In an active shooter incident, Evacuation Care refers to the ambulance transport phase of patient care. In most jurisdictions, treatment is governed by local EMS protocols. C-TECC also provides guidance for appropriate Evacuation Care treatment.
C-TECC guidance for Evacuation Care includes the following items, which local EMS protocols may adopt or modify:
- CPR may be considered if transport is under 5 minutes to the receiving facility
- Spreading patients across receiving facilities so no single hospital is overwhelmed
- Head-up 30° positioning for suspected TBI (Traumatic Brain Injury) when the patient is not in shock
- Chest tubes and repeat needle decompression
- Finger thoracostomy in traumatic arrest
- Lung-protective ventilation
- Selective spinal motion restriction, with full restriction not recommended for penetrating face/neck trauma and high suspicion for blunt trauma over age 65
- Formal tourniquet relocation, with four downgrade criteria
- Damage control resuscitation with an SBP target of 80–90
- Herniation management: 3% hypertonic saline (3–5 cc/kg), mannitol (1 g/kg), and targeted hyperventilation (PaCO2 30–35)
- Seizure prophylaxis
- Peripheral nerve blocks
- Fixed-dose ketamine (25–50 mg)
Sources: C-TECC First Responders with a Duty to Act (2024) and C-TECC BLS/ALS Clinicians (2025).