TECC-NAEMT TACTICAL EMERGENCY CASUALTY CARE by NAEMT
Los siguientes cursos están disponibles para satisfacer las necesidades de los proveedores y los instructores:
- Curso de proveedor: curso presencial de 16 horas para los técnicos de emergencias médicas y paramédicos. Al completar con éxito el curso, los estudiantes reciben un certificado de finalización, una tarjeta de bolsillo reconocerlos como proveedores Tecc por 4 años, y 16 horas de crédito CAPCE.
- TECC de agentes de la autoridad y de la respuesta inicial (TEC-LEO): En Desarrollo: curso presencial de 4-8 horas diseñado específicamente para los no-EMS de primera respuesta. El curso abarca materiales que se encuentran en el curso proveedor de 16 horas a un nivel apropiado para los primeros respondedores. Incluye 4 horas de contenido básico, con módulos adicionales que pueden añadirse para hacer frente a las necesidades de los respondedores específicos. Al completar con éxito el curso, los estudiantes reciben un certificado de finalización, una tarjeta de bolsillo reconociéndolas como un proveedor de TEC-LEO durante 4 años, y 4-8 horas de crédito CAPCE.
TECC Courses
The following courses are available to meet the needs of providers and instructors:
Provider Course: 16-hour classroom course for EMTs and paramedics. Upon successful completion of the course, students receive a certificate of completion, a wallet card recognizing them as TECC providers for 4 years, and 16 hours of CAPCE credit.
TECC for Law Enforcement Officers and First Responders (TECC-LEO): In Development: 4-8 hour classroom course specifically designed for non-EMS first responders. The course covers materials found in the 16-hour provider course at a level appropriate for first responders. It includes 4 hours of core content, with additional modules that can be added to address the needs of specific responders. Upon successful completion of the course, students receive a certificate of completion, a wallet card recognizing them as a TECC-LEO provider for 4 years, and 4-8 hours of CAPCE credit.
Tactical
Emergency Casualty Care (TECC) Guidelines for First Responders with a Duty to
Act
Guías
para Primeros Respondedores con Deber de Actuar “En Acto de Servicio”
(Fuerzas de
Seguridad, Bomberos no SEM)
Muertes Prevenibles en Combate:
Hemorragia de Extremidades, Neumotorax a Tension y Obstruccion de Vias Aereas.
Todos Nuestros VIDEOS en YouTube https://www.youtube.com/c/
Grupo en TELEGRAM Sociedad Iberoamericana de Emergencias
https://t.me/joinchat/FpTSAEHYjNLkNbq9204IzA
https://t.me/joinchat/FpTSAEHYjNLkNbq9204IzA
Cadena de Supervivencia TECC by Committee Tactical Emergency
Casualty Care
1. Primeros Respondientes: Profesores, Trabajadores, cuidadanos
2. Primeros Respondintes Profesionales en Acto de Servicio ej Bomberos, Policias
3. Cuidado Medico PreHospitalario
4. Departamentos de Emergencias
5. Centros de Trauma
Traducido y adaptado
Miembro Comite TECC
TacMed: We are very privileged to have the secretary of ATMA, Tim Makrides, write us a guest post on the recent winter meeting of the Committee for Tactical Emergency Casualty Care. At the bottom of the post are the replays of the live videos from the meeting. Thanks Tim & ATMA (and of course C-TECC!).
C-TECC MEETING DEBRIEF BY ATMA SECRETARY TIM MAKRIDES
I was recently privileged enough to attend the Committee on Tactical Emergency Casualty Care (C-TECC) winter meeting in California as a representative of the Australian Tactical Medical Association (ATMA) along with ATMA’s President, Matt Pepper.
For those of you who don't know much about ATMA, we are an association formed in mid-2017 with the aim of representing the interests of everyone involved in the provision of first aid or medical care in high threat environments. We carry out our work on behalf of paramedics, doctors, law enforcement officers and even the general public.
While some of the members of the Board of Directors have worked for or currently work for Tacmed Australia, they are two distinct entities, and ATMA is strictly a not for profit organisation.
We are very grateful for the support TacMed has given us, and openly acknowledge that they are one of a few organisations in Australia that have been relentlessly advocating for improved access to tactical medical education and equipment.
Back to the meeting…
We flew over for a very short three-day trip and hit the ground running for the amazing one and half day meeting.
Before I fill you in on the ins and outs of the meeting, it's important to give you a quick run down on who C-TECC are and what they’re trying to achieve (click HERE for the run down).
After arriving very jet lagged but excited we headed in for day one of the meeting.
We started with a presentation from the local Police Chief and Fire Chief who both provided an interesting context into the work being achieved by the committee. It was very evident that this particular County in Southern California was heavily invested in TECC from the ground up. The local police department has trained every officer in bleeding control, and the fire/ EMS Department has one of the strongest tactical medicine programs in the state.
The county was also one the first in the state to co-locate ‘Stop the Bleed’ kits with every defibrillator in a public place. The conference centre alone had three kits.
By mid-morning we heard from the director of the newly formed High Threat Institute, a joint venture involving George Washington University. The institute has recently set up “Go Teams” a highly effective and intriguing concept.
In a nutshell, this newly formed team was created out of a distinct need to learn from major incidents in real or near real time. Go Teams are deployed in the immediate aftermath of a major incident with 2-3 members hitting the ground in the first 24-48 hours. Their job is to link into the local emergency network and talk “offline” with operators involved in the incident. These operators range from paramedics and doctors through to security staff and local law enforcement assets.
While the conversations with responders are informal, the teams are taught to gather and collate specific de-identified data sets. Once the team returns back to their headquarters, the data is translated into an after action report (AAR) and published within a couple of weeks of the incident.
The beauty of this program is that lessons are learned from these incidents much quicker than conventional post incident AAR’s which can often take 2 or so years to publish.
Just before lunch, we heard from Pete Carlo, Assistant Medical Director of Las Vegas Police Department, who briefed us into the Mandalay Bay Shooting in September this year.
The incident was the worst civilian mass shooting in U.S. history and while it was a dark day for everyone involved, the overwhelming body of evidence showed that both EMS and police training before the event ensured a rapid and coordinated response to neutralize the threat and evacuate patients to the local trauma centres.
This presentation raised some interesting questions regarding hospital preparedness for major incidents. C-TECC has recently released ‘First Receiver’ Guidelines which are designed to help hospitals cope with a large number of trauma patients following a major intentional violence incident. There’s a great deal of interesting information available to hospital staff, so if you're an influencer in this space, or just purely interested I urge you to read more about it HERE.
After lunch, ATMA President, Matt Pepper, provided the committee with an introduction to the association, as well as an update on tactical medicine in Australia. The short presentation was very well received with a long list of questions waiting for Matt at the end.
The remainder of the day was spent on working group updates, including:
- First Care Providers
- K9
- First Receivers
- Triage
- Breaching
- Hazmat
- International engagement
Whilst there was a lot of great content covered in the working group updates, it’s far too in-depth to cover on this blog.
The one thing I will quickly mention is that the HAZMAT working group highlighted that there is a very real and likely possibility that fire could be used as part of complex coordinated attacks, as shown by recent ISIS propaganda. The intention is that this will be worked into the guidelines in the future.
The first day wrapped up with a social event at a local bar where many new international friendships were forged over a beer or two.
Day two kicked off bright and early with an animated discussion on the data surrounding head injuries. The C-TECC working group presented a draft of their soon to be released Traumatic Brain Injury (TBI) guideline.
There was a great deal of discussion surrounding the finer detail of the guideline, and a decision was made to re-present the final product at the next meeting in May 2018.
The final topic for the morning was the TECC guidelines for penetrating thoracic trauma and the use of chest seals. The scarce evidence was presented which consists mainly of experimental swine studies. The possibility that covering a wound with a non vented occlusive dressing can consistently cause the development of tension pneumothorax was apparent. The main change to the guidelines will, therefore, be that sucking chest wounds/open pneumothoraces should be covered with a vented seal, and if one is not available, then it should be left uncovered.
This is a significant change for many providers and trainers, and ATMA will be putting out more information on this change over the next few weeks.
The meeting was adjourned around lunchtime, with the Committee sitting again in May 2018 at the Special Operations Medicine Scientific Assembly in Charlotte, NC next year.
Overall the trip was an invaluable experience, and it gives ATMA members and those we inform in Australia a voice and a direct link into the C-TECC. It is the responsibility of ATMA to disseminate this information and to continue to advocate for our member's interests in high threat medical care. We have paved the way for ATMA members to sit on several working groups so if there is something that interests you; please get in touch with me.
Finally, if you’re keen to stay up to date with ATMA then check out our website or social media pages.
Stay safe.
Tim Makrides
Secretary
Australian Tactical Medical Association
email: tim@atma.net.au
website: www.atma.net.au
facebook: www.facebook.com/australiantacticalmedicalassociation
Below are the videos that were live broadcast by the Committee for Tactical Emergency Casualty Care. Thanks to the committee for broadcasting!
Comite IberoAmericano de Medicina Tactica y Operacional
Guidelines Tactical Emergency Casualty Care TECC by CTECC every day getting more space in Europe...
| TECC-NAEMT TACTICAL EMERGENCY CASUALTY CARE.
Les Esperamos en nuestro Grupo en TELEGRAM Soc. IberoAmericana de Emergencias
DIRECT THREAT CARE (DTC) /
HOT ZONE Guidelines:
1.
Mitigate
any threat and move to a safer position (e.g. Return fire, utilize less lethal
technology, assume an overwhelming force posture, etc.).
a.
Recognize
that threats are dynamic and may be ongoing, requiring continuous threat
assessments.
2.
Direct the
law enforcement/first responder casualty to stay engaged in tactical operation
if able and appropriate.
3. Extract casualty to a safer position:
a. Instruct the casualty to move to a safer position and apply self-‐aid
if capable.
b. If the casualty is responsive but cannot move, a
rescue plan should be devised and implemented.
c.
If a
casualty is unresponsive, weigh the risks and benefits of an immediate rescue
attempt in terms of manpower and likelihood of success. Remote
medical assessment techniques for survivability should be considered.
4.
Stop life
threatening external hemorrhage if present and reasonable depending on the
immediate threat, severity of the bleeding and the extraction distance to
safety. Consider moving to safety prior to application of the tourniquet if the
situation warrants.
a.
Direct
casualty to apply direct pressure to wound and/or own effective tourniquet if
able.
b.
Tourniquet application:
i.
Apply the
tourniquet as high on the limb as possible, including over the clothing if
present.
ii. Tighten until cessation of bleeding and move to safety.
5. Consider quickly placing unresponsive casualty in recovery position to
protect airway.
INDIRECT THREAT CARE (ITC) /
WARM ZONE Guidelines:
1.
Any
casualty with a weapon should have that weapon made safe and secured once the
threat is neutralized and/or if mental status is altered.
2. Bleeding:
a. Assess for and control any unrecognized major bleeding:
i.
Use a tourniquet
or an appropriate pressure dressing with deep wound packing (either plain gauze
or, if available, hemostatic dressing to control life-‐ threatening bleeding
in an extremity or a junctional area:
- Apply
the tourniquet over the clothing as proximal-‐-‐ high on the limb-‐-‐ as possible, or if able to fully
expose and evaluate the wound, apply directly to the skin at least 2-‐3 inches
above wound (DO NOT APPLY OVER THE JOINT).
- For any
traumatic total or partial amputation, a tourniquet should be applied as high on the
extremity as possible regardless of bleeding.
b. If available, immediately apply a junctional
tourniquet device for anatomic junctional areas where bleeding cannot be easily
controlled by direct pressure and hemostatics/dressings.
c.
Reassess all
tourniquets that were hastily applied during Direct Threat/Hot Zone Care.
i.
Evaluate
the wound for continued bleeding or a distal pulse in the extremity. - If there is continued bleeding
or a distal pulse is still present, either
tighten the existing tourniquet further or apply a
second tourniquet, side-‐ by-‐side and, if possible, proximal to the first,
to eliminate the distal pulse.
d. If possible, mark all tourniquet sites with the time of tourniquet
application.
3. Airway Management:
a. If the casualty is unconscious or is conscious but unable to follow
commands:
i.
Clear mouth of any foreign
bodies (vomit, food, teeth, gum, etc).
ii.
Apply basic chin lift or jaw
thrust maneuver to open airway.
iii.
Consider placing a
nasopharyngeal airway.
iv.
Place casualty in the
recovery position to maintain the open airway.
b. If the casualty is conscious and able to follow commands:
i.
Allow
casualty to assume position of comfort, including sitting up. Do not
force to lie down.
a.
All open
and/or sucking torso wounds should be treated by immediately applying a vented
or non-‐vented occlusive seal to cover the defect.
b. Monitor any casualty with penetrating torso trauma for
the potential development of a tension pneumothorax. Most common presentation
will be penetrating chest injury with subsequent increasing shortness of breath
and difficulty breathing and/or increasing anxiety/agitation.
i.
If tension
pneumothorax appears to be developing, removing the occlusive dressing and/or “burp”
the chest seal.
ii.
Casualties
with concern for developing tension pneumothorax should be prioritized for
evacuation to higher level of care.
5.
Shock
Management/Resuscitation:
a.
Assess for hemorrhagic shock
i.
Altered
mental status (in the absence of head injury) and weak or absent peripheral
pulses are the best field indicators of shock.
b.
If not in shock:
i.
Casualty may
drink if conscious, can swallow, and there is a confirmed delay in evacuation
to care.
c.
If in shock:
i.
Prioritize
for rapid evacuation any patient, especially those with penetrating torso injury,
displaying signs of shock.
6.
Prevention of hypothermia:
a. Minimize casualty’s exposure and subsequent heat loss.
i.
Keep protective gear on or
with law enforcement casualty if feasible.
ii.
Keep casualty warm and dry:
- Place the casualty onto an
insulated surface to reduce conductive heat loss as soon as possible.
- Minimize exposure to
the elements.
- Replace wet clothing
with dry if possible.
- Cover
casualty with commercial warming device, blankets, poncho liners, sleeping bags, or anything
that will retain heat and keep the casualty dry.
7.
Reassess casualty:
a.
Perform a
rapid blood sweep, front and back, checking for additional injuries. Tearing,
cutting, or otherwise exposing the wound may be necessary.
8.
Burns:
a.
Stop the burning process.
b. Cover burns with loose dry dressings if available.
c.
Large area
burns and signs of significant airway burns or smoke inhalation (e.g. singed
facial hair, soot/burns/swelling around the nose or mouth) should be
prioritized for rapid evacuation.
d. Burn patients are more susceptible to hypothermia – minimize heat loss
as above.
9.
Prepare casualty for
movement:
a. Consider operational and environmental factors for safe and expeditious
evacuation.
b. Secure casualty to a movement assist device when available.
c. If vertical extraction required, ensure casualty secured appropriately.
10. Communicate
with the casualty if possible. a. Encourage, reassure and explain
care.
a.
CPR within
this phase of care for victims of blast or penetrating trauma who have no pulse,
no ventilations, and no other signs of life will likely not be successful and
should not be attempted.
b. In other circumstances, performing CPR may be of benefit and may be considered
in the context of the operational situation.
12.
Documentation of Care:
a.
Communication
of assessments and treatments rendered should be passed along with the casualty
to the next level of care. This should be documented on a simple standardized
casualty care card with the casualty to the next level of care.
EVACUATION CARE (EVAC) /
COLD ZONE Guidelines:
1. Reassess all interventions applied in previous phases of care.
2.
If multiple
wounded, perform primary triage for priority and destination of evacuation to a
higher level of care.
3. Airway Management:
a.
The
principles of airway management in Evacuation Care / Cold Zone are similar to
that in ITC / Warm Zone.
b. If the casualty is unconscious or is conscious but unable to follow
commands:
i.
Clear mouth of any foreign
bodies (vomit, food, teeth, gum, etc).
ii.
Apply basic chin lift or jaw
thrust maneuver to open airway.
iii.
Consider placing a
nasopharyngeal airway.
iv.
Place casualty in the recovery
position to maintain the open airway.
c. If the casualty is conscious and able to follow commands:
i.
Allow
casualty to assume position of comfort, including sitting up. Do not force
to lie down.
4.
Breathing:
a.
All open
and/or sucking chest wounds should be treated immediately by applying a vented
or non-‐vented occlusive seal to cover the defect. Monitor the casualty for
the potential development of a subsequent tension pneumothorax.
b. Reassess casualties who have had chest seals applied.
Any developing tension pneumothorax should be treated as described in ITC /
Warm Zone.
c.
If
available, administration of oxygen may be of benefit for all traumatically
injured patients, especially for the following types of casualties:
- Chest injuries
- Torso injuries associated with shortness of breath - Unconscious or altered mental
status
- Post-‐blast injuries -
Casualty in shock - Casualty at altitude
5.
Bleeding:
a. Fully expose wounds to reassess for and control any unrecognized major
bleeding:
i.
Use a
tourniquet or an appropriate pressure dressing with deep wound packing (either
plain gauze or, if available, hemostatic gauze) to control life-‐
- Apply the tourniquet over the clothing as
proximal-‐-‐ high on the limb-‐-‐ as possible, or if able to fully expose
and evaluate the wound, apply directly to the skin 2-‐3 inches above wound (DO
NOT APPLY OVER THE JOINT).
- For any traumatic total or partial amputation, a
tourniquet should be applied regardless of bleeding.
b. If available, immediately apply a junctional
tourniquet device for anatomic junctional areas where bleeding cannot be easily
controlled by direct pressure and hemostatics/dressings.
c. Reassess all tourniquets that were hastily applied during prior phases
of care.
i.
Evaluate
the wound for continued bleeding or a distal pulse in the extremity. - If there is continued bleeding
or a distal pulse is still present, either
tighten the existing tourniquet further or apply a
second tourniquet, side-‐ by-‐side and, if possible, proximal to the first,
to eliminate the distal pulse.
d. Clearly mark all tourniquet sites with the time of tourniquet
application.
6.
Shock
Management/Resuscitation:
a. Re-‐assess for developing hemorrhagic shock
i.
Altered
mental status (in the absence of head injury) and weak or absent peripheral
pulses are the best field indicators of shock.
ii.
Utilize
additional medical assessment and monitoring equipment that may be available in
this phase.
b.
If not in shock:
i.
Casualty may
drink if conscious, can swallow, and there is a confirmed delay in evacuation
to care.
ii.
Allow casualty to assume
position of comfort.
c.
If in shock:
i.
Prioritize
for rapid evacuation any penetrating torso injury patient displaying signs of
shock.
ii.
Consider
alternative methods of transportation to definitive medical care if traditional
methods delayed or unavailable. Ensure coordination of patient distribution to
avoid overwhelming any one medical receiving facility.
d. If altered mental status due to suspected TBI and
casualty not in shock, position the casualty supine and raise the casualty’s
head to 30 degrees.
7. Prevention of hypothermia:
a. Minimize casualty’s exposure and subsequent heat loss.
i.
Keep protective gear on or
with law enforcement casualty if feasible.
ii.
Keep casualty warm and dry:
-‐ Place the casualty onto an insulated surface to reduce conductive heat
loss
as soon as possible.
-‐ Minimize
exposure to the elements.
-‐ Replace
wet clothing with dry if possible.
-‐ Cover
casualty with commercial warming device, blankets, poncho liners,
sleeping bags, or anything that will retain heat and keep the casualty
dry.
iii.
Move into a vehicle or
warmed structure if possible.
8. Reassess casualty:
a.
Complete
full front and back re-‐assessment checking for additional injuries. Inspect and
dress known wounds that were previously deferred.
b. Frequently re-‐check the casualty for any changes in
condition. Worsening status at any point should prompt priority evacuation.
Consider alternative methods of transportation to definitive medical care if
traditional methods delayed or unavailable. Ensure coordination of patient
distribution to avoid overwhelming any one medical receiving facility.
9.
Burns:
a.
Stop the burning process.
b. Cover burns with loose dry dressings if available.
Clean, dry sheets are effective for casualties with large area burns.
c.
Large area
burns and signs of significant airway burns or smoke inhalation (e.g. singed
facial hair, soot/burns/swelling around the nose or mouth) should be
prioritized for rapid evacuation. Consider alternative methods of
transportation to definitive medical care if traditional methods delayed or
unavailable. Ensure coordination of patient distribution to avoid overwhelming
any one medical receiving facility.
d. Burn patients are more susceptible to hypothermia – minimize heat loss
as above.
10. Prepare casualty for movement:
a. Consider environmental factors for safe and expeditious evacuation.
b. Secure casualty to a movement assist device when available.
c. If vertical extraction required, ensure casualty secured appropriately.
11. Communicate with the casualty if possible, and with the
operational medical provider or medical
facility assuming care of the casualty.
a.
Encourage,
reassure and explain care and expectations to patient, family and/or
caregivers.
b. Notify receiving provider or facility of wounds,
patient condition, and treatments applied.
12. Cardiopulmonary resuscitation
a.
CPR may have
a larger role during the evacuation
phase especially for patients with electrocution, hypothermia, non-‐traumatic
arrest or near drowning.
13. Documentation of Care:
a.
Continue or
initiate documentation of clinical assessments, treatments rendered, and
changes in the casualty’s status in accordance with local protocol.
b. Forward this information with the casualty to the next level of care.
GOALS, PRINCIPLES, SKILL SETS
Care
provided within the TECC guidelines is inherent upon individual first responder
training, available equipment, local medical protocols, and medical director
approval.
I. Direct Threat Care
(DTC)/Hot Zone
Primary Goals:
1. Accomplish the mission with minimal additional casualties.
2. Prevent any casualty from sustaining additional injuries.
3.
Keep
response team maximally engaged in neutralizing the existing threat (e.g.
active shooter, barricade, high threat warrant etc.).
4.
Minimize public harm.
Operational Principles:
1.
Establish tactical supremacy and defer in-‐depth
medical interventions if engaged in ongoing
direct threat mitigation (e.g. active fire fight, dynamic explosive
scenario, etc.).
2.
Threat mitigation techniques will minimize risk to casualties and the providers. These should include techniques and tools for
rapid casualty access and egress.
3.
Triage
should be deferred to a later phase of care. Prioritization for extraction is
based on resources available and the tactical situation.
4. Minimal trauma interventions are warranted during this phase.
5.
Consider bleeding control.
a. Tourniquet application is the primary “medical” intervention to be considered.
b. For response personnel, tourniquet should be readily
available and accessible with either hand.
DTC/Hot Zone Required Skill
Set (applied per approved SOP/protocol only):
1. Direct pressure and hasty tourniquet application
a. Consider PACE Methodology-‐ Primary, Alternative, Contingency,
Emergency
b.
Commercially available tourniquets
c.
Field expedient tourniquets
2.
Tactical casualty extraction
3.
Rapid placement in recovery position
Primary Goals:
1. Goals 1-‐4 as above with DTC / Hot Zone care
2.
Stabilize
the casualty as required to permit safe extraction to dedicated treatment
sector or medical evacuation assets.
Operational Principles:
1. Maintain tactical supremacy
and complete the overall mission.
2.
As
applicable, ensure safety of both first responders and casualties by rendering weapons safe and/or rendering any adjunct tactical gear safe for
handling (flash bangs, gas canisters,
etc).
3.
Conduct dedicated patient assessment and
initiate appropriate life-‐saving interventions as outlined in the ITC / Warm
Zone guidelines. DO NOT DELAY casualty extraction/evacuation for non
life-‐saving interventions.
4. Consider establishing a casualty collection
point if multiple casualties are encountered.
5.
Unless in a
fixed casualty collection point, triage in this phase of care should be limited
to the following categories:
a. Uninjured and/or capable of ambulation or self-‐extraction
b.
Deceased / expectant
c.
All others
6.
Establish communication with the tactical and/or
unified command and request or verify initiation of casualty
extraction/evacuation.
7.
Prepare
casualties for extraction and document care rendered for continuity of care
purposes.
ITC/Warm Zone Required Skill
Set (applied per approved SOP/protocol only):
1.
Hemorrhage Control:
a.
Application of direct pressure
b.
Application of tourniquet
i.
Consider PACE Methodology-‐
Primary, Alternative, Contingency, Emergency
ii.
Commercially available tourniquets
iii.
Field expedient tourniquets
c. Perform wound packing with gauze or hemostatic agent
d.
Application of pressure dressing
2.
Airway:
a. Perform Manual Maneuvers (chin lift, jaw thrust, recovery position)
b.
Insert nasal pharyngeal airway
3.
Breathing:
a. Application of effective occlusive chest seal
b.
Apply oxygen
c. Recognize the symptoms of tension pneumothorax
d.
“Burp” occlusive dressing
4.
Circulation:
a. Recognize the symptoms of hemorrhagic shock
a. Apply available materials to prevent heat loss
6.
Wound management:
a.
Initiate basic burn treatment
7.
Casualty evacuation:
a. Move casualty (drags, carries, lifts)
b.
Secure casualty to litter
8.
Other Skills:
a.
Monitor casualty
b. Recognize need and requirements for, and establish Casualty Collection
Point.
Primary Goals:
1. Maintain any lifesaving interventions applied during DTC and ITC phases.
2. Provide rapid and secure evacuation to an appropriate medical receiving
facility.
3.
Provide
good communication and patient care data between field medical providers and
fixed receiving facility.
4. Avoid additional preventable causes of death.
Operational Principles:
1. Reassess the casualty or casualties for efficacy of all applied medical
interventions.
2.
Utilize a
triage system/criteria per local policy that considers priority AND destination
to ensure proper distribution of patients.
3. Utilize additional available resources to maximize advanced care.
4.
Avoid hypothermia.
5.
Communication
is critical, especially between tactical elements and non-‐tactical EMS teams.
6. Maintain situational awareness: in dynamic events, there are NO threat
free areas.
Evac/Cold Zone Required
Skill Set (applied per approved SOP/protocol only):
1.
Same as ITC/Warm Zone
2.
Apply triage prioritization of casualties
3. Communicate effectively between non-‐medical, pre-‐hospital and
hospital medical assets
There is no official or national certification in TECC. There is no official designation as a TECC instructor. The Committee maintains the belief that the guidelines are the evidenced based 'what to do' and 'why to do it.' The 'how' is up to you, and that planning and training should occur on an local/agency level.
So, take the guidelines and create your own training. However, if you can't, be sure to chose a training entity that displays the CTECC recognized educational content logo. This means the training adheres to the Committee's educational principles.
No existe una certificación oficial o nacional en tecc. No hay designación oficial como instructor de tecc. El Comité mantiene la creencia de que las directrices son las que se basan en " qué hacer " y " por qué hacerlo " el " Cómo " depende de ti, y que la planificación y la formación deben tener lugar a nivel local o de la agencia.
Así que, toma las directrices y crea tu propio entrenamiento. Sin embargo, si no puedes, asegúrate de elegir una entidad de entrenamiento que muestre el logotipo de contenido educativo reconocido por ctecc. Esto significa que la formación se atiene a los principios educativos del comité.
Introduction to Tactical Emergency Casualty Care (TECC)
FEMA Introduction TECC Tactical Emergency Casualty Care Course with Certificate
This course represents the foundational curriculum in a series of courses sponsored by the Federal Emergency Management Agency’s, National Training and Education Division, developed by The George Washington University and its partners. It is designed for all levels of providers: citizens who become a first care provider, police officers, fire and EMS professionals, hospital based first receivers and all those comprised in the TECC Chain of Survival.
This course provides an overview of civilian high threat medical principles that can be applied by all first care and medical providers during active acts of violence and intentional mass casualty events, such as an active shooter, detonation of explosives, or use of fire as a weapon. The goal is to better prepare our nation’s communities to respond to atypical incidents that involve mass-casualties and preserve life.
The training challenges some long-standing principles of emergency response, and establishes a platform from which to build additional knowledge and skills.
Completion of this introductory course is required prior to participating in any of the other courses specifically designed for your role as a first responder. All other courses in this series are delivered in person, are based on your experience and professional scope of practice, and include practical hands on skills practice.
For information about additional FEMA training, visit www.training.fema.gov.
Christian Goring, Dr. Luis Perez-Bolde, MD, Dr. Ramon REYES, MD
Presentacion realidad Iberoamericana de la MEDICINA TACTICA
Reunion Comite TECC
Dr. Reed Smith, MD Chair CTECC y Dr. Ramon REYES, MD
Reunion Comite TECC
Australia, Mexico, Chile, Dominicana, España
Reunion Comite TECC
Comite Iberoamericano de Medicina Tactica
Reunion Comite TECC
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Curso TECC Tactical Emergency Casualty Care by CoTECC
Parte de las acciones formativas del Grupo de Trabajo en Medicina Tactica de SEMES Andalucia.
Enseña a los Servicios Medicos Civiles SEMs, a trabajar en conjunto a las Fuerzas de Seguridad del Estado. Dirigido a todos los actores en situaciones TACTICAS (Tiradores Activos, Bombas, Ataques Terroristas). No es un curso en donde se enseña a ser un SWAT, o Personal Tactico (Equipos de Contacto encargados de neutralizar las Amenazas) Se enseña Como Trabajar en la Fase posterior a la entrada en escena de los equipos de contacto, digase en la Fase de Rescate, practicando Maniobras en la medida de lo posible que permitan salvar la vida de las victimas y proceder a la Extricacion y Evacuacion de Heridos en las mejores de las condiciones posibles. Dirigido a TES, DUEs, Medicos, Bomberos, Personal de Proteccion Civil, etc.
El Director Medico con Experiencia Militar, Policial SWAT en EUA, ha trabajado en conflictos en Irak, Mali, Mauritania, etc. es Facultado Internacional TCCC-PHTLS-TECC y Autorizado por escrito para Impartir TCC-LEFR por el propietario del curso Dr. Peter Pons (Unico en España) y se dedica a la medicina de alto riesgo a nivel internacional. Es miembro del SOMA Special Operations Medical Association ID 17479 y Miembro Sociedad Europea de Medicina de Emergencias EUSEM.
Curso TECC TACTICAL EMERGENCY CASUALTY CARE
Reunion de Trabajo "GRUPO MEDICINA TACTICA SEMES ANDALUCIA"
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Localizacion de nuestro centro de entrenamiento
November 2018
New Orleans, Louisiana USA
More information in the link http://emssolutionsint.blogspot.com.es/2016/07/phtls-founder-and-medical-director.html
| Curso Celebrado 28 Septiembre 2017 |
Faculty TCCC /TECC / PHTLS
Especialista de Medicina de Alto Riesgo a Nivel Internacional
El Comité del Tactical Emergency Casualty Care (C-TECC), un grupo de voluntarios expertos en materias médicas operacionales civiles, publicó en el año 2011 sus primeras directrices reflejando el concepto IPA/FCP. El proceso de creación y las directrices del C-TECC se basaron en las exitosas directrices militares del Tactical Combat Casualty Care (TCCC) y fueron modificadas para ajustarse a los aspectos únicos de la respuesta en escenarios civiles con amenaza elevada. En el ámbito militar, el TCCC tuvo más éxito en la reducción de la tasa de mortalidad cuando se establecía como parte de un sistema de tratamiento de heridos de manera integral, como el Sistema de Primer Interviniente de los Rangers (Ranger First Responder). Sin embargo, existen grandes diferencias entre las respuestas a nivel operativo civiles y las militares: las peculiaridades de los pacientes de la población civil, las restricciones legales y las diferencias en cuanto a logística y recursos, impiden la aplicación directa del TCCC en las operaciones civiles. Las directrices del TECC tienen en cuenta esos aspectos únicos para la actuación en estos escenarios con nivel de amenaza elevada y, permiten a las autoridades locales, implementar de manera adecuada los programas de respuesta en este tipo de incidentes con heridos que involucren “a toda la comunidad”.
| Curso TECC Gr |
Comite Ejecutivo TECC
Co-Operating Chair
Reed Smith, MD
Arlington County Fire Department
Co-Operating Chair
David Callaway, MD
Carolinas Medical Center
Secretary
Brendan Hartford, EMT
Chicago SWAT
Treasurer
Geoff Shapiro, EMT-P
George Washington University
At-Large
Sean McKay, EMT-P
Clearwater Fire and Rescue
Reed Smith, MD
Arlington County Fire Department
Co-Operating Chair
David Callaway, MD
Carolinas Medical Center
Secretary
Brendan Hartford, EMT
Chicago SWAT
Treasurer
Geoff Shapiro, EMT-P
George Washington University
At-Large
Sean McKay, EMT-P
Clearwater Fire and Rescue
Junta Directiva TECC
Chief Skip Kirkwood
Wake County EMS Division
Chief James Schwartz
Arlington County Fire Department
Babak Sarani, MD
George Washington University Medical Faculty Associates
Rick Mathews
National Center for Security and Prepredness
David Davis, EMT-P
DHS
Nelson Tang, MD
Johns Hopkins University
Wake County EMS Division
Chief James Schwartz
Arlington County Fire Department
Babak Sarani, MD
George Washington University Medical Faculty Associates
Rick Mathews
National Center for Security and Prepredness
David Davis, EMT-P
DHS
Nelson Tang, MD
Johns Hopkins University
Comite de Directrices
Mark Gibbons, EMT-P
Maryland State Police
John Gandy, MD
US Air Force
Matthew Sztajnkrycer, MD
Mayo Clinic
Jeff Cain, MD
Emergency Medicine
Michael Marino, EMT-P
Prince George Fire Department
David Tan, MD
Washington University
Mark Anderson, EMT-P
Seattle/King County Medic One
Capt. John Delaney, EMT
Arlington County Fire Department
Scott Weir, MD
Fairfax County Fire Department
Keith Monosky, PhD
Central Washington University
Jeff Lindsey, PhD
24-7 EMS Training
William Bozeman, MD
Wake Forest University
Joshua Bobko, MD
Loma Linda University
Barry Frasier, EMT-P
US Air Force
Tom Burnett, MD
Virginia Polytechnical Institute
Mike Shertz, MD
Oregon Emergency Physicians
Rich Kamin, MD
State of Connecticut Department of Public Health
Jason Pickett, MD
Wright State University Dept. of Emergency Medicine
Russ Kotwall, MD
US Army, Joint Trauma System Division Director for Trauma Care Delivery
Chief Robert Wylie, EMT
Cottleville Community Fire Protection District
Scott Kimball, EMT-P
Special Operations Group, US Marshall's Service
Vincent Johnson, EMT-P
Fire Department of NY
Eileen Bulgar, MD
Harborview Medical Center
Ofer Lichtman, EMT-P
Rancho Cucamonga Fire District
Gina Piazza, DO
SUNY at Buffalo
Liaison Positions:
Maryland State Police
John Gandy, MD
US Air Force
Matthew Sztajnkrycer, MD
Mayo Clinic
Jeff Cain, MD
Emergency Medicine
Michael Marino, EMT-P
Prince George Fire Department
David Tan, MD
Washington University
Mark Anderson, EMT-P
Seattle/King County Medic One
Capt. John Delaney, EMT
Arlington County Fire Department
Scott Weir, MD
Fairfax County Fire Department
Keith Monosky, PhD
Central Washington University
Jeff Lindsey, PhD
24-7 EMS Training
William Bozeman, MD
Wake Forest University
Joshua Bobko, MD
Loma Linda University
Barry Frasier, EMT-P
US Air Force
Tom Burnett, MD
Virginia Polytechnical Institute
Mike Shertz, MD
Oregon Emergency Physicians
Rich Kamin, MD
State of Connecticut Department of Public Health
Jason Pickett, MD
Wright State University Dept. of Emergency Medicine
Russ Kotwall, MD
US Army, Joint Trauma System Division Director for Trauma Care Delivery
Chief Robert Wylie, EMT
Cottleville Community Fire Protection District
Scott Kimball, EMT-P
Special Operations Group, US Marshall's Service
Vincent Johnson, EMT-P
Fire Department of NY
Eileen Bulgar, MD
Harborview Medical Center
Ofer Lichtman, EMT-P
Rancho Cucamonga Fire District
Gina Piazza, DO
SUNY at Buffalo
Junta de Asesores
- CAPT (R) Frank Butler, MD, Chair Committee for Tactical Combat Casualty Care
- Thomas Scalea, MD, R. Cawley Shock Trauma
- Roger Band, MD, University of Penn
- Daniel Fagbuyi, MD, Children's National Medical Center
- William Gephart, PA-C, US Army Special Operations
- Paul Pepe, MD, University of Texas Southwestern
- John Freese, MD, Fire Department of New York City
- Brent Myers, MD, Wake County EMS
- Gary Kibbee, EMT-P, South San Francisco Fire Dept
- Jose Henao, MD, US Navy
- Alex Eastman, MD, Dallas Police Department
- Mel Otten, MD, Cincinnati SWAT
- Crawford Mechem, MD, University of Pennsylvania
- Rick Hammesfahr, MD, Marietta GA SWAT
- Lawrence Heiskel, MD, International School of Tactical Medicine
- James McGinnis, PA-C, Health Intervention and Disaster Response, George Washington University
- David Slattery, MD, Las Vegas Fire and Rescue
- Chief Michael Touchstone, Philadelphia Fire Department
- SGT James Gordon, Los Angeles Police Department
- Scott Sasser, MD, Emory University
- Alex Isakov, MD, Emory University
- John Armstrong, MD, Florida State Surgeon General and Secretary of Department of Health
- Duane Caneva, MD, Customs and Border Protection
- Peter Carlo, PA-C, Las Vegas SWAT
- COL Isaac Ashkenazi, MD Retired, Israeli Defense Forces
- Allen Yee, MD, Chesterfield Fire Department
- Darryl Stroud, Special Operations Group, London Fire Brigade
- LT Tracy Frazzano, Township of Montclair Police Department
- Cory Slovis, MD, Vanderbilt University Medical Center
- Don Jenkins, MD, Trauma Center, Mayo Clinic
- Kevin Gerold, MD, TEMS Section, NTOA
- Carol Cunningham, MD, Ohio Department of Public Safety, Division on EMS
- August Vernon Forsyth, County Emergency Management
- Glenn Bollard, MD, Gallatin County SRT
- Steve Giebner, MD, Committee for Tactical Combat Casualty Care
- Howard Champion, MD, University of Maryland
- Stuart Thomas – Director, Line9Medic Ltd UK
- Matthew Wentzel , Psy.D, M.Ed - Blue Pearl Consulting
- Kristina Anderson, KOSHKA Foundation for Safe Schools
- Detective Eric Soderlund, Pinellas County Sheriff's Department
- Terry Nichols, ALERRT, Texas State University
- Captain Christopher Baldini, Philadelphia Fire Department
- Lee Palmer, DVM, K9 Medic, Oregon State University
- Nate Hiner, EMT-P, Arlington County Fire Department
- Denis Fitzgerald, MD, CONTOMS
- Greg Smith, EMT-P, CONTOMS
- Andre Pennardt, MD, National TEMS Initiative and Council
- Todd Baldridge, EMT-P, Orange County Fire Authority
- Carol Cunningham, MD, Ohio Department of Public Safety, Division of EMS
Liaison Positions:
- DHS/FBI/NCTC Joint Counter Terrorism Awareness Workshop Series Liaison
- Coalition for Tactical Medicine Liaison
- National TEMS Initiative and Council Liaison
- International Trauma Life Support Liaison
- PreHospital Trauma Life Support Liaisonls Liason
- Koshka Foundation for Safe Schoo
Videos Ejemplos de habilidades practicadas en el Curso
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| Conjunto de Habilidades del C-TECC Segun el Nivel del Asistente |
¿Como actuar ante tiradores Activos? Corra- Escondase-Pelee
RUN HIDE FIGHT
Bleeding Control Basic by American College of Surgeons and The Hartford Consensus IV StopTheBleed "Stop the Bleed" http://emssolutionsint.blogspot.com.es/2016/07/the-hartford-consensus-iv-compendium.html
#trauma #phtls #terrorismo #explosion #tecc #tccc #ems #sem #emergencias #urgencias #tiradoractivo #semes #eate #ctecc #cotccc #ambulancias #BCon #hartford #StopTheBleed #BleedingControl #hemorragia #sangrado #torniquete #SAMXT #CAT #EmpaquetamientoHeridas #hemostasia #viasaereas
Hola y saludos desde Nueva Orleans, Soy el Dr. Lance Stuke Director Medico PHTLS y miembro del Comite de Trauma del Colegio Americano de Cirujanos. Quiero extender mis felicitaciones al Grupo de Trabajo Tactico de la Sociedad Española de Medicina de Urgencias y Emergencias. SEMES, quienes estaran entrenando en Control de Sangrados y Manejo de Multiples Victimas en Situaciones Tacticas, adicionalmente quiero dar las gracias al Dr. Ramon Reyes por su liderazgo para brndar este curso a cada uno de ustedes, en el mundo en que vivimos multiples victimas, vienen haciendose mas y mas comun, y estos entrenamientos son valiosos al proveer estandares de calidad para la comunidad y y finalmente a nuestros pacientes. Gracias por su dedicacion, espero a conocerlos a todos en el futuro"
Dr. Lance Stuke
PHTLS Medical Director
Curso T.E.C.C. TACTICAL EMERGENCY CASUALTY CARE . ESPAÑA
El Curso es endosado por el Comite TECC de los Esatados Unidos y tenemos autorizacion escrita para utilizar material y logos del C-TECC.
Curso Cardioprotegido por
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| Telefunken Desfibrilador |
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Emergency Educational Training Institute https://www.eeti.training/ |
International EMS Registry
http://www.iemsr.org/the-board.html
Emergency Educational Training Institute
Florida USA
Cómo actuar ante un incidente terrorista
Si te ves involucrado en un incidente terrorista, sigue los consejos que te ofrecemos desde #DivulgaSEMES y el Grupo de Enfermería Militar de SEMES:
ANTES DEL INCIDENTE
- Conoce el lugar en el que estás y busca al menos 2 salidas para caso de emergencia.
- Reconoce los lugares en los que podrías quedar atrapado en caso de salida.
- Identifica posibles lugares en los que refugiarte si fuera necesario.
- Notifica lo antes posible a la policía si observas alguna actitud extraña (alguien con un cuchillo/arma)
DURANTE EL INCIDENTE
HUYE:
- No siembres el pánico e intenta mantener la calma.
- Dirígete con decisión al lugar de salida/ huida que habías identificado.
- No te dirijas hacia la persona que está produciendo el tumulto.
- Intenta tranquilizar a los que están alrededor tuyo y abandonar la escena.
- No corras si no tienes espacio para ello, puedes crear avalanchas.
- Deja en el lugar tus pertenencias si suponen un lastre para huir.
- No te pares a grabar fotos ni vídeos.
- No te pares a atender heridos.
- No te enfrentes.
- Ponte en lugar cubierto lo antes posible.
Si no puedes huir, trata de ocultarte.
ESCÓNDETE:
- Mantente oculto.
- Manténgase en silencio.
- Esté en disposición de pelear.
- Intenta esconderte en lugar cerrado y bloquea la puerta.
- Silencia tu teléfono móvil y quita todas las fuentes de ruido.
SI no puedes huir ni esconderte,
PELEA (esta es la última opción):
- Actúa con agresividad.
- Utiliza cualquier objeto de fortuna para golpear.
- Pide ayuda y ataca en grupo.
DESPUÉS DEL INCIDENTE
CUANDO ESTÉS A SALVO, LLAME AL 112 Y DE INFORMACIÓN AL OPERADOR.
- Dónde estás
- Cuantas personas estáis.
- Hay heridos o no
- Número de atacantes y dónde los viste por última vez.
- Tipo de ataque, (armamento, vehículo…).
- Cualquier dato que consideres relevante.
- Pon un CHECK de “me encuentro bien” en tus redes sociales
CUANDO LLEGUEN LAS FUERZAS DE SEGURIDAD:
- Suelte cualquier objeto que tenga en sus manos que pueda considerarse una amenaza.
- Aproxímese con las manos visibles o en la cabeza.
- Siga sus instrucciones.
Y recuerda:
- HAZ LO POSIBLE POR MANTENERTE A SALVO
- MANTEN LA CALMA
- OBEDECE A LOS EQUIPOS DE EMERGENCIAS
- DISFRUTA CON SEGURIDAD
GUIA PARA LE MANEJO DE HERIDOS EN INCIDENTES
INTENCIONADOS CON MULTIPLES VICTIMAS Y TIRADORES ACTIVOS
GUIA M.A.C.T.A.C. Actualizacion 2017
Tamaño del archivo en PDF Gratis
2.34 MB
21 Paginas
Este obra cuyo autor es JUAN JOSE PAJUELO CASTRO Y JOSE CARLOS MENESES PARDO está bajo una licencia de Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional de Creative Commons.
GUIA DE SOPORTE VITAL EN INCIDENTES CON AMENAZA ELEVADA PARA PRIMER INTERVINIENTE POLICIAL by Juan Jose Pajuelo. España 2017
Descargate la guia: Guía para Primer Interviniente Policial
El objetivo de estas Guías no es otro que resumir de manera breve y concisa los pasos ideales (en ocasiones lo ideal no es lo real) para una valoración y manejo iniciales de las principales causa de muerte evitable, hasta la llegada de los Servicios de Emergencia, en los compañeros o ciudadanos heridos.
Se pretende que estas Guías aborden la asistencia inicial, en el contexto de una intervención o incidente donde exista un alto nivel de amenaza, en el que se vean involucrados los “policías de a pie”, puesto que ha quedado demostrado que son los primeros (y en ocasiones los únicos) en abordar inicialmente tanto al incidente en sí mismo, como a las víctimas si se han producido.
Un incidente con alto nivel de amenaza no se limita a sucesos como atentados terroristas con múltiples víctimas, si no que contempla también otro tipo de circunstancias como incidentes con individuos armados y/o, aglomeraciones populares con individuos violentos.
Toman como referencia las Directrices para Primeros Intervinientes con la Obligación de Asistir (First Responders with a Duty to Act) del Comité del Tactical Emergency Casualty Care que, al igual que estas Guías, son meras recomendaciones y no protocolos rígidos que deben adaptarse a la legislación vigente y, a las especificidades de cada Institución/Servicio/Organismo.
Con independencia de lo mencionado anteriormente, tienen como objetivo final estandarizar un lenguaje y unas actuaciones a nivel nacional dado que, están basadas en la evidencia científica “in vivo” y, en las lecciones aprendidas de muchos profesionales nacionales e internacionales. Estas recomendaciones/guías, no sustituirán el buen juicio clínico.
Por lo tanto, se espera que las recomendaciones que se presentan a continuación sirvan de ayuda para todo aquél personal policial que se pueda ver involucrado en un incidente con un nivel de amenaza elevado, a la hora de enfrentarse al manejo de las principales causas de muerte evitable que se producen en actuaciones con un alto nivel de amenaza.
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MANUAL DE SOPORTE VITAL AVANZADO EN COMBATE Ministerio de Defensa España 2014 http://emssolutionsint.blogspot.com.es/2016/02/manual-de-soporte-vital-avanzado-en.html |
DOWNLOAD PDF FREE
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| Link to the web to download |
ANTES
DURANTE
DESPUES
¿Como actuar ante Incidente TERRORISTA? by SEMES
Ampliar informacion en el enlace http://emssolutionsint.blogspot.com/2017/09/curso-tcc-lefr-tactical-casualty-care_4.html
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TACTICAL MEDICINE TACMED “Medicina Bona Locis Malis” tm. Good Medicine In Bad Places España by EMS Solutions International
Tactical Medicine TACMED España Marca Registrada Nº. 377.032
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