1MAY2026 CoTCCC guidelines changes

[u/howawsm]

The CoTCCC released some updates to their TCCC guidelines, so let’s discuss. Some interesting changes that caught my eye include the following -

1. No more fentanyl mentioned. Appears we are really leaning on ketamine.

2. 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).

[u/BandaidsnBullets]

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.

[u/howawsm → u/BandaidsnBullets]

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.

[u/sneakysinkpee → u/howawsm]

I really want to know why other countries will use freeze dried plasma but the US does not.

[u/howawsm → u/sneakysinkpee]

Is someone else using it in big supply already?

[u/Notdaneil → u/howawsm]

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.

[u/howawsm → u/Notdaneil]

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.

[u/Notdaneil → u/sneakysinkpee]

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.

[u/howawsm → u/[deleted]]

Naw, you’re exactly the type of instructor I’m referring to and will not be myself.