TECC Guide for Active Bystanders
A prioritized guide for providing life-saving care in high-threat environments.
Introduction: Your Role as an Active Bystander
In high-threat emergencies, traditional response can be delayed. The Tactical Emergency Casualty Care (TECC) guidelines empower you, an active bystander, to provide immediate, life-saving care. This guide reorganizes the official TECC document into a prioritized, step-by-step process. Your actions in the first few minutes can make the difference between life and death. This section provides the foundational principles of TECC, including the phases of care and the importance of a clear priority system for treating injuries.
The Three Phases of Care
TECC is dynamic and adapts to the threat level, not just the location.
- 1Direct Threat: Care is rendered while under active threat. Focus on mitigating the threat and stopping massive bleeding.
- 2Indirect Threat: The immediate threat has been suppressed, but the scene is not yet secure. More extensive care can be provided.
- 3Evacuation: Care is rendered during transport.
Step 1: Assess the Scene & Secure Your Safety
You cannot help others if you become a victim yourself. Before providing any medical care, your absolute first priority is to ensure your own safety and the safety of others by mitigating any direct threats. This section guides you through the initial actions of assessing danger, responding appropriately, and communicating to establish a safer environment for care.
RUN
If there is a clear escape path, evacuate. Leave your belongings behind and help others escape if possible.
HIDE
If you cannot evacuate, find a place to hide where the threat is less likely to find you. Block entry and remain quiet.
FIGHT
As a last resort and only when your life is in imminent danger, act with aggression. Improvise weapons and commit to your actions.
Communicate and Get Help
- Tell injured and uninjured people to move to a safer position if able.
- Provide clear, direct instructions to others who can assist.
- Ensure 9-1-1 is activated, but only when it is safe for you to do so.
- Provide psychological support: reassure and encourage others.
Step 2: Stop Life-Threatening Bleeding
Uncontrolled bleeding is the number one cause of preventable death in trauma. This is your most critical medical task. This section details how to identify and treat severe bleeding using different methods depending on the wound's location and the supplies available. Focus on these actions as soon as the immediate threat is managed.
How to Identify Severe Bleeding
Look for any of the following:
- Massive squirting or steady bleeding from the wound.
- Blood pooling on the ground.
- Overlying clothes soaked with blood.
- Bandages are ineffective and rapidly becoming soaked.
- The person was bleeding and is now in shock (confused, pale, unconscious).
- Any traumatic amputation.
For Arms and Legs
This is the most common type of severe bleeding. A tourniquet is the best tool.
1. Use a Tourniquet
- Apply it as high as possible on the limb.
- Apply over clothes if necessary, but avoid bulky items in pockets.
- Tighten until bleeding stops. It will be painful.
- Do NOT remove it.
- If bleeding continues, apply a second tourniquet above the first.
2. If No Tourniquet, Use a Pressure Dressing
- Pack the wound tightly with gauze or clean cloth.
- Apply firm, constant direct pressure.
- Wrap the wound tightly with an elastic dressing to maintain pressure.
For Neck, Shoulder, or Groin (Junctional Areas)
Tourniquets cannot be used here. The only option is to pack the wound.
- Stuff gauze or a clean cloth as deep as possible into the wound.
- Use hemostatic (clotting) gauze if available.
- Apply firm, continuous direct pressure on top of the packing with both hands.
- Hold pressure until help arrives.
Step 3: Ensure Airway & Breathing
After controlling severe bleeding, you must ensure the victim can breathe. An unconscious person can lose their airway, and a chest wound can collapse a lung. This section covers the simple but vital steps for managing a patient's airway and treating open torso wounds.
Manage the Airway
- If the person is awake, allow them to find a position of comfort (usually sitting up).
- If the person is unconscious, clear any obvious foreign material from their mouth.
- Place them in the recovery position (roll them onto their side) to keep the airway open.
Support Breathing
- Treat open and/or sucking torso wounds (belly button to shoulders, front or back).
- Immediately apply a non-occlusive (vented) chest seal if available.
- If no seal is available, leave the wound open to the air.
- Watch for increasing difficulty breathing. If it occurs after placing a seal, "burp" it by lifting a corner to let air escape, then reseal.
Step 4: Other Critical Care
Once life-threats from bleeding and airway are managed, other conditions can become serious. Hypothermia is a silent killer, even in warm environments. This section covers how to prevent heat loss and provide initial care for burns and pain.
Prevent Hypothermia
All trauma patients are at risk of losing body heat. This impairs blood clotting and increases risk of death.
- Remove wet clothing.
- Place something between the victim and the ground.
- Cover with dry blankets, coats, or anything that will retain heat.
Care for Burns
Stop the burning process first, then cover to prevent infection and heat loss.
- Stop the burning process (water, remove smoldering clothes).
- Cover the burn with a dry, clean dressing.
- For large burns, prioritize preventing hypothermia.
Manage Pain
Pain control reduces stress and can improve outcomes.
- Immobilize injured limbs to reduce movement.
- Consider ice and elevation if appropriate.
- AVOID aspirin, ibuprofen, or naproxen. They interfere with blood clotting.
- Acetaminophen is acceptable if the person can swallow.
Step 5: Monitor for Shock & Prepare for Evacuation
As you wait for professional responders, you must continue to monitor the victim for signs of worsening condition, specifically shock. You should also prepare for their movement and be ready to communicate your actions to the arriving medical team. This is the final and crucial step in the chain of survival.
Monitor for Shock
Shock is inadequate blood flow to the brain and vital organs. It's a killer.
Best field indicators of shock:
- Altered Mental Status (confused, can't follow simple commands like "squeeze my hand").
- PLUS Weak or absent pulse at the wrist.
If you suspect shock, continue efforts to stop bleeding and keep the patient warm.
Prepare for Movement & Handoff
Make it easier for responders to take over.
- Consider environmental factors for a safe evacuation path.
- Improvise a litter using common items: sheets, blankets, tables, chairs.
- When help arrives, clearly and calmly communicate all interventions you provided (e.g., "I applied one tourniquet to the right leg at 10:15 AM").
Scenario Assistant ✨: Get Immediate TECC Guidance
Describe a brief emergency scenario below, and the assistant will suggest the single most immediate and critical TECC step an active bystander should take. This tool is for quick, high-level guidance based on TECC principles.