Tactical Combat Casualty Care guidelines. When discussing the differences between the two, it is important to emphasize that TECC and TCCC are not in competition with each other; although, as the pictures from the recent Boston Marathon bombing demonstrate, the bullets and explosives may be similar in civilian settings as in military combat, this does not make the military guidelines directly applicable for civilian applications.
The two sets of guidelines are naturally related, but each with a necessary difference in language, scope, applicability and flexibility. There are three primary differences between TECC and TCCC: guideline terminology, trauma care recommendations and operational focus.
Terminology/ Language: TCCC was written by the military special operations community to specifically address the specificities and conditions surrounding combat operations. These guidelines are researched, developed, and written with the assumption that the patient is an otherwise healthy 18-45yo soldier and that the provider is working under the military defined scope of practice. The TCCC guidelines assume a military medical support system, military rules of engagement, and military legal precedent. While individual recommendations such as tourniquet use are valid, TCCC as a system has limited application in the civilian setting. The TCCC courses currently being taught were not intended for civilian application. The Pre-Hospital Trauma Life Support TCCC course comes from the military PHTLS textbook, a version that was specifically written for the military medical community because the civilian PHTLS textbook had a different focus and application.
All leaders with operational experience understand that the language changes in TECC are critical. As with the Incident Command System (ICS), common operating language is important for interagency response to complex threats. For example, “Care Under Fire”, has variable meanings across the Fire (e.g. actual fire), EMS (e.g. fire or gunshots- but a non operational zone) and Law Enforcement (e.g. active gunfire in the area) communities. Tactical Emergency Casualty Care was created to address these system limitations and specific scope of practice challenges related to TCCC. The C-TECC members, many of whom are active and past CoTCCC members, worked with civilian leaders to codify threat based guidelines (the core of TCCC) in a way that was easily applicable to civilian operations, legal and liability limitations and scope of practice, and in a way that is broadly applicable to the entirety of the civilian patient population.
Trauma care guidelines: TECC and TCCC trauma recommendations are closely related. TECC places less emphasis on pre-hospital antibiotics, hextend as a resuscitation fluid, and specific product solutions. The TECC guidelines place more emphasis oninteragency communication, integrated operations between EMS, Fire and Law Enforcement, casualty extraction and evacuation, and care of non-combatant civilians. Additionally, as the civilian high threat focus continues with the results of on-going study and medical data, the recommendations of TECC will necessarily diverge in small ways from TCCC. One recent example is the 2013 pediatric TECC guidelines. Children are not accounted for in the TCCC guidelines as they are not in the military deployable population. As such, the C-TECC specifically examined the research and data specific to the pediatric population and created a specific set of recommendations for children.
Operational: The fundamental mission difference between the military and civilian high threat operations is important. In general, military operations focus on clearing, holding, and/or gaining territory with an emphasis on domination of enemy forces. By definition, civilian operations are rescue operations with the key missions of limiting civilian morbidity and mortality. Civilian first responders are sworn to “serve and protect”. Any guidelines must acknowledge this important difference and account for rescue operations, limitations in use of force, and other regional operational requirements.