Introduction: In 2023, the Committee for Tactical Emergency Casualty Care (C-TECC) issued updated guidelines for the care of pediatric patients who are victims of a high-threat incident such as an active shooter event. C-TECC is a not-for profit coalition that brings together subject matter experts from EMS, fire, law enforcement, government, and emergency medicine to translate military trauma lessons learned into the civilian high-threat prehospital community. The revised pediatric guidelines provide evidence-based or best practice considerations to those individuals and departments that provide operational medical support and that may care for children in this uniquely dangerous and under-resourced prehospital environment. Methods: The evidence base for the care of children in this environment is lacking, and the medical care delivered in the high-threat environment is inconsistent and often not optimized for the care of infants and children. The guidelines are supported from the existing literature base where possible, and where it is not, by consensus as to the current best practices as determined by iterative deliberations among the C-TECC organization. Results: The guidelines provide patient assessment and management considerations specific to the care of children in three dynamic phases of the high-threat environment: Direct Threat, Indirect Threat, and Evacuation. The guidelines can inform both planning and operations in order to optimize the care of children in this high-risk environment. Conclusion: The high-threat environment is dynamic and there are competing safety, tactical/operational, and patient care priorities for responders when infants and children are injured. The guidelines provide recommendations on the type of medical and psychological care that should be considered under each phase of threat and establishes the context for them in order the maximize the opportunity for a good outcome for an injured pediatric patient.
Garrett et al. (Sun,) studied this question.