In late November, the Committee for Tactical Emergency Casualty Care (C-TECC) issued updated protocols for Basic Life Support (BLS) and Advanced Life Support (ALS) clinicians. These updates are part of the ongoing efforts to enhance the effectiveness and efficiency of emergency medical response in high-threat environments. The new guidelines aim to provide clear and actionable recommendations for clinicians operating in situations where traditional response paradigms may not be feasible.
Committee for Tactical Emergency Casualty Care
The Committee for Tactical Emergency Casualty Care (C-TECC) is an organization dedicated to developing and promoting evidence-based medical guidelines for emergency medical responders operating in high-threat environments. These environments can include active shooter situations, terrorist attacks, natural disasters, and other scenarios where traditional emergency medical response may be hindered by ongoing threats.
The C-TECC’s guidelines are designed to enhance the effectiveness and safety of medical care provided by Basic Life Support (BLS) and Advanced Life Support (ALS) clinicians in these challenging situations. By focusing on immediate access to the injured, rapid life-saving interventions, and early extraction to definitive care, the C-TECC aims to improve patient outcomes and support the overall mission of emergency responders.
The Importance of Updated Protocols
The updated protocols are designed to address the unique challenges faced by BLS and ALS clinicians in tactical and high-threat scenarios. These environments often involve real or perceived threats, such as active violence, hazardous materials, fires, or structural instability, which can significantly impact the delivery of medical care. The C-TECC guidelines emphasize the need for immediate access to the injured, rapid life-saving interventions at or near the point of injury, and early extraction of those needing transport to definitive medical care.
Key Updates in the Protocols
Massive Bleeding: The updated guidelines include new recommendations for hemorrhage control. Clinicians are advised to convert or relocate tourniquets within two hours of application, consistent with current Committee on Tactical Combat Casualty Care (CoTCCC) recommendations. This change aims to reduce the risk of complications associated with prolonged tourniquet use.
Airway Management: The guidelines now recommend the use of supraglottic airways (SGAs) as a viable option for airway management in warm zone care. Additionally, oro- and nasotracheal intubation are recommended, providing clinicians with multiple options for securing the airway in high-threat environments.
Medications: The updated protocols include recommendations for the use of nonsteroidal anti-inflammatory drugs (NSAIDs), specifically Celecoxib, which has a more gastrointestinal (GI)-protective profile and a more pronounced COX-2 preference than Meloxicam, which is recommended in the TCCC guidelines. This change aims to provide safer and more effective pain management options for patients.
Phases of Care
The TECC guidelines outline three dynamic phases of care: Direct Threat Care (DTC), Indirect Threat Care (ITC), and Evacuation Care (EC). These phases are intended to correlate directly with the contemporaneous threat level and are not solely geographic in nature. The guidelines emphasize the importance of adapting medical response to the specific operational threats present, ensuring that care is both timely and effective.
Mental Health Considerations
In addition to physical injuries, the updated protocols also address the mental health needs of patients, survivors, and responders. Key principles include limiting exposure of personnel to the incident and providing appropriate early psychological support. These measures aim to reduce the long-term psychological impact of high-threat incidents on all involved.
Conclusion
The updated TECC guidelines for BLS and ALS clinicians represent a significant advancement in the field of tactical emergency medical care. By incorporating the latest evidence-based practices and addressing the unique challenges of high-threat environments, these protocols aim to improve patient outcomes and enhance the safety and effectiveness of emergency medical response. As the landscape of emergency medical care continues to evolve, the C-TECC remains committed to providing clinicians with the tools and guidance they need to deliver the highest standard of care in the most challenging situations.
Resource
Committee for Tactical Emergency Casualty Care
c-tecc.org