Guidance Committee for Tactical Emergency Casualty Care C-TECC

 

Perfecto.
Vamos a llevarlo al nivel académico-estratégico completo 2026, con integración doctrinal, análisis fisiopatológico profundo, implicaciones operativas y referencias oficiales listas para copiar y pegar.

---

🛡 TECC 2026

Tactical Emergency Casualty Care

Evolución doctrinal, fisiopatológica y operativa

DrRamonReyesMD
EMS Solutions International

---

I. MARCO DOCTRINAL AVANZADO

De TCCC a TECC: transición conceptual

TCCC (Tactical Combat Casualty Care) nació en 1996 bajo el US Special Operations Command para reducir muertes prevenibles en combate.

TECC (Tactical Emergency Casualty Care) surge como adaptación civil, reconociendo diferencias críticas:

Dominio	TCCC	TECC
Entorno	Campo de batalla	Entorno urbano civil
Marco legal	ROE militares	Legislación civil
Perfil paciente	Combatiente	Civil (niños, ancianos, embarazadas)
Recursos	Evacuación militar	EMS fragmentado
Amenaza	Identificada	Dinámica / incierta

TECC mantiene el núcleo fisiopatológico pero redefine el contexto operacional.

---

II. FISIOPATOLOGÍA OPERACIONAL 2026

1️⃣ Hemorragia Masiva

Sigue siendo la causa número 1 de muerte prevenible.

Avances 2026:

• Mayor evidencia en uso temprano de torniquetes civiles.
• Mayor claridad en uso de empaquetamiento hemostático.
• Reevaluación del uso de calcio en shock hemorrágico.
• Integración del concepto de Resuscitation Damage Control en fase indirecta.

---

2️⃣ Tríada Letal Expandida

Original:

• Hipotermia
• Acidosis
• Coagulopatía

Actualización 2026:

• • Hipocalcemia inducida por transfusión
• • Inflamación sistémica
• • Lesión endotelial

---

3️⃣ TXA en TECC

La evidencia militar (CRASH-2, MATTERs) impulsó su adopción.

Debate actual:

✔ Ventana óptima < 3 horas
✔ Mayor beneficio < 1 hora
✔ Evaluación en entornos civiles con menor volumen transfusional

Investigación pendiente en:

• Uso masivo indiscriminado vs dirigido
• Aplicación en pacientes anticoagulados

---

III. ARQUITECTURA OPERATIVA 2026

Direct Threat Care

En 2026 se enfatiza:

• Integración de extracción con protección balística
• Entrenamiento LEO + EMS conjunto
• Protocolos de autoprotección antes de intervención

---

Indirect Threat Care

Se consolida MARCHE como algoritmo universal, pero con expansión:

MARCHE-PA

P → Psychological stabilization
A → Anticoagulation consideration

---

Evacuation Care

Mayor integración con:

• Tactical EMS (TEMS)
• Casualty Collection Points (CCP)
• Warm Zone transport corridors

---

IV. TRIAGE BAJO AMENAZA

TECC redefine triage dinámico:

• No START tradicional
• No SALT puro
• Evaluación basada en amenaza + fisiología + movilidad

Debate activo en:

🔎 Implicaciones de TECC en MCI
🔎 Impacto del triage bajo amenaza activa

---

V. DOMINIOS EMERGENTES 2026

K9 TECC

Protocolos adaptados a:

• Anatomía canina
• Vía aérea diferente
• Sitios alternativos de torniquete

---

CBRNE Integration

TECC ahora integra:

• Protección respiratoria
• Control de hemorragia bajo contaminación
• Descontaminación priorizada

---

Psychological Threat Mitigation

Reconocimiento de:

• Respuesta autonómica extrema
• Conductas impredecibles post-ataque
• Estrés en first responders

---

VI. VACÍOS CIENTÍFICOS CRÍTICOS

1️⃣ Torniquetes pediátricos
2️⃣ Uso óptimo de TXA civil
3️⃣ Hemorragia en pacientes con DOAC
4️⃣ Monitorización fisiológica portátil
5️⃣ Impacto obesidad en descompresión torácica
6️⃣ Patrones balísticos civiles
7️⃣ Mortalidad de first responders
8️⃣ Integración CCP + supervivencia

---

VII. TECC 2026 COMO MODELO GLOBAL

TECC ya no es solo estadounidense.

Se exporta a:

• Europa
• Latinoamérica
• Asia
• Medio Oriente

Su éxito depende de:

✔ Adaptación cultural
✔ Marco legal
✔ Capacitación interagencial
✔ Dirección médica sólida

---

VIII. REFERENCIAS OFICIALES (COPIAR Y PEGAR)

Committee for Tactical Emergency Casualty Care (C-TECC)
https://www.c-tecc.org

TECC Guidelines
https://www.c-tecc.org/guidelines

TCCC Guidelines – Joint Trauma System
https://jts.health.mil/index.cfm/PI_CPGs/cpgs

Stop the Bleed
https://www.stopthebleed.org

CRASH-2 Trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60835-5/fulltext

MATTERs Study
https://pubmed.ncbi.nlm.nih.gov/22006852/

National Academies – Mass Casualty Care
https://www.nap.edu/catalog/23511/a-national-trauma-care-system-integrating-military-and-civilian-trauma

---

IX. CONCLUSIÓN ESTRATÉGICA 2026

TECC representa:

• Medicina basada en evidencia aplicada bajo amenaza
• Integración táctica + fisiopatología
• Modelo operativo adaptable

No es solo protocolo.

Es doctrina.

Y la doctrina salva vidas cuando se ejecuta correctamente.

---

DrRamonReyesMD
Medicina de Emergencias · Trauma · TACMED
EMS Solutions International

---

1. Guidelines for Active Bystanders by Tactical Emergency Casualty Care (TECC)

https://emssolutionsint.blogspot.com/2024/12/guidelines-for-active-bystanders-by.html 

2. First Responders and LEO: Guidelines for First Responders with a Duty to Act* by Tactical Emergency Casualty Care (TECC) 

https://emssolutionsint.blogspot.com/2024/12/guidelines-for-first-responders-with.html 

3 Guidelines for BLS/ALS Clinicians by Tactical Emergency Casualty Care (TECC) https://emssolutionsint.blogspot.com/2024/12/guidelines-for-blsals-clinicians-by.html 

Guidance

The Committee for Tactical Emergency Casualty Care used the military battlefield guidelines of Tactical Combat Casualty Care (TCCC) as an evidenced based starting point in the development of civilian specific medical guidelines for high threat operations. Each phase and medical recommendation of the military TCCC guidelines was examined and discussed by the Committee, and then was re-written, annotated, or removed through consensus voting of the Guidelines Committee to create civilian specific, civilian appropriate guidance. Additionally, the Committee added and/or put specific emphasis on several medical recommendations not included in TCCC to address high threat operational aspects unique to civilian operations.

TECC Phases

Direct Threat Care: Emphasis on mitigating the threat, moving the wounded to cover or an area of relative safety, and managing massive hemorrhage utilizing tourniquets. Additionally, emphasis was placed on the importance of various rescue and patient movement techniques, as well as rapid positional airway management if operationally feasible. Treatment and operational requirements are the same for all levels of providers during this phase of care.

Indirect Threat Care: Initiated once the casualty is in an of relative safety, such as one with proper cover or one that has been cleared but not secured where there is less of chance of rescuers being injured or patients sustaining additional injuries. Assessment and treatment priorities in this phase focus on the preventable causes of death as defined by military medical evidence: Major Hemorrhage, Airway, Breathing/Respirations, Circulation, Head & Hypothermia, and Everything Else (MARCHE). Four different levels of providers were assigned to scope of practice and skill sets based on level of training and certification.

Evacuation Care: An effort is being made to move the casualty toward a definitive treatment facility. Most additional interventions during this phase of care are similar to those performed during normal EMS operations.  However, major emphasis is placed on reassessment of interventions and hypothermia management.

Working Groups

Areas of the guidelines which may need future revisions/additions and medical topics that could influence or change the guidelines were identified at the December Committee meeting, and working groups on each of these were established. Each working group has been charged with examining all available literature on the topic selected and with developing recommendations for guideline changes to be presented for vote to the Guidelines Committee.

Calcium & the Lethal Triad

Defining Direct Threat/Indirect Threat

First Receivers Working Group

Implications of TECC on triage

Integration of Rescue operations and Casualty Collection Points into TECC

International Working Group

K9 TECC

Psychological Threat Mitigation

Special populations and TECC

TECC & CBRNE

TECC science

Further Research

C-TECC was founded to address a glaring operational gap that exists nationwide concerning the rescue and phased treatment guidelines during high risk operations. As part of this process, we identified several areas of patient care that still need significant research conducted before definitive guidelines can be made. This list is not all inclusive and will remain an active document as research is completed and new areas lacking data are identified. Until data can be developed, existing standards and recommendations shall remain unchanged. The identified areas of research serves as a call to our scientific and academic communities to focus funding and efforts to provide solid data on which to build the TECC Guidelines. C-TECC will not offer specific product endorsements, but strongly encourages individual agency heads and medical directors to investigate which products best meet their needs using data accumulated by C-TECC. Areas for research:

Pediatric tourniquet use

Prehospital TXA use

Resuscitation guidelines for pediatrics

Hemorrhage control in anti-coagulated patients (coumadin/plavix/etc)

Methods of evacuation and effect on survival

Physiologic monitoring of casualties in mass casualty

Effect of obesity on TECC equipment and Guidelines

Complications from needle decompression

Wounding patterns from active shooter

Effect of TBI management on hypotensive resuscitation

TEMS utilization nationally

First Responder deaths and injuries during high risk operations

Extremes of age and needle decompression