TECC in three phases: how to treat casualties in civilian tactical incidents according to the threat
In a civilian tactical incident, the first question is not “what injury do they have?” but “can we get close without increasing the number of casualties?”. That difference changes everything.
TECC, short for Tactical Emergency Casualty Care, adapts trauma care principles to civilian scenarios where a threat may still exist: an armed attack, a vehicle ramming, a violent riot, a hostage situation, an explosion or an active incident on a public street. Its value lies in ordering care according to the risk at each moment.
You do not act the same way when the danger is still present as when the team already has some cover. Nor do you work the same way inside a moving ambulance as at a casualty collection point. TECC divides the response into three phases: direct threat care, indirect threat care and evacuation care.
This article is for information only and does not replace formal training, local protocols or the instructions of authorized medical or security personnel.
Why the threat level defines care
In trauma, minutes matter. But in a tactical incident, safety also takes time and shapes every decision. If someone tries to provide full care in an unsafe area, they may be exposed, block other teams from entering or turn one casualty into several.
That is why TECC first asks about the context:
Is the threat active and close?
Can the casualty move on their own?
Is cover available?
Can the team intervene without being exposed?
Are there safe exit routes or collection points?
Has evacuation already been organized?
The level of care changes based on those answers. The same external bleeding, for example, may be handled differently depending on the phase. In DTC, there may only be time to tell the casualty to crawl to cover or to apply a tourniquet themselves if they can. In ITC, the team can check the tourniquet’s position, look for other injuries and prepare the transfer. In EVAC, they check whether bleeding has resumed, record the time and inform the hospital or receiving team.
The goal is not to do “less medicine”. It is to perform the right intervention at the moment it is possible.
Direct threat care
Direct threat care, or DTC for Direct Threat Care, takes place when the danger is still present or could immediately affect the casualty and the team. It is the most restrictive phase.
Here the priority is clear: reduce exposure to risk. Medical care is limited to the essentials, because staying in place may be more dangerous than the injury itself.
What is prioritized in DTC
In this phase, actions usually focus on three goals:
Prevent further casualties.
Move the casualty to cover or a relatively safer area, if possible.
Control massive bleeding when it can be done quickly.
If the casualty is conscious and able to move, a simple instruction can save time: “come toward my voice”, “crawl to the wall”, “press hard on your leg”. Commands must be short, specific and easy to follow under stress.
If the casualty cannot move and the threat is still active, the team must assess whether approaching is feasible. In many cases, direct intervention is delayed until there is a minimal window of safety. This can be emotionally difficult, but it is a central part of TECC.
Typical interventions in DTC
The medical intervention most associated with this phase is massive hemorrhage control in the limbs, especially with a commercial tourniquet when indicated and available. It may also include direct pressure if the situation allows.
What is generally not done in DTC is a full assessment. The aim is not to “check everything”. Clothing is not removed unnecessarily, no extensive medical history is taken and no procedures are performed that would force the team to stay still in an exposed area.
A practical example:
A person is wounded on the sidewalk during a violent incident. They are conscious, screaming and bleeding heavily from a thigh. The threat is not under control. From cover, an appropriate response may be to tell them to crawl toward a parked vehicle or a solid wall. If they have a tourniquet and can use it, they are guided with simple instructions. If a responder can approach without unacceptable exposure, they apply the tourniquet high and tight on the limb and then move the casualty.
In this phase, perfect care is not the goal. The goal is for the person to reach the next phase alive.
Tips for applying DTC
Use short phrases and repeat them if necessary.
Avoid crowding around the casualty.
Do not stand in open areas.
Prioritize real cover over visual concealment.
Practice applying tourniquets one-handed and with gloves.
Keep medical equipment in accessible places, not buried inside a backpack.
Prior preparation matters a great deal. In DTC, there is no time to look for items, read instructions or debate options.
Indirect threat care
Indirect threat care, or ITC for Indirect Threat Care, begins when the threat no longer has an immediate impact, but the scene is not yet completely safe. There may be residual risk, incomplete information, multiple casualties or a need for rapid evacuation.
This phase usually takes place in an area with cover, a casualty collection point, an area protected by security personnel or a place where the team can work for a few minutes with less exposure.
Here the focus changes: it is no longer just about surviving the next minute. Now the aim is to assess better, treat critical injuries and prepare for evacuation.
What changes in ITC
ITC makes a more systematic assessment possible. Many teams use the MARCH, scheme, which helps order trauma priorities:
Priority | What it looks for | Examples of action |
M | Massive hemorrhage | Tourniquet, direct pressure, pressure dressing, hemostatic gauze if indicated |
A | Airway | Position the casualty, remove visible obstructions if safe |
R | Respiration | Check the chest, identify breathing difficulty, cover open chest wounds according to protocol |
C | Circulation | Look for signs of shock, check pulse, cold skin or confusion |
H | Hypothermia and head | Keep warm, insulate from the ground, protect injuries, monitor neurological status |
This order avoids wasting time on less urgent injuries while severe bleeding remains uncontrolled.
A more detailed assessment without losing tactical sense
In ITC, clothing can be cut to see an injury, the back can be checked if the situation allows, tourniquets already applied can be checked and hidden bleeding can be looked for. Casualties can also be sorted by severity, which is key when there are more casualties than available resources.
At the same time, the team should not “settle in” as if they were in an emergency department. The threat can change. Evacuation can come earlier. A collection point can stop being safe.
A good practical approach is to work in cycles:
Treat what kills quickly.
Reassess whether the location is still safe.
Prepare the casualty to move.
Communicate needs.
Check again.
Practical example of ITC
After an incident in a shopping center, several people are moved to a protected corridor. One of them has a tourniquet on the arm, applied during the exit. In DTC, that was enough. In ITC, the team checks whether the bleeding has stopped, confirms that the tourniquet is tight enough, notes the approximate time, looks for other injuries and covers the person to prevent heat loss.
Another casualty is having difficulty breathing and has a chest wound. In this phase, the team can expose the area, treat according to protocol and watch for changes. They may also decide that this person needs priority evacuation.
The difference is clear: in DTC, safety and minimal actions dominate. In ITC, more complete care is added, without forgetting that the environment still calls the shots.
Tips for applying ITC
Designate a casualty collection point if the scene allows.
Assign simple roles: who assesses, who treats, who records, who communicates.
Use cards, tape or visible methods to mark priorities if there are multiple casualties.
Check every tourniquet applied in the previous phase.
Prevent hypothermia even in mild weather.
Prepare each casualty to move before transport arrives.
As in any emergency system, coordination with local services, security and medical teams largely determines the outcome. TECC works best when everyone shares a common language.
Evacuation care
The third phase is evacuation care, or EVAC. It begins when the casualty is moved toward a safer or definitive level of care. This may be by ambulance, rescue vehicle, helicopter, stretcher, a police vehicle adapted to the situation or on foot to a medical point.
Evacuation is not a pause in care. It is a dynamic phase in which the casualty’s condition can improve, worsen or change suddenly.
What is done in EVAC
During evacuation, the team must reassess what has already been treated and detect new problems. This includes:
Checking that bleeding remains controlled.
Checking tourniquets, dressings and chest seals.
Monitoring level of consciousness.
Watching breathing and signs of shock.
Maintaining warmth and protection from the environment.
Recording relevant changes.
Preparing a clear handover for the receiving team.
Communication is an intervention in its own right. A confused handover can cause critical information to be lost, such as the time a tourniquet was applied, a deterioration in breathing or a suspected serious injury.
A simple format may include:
Approximate identification of the casualty, if known.
Mechanism of injury.
Injuries found.
Treatments given.
Response to treatment.
Changes during transfer.
There is no need to fill the handover with secondary details. It should be brief, organized and useful.
Practical example of EVAC
A person with a penetrating injury to the leg was treated in ITC with a tourniquet and a dressing. During transfer, they start to become pale, sweaty and confused. The team reassesses the tourniquet, looks for additional bleeding, checks that they are kept warm and communicates the change to the receiving facility.
Another case: a casualty with a chest wound seemed stable at the collection point, but during transfer their breathing difficulty increases. In EVAC, this change must be detected quickly and passed on without delay. The information may change how the receiving team prepares.
Tips for applying EVAC
Position the casualty so that critical injuries remain accessible.
Do not completely cover dressings or tourniquets without leaving a way to check them.
Secure equipment before moving the vehicle or stretcher.
Reassess after every significant movement.
Communicate changes, not just the initial condition.
Hand over the patient with a clear summary and no assumptions.
EVAC also requires coordination. If there are several casualties, not all of them can leave at the same time. Prioritization must take into account severity, available resources, distance to the receiving facility and the ability to sustain care during transfer.
How to bring the three phases together in a real response
The strength of TECC lies in the transition between phases. A scene does not come with signs saying “DTC”, “ITC” or “EVAC”. The team must read the environment and adjust care.
The same incident can move forward and backward. An area that seemed safe can stop being so. Evacuation can be delayed. A stable casualty can deteriorate. That is why, rather than memorizing a rigid list, it is better to understand the logic:
Phase | Key question | Priority |
DTC | Can we intervene without exposing ourselves to the direct threat? | Safety and rapid control of massive hemorrhage |
ITC | Do we have time to assess and prepare the transfer? | Systematic assessment and treatment of critical injuries |
EVAC | What has changed during transfer and what does the receiving team need to know? | Reassessment, continuity of care and communication |
Applying a phase at the wrong time causes problems. If ITC is attempted under direct threat, the team can become trapped. If a DTC mindset is kept once there is cover, treatable injuries can be missed. If nobody reassesses during EVAC, deterioration may be detected late.
Practice helps recognize these changes. Drills with realistic scenarios, role reviews and joint training between security, emergency medical services, firefighters and first responders reduce improvisation.
It also helps to prepare individual and team kits with suitable equipment: commercial tourniquets, gloves, gauze, pressure dressings, thermal blankets, trauma shears and recording materials. Having equipment is not enough. You have to know how to use it under pressure, in low light, with noise, cold, fear and fatigue.
TECC does not turn every responder into a doctor, nor does it replace a safe scene. Its contribution is more concrete: it offers a way to think and act when danger, injuries and time collide at once.
The best application begins before the incident. Training, practice, coordination and judgment. At the scene, the rule is simple: first survive the threat, then treat better, and during transfer never stop watching the casualty.
SIRONA Medical Training · Knowledge saves lives.
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