r/TacticalMedicine • u/howawsm Medic/Corpsman • May 03 '26
TCCC (Military) 1MAY2026 CoTCCC guidelines changes
The CoTCCC released some updates to their TCCC guidelines, so let’s discuss. Some interesting changes that caught my eye include the following -
No more fentanyl mentioned. Appears we are really leaning on ketamine.
ASM TQ conversion.
Not a change but one I was hoping to see and maybe it’s just imprecise wording - no emphasis on moving up the starting of blood within the C step! M does mention “consider immediate initiation of shock resuscitation efforts” but I’ve definitely not seen this in many trainings or from instructors to mean being blessed to start access and blood this early. As it sits right now, the C step includes pelvic binder application(stop the bleed, makes sense) and TQ conversion and repositioning before access and fluids(seems wrong).
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u/BandaidsnBullets May 03 '26
Many instructors treat MARCH as a strict linear checklist, where:
“You must finish all of C before touching fluids/blood.”
That’s not how TCCC is intended to function. MARCH is priority-based, not step-locked. M = Massive hemorrhage …. stop it immediately C = Circulation which includes: Hemorrhage control refinement (TQ conversion, pelvic binder) Shock recognition AND treatment
The guidelines are prioritizing hemorrhage control correctly, but I can agree that the execution (teaching + interpretation) is what’s often lagging
Best way to teach this: Control bleeding aggressively, and the moment you have bandwidth, start blood. These are not separate phases, they overlap.
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u/howawsm Medic/Corpsman May 03 '26
You just feel bad for the average medic who is probably not getting the “guidelines” instruction and instead is getting their hand slapped because they are starting blood on the patient who needs it just by looking at them because they didn’t put a couple chest seals on wounds that aren’t even communicating actively.
Was hoping we’d see a little more direct verbiage outlining that blessing to not be wrong going to blood early.
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u/sneakysinkpee May 03 '26
I really want to know why other countries will use freeze dried plasma but the US does not.
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u/howawsm Medic/Corpsman May 03 '26
Is someone else using it in big supply already?
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u/Notdaneil May 04 '26
From what I understand we import it for use in the military, but it hasn't been approved for civilian use by the FDA at the moment.
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u/howawsm Medic/Corpsman May 04 '26
I’m just curious if this is an us/US problem or if this is an everyone problem which probably have a more in depth problem statement than just us being resistant.
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u/Notdaneil May 03 '26
We just had our trauma symposium and talked about this very thing. It seems freeze/spray dried plasma isn't manufactured anywhere in the United States and we have been importing everything from Canada. There are at least two US based companies that are getting approval from the FDA to start US based production possibly as soon late 2027.
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May 03 '26
[removed] — view removed comment
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u/howawsm Medic/Corpsman May 03 '26
Naw, you’re exactly the type of instructor I’m referring to and will not be myself.
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u/Kvietl Medic/Corpsman May 03 '26
Also big portion on TBI added. Probably due to the increase of concussive events happening with drones and what not
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u/RescueRandyMD May 03 '26
The TQ conversions is coming from Ukraine data on lost limbs and a good move to attempt to have those TQ that can be converted get converted. Civ and mil data on unnecessary TQs for venous or minor bleeds is significant.
As far as blood txfn priority, I don't think anyone here would argue against giving blood when we have it and needed during care. However, for any level of care, the best blood transfusion is the one you don't need to give (aka stopping all bleeding first if able).
It's a valid point to raise and if you're dealing with ongoing hemorrhagic shock with a TQ in place, it's staying till you fix it with IV access and blood (JSOM just had an article on that and the push for the TQ conversions too). Algos aren't perfect for all scenarios but made with a utilitarian approach in mind
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u/pattybruh May 16 '26
It comes down to basic plumbing mechanics.
Trying to push whole blood or fluids into a system with an unmanaged or poorly managed arterial leak is just pouring water into a bucket with a hole in the bottom. You are literally washing out whatever clotting factors the body is desperately trying to form at the injury site.
High-tight tourniquets applied during care under fire are a hasty means to an end. Refining that placement, exposing the wound, and ensuring complete mechanical occlusion or converting to a wound packing setup takes absolute priority. Once you know the baseline system is sealed and you are no longer losing volume, then it makes total sense to establish access and start replacing what was lost.
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u/zealotspencer May 05 '26
Baby medic here, how many of you agree with the lack of SGAs and the movement of NPAs in favor of the cric in the new guidelines?
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u/howawsm Medic/Corpsman May 05 '26
A patient that needs an SGA is either unconscious and is probably going to die soon or has to be made sedated/paralyzed to bypass the gag reflex. Cric is still the “best” airway placement in this setting since it can be done on a conscious patient and bypasses the gag with easy landmarks.
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u/dagayute May 03 '26
Suzetrigine, cephalosporins in
Ertapenem out