Tactical Emergency Casualty Care (TECC) Guidelines for BLS/ALS Clinicians
ACTUALIZADA a la versión Final 2025-1-2.
ENGLISH VERSION — Tactical Emergency Casualty Care (TECC) 2025
Updated to the Final 2025-1-2 Edition
Summary | DrRamonReyesMD
Tactical Emergency Casualty Care (TECC) Guidelines for BLS/ALS Clinicians
The new TECC 2025 Guidelines consolidate the evolution of civilian tactical medicine into a truly principle-driven model—extrapolated from military experience yet formally adapted to the civilian, multi-threat and multidisciplinary environment: active shooters, IED attacks, industrial incidents, offshore emergencies, CBRN hazards, law enforcement operations, and dignitary protection scenarios.
The Final 2025-1-2 Edition represents the most complete update to date, integrating new evidence, refined operational recommendations, and a more robust conceptual framework.
For BLS/ALS clinicians, these guidelines constitute the international operational gold standard.
1. Official Links (Updated 2025) — copy & paste
✔️ TECC 2025 BLS/ALS Full PDF
https://www.c-tecc.org/images/F_TECC_ALS_BLS_Guidelines_2025_FINAL.pdf
✔️ TECC Pediatric Guidelines 2025
https://www.c-tecc.org/images/F_TECC_Peds_Guidelines_2025_FINAL.pdf
✔️ Official Guidelines Page (all updates)
https://www.c-tecc.org/guidelines
2. TECC 2025 Philosophy: From the Battlefield to Civilian Threats
TECC 2025 reinforces that:
- It is not “civilian TCCC.”
- It is a doctrine of medical care in high-threat civilian environments, evidence-based, flexible, and adapted to real civilian resources.
- Replaces rigid protocols with operational principles, recognizing that each incident (urban, rural, industrial, riot control, tactical, offshore, VIP protection) requires immediate adaptation.
- Removes strict military terminology, but preserves the survivability-based physiologic priorities.
- Reinforces a continuous threat-driven care model, integrating risk dynamics, rescuer safety, and coordination with law enforcement.
3. The Three TECC 2025 Phases: Maximum Operational Precision
A. Direct Threat Care (DTC) / Care Under Immediate Threat
Applied when danger is ongoing: gunfire, secondary explosions, collapsing structures, active aggressor, crossfire, industrial critical hazards.
Priorities:
- Rescuer survivability: movement, cover, security
- Self-aid / buddy-aid
- Massive hemorrhage control with rapid application of an effective tourniquet (within 10 seconds)
- Rapid casualty extraction to cover
- No interventions that do not directly improve immediate survival
B. Indirect Threat Care (ITC) / Care in Reduced Threat
Environment is more stable but still not “cold.”
Best suited for expanded interventions while maintaining tactical awareness.
TECC 2025 prioritizes the physiologic algorithm MARCHE-R:
M – Massive Hemorrhage
A – Airway (positioning, basic and supraglottic airways; avoid advanced airway if threat remains unstable)
R – Respiration (chest seals, needle decompression when indicated)
C – Circulation (additional bleeding control, tourniquet reassessment, performance-based fluid resuscitation)
H – Hypothermia and Head Injury
E – Exposure/Environment
R – Reassessment
Hypothermia prevention is emphasized as a critical survival determinant, even in warm climates.
C. Evacuation Care (EVAC)
Care delivered during movement toward definitive treatment.
Priorities:
- Systematic reassessment
- Stabilization for transport
- Full thermal protection
- Advanced medical communications (MEDEVAC/CASEVAC adapted to civilian systems)
- Multisector coordination (EMS, fire, police, tactical units, industrial teams)
4. Key TECC 2025 Updates Compared to Previous Editions
- Stronger emphasis on principles instead of rigid checklists, enabling adaptation to high-variability scenarios.
- Clarifies BLS/ALS intervention boundaries according to realistic resource availability.
- Reinforces the TECC doctrine: no commercial brands or product endorsements, only validated clinical capabilities (e.g., “an appropriate, validated tourniquet”).
- Multi-threat expansion: not limited to ballistics—fire, structural collapse, CBRN, vehicular trauma, maritime/offshore, riot events.
- New working-group focuses:
- TXA use in civilian populations
- Anticoagulated casualties
- Pediatrics
- Technical rescue
- Deep gluteal hemorrhage
- K9 operational casualty care
- Updated timing and indications for needle decompression and airway interventions.
- Stronger emphasis on immediate hypothermia prevention.
- Reaffirmation of what must NOT be done in hot zones (e.g., advanced airway procedures).
5. Relevance for Tactical Physicians, EMS Medical Directors and Coordinators
As a clinician trained in ATLS, PHTLS, ITLS, TECC, TCCC, TCC-LEFR, and with operational experience in conflict zones, presidential protection, offshore environments and aeromedical evacuation, TECC 2025 positions you as:
- A reference authority for local adaptation and doctrinal implementation.
- A consultant capable of advising governments, energy corporations, special units and hospitals in multi-threat readiness.
- A practitioner able to integrate TECC + ATLS + VIP protection medicine + tactical medicine into a unified professional doctrine.
Official Statement | DrRamonReyesMD
“The TECC 2025 Update (Final 2025-1-2) redefines the standard of civilian tactical emergency medicine.
It is not a manual— it is a doctrine grounded in physiologic priorities, threat-based decision-making, and extreme adaptability.
Every BLS/ALS clinician operating in high-risk environments must master these guidelines.
Proper implementation saves lives and distinguishes professional tactical medicine from improvised intervention.”
— DrRamonReyesMD, EMS Solutions International
VERSIÓN EN ESPAÑOL — Cuidado Táctico de Emergencias (TECC) 2025
Actualizada a la versión Final 2025-1-2
Resumen | DrRamonReyesMD
Tactical Emergency Casualty Care (TECC) — Guías para Clínicos BLS/ALS
Las Guías TECC 2025 consolidan la medicina táctica civil moderna en un modelo basado en principios fisiológicos y operativos, derivado de la experiencia militar pero actualizado al entorno civil multiamenaza: tiradores activos, explosivos, incidentes industriales, offshore, CBRN, operaciones policiales y protección de dignatarios.
La versión Final 2025-1-2 es la actualización más completa hasta la fecha.
Para BLS/ALS, representa el estándar internacional de referencia.
1. Enlaces oficiales (actualizados 2025) — copiar y pegar
✔️ Guía TECC 2025 BLS/ALS (PDF completo)
https://www.c-tecc.org/images/F_TECC_ALS_BLS_Guidelines_2025_FINAL.pdf
✔️ Guía TECC Pediátrica 2025
https://www.c-tecc.org/images/F_TECC_Peds_Guidelines_2025_FINAL.pdf
✔️ Página oficial con todas las directrices
https://www.c-tecc.org/guidelines
2. Filosofía TECC 2025: de la guerra al entorno civil
- No es un “TCCC civil”.
- Es una doctrina de atención médica en escenarios de alto riesgo, flexible, basada en evidencia y adaptada a recursos civiles reales.
- Sustituye protocolos rígidos por principios operacionales porque cada incidente requiere adaptación inmediata.
- Elimina el lenguaje militar estricto, pero mantiene las prioridades de supervivencia.
- Integra riesgo, seguridad del rescatador e interacción con fuerzas policiales.
3. Las tres fases TECC 2025
A. Direct Threat Care (ATC / Atención en amenaza directa)
Prioridad absoluta: supervivencia del rescatador, cobertura, movimiento y control del sangrado masivo (TQ eficaz en <10 s).
Extracción inmediata a cobertura.
No realizar maniobras que no aumenten supervivencia inmediata.
B. Indirect Threat Care (ITC / Atención en amenaza indirecta)
Zona menos peligrosa pero aún no segura.
Aplicación del algoritmo fisiológico MARCHE-R (Hemorragia masiva, Vía aérea, Respiración, Circulación, Hipotermia/TCE, Exposición, Reevaluación).
Énfasis extremo en la prevenir hipotermia desde el primer minuto.
C. Evacuation Care (EVAC / Atención en evacuación)
Reevaluación continua, estabilización, comunicaciones avanzadas y coordinación interagencias.
Mantenimiento de la normotermia y del control de todas las intervenciones previas.
4. Cambios clave TECC 2025
- Mayor énfasis en principios sobre protocolos.
- Claridad en lo que BLS y ALS pueden hacer según disponibilidad real.
- Prohibición de recomendar marcas comerciales: solo capacidades clínicas validadas.
- Expansión al concepto multiamenaza (balística, fuego, CBRN, colapsos, marítimo, vehículos).
- Nuevos grupos de trabajo en TXA civil, anticoagulados, pediatría, rescate técnico, hemorragia glútea profunda, K9.
- Ajustes en vía aérea, descompresión torácica y reconsideración de torniquete.
- Foco mayor en la hipotermia inmediata incluso en clima cálido.
5. Relevancia para el médico táctico y coordinador médico
TECC 2025 permite integrar doctrina, entrenamiento, certificación y respuesta multiamenaza en un sistema unificado de medicina táctica civil avanzada.
“La actualización TECC 2025 (Final 2025-1-2) redefine el estándar de medicina táctica civil.
No es un manual, sino una doctrina basada en principios fisiológicos, toma de decisiones bajo amenaza y adaptabilidad extrema.
Todo clínico BLS/ALS expuesto a escenarios de alto riesgo debería dominar estas directrices.
Su correcta aplicación salva vidas y marca la diferencia entre intervención improvisada y medicina táctica profesional.”
— DrRamonReyesMD, EMS Solutions International
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