Full Spectrum Training and Consulting TECC Course
I recently had the opportunity to attend the Full Spectrum Training & Consulting TECC class. TECC (Tactical Emergency Casualty Care) is an acronym similar to TCCC, and more recently better understood by many as “Stop the Bleed.” For more on those acronyms refer to the following links:
Stop the Bleed:
Full Spectrum Training & Consulting:
Kevin is the lead instructor for Full Spectrum. Kevin’s background is covered in the class, but he has been in a responder role both as a Army Ranger, to now as a full time Firefighter and SWAT Medic. From this background, Kevin is able to give real examples of a variety of injuries and how following the MARCH protocols as well as with a basic trauma kit what you can do to treat it.
The course started with a quick overview of the Gen 7 CAT Tourniquet and how to properly stage it. After this, we had regular practice to apply to arms and legs (including without the use of vision, and one handed application to a leg). The practice continued through the rest of the day.
*This method of TQ preparation is very close to what is shown on this video from Kerry Davis of Dark Angel Medical:*
Next was an overview of TCCC/TECC and the acronym “MARCH.” MARCH is an industry standard for priority of treatment based on evidence based medicine – data compiled from injuries.
· Massive Hemorrhage
· Hypothermia Prevention
For the first half of the class, we covered the M in MARCH; Massive Hemorrhage. It started with a quick history of Tourniquets (TQ) – dating back to the middle ages, with modern use in the civil war and WW2, post “Black Hawk Down” TQ options, then to all the current CoTCCC recommended TQ’s.
During this class, Kevin also showed us how to make improvised TQ’s. Kevin showed how to do this with a cravat and windlass as well using the pants a subject is wearing (no, yoga pants are probably not going to work). Kevin then demonstrated how to apply the various TQ’s available, downsides and positives with various recommended TQ’s and why non-recommended TQ’s should be avoided.
Kevin broke out a Doppler unit to measure pulse and we tried various TQ options. From the improvised, to CoTCCC recommended TQ’s, then to products that continue to fail to meet CoTCCC recommendations. Kevin also showed how to make as well as use improvised junctional TQ’s including proving them on Doppler.
Doppler was eye opening in how you can take some of these options and by literally removing half a turn on a windlass lose all pressure. Also in how the non-recommended TQ’s work or more importantly don’t work and seeing the downsides to those options in a sterile classroom environment without real world implications.
Next up was pressure dressings/gauze/wound packing. Kevin showed how most commercial pressure dressings are doing what a roll of Kerlix Gauze and Ace Bandage do. Kevin proceeded to show us how to pack a wound and wrap the Ace bandage on it. Kevin also covered the history of Hemostatic agents and how we have moved to the Hemostatic impregnated Gauze options of today. This is an excellent reminder that Evidence Based Medicine is a must for the medical field, not “Instagram cool points.”
This moved into a sampling of other things that Kerlix/Ace can do. To me the biggest takeaway from this class was what all is able to be done with Kerlix/Ace. Neck/junctional bandaging, amputation coverage, pressure dressings, etc. The students took multiple turns practicing applications of the tools on each other.
Next up was “A” or Airway. This was both how to place someone in the recovery position, but also a how to apply commercial Nasopharyngeal Airway. Some stories on how to consider that a recovery position may be different for someone based on their injury helped drive home it’s a concept, not a absolute position.
Next up was “R”, Respiration. Most of us consider this as the Chest Seal phase. Kevin explained how the medical world in the US only has certain levels of care providers allowed to apply chest dart/needle decompression, but how to recognize the signs of a tension pneumothorax. Kevin explained how as such he (and nobody else I’ve found for a civilian responder/LE responder class) will not teach how to needle decompression. Kevin showed how to try to “burp” the injury and to mitigate it.
The history/progression of Chest Seal options was shown then to the current CoTCCC recommended options. Kevin also explained what the Chest Seal is doing, and as such, how we can improvise this. To me, understanding what a Chest Seal does, therefore how to improvise one is super important. Looking at the wounding data available for CONUS mass casualty incidents, chest injuries are the biggest killer. This comes from the fact that Military/LE data have a big thing in common, we all wear body armor making the major survivable wound placement, extremity hemorrhage.
Next covered was the “C”, Circulation phase. How to do a rapid blood sweep, then how to assess mental status. In this check it was explained how we can find signs of an altered mental state which should let us know to remove our patient’s (as a cop, your brother/sister officer) weapons or anything else that may be dangerous. A severely altered mental state may cause someone to be violent that doesn’t know it and as such this makes us safer and our responding aid safer.
We them moved to reassessment of prior interventions. We should ensure our TQ’s were still in place and working, or if we needed to pack/pressure wrap an extremity wound.
Finally in the MARCH protocols was “H”, Hypothermia prevention. This is as simple as remove anything wet, apply dry clothing/blankets. Commercially available options for this were shown, but then how to apply the principles. The Lethal Triad was discussed and how coagulopathy, hypothermia, and acidosis contribute to someone’s demise.
We then moved onto patient extraction. This was both tools that make it easier, but also techniques not requiring equipment. Kevin showed us commercially available options like the Foxtrot/Skedco and Megamover. Kevin had us do 1 and 2 person movement techniques (carries and drags) where even smaller individuals were able to move larger individuals.
To round out the classroom portion, Kevin covered Mass Casualty Incident triage ideas (MCI) and some open source info learned from some MCI’s of note. Kevin also addressed suggestions for an IFAK, daily carry trauma kit as CCW, LE on duty kit, overt tactical kit and Car/Bag options. Kevin also showed how he had worked with his agency to setup MCI response kits and the thought process and prep that went into those.
The class moved outside for scenario’s. These drove home the importance of MARCH, teamwork, environmental awareness, and other things. I won’t go into depth to give the scenarios away for future students. I will say that I appreciated how much learning was packed into the scenarios, while it didn’t cause learning overload and the inevitable brain shutdown for students getting their first exposure to a category of training.
Moving back to the classroom, Kevin covered some last terms that came up that needed clarification or further clarification – Hasty vs Deliberate Tourniquet application, how to make an improvised Pelvic Binder and why, burns, eye injuries, abdominal eviscerations, etc. Some of these were covered earlier in the appropriate MARCH category, but students wanted clarification after doing scenarios.
We did a wrap up/debrief where what was learned was covered. Kevin then answered questions from students on various trauma kits/components they currently used/had, and what options he would use for that role.
I’ve had several prior TCCC/TECC focused classes. This covered some stuff that I hadn’t previously seen in a class, and built on the things I was personally wanting to be better able to do or understand. As always when training with Kevin, there is the valuable data dump he sends after class of source materials that further your knowledge and learning.