Stop the Bleed teaches anyone three basic ways to control severe bleeding. TECC, or Tactical Emergency Casualty Care, is a full set of guidelines for treating casualties while a threat may still be present, and it covers much more than bleeding. Stop the Bleed is the foundation. TECC is what responders who work in dangerous scenes build on top of it.

They are not competitors. Both grew out of the same lesson from military medicine. The Joint Trauma System's Damage Control Resuscitation guideline states that "hemorrhage is the leading cause of preventable death on the battlefield." Bleeding that can be stopped has to be stopped by whoever gets there first. The difference is scope, audience and the conditions each one prepares you for.

This guide explains what each program is, what TECC adds, and who needs which.

What is Stop the Bleed?

Stop the Bleed is a bleeding-control program run by the American College of Surgeons (ACS). ACS describes itself as "the original U.S. Department of Defense STOP THE BLEED® partner" and operates the program under a Department of Defense licensing agreement.

According to ACS, the campaign was "initiated by a federal interagency workgroup convened by the National Security Council Staff, The White House," with leadership from the ACS Committee on Trauma. It draws on "advances made by military medicine and research in hemorrhage control during the wars in Afghanistan and Iraq."

The ACS Stop the Bleed course teaches three actions:

  • "Use your hands to apply direct pressure to a wound"
  • "Pack a wound to control bleeding"
  • "Apply a tourniquet"

The course is "for anyone who is interested in learning this lifesaving skill," and is offered both in person and virtually. ACS reports more than 5 million people trained.

That is the point of Stop the Bleed: put basic bleeding control in as many hands as possible, the same way CPR spread to the public.

Where did Stop the Bleed come from? The Hartford Consensus

After the Sandy Hook Elementary School shooting in December 2012, the American College of Surgeons convened a joint committee in Hartford, Connecticut, on April 2, 2013. Its recommendations became known as the Hartford Consensus.

The Hartford Consensus recommends that an integrated active shooter response include the actions in the acronym THREAT:

  • Threat suppression
  • Hemorrhage control
  • Rapid Extrication to safety
  • Assessment by medical providers
  • Transport to definitive care

The consensus called for early bleeding control as part of the police response, stating that "knowledge of hemorrhage control needs to be a core law enforcement skill." Later statements widened the circle to the public, treating uninjured bystanders as immediate responders. As the ACS compendium puts it, "every bystander carries a set of tools at all times to control hemorrhage: his or her hands."

THREAT describes the whole response. Stop the Bleed trains the public for the "H." TECC trains responders for the whole sequence, with medical care matched to the level of threat.

What is TECC?

TECC is the civilian set of guidelines for casualty care in high-threat settings, developed by the Committee for Tactical Emergency Casualty Care (C-TECC). C-TECC says it adapted the military's Tactical Combat Casualty Care (TCCC) by reviewing "each phase and medical recommendation" and rewriting them "through consensus voting of the Guidelines Committee to create civilian specific, civilian appropriate guidance." For more, see What Is TECC? and TECC vs TCCC.

TECC is written for law enforcement, fire, EMS and other responders who may have to provide care before a scene is safe.

What does TECC add beyond Stop the Bleed?

Threat-based phases of care. Stop the Bleed assumes you can safely reach and treat the person. TECC starts by asking whether you can. C-TECC organizes care into three phases:

  • Direct Threat Care: threat mitigation, moving the casualty to safety and managing massive bleeding with tourniquets.
  • Indirect Threat Care: assessment and treatment once the casualty is in relative safety, using the MARCHE sequence.
  • Evacuation Care: moving casualties toward definitive care, reassessing earlier interventions and managing hypothermia.

In C-TECC's June 2015 guidelines, Direct Threat care is deliberately minimal. Responders are told to "defer in depth medical interventions if engaged in ongoing direct threat," to direct the casualty to self-aid if able, and to control life-threatening bleeding with a tourniquet when the tactical situation allows. Knowing what not to do yet is a skill Stop the Bleed does not try to teach. See TECC phases of care.

The full MARCHE assessment. Stop the Bleed covers the "M" (massive bleeding). TECC's MARCHE sequence continues: Major hemorrhage, Airway, Respirations, Circulation, Head injury and Hypothermia, and Everything else. That brings in airway positioning, chest wound care, hypothermia prevention and more, each limited by the provider's training and protocols. See MARCHE assessment.

Casualty movement and extraction. Stop the Bleed does not teach you how to move a wounded person out of a hallway while someone may still be shooting. TECC does. The 2015 guidelines address casualty extraction in every phase and warn: "DO NOT DELAY casualty extraction/evacuation for non life-saving interventions." Drags, carries, movement through doorways and stairs, and handoff to EMS are core TECC skills.

Provider levels and scope. Stop the Bleed is the same three skills for everyone. TECC is scaled. C-TECC says it assigned "four different levels of providers" in Indirect Threat Care, "based on level of training and certification." The 2015 guidelines also state that care "is based upon individual first responder training, available equipment, local medical protocols, and medical director approval." A patrol officer, an EMT and a paramedic do not do the same things, and TECC reflects that.

Triage, documentation and handoff. TECC defers triage out of Direct Threat Care and addresses it in later phases when there are multiple casualties, and calls for a casualty care card "that can be quickly and easily completed by non-medical first responders," so the next provider knows what was done and when.

TECC vs Stop the Bleed at a glance

  • Who runs it: Stop the Bleed is an ACS program. TECC guidelines come from C-TECC, and courses are taught by various training organizations.
  • Audience: Stop the Bleed is for anyone. TECC is for responders who may work in high-threat scenes.
  • Scope: Stop the Bleed is bleeding control only. TECC covers bleeding, airway, breathing, circulation, head injury, hypothermia and more.
  • Threat: Stop the Bleed assumes the scene is safe enough to act. TECC ties every action to the level of threat.
  • Movement: Stop the Bleed does not teach extraction. TECC does.
  • Levels: Stop the Bleed is one level. TECC scales by training and protocol.

Who needs Stop the Bleed, and who needs TECC?

Stop the Bleed is a good fit for: teachers, school staff, church and event volunteers, security staff, office workers, family members, and anyone who wants to be useful in the first minutes of a bleeding emergency.

TECC is the right fit for: patrol officers, SWAT and tactical teams, fire and EMS personnel who may enter warm zones, tactical medics, armed security and protective details, and anyone expected to treat casualties before a scene is secure.

Law enforcement needs more than Stop the Bleed. Officers are the people most likely to reach a casualty during an active threat, and the people most likely to become the casualty. Bleeding control is the starting point, but officers also need to decide when to treat and when to move, how to treat themselves, and how to hand off to EMS. See TECC training for law enforcement.

Whichever course you take, skills fade. A 2020 study in the Journal of Emergency Nursing found that 39 percent of bleeding-control course participants failed a tourniquet skills test six months later, and its author recommended refresher training within six months. Plan for repetition, not a one-time class.

Frequently Asked Questions

Is TECC the same as Stop the Bleed?

No. Stop the Bleed teaches the public three bleeding-control actions: direct pressure, wound packing and tourniquets. TECC is a complete set of guidelines for casualty care in high-threat environments, including threat-based phases, the MARCHE assessment and casualty movement.

Is Stop the Bleed enough for police officers?

It is a good foundation, but most officers need more. Police are often first on scene while a threat may still be present, so they need to know when to treat, when to move, how to provide self-aid and how to hand off to EMS. That is what TECC covers.

Who runs Stop the Bleed?

The American College of Surgeons runs the Stop the Bleed program under a Department of Defense licensing agreement. ACS says the campaign began with a federal interagency workgroup convened by National Security Council staff at the White House.

What does THREAT stand for?

THREAT comes from the Hartford Consensus: Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical providers, and Transport to definitive care. It describes the actions of an integrated active shooter response.

Should I take Stop the Bleed before TECC?

It is not required, but it helps. Stop the Bleed builds basic bleeding-control skills that TECC then places inside a threat-based system. Either way, reading is no substitute for hands-on training, and your scope depends on your training level, local protocols and medical direction.

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