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Tactical emergency care for law enforcement: Phases of care

In this video, learn about the three essential phases of TECC that all law enforcement officers should understand in tactical scenarios

In the second of a nine-part series, Robert Carlson from Brave Defender Training Group focuses on the civilian adaptation of the Tactical Emergency Casualty Care (TECC) system, emphasizing its importance for law enforcement officers to understand and identify the phases of care during tactical scenarios to provide effective medical aid while ensuring personal and team safety.

Carlson breaks down the TECC into three distinct phases:

  1. Direct threat care
  2. Indirect threat care
  3. Evacuation care

Direct threat care, or the “hot zone,” prioritizes dealing with immediate threats and controlling life-threatening bleeding, highlighting the use of tourniquets for hemorrhage control on extremities.
Once the threat level decreases, the focus shifts to indirect threat care, or the “warm zone,” where the reduced (but not eliminated) threat allows for broader medical interventions. This phase employs the MARCH algorithm (massive bleeding, airway, respirations, circulation and head injuries/hypothermia) to prioritize and address injuries systematically.

Finally, the evacuation care phase is about efficiently transitioning patients to higher levels of care, such as EMS, focusing on stabilizing the patient for transport and potentially conducting casualty evacuations when professional medical help is not immediately available.

The discussion underscores the dynamic nature of tactical medical response, urging law enforcement officers to remain vigilant, adaptable and knowledgeable about the phases of care. This approach not only saves lives but also ensures the safety of the responders.

Key learning points

  • Understanding the TECC phases is crucial for effective emergency response in tactical situations: Each phase corresponds to the level of threat present and dictates specific actions and priorities. Recognizing and adapting to the phase of care ensures that responders provide the most appropriate treatment without compromising safety.
  • The importance of immediate threat neutralization and hemorrhage control: The use of tourniquets to stop life-threatening bleeding is a primary intervention in this phase. This dual focus ensures responders can maintain their safety while preventing the patient from succumbing to their injuries.
  • The MARCH algorithm provides a structured approach to addressing critical injuries: This systematic method helps responders to quickly assess and address the most critical needs of the patient, ensuring that the interventions are both timely and effective.
  • Efficient transition to higher care levels is vital: In situations where EMS is delayed or unavailable, officers may need to undertake casualty evacuations themselves, requiring a clear understanding of how to maintain the stability of the patient during transport.
  • Continuous risk assessment and adaptability are essential for law enforcement officers to provide effective medical aid while ensuring their own safety: Law enforcement officers must balance the urgency of medical intervention with the need for personal and team safety. This balance requires constant vigilance, situational awareness and flexibility in approach.

Questions for discussion

  1. How do the principles of TECC adapt to non-combat, civilian environments, especially in terms of risk assessment and threat neutralization?
  2. What challenges might law enforcement officers face when transitioning between the different phases of care in a real-world scenario?
  3. How does the MARCH algorithm aid in prioritizing medical interventions during the indirect threat care phase?
  4. In what ways can law enforcement agencies train and prepare their officers for the evacuation care phase, particularly in environments where EMS is delayed or unavailable?
  5. How can continuous education and training in TECC principles enhance the tactical and medical response capabilities of law enforcement personnel?
This phase is characterized by the presence of an immediate, ongoing threat

Robert Carlson is a firearms instructor for the Memphis (Tennessee) Police Department specializing in active shooter, counterambush and tactical medicine training. He is the lead TECC instructor for the Mississippi National Guard’s Regional Counterdrug Training Academy, providing no-cost training to law enforcement across the country. He has been recognized as an expert in active shooter response by law enforcement. Carlson also owns Brave Defender Training Group and is an IADLEST nationally certified instructor.