TECC has three phases: Direct Threat Care, Indirect Threat Care and Evacuation Care. Each phase is set by how much danger the responder and casualty face right now, not by a spot on a map. The more threat there is, the less medicine you do. As the threat drops, you do more.

The Committee for Tactical Emergency Casualty Care (C-TECC) built these phases by adapting the military's Tactical Combat Casualty Care (TCCC) for civilian responders. They are often described with the hot, warm and cold zone language that fire and EMS use.

This guide explains what each phase is, what care belongs in it, and how the zone terms fit. For background on TECC itself, see What Is TECC?

Why does TECC use phases?

In a high-threat incident, the medical problem and the tactical problem happen at the same time. A responder who starts detailed treatment in the open can become the next casualty.

The founding TECC paper by Callaway and colleagues, published in the Journal of Special Operations Medicine in 2011, describes the first phase as the point where the "external, ongoing threat to life is as dangerous, or more dangerous, than the injury sustained." The phases give responders a shared way to decide what to do and when.

The American College of Surgeons' Hartford Consensus II lays out a similar logic in its THREAT sequence: Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical providers, and Transport to definitive care. The TECC phases follow a similar order.

Direct Threat Care: what happens in the hot zone?

Direct Threat Care happens while the threat is still active. That could be an active shooter, ongoing gunfire, a structural hazard or anything else that can still hurt people.

C-TECC's guidance describes the focus as "mitigating the threat, moving the wounded to cover or an area of relative safety, and managing massive hemorrhage utilizing tourniquets." According to the guidance page, all provider levels use the same treatment approach in this phase. A paramedic under fire doesn't do more medicine than a patrol officer does.

Key principles from the June 2015 C-TECC guidelines:

  • "Establish tactical supremacy and defer in depth medical interventions if engaged in ongoing direct threat."
  • "Minimal trauma interventions are warranted."
  • "TQ application is the primary 'medical' intervention."
  • "Direct the casualty to move to a safer position and apply self-aid if able."
  • "Apply the tourniquet over the clothing as proximal--high on the limb--as possible."

In plain terms, stop the threat, get the wounded out of the line of fire, and stop life-threatening limb bleeding. Detailed assessment waits. C-TECC's guidance also mentions airway positioning when operationally feasible.

Self-aid matters most here, because the first person who can treat a wounded officer is often that officer. In one case we covered, a Rochester officer applied his own tourniquet while radioing for help, before other officers reached him.

For more detail on tourniquets, see Tourniquets in TECC.

Indirect Threat Care: what happens in the warm zone?

Indirect Threat Care begins once the casualty reaches an area of relative safety. The threat may be suppressed or out of direct line, but it hasn't necessarily gone away.

The 2011 paper describes this as an "area of higher security, such as a casualty collection point (CCP) with cover and/or concealment." This is where responders can slow down enough to do a real assessment.

C-TECC's guidance says this phase focuses on "preventable causes of death" using the MARCHE sequence:

  • Major hemorrhage
  • Airway
  • Respirations (breathing)
  • Circulation
  • Head injury and hypothermia
  • Everything else

Here, unlike under direct threat, scope of practice starts to matter. According to C-TECC's guidance, in Indirect Threat Care "four different levels of providers were assigned to scope of practice." An officer with basic training, an EMT and a paramedic will each do different things, based on their training, local protocols and medical direction.

Depending on scope, care in this phase follows the MARCHE letters and can include:

  • Reassessing and tightening or adding tourniquets
  • Packing wounds or using pressure dressings for bleeding a tourniquet can't reach
  • Opening and positioning the airway
  • Sealing open chest wounds and watching for tension pneumothorax
  • Checking for shock
  • Preventing heat loss

Also watch that the situation doesn't change. The 2015 guidelines warn that "in dynamic events, there are NO threat free area (e.g. green or cold zone)." A casualty collection point that was safe five minutes ago may not be safe now. The full assessment sequence is covered in the MARCHE assessment guide.

Evacuation Care: what happens in the cold zone?

Evacuation Care is the phase where the casualty moves toward definitive care. That usually means handing off to EMS and transport to a hospital. The 2011 paper describes it as a phase with "generally reduced threat to the patient and medical provider."

C-TECC's guidance puts "major emphasis" in this phase "on reassessment of interventions and hypothermia management." In practice, that means:

  • Recheck everything done earlier. Tourniquets, dressings, packed wounds and chest seals can loosen, shift or fail during a move.
  • Prevent heat loss. The Joint Trauma System's hypothermia guideline says that "hypothermia, coagulopathy, and acidosis are the physiological derangements constituting the 'triad of death' in trauma patients." It also warns that trauma-induced hypothermia "can occur even in warm climates."
  • Hand off clearly. The receiving team needs to know what was done and when.

In many civilian settings, evacuation can be fast. The 2011 paper noted that "a large percentage of civilian high-risk scenarios will have resources and circumstances that allow for the patient to be rapidly transferred without scene delay directly to a high level fixed medical center." That depends on where you work. A rural scene with a long transport has more time in this phase, so reassessment matters even more.

Hot, warm and cold zones: how do they map to TECC phases?

The June 2015 C-TECC guidelines pair each phase with a zone:

  • Direct Threat (DT) / Hot Zone Care
  • Indirect Threat (IDT) / Warm Zone Care
  • Evacuation (EVAC) / Cold Zone Care

The zone words help police, fire and EMS talk to each other at a unified command. They can also mislead. The founding paper stresses that "threat zones are situational, not geographic." A hallway can go from warm to hot in a second, and a responder standing in the "cold zone" can still be hit.

Treat the phase as a judgment call you keep updating, not a fixed boundary on a map. When the threat changes, the care changes with it.

How do TECC phases compare with TCCC phases?

TCCC, the military standard, uses three matching phases. The 2011 paper lays out the mapping:

  • Care Under Fire (TCCC) corresponds to Direct Threat Care (TECC)
  • Tactical Field Care corresponds to Indirect Threat Care
  • Tactical Evacuation Care corresponds to Evacuation Care

The current TCCC Guidelines (01 May 2026) name the first phase "Care Under Fire/Threat." They open it with "Return fire and take cover." That's language written for combatants. TECC rewrites it for civilian responders and populations. See TECC vs TCCC for the full comparison.

A note on scope and training

The phases describe how to think. They don't tell you what you're allowed to do. That depends on your training level, your agency's protocols and your medical director.

Knowing the phases on paper also doesn't mean you can run them under stress. Deciding when to treat and when to move is a skill, and it has to be practiced hands-on in realistic scenarios.

Frequently Asked Questions

What are the three phases of TECC?

The three phases are Direct Threat Care, Indirect Threat Care and Evacuation Care. They roughly match the hot, warm and cold zones. Each phase is set by the current level of threat, and the care you give grows as the threat drops.

What care is given in Direct Threat Care?

Very little medicine. C-TECC focuses this phase on stopping the threat, moving the wounded to safety, and controlling massive limb bleeding with tourniquets. The 2015 guidelines call tourniquet application "the primary 'medical' intervention" and direct casualties to use self-aid if they can.

What is the difference between Direct Threat Care and Indirect Threat Care?

In Direct Threat Care, the threat is active and medical care is kept to a minimum. Indirect Threat Care starts once the casualty is in an area of relative safety. Responders there run a full MARCHE assessment and treat within their scope of practice.

What is the warm zone in TECC?

The warm zone matches Indirect Threat Care. It's an area where the threat is reduced but not gone, such as a casualty collection point with cover or concealment. Zones are situational, not geographic, and can change quickly.

What happens during Evacuation Care?

The casualty is moved toward definitive care. C-TECC emphasizes reassessing every earlier intervention and preventing hypothermia during this phase. A clear handoff to the receiving team matters too.

Are TECC phases the same as TCCC phases?

They map closely. Care Under Fire lines up with Direct Threat Care, Tactical Field Care with Indirect Threat Care, and Tactical Evacuation Care with Evacuation Care. TECC changes the wording and content for civilian responders and patients.

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