7.2 Tactical Emergency Casualty Care (TECC) & CPR/AED

Tactical Emergency Casualty Care (TECC)

Adapted from the military's Tactical Combat Casualty Care (TCCC), Tactical Emergency Casualty Care (TECC) provides civilian law enforcement with a framework for managing severe trauma in high-risk, dynamic environments. The core philosophy of TECC is that the tactical situation heavily dictates the appropriate medical interventions. Performing the right intervention at the wrong time can be fatal.

The Three Phases of TECC

TECC is divided into three distinct phases based on the threat level in the immediate environment:

1. Direct Threat Care (Care Under Fire): The officer and the victim are under active, hostile fire or immediate threat. The absolute priority is stopping the threat and minimizing further injury. Medical care in this phase is restricted exclusively to applying a tourniquet to life-threatening extremity hemorrhage. Officers should direct the casualty to stay engaged, move to cover, and apply self-aid if possible.
2. Indirect Threat Care (Tactical Field Care): The threat has been suppressed, neutralized, or the officer and casualty have relocated to a secure area (cover/concealment). The environment is safer, but the situation remains fluid. In this phase, officers can conduct a more thorough assessment (such as the MARCH algorithm: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia) and apply chest seals, pressure dressings, and maintain the airway.
3. Evacuation Care (Tactical Evacuation Care): The casualty is being moved toward definitive medical care via EMS or a tactical vehicle. The focus shifts to reassessing interventions, preventing hypothermia, and preparing the patient for handoff to advanced medical personnel.

Trauma Management: Hemorrhage and Airway

Exsanguination (bleeding out) from extremity wounds is the leading cause of preventable death in tactical environments. Officers must be proficient in rapidly deploying hemorrhage control devices.

Tourniquet Application

A tourniquet is a constricting band used to stop arterial blood flow to an extremity. When encountering massive hemorrhage during the Direct Threat phase, an officer should:

• Apply the tourniquet "high and tight" on the limb, over the clothing, as close to the armpit or groin as possible.
• Pull the strap tightly before twisting the windlass.
• Twist the windlass rod until the bright red bleeding completely stops and the distal pulse is eliminated.
• Secure the windlass rod in the retaining clip.
• Mark the time of application directly on the tourniquet or the patient's forehead (e.g., "TK 1430"). This information is critical for surgeons to determine tissue viability.

Pressure Dressings and Wound Packing

For severe bleeding in junctional areas (neck, armpits, groin) where a tourniquet cannot be applied, wound packing is required. Officers use hemostatic gauze, packing it deeply into the wound cavity directly to the bleeding source, and maintaining continuous, firm direct pressure for several minutes before applying a pressure dressing over the top.

Chest Seals for Penetrating Trauma

Penetrating trauma to the torso (chest, back, abdomen) from gunshot or stab wounds can compromise the respiratory system, potentially causing a tension pneumothorax (a collapsed lung caused by trapped air). Officers must inspect the torso fully and apply an occlusive dressing, commonly known as a chest seal.

• If available, use a vented chest seal, which allows trapped air to escape while preventing ambient air from entering the chest cavity.
• Ensure the skin is wiped relatively dry before application to maintain strong adhesion.
• Always check for exit wounds on the back and seal those as well.

CPR and AED Standards

When encountering a victim in sudden cardiac arrest (unresponsive and not breathing normally), immediate cardiopulmonary resuscitation (CPR) and the rapid use of an Automated External Defibrillator (AED) are the links to survival.

High-Quality Chest Compressions

The American Heart Association (AHA) mandates specific standards for high-quality CPR to ensure adequate blood flow to the brain and vital organs:

• Rate: Compress the chest at a rate of 100 to 120 compressions per minute.
• Depth: Push hard, compressing the chest at least 2 inches (5 cm) for an adult, but no more than 2.4 inches (6 cm).
• Recoil: Allow the chest to fully recoil after each compression. Do not lean on the chest.
• Minimizing Interruptions: Keep pauses in compressions to less than 10 seconds.

Compression-to-Ventilation Ratio

For adults, the standard ratio for CPR is 30 chest compressions to 2 rescue breaths (30:2). When delivering rescue breaths using a pocket mask or bag-valve-mask, each breath should last about one second, just enough to produce visible chest rise.

Automated External Defibrillators (AED)

An AED is a portable device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock (defibrillation) to re-establish an effective rhythm.

• Turn on the AED immediately upon arrival.
• Follow the voice prompts.
• Apply the pads to the bare, dry chest of the patient.
• Ensure no one is touching the patient during rhythm analysis and shock delivery.
• Resume CPR immediately after a shock is delivered (or if no shock is advised), starting with chest compressions.