In late 2014 the FBI released a study confirming what many suspected – the number of active shooter incidents in the United States has risen.
The report found that in the 14-year period between 2000 and 2013, active shooters left 557 wounded and 486 dead. Yet the incidents were not evenly distributed over time. In the first seven years studied, there were an average of 6.4 active shooter incidents annually. Between 2007 and 2013, the annual average more than doubled to 16.4 annually.
The alarming rise in active shooters, combined with incidents such as the Boston Marathon bombing, led to the NAEMT Prehospital Trauma Life Support (PHTLS) Committee’s decision to do more to help EMS practitioners ensure they have the medical skills to respond.
After more than a year in development, during which committee members studied what occurred during active shooter and other mass casualty events and what medical treatment had the potential to improve survivability, NAEMT will launch a new course this summer, Tactical Emergency Casualty Care (TECC). TECC is aimed at any paramedic or EMT who may be called on to respond to a mass casualty or active-shooter event in their community.
“TECC is not necessarily for tactical medics,” says Greg Chapman, vice chair of the PHTLS committee and director of the Center for Prehospital Medicine at Carolinas Medical Center in Charlotte, N.C. “In Boston, the people who treated those injuries were not tactical medics. In active shooter situations, such as at Sandy Hook Elementary, had their been survivors, the medics treating patients weren’t going to be tactical medics. They would be medics who were working in that community.”
Lessons learned from the military
NAEMT has long been the nation’s recognized leader in trauma care education for EMS and other responders. In 2010, NAEMT began offering Tactical Combat Casualty Care (TCCC), the 16-hour course developed by the military to prepare military medics for treating battlefield injuries. NAEMT’s TCCC course, also popular among civilian tactical medics, utilizes the military version of the PHTLS textbook, written in collaboration with the NAEMT TCCC Committee.
Yet, as the number of active shooter incidents grew, there was a growing awareness that it wasn’t just tactical medics who might be called on to respond to active shooters.
Often, tactical medics are embedded with SWAT teams, whose missions are often planned events, such as serving a high-risk warrant and taking someone into custody.
“If you know you are going to be serving a warrant, you will have had a chance to sit down, have all teams together, and plan,” Chapman said.
Active shooters are unanticipated events. With active shooters, first responding patrol officers are being taught to not wait for SWAT, but instead to quickly enter the building and do whatever it takes to subdue the shooter to prevent more deaths. In doing so, they may encounter shooting victims who could be saved if the bleeding could be stopped soon enough, explained Dr. Peter Pons, an emergency physician in Denver and associate PHTLS committee medical director.
In 2010, Dr. Pons led the development of an eight-hour course, Law Enforcement and First Response Tactical Casualty Care (LEFR-TCC). The course trains police and other first responders on hemorrhage control, basic airway management and the use of combat gauze to stanch bleeding.
Because all police departments weren’t willing to put their personnel through the eight-hour LEFR-TCC course, Dr. Pons also led the development of a new, two-hour course on controlling bleeding, known as B-Con, short for Bleeding Control for the Injured, which can be taken by police officers or members of the public, such as teachers.
Like CPR, “hemorrhage control is quite frankly a concept that every citizen ought to know,” Dr. Pons said.
Enter TECC
Yet even with TCCC directed at military medics, LEFR-TCC for police and other first responders, and B-Con for the public, there still wasn’t a course tailored for EMS practitioners not assigned to a tactical team but who still may be called on to treat the victims of mass casualty events. TECC includes lessons on:
- Hemorrhage control (including external hemorrhage control, direct pressure and wound packing, early use of tourniquet for severe hemorrhage).
- Surgical airway control and needle decompression.
- Strategies for taking care of patients or treating wounded responders when under direct threat of being shot at, or indirect threat, meaning the shooter or other threat does not appear to be immediate or nearby but could reappear at any moment.
- Caring for pediatric patients.
- Techniques for dragging and carrying victims to safety.
“A lot of the medicine is the same as what’s taught in military TCCC, but the wounding patterns tend to be somewhat different in the civilian world,” Chapman said. “Until the Boston bombing, we never had to deal with IEDs in this country, which is the main cause of devastating injuries on the battlefield. Here, we typically deal with gunshot wounds from medium velocity handguns, although sometimes we deal with wounds from high velocity assault rifles.”
While TECC includes information about situational awareness and operating in hostile situations, the focus is on medicine, not the tactical skills needed to be embedded with SWAT, he adds. Current NAEMT TCCC instructors will be able to teach this new course.
“I believe every EMS responder should take either TCCC, TECC or LEFR-TCC, depending on the agency’s needs, and what the agency sees as the role of their EMTs, medics and firefighters,” Chapman said.
For more information on NAEMT’s tactical education suite, visit the Education section of naemt.org or contact education@naemt.org.
