TECC, or Tactical Emergency Casualty Care, is a set of civilian guidelines for treating injured people when a threat is still active or might come back. The Committee for Tactical Emergency Casualty Care (C-TECC) publishes it. C-TECC built TECC by taking the military's Tactical Combat Casualty Care (TCCC) guidelines and rewriting them for police, fire, EMS and other civilian responders.

The core idea is simple: in a high-threat incident, good medicine at the wrong time can get more people hurt. TECC matches the care you give to the threat you face. As the threat drops, you do more.

This guide covers where TECC came from, who uses it, how its three phases work, and why it matters for patrol officers who are usually first on scene.

Where did TECC come from?

TECC started with the military. TCCC is the battlefield trauma care standard, written by the Committee on Tactical Combat Casualty Care (CoTCCC). It worked. The problem was that it was written for soldiers, not civilian responders.

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." It is a 501(c)(3) nonprofit, and it describes itself as "modeled after the highly successful Committee on Tactical Combat Casualty Care (CoTCCC)."

In 2011, the founding group laid out the case in the Journal of Special Operations Medicine (Callaway et al.). They said TCCC could not be copied straight into civilian practice. Among the reasons they listed:

  • Scope of practice and liability. Civilian responders "must practice under State and local scope of practice and protocols, and are subject to both negligence and liability."
  • Patient population. TCCC data "was heavily based off of an 18-30 year old population." It "does not address high threat care for innocent non-combatants."
  • Special populations. Special populations, such as pregnant or physically disabled patients, "are prevalent in the civilian setting."
  • Chronic medications. TCCC "does not account for or address the effects of chronic medication use, such as beta-blockers and anti-coagulants."

C-TECC's guidance page describes its method as using TCCC as "an evidenced based starting point." Each phase was "re-written, annotated, or removed" for civilian use. For a side-by-side comparison, see TECC vs TCCC.

Who uses TECC?

It's a mistake to think TECC is only for SWAT medics. C-TECC's FAQ says the guidelines apply to "ALL high risk operations," including:

  • Active shooter response
  • Law enforcement operations and SWAT support
  • Technical rescue
  • Wilderness medicine
  • Mass casualty response

In practice, that means patrol officers, tactical teams, firefighters, EMS crews, rescue task forces, security teams and anyone else who might be treating casualties before a scene is secure.

C-TECC has also been working to widen that reach. In a February 2023 update for the American College of Emergency Physicians, C-TECC's Jeremy Ackerman, MD, PhD, described a "de-Velcroing" effort: "moving away from the equipment of military and tactical teams." The committee presents TECC as "a framework for tactical medical decision making" for any setting with "an imminent external threat," not only military or SWAT work.

Formal training usually comes through courses built on C-TECC guidelines. NAEMT offers a TECC course (3rd edition) for EMS clinicians and other prehospital practitioners, which carries 16 hours of CAPCE-accredited continuing education. It also offers TECC-LEO, an 8-hour classroom course for law enforcement officers and other non-EMS first responders.

What are the three phases of TECC?

TECC splits care into three phases based on threat, not on location. C-TECC's guidance describes them this way.

  • Direct Threat Care. The threat is still active. The priorities are "mitigating the threat, moving the wounded to cover or an area of relative safety, and managing massive hemorrhage utilizing tourniquets." Medicine is kept to a minimum.
  • Indirect Threat Care. This phase starts once the casualty reaches an area of relative safety. The danger hasn't necessarily passed. Responders run a structured assessment, MARCHE, aimed at "preventable causes of death."
  • Evacuation Care. The casualty is moving toward definitive care, and "major emphasis is placed on reassessment of interventions and hypothermia management."

These phases are often mapped to hot, warm and cold zones. The founding paper warns that "threat zones are situational, not geographic." The June 2015 C-TECC guidelines go further: "In dynamic events, there are NO threat free area." The full breakdown is in TECC phases: Direct Threat, Indirect Threat and Evacuation Care.

What is MARCHE?

MARCHE is TECC's order of assessment and treatment once you're out of the direct threat. C-TECC spells it out as Major Hemorrhage, Airway, Breathing/Respirations, Circulation, Head & Hypothermia, and Everything Else.

The order follows what kills fastest. The Joint Trauma System's Damage Control Resuscitation guideline puts it bluntly for the military setting: "Hemorrhage is the leading cause of preventable death on the battlefield." That's why major bleeding comes first. The MARCHE assessment guide walks through each letter.

Why does TECC matter for police?

Patrol officers usually get there first. In an active threat, they may be the only people who can reach the wounded for several minutes. Often that includes one of their own, or themselves.

The American College of Surgeons made this point years ago. The Hartford Consensus II (2013) says "medical training for external hemorrhage control techniques is essential for all law enforcement officers." It adds that "the interval from wounding to effective hemorrhage control can be minimized by law enforcement officers trained in hemorrhage control." It called on agencies to make sure "tourniquets and hemostatic dressings are available to every law enforcement officer." It also introduced the THREAT sequence: Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical providers, and Transport to definitive care.

TECC gives officers a way to make those decisions. It answers questions like these:

  • When do I treat and when do I fight? In Direct Threat Care, the tactical problem comes first. The 2015 guidelines say to "defer in depth medical interventions if engaged in ongoing direct threat."
  • What if I'm the one hit? The guidelines tell responders to "Direct the casualty to move to a safer position and apply self-aid if able." That's more than a theory. A Rochester officer applied his own tourniquet while radioing for help before other officers reached him.
  • What comes next once we're behind cover? MARCHE gives a clear order under stress, so the most urgent problems get handled first.

The founding authors also called law enforcement and SWAT operations "a critical area for implementation." Officers carry their own rules and constraints. Callaway et al. noted that "law enforcement personnel must deploy a broader spectrum of options to subdue threats than the military." TECC was written with that civilian reality in mind. Pure battlefield guidance was not.

What TECC is not

TECC is a set of guidelines. It isn't a license, and it doesn't replace your protocols. Keep these points in mind:

  • Scope depends on you. What any responder may do depends on their training level, local protocols and medical direction. C-TECC's guidance assigns scope of practice across four provider levels "based on level of training and certification."
  • It isn't TCCC. Military guidance is useful context, but it isn't automatically right for civilian law enforcement. Read the TCCC May 2026 update with that in mind.
  • Reading is not training. You can't learn tourniquets, wound packing or casualty movement from a web page. They take hands-on repetition under realistic stress.

Frequently Asked Questions

What does TECC stand for?

TECC stands for Tactical Emergency Casualty Care. It is a set of civilian trauma care guidelines for high-threat settings such as active shooter events, published by the Committee for Tactical Emergency Casualty Care (C-TECC).

Is TECC the same as TCCC?

No. TCCC (Tactical Combat Casualty Care) is the military standard, written by CoTCCC. TECC is C-TECC's civilian adaptation. It accounts for civilian scope of practice, liability, and patients of every age and health status. The two share the same basic logic but are separate guidelines.

Who created TECC?

TECC was created by the Committee for Tactical Emergency Casualty Care (C-TECC). According to C-TECC, it was formed in 2010 to translate military trauma lessons into civilian high-threat prehospital care. The founding guidelines were published in the Journal of Special Operations Medicine in 2011.

Is there an official TECC certification?

C-TECC's FAQ states: "There are currently no 'official TECC courses' or a certified TECC provider/instructor." C-TECC does not certify providers or instructors. Training organizations such as NAEMT offer TECC courses built on C-TECC guidelines and issue their own course completion.

Do police officers need TECC training?

The American College of Surgeons' Hartford Consensus calls external hemorrhage control training "essential for all law enforcement officers." Officers are often first to reach the wounded, including other officers. TECC gives them a framework for deciding when and how to give care under threat.

What are the three phases of TECC?

The three phases are Direct Threat Care, Indirect Threat Care and Evacuation Care. They roughly line up with hot, warm and cold zones. Each phase is set by the current threat level, not by a fixed spot on a map.

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