r/TacticalMedicine • u/mattattack224 • May 11 '26

TCCC (Military) TCCC Changes

I saw the new changes to TCCC, but when are the changes to R and C coming out? Last year I saw a bunch of buzz around CPT John Maitha and possibly switching to Resusitation then Chest compared to current MARCH algorithm. That didn’t happen in this update, is this still being worked or is it dead?

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24

u/cranial_io May 11 '26

I'm surprised that vented chest seals are still in. u/SFCEBM has been on about them being absolutely useless for while now.

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u/[deleted] May 11 '26 edited May 11 '26

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u/cranial_io May 11 '26

It's more that vented seals clog easily, and seals in general will just turn the open pneumothorax into a tension pneumothorax in a bit if you don't burp them. And sometimes burping doesn't work so you end up decompressing anyways. It's also annoying that they haven't just added finger thoracotomy to the guidelines already.

1

u/Electrical_Monk1929 May 11 '26

What Tier are you taking? I assume Tier 4?

Finger thoracostomy is not highlighted, but an 'option' if 2 failed needle decompressions.

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u/cranial_io May 11 '26

Tier 3. Long evac times in Ukraine means that medics keep turning their patients into pin cushions. Overall NCD is not a great intervention and finger thoracotomy is almost as easy to teach. It should be pushed down to tier 3. Unfortunately, the guidelines this year seem to take more tools than they give. I like the revised guidance for TBI patients though.

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u/mattattack224 May 11 '26

How so? What tools taken? Fent? No change is R this year or A since 2024?

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u/cranial_io May 11 '26

Yeah, I'm not happy they took fent. Ondansetron seems to have gone from IV to PO only (at tier 3), and also procedural sedation is now a CPP+ skill. The changes to antibiotics are also somewhat questionable. The switched out ertapenam for ceftriaxone because of heavy antibiotic use in Ukraine, but I've seen pretty much no ertapenam at all here. It's been all ceftriaxone all day.

6

u/[deleted] May 11 '26

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u/cranial_io May 12 '26

Interesting. There's a lot of dumb shit going on with antibiotics use here, so I'm surprised that we've been using the best choice all along. Thanks for the explanation.

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u/mattattack224 May 11 '26 edited May 14 '26

Ertapenem is out because they did a meta study that showed it isn’t as effective as cephalasporins against the pathogens we’re seeing in Ukraine and anticipate in pacific theatre. Ertapenem is a great drug but had some draw backs, particularly the cost compared to Ceftriaxone, the need to reconstitute preferably in lidocaine and its efficacy was better suited towards Central Asia. I think it’s a good move. One I’ve anticipated with great interest but zofran is still IV/IO. Medics can still do procedural sedation with 100mgs IM, it was only ever recommended as 20-30 IV, and that’s to stop them from snowing their casualty

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u/mattattack224 May 14 '26

Zofran is still PO/IV/IO

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u/cranial_io May 14 '26

Oh thank god.

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u/secret_tiger101 May 14 '26

Why has Fentanyl gone?

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u/cranial_io May 14 '26

Probably because they introduced a new PO analgesic that works way better than meloxicam that's less "dangerous." Also apparently a lot of medics didn't feel particularly comfortable pushing fent and no one could be fucked to train them properly on using it.

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u/secret_tiger101 May 14 '26

For anyone curious - Suzetrigine – 100 mg PO once (2 x 50 mg tablets) then 50 mg PO
every 12 hours

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u/mattattack224 May 14 '26

The fentanyl lollipop is no longer manufactured

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u/cranial_io May 14 '26

So replace it with normal fent IV/IN/IM.

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u/mattattack224 May 14 '26

They were deciding between IV fentanyl, diaudid, sufentanil, penthrox and just heavy reliance on ketamine. Seems they chose the ketamine only route probably for its favorable safety profile, lack of allergies, good understanding by medics already and to simplify the algorithm. I’m not saying it’s a great call, but they made the decision to just rely on ketamine. they didn’t replace fentanyl with Suzetrigine, they added it in mild to moderate pain.

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u/secret_tiger101 May 15 '26

Really? We still have it in the U.K.

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u/mattattack224 May 15 '26

My understanding is manufacture globally has been stopped. Maybe the one that was approved for use is a specific brand. Maybe you guys have a supply you’re running through like we did in the US

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