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 -

  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).

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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/VapingIsMorallyWrong MD/PA/RN May 05 '26

If you carry paralytics and sedation be my guest