TCCC (Tactical Combat Casualty Care) is the military's trauma care standard for the battlefield. TECC (Tactical Emergency Casualty Care) is the civilian version, adapted for police, fire, EMS and other responders working in high-threat incidents. They share the same logic and nearly the same structure. The differences are in who the patients are, who the responders are, what resources are on hand, and what legal rules those responders work under.

Two different groups write them. The Committee on Tactical Combat Casualty Care (CoTCCC) writes TCCC. The Committee for Tactical Emergency Casualty Care (C-TECC) writes TECC.

If you're a civilian officer or medic, this matters. Military guidance is valuable context, but it isn't automatically your standard of care. Here's how the two line up.

Where TECC came from

TECC grew directly out of TCCC. According to C-TECC, the committee was "formed in 2010 to formally translate military trauma lessons learned into the civilian high-threat pre-hospital community," and it is "modeled after the highly successful Committee on Tactical Combat Casualty Care (CoTCCC)."

C-TECC's guidance page says the committee used TCCC as "an evidenced based starting point." Each phase was then "re-written, annotated, or removed" for civilian use. C-TECC's FAQ lists the reasons for those changes: differences that "address civilian specific language, provider scope of practice, population, civilian liability, civilian mission and operational constraints, logistics, and resource acquisition."

For the basics of TECC itself, start with What Is TECC?

TECC vs TCCC: key differences at a glance

The differences fall into five areas: who writes the guidelines, who the patients are, the threat and rules of force, resources and evacuation, and provider scope.

Who governs TCCC and TECC? CoTCCC vs C-TECC

  • TCCC: The CoTCCC writes the TCCC Guidelines. The current edition is dated 01 May 2026 and is published through NAEMT.
  • TECC: C-TECC writes the TECC Guidelines. It's a 501(c)(3) nonprofit focused on "civilian high-threat pre-hospital environments."

Neither committee is a licensing body. C-TECC's FAQ states that "There are currently no 'official TECC courses' or a certified TECC provider/instructor."

Patient population: adults, children and special populations

This is the biggest difference. In the 2011 paper that launched TECC, published in the Journal of Special Operations Medicine, Callaway and colleagues wrote that "TCCC data and research was heavily based off of an 18-30 year old population, not all age groups as represented in civilian operations." They also noted that TCCC "does not address high threat care for innocent non-combatants."

Civilian responders treat everyone who is there. The 2011 paper names several gaps:

  • Special populations such as pregnant or physically disabled patients "are prevalent in the civilian setting."
  • Chronic illness. The TCCC population is "relatively healthy and physically fit without the high incidence of chronic medical illness."
  • Medications. TCCC "does not account for or address the effects of chronic medication use, such as beta-blockers and anti-coagulants."

Children are part of that population. C-TECC's FAQ says it developed pediatric guidelines in 2013. In a February 2023 update for the American College of Emergency Physicians, C-TECC's Jeremy Ackerman, MD, PhD, wrote that the pediatric priorities stay the same: "avoiding additional injuries, hemorrhage control and basic airway management." The update adjusts airway management and hypothermia treatment, and adds "treatment and monitoring for hypoglycemia."

The threat and the rules of force

The TCCC guidelines open "Care Under Fire/Threat" with this: "Return fire and take cover." Next comes: "Direct or expect casualty to remain engaged as a combatant if appropriate."

TECC's Direct Threat Care has the same goal, which is to fix the threat before the wound. The wording changes for civilian use, though. C-TECC describes it as "mitigating the threat, moving the wounded to cover or an area of relative safety, and managing massive hemorrhage utilizing tourniquets."

The 2011 paper explains why. Civilian responders work under a different legal framework, and "law enforcement personnel must deploy a broader spectrum of options to subdue threats than the military." Many of the people you'll treat, such as bystanders, children and victims, were never part of the fight.

Resources and evacuation times

Soldiers may be far from a hospital. Many civilian scenes are not. The 2011 paper describes civilian settings as having "generally shorter distances and greater resources available for evacuation to definitive care." It says 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."

Civilian responders still hit resource limits. The same paper warns that "available medical equipment is often limited and the tactical scenario dictates medical interventions." It also points to "variable resources for responses to atypical emergencies." A rural deputy an hour from a trauma center faces a very different problem than an urban officer with medics staged down the block. The phase framework helps in both cases.

The 2011 paper also notes that "secondary attacks and armed resistance to evacuation is far less common in the civilian setting". Less common doesn't mean it never happens.

Provider levels and scope of practice

The 2011 paper puts this first: "Federal and civilian medical responders must practice under State and local scope of practice and protocols, and are subject to both negligence and liability that the military provider is often not."

C-TECC's guidance says that in Indirect Threat Care, "four different levels of providers were assigned to scope of practice." That's why a patrol officer, an EMT and a paramedic don't all get the same toolbox. What you're allowed to do depends on your training, your agency's protocols and your medical director. A military guideline doesn't change that.

What TECC and TCCC share

The frameworks differ in the details. The structure is the same.

  • Three threat-based phases. TCCC uses Care Under Fire/Threat, Tactical Field Care and Tactical Evacuation Care. TECC uses Direct Threat Care, Indirect Threat Care and Evacuation Care. See TECC phases for how they map.
  • Self-aid first. TCCC says "apply self-aid if able." The June 2015 TECC guidelines say "Direct the casualty to move to a safer position and apply self-aid if able."
  • Tourniquets as the main intervention under threat. The 2015 TECC guidelines call tourniquet application "the primary 'medical' intervention" in Direct Threat Care. TCCC directs use of a "CoTCCC-recommended limb tourniquet" in Care Under Fire/Threat.
  • Airway can wait under fire. TCCC says "Airway management is generally best deferred until the Tactical Field Care phase." The 2015 TECC guidelines say to "defer in depth medical interventions if engaged in ongoing direct threat."
  • Hemorrhage-first assessment. TECC uses MARCHE. TCCC's Tactical Field Care sections follow Massive Hemorrhage, Airway, Respiration/Breathing, Circulation and Hypothermia Prevention in that order. That sequence is widely taught as MARCH-PAWS. See the MARCHE assessment guide.

The reason for the shared order is the same in both worlds. The Joint Trauma System says it plainly: "Hemorrhage is the leading cause of preventable death on the battlefield."

Which one should civilian responders train to?

If you're civilian law enforcement, fire or EMS, TECC is the framework written for you. TCCC is still worth knowing. Many tactical medics trained on it, and CoTCCC's updates are useful context for civilian responders. Our breakdown of the May 2026 TCCC update is one example.

Just don't treat a military change as an automatic change to your protocol. That takes your medical director.

Also remember that no guideline replaces hands-on training. Knowing the difference between TECC and TCCC on paper won't get a tourniquet on in the dark with your own hands shaking.

Frequently Asked Questions

What is the main difference between TECC and TCCC?

TCCC is military guidance written by CoTCCC for combat casualties, mostly young, healthy service members. TECC is civilian guidance written by C-TECC. It covers patients of all ages and health conditions, civilian scope of practice and liability, and civilian resources.

Is TECC based on TCCC?

Yes. C-TECC says it used TCCC as "an evidenced based starting point." Each phase was then "re-written, annotated, or removed" to fit civilian high-threat operations.

Should police use TECC or TCCC?

Civilian law enforcement agencies generally train to TECC, because it was written for civilian populations and legal frameworks. The final call on what officers may do rests with each agency's training standards, protocols and medical direction.

Does TECC cover children?

Yes. C-TECC's FAQ says it developed pediatric guidelines in 2013. A 2023 update described pediatric changes to airway management and hypothermia treatment, plus monitoring for hypoglycemia. TCCC's research base is built mainly on adults aged 18 to 30.

Who writes the TCCC and TECC guidelines?

The Committee on Tactical Combat Casualty Care (CoTCCC) writes TCCC. The Committee for Tactical Emergency Casualty Care (C-TECC) writes TECC. They are separate bodies.

Are the phases of TECC and TCCC the same?

They line up closely. Care Under Fire/Threat maps to Direct Threat Care, Tactical Field Care maps to Indirect Threat Care, and Tactical Evacuation Care maps to Evacuation Care. The names and some content differ.

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