Committee for Tactical Emergency Casualty Care (C-TECC) Winter Meeting

Committee For Tactical Emergency Casualty Care

TacMed: We are very privileged to have the secretary of ATMA, Tim Makrides, write us a guest post on the recent winter meeting of the Committee for Tactical Emergency Casualty Care. At the bottom of the post are the replays of the live videos from the meeting. Thanks Tim & ATMA (and of course C-TECC!).

I was recently privileged enough to attend the Committee on Tactical Emergency Casualty Care (C-TECC) winter meeting in California as a representative of the Australian Tactical Medical Association (ATMA) along with ATMA’s President, Matt Pepper.

For those of you who don’t know much about ATMA, we are an association formed in mid-2017 with the aim of representing the interests of everyone involved in the provision of first aid or medical care in high threat environments. We carry out our work on behalf of paramedics, doctors, law enforcement officers and even the general public.

While some of the members of the Board of Directors have worked for or currently work for Tacmed Australia, they are two distinct entities, and ATMA is strictly a not for profit organisation.

We are very grateful for the support TacMed has given us, and openly acknowledge that they are one of a few organisations in Australia that have been relentlessly advocating for improved access to tactical medical education and equipment.

Back to the meeting…

We flew over for a very short three-day trip and hit the ground running for the amazing one and half day meeting.

Before I fill you in on the ins and outs of the meeting, it’s important to give you a quick run down on who C-TECC are and what they’re trying to achieve (click HERE for the run down).

After arriving very jet lagged but excited we headed in for day one of the meeting.

We started with a presentation from the local Police Chief and Fire Chief who both provided an interesting context into the work being achieved by the committee. It was very evident that this particular County in Southern California was heavily invested in TECC from the ground up. The local police department has trained every officer in bleeding control, and the fire/ EMS Department has one of the strongest tactical medicine programs in the state.

The county was also one the first in the state to co-locate ‘Stop the Bleed’ kits with every defibrillator in a public place. The conference centre alone had three kits.

By mid-morning we heard from the director of the newly formed High Threat Institute, a joint venture involving George Washington University. The institute has recently set up “Go Teams” a highly effective and intriguing concept.

In a nutshell, this newly formed team was created out of a distinct need to learn from major incidents in real or near real time. Go Teams are deployed in the immediate aftermath of a major incident with 2-3 members hitting the ground in the first 24-48 hours. Their job is to link into the local emergency network and talk “offline” with operators involved in the incident. These operators range from paramedics and doctors through to security staff and local law enforcement assets.

While the conversations with responders are informal, the teams are taught to gather and collate specific de-identified data sets. Once the team returns back to their headquarters, the data is translated into an after action report (AAR) and published within a couple of weeks of the incident.

The beauty of this program is that lessons are learned from these incidents much quicker than conventional post incident AAR’s which can often take 2 or so years to publish.

Just before lunch, we heard from Pete Carlo, Assistant Medical Director of Las Vegas Police Department, who briefed us into the Mandalay Bay Shooting in September this year.

The incident was the worst civilian mass shooting in U.S. history and while it was a dark day for everyone involved, the overwhelming body of evidence showed that both EMS and police training before the event ensured a rapid and coordinated response to neutralize the threat and evacuate patients to the local trauma centres.

This presentation raised some interesting questions regarding hospital preparedness for major incidents. C-TECC has recently released ‘First Receiver’ Guidelines which are designed to help hospitals cope with a large number of trauma patients following a major intentional violence incident. There’s a great deal of interesting information available to hospital staff, so if you’re an influencer in this space, or just purely interested I urge you to read more about it HERE.

After lunch, ATMA President, Matt Pepper, provided the committee with an introduction to the association, as well as an update on tactical medicine in Australia. The short presentation was very well received with a long list of questions waiting for Matt at the end.

The remainder of the day was spent on working group updates, including:

  • First Care Providers
  • K9
  • First Receivers
  • Triage
  • Breaching
  • Hazmat
  • International engagement

Whilst there was a lot of great content covered in the working group updates, it’s far too in-depth to cover on this blog.

The one thing I will quickly mention is that the HAZMAT working group highlighted that there is a very real and likely possibility that fire could be used as part of complex coordinated attacks, as shown by recent ISIS propaganda. The intention is that this will be worked into the guidelines in the future.

The first day wrapped up with a social event at a local bar where many new international friendships were forged over a beer or two.

Day two kicked off bright and early with an animated discussion on the data surrounding head injuries. The C-TECC working group presented a draft of their soon to be released Traumatic Brain Injury (TBI) guideline.

There was a great deal of discussion surrounding the finer detail of the guideline, and a decision was made to re-present the final product at the next meeting in May 2018.

The final topic for the morning was the TECC guidelines for penetrating thoracic trauma and the use of chest seals. The scarce evidence was presented which consists mainly of experimental swine studies. The possibility that covering a wound with a non vented occlusive dressing can consistently cause the development of tension pneumothorax was apparent. The main change to the guidelines will, therefore, be that sucking chest wounds/open pneumothoraces should be covered with a vented seal, and if one is not available, then it should be left uncovered.

This is a significant change for many providers and trainers, and ATMA will be putting out more information on this change over the next few weeks.

The meeting was adjourned around lunchtime, with the Committee sitting again in May 2018 at the Special Operations Medicine Scientific Assembly in Charlotte, NC next year.

Overall the trip was an invaluable experience, and it gives ATMA members and those we inform in Australia a voice and a direct link into the C-TECC. It is the responsibility of ATMA to disseminate this information and to continue to advocate for our member’s interests in high threat medical care. We have paved the way for ATMA members to sit on several working groups so if there is something that interests you; please get in touch with me.

Finally, if you’re keen to stay up to date with ATMA then check out our website or social media pages.

Stay safe.

Tim Makrides


Australian Tactical Medical Association                  




Below are the videos that were live broadcast by the Committee for Tactical Emergency Casualty Care. Thanks to the committee for broadcasting!


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