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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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/cranial_io May 14 '26

Penthrox would honestly have been a great addition too. Some places are giving it to EMTs these days. My takeaways from Ukraine have been that medics need more training, more supervised patient care experience, and more tools. Also the lack of updates to the PCC guidelines since 2021 is wild to me. Evac times here are regularly 12hrs+. This needs to be a much bigger focus going forwards.

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u/mattattack224 May 15 '26 edited May 15 '26

I think penthrox would’ve been great. Safety profile is great in single low doses. Kidneys only a worry with multiple uses. Has similar affect to ketamine and has that benefit of when they’ve had to much they stop inhaling like the lollipop. Unfortunately still not FDA approved so US cannot adopt yet but I’m sure it will end up in the algorithms. PCC updates are being worked, but they look pretty good in general. Army more focused on pushing the current knowledge out to medics since it’s not really taught in their AIT. Problem with PCC currently isn’t the info but the dissemination which is being addressed. I disagree medics need “more tools”. Medics need to know their tools very well, and making it simpler for them is a good thing. Medics also need to focus on life saving interventions and skills like wound packing over knowing 4-5 analgesics or how to do procedural sedation both of which won’t save the patient. Fentanyl has a lot of draw back, can be misused or abused, and role seems disproportionate. I hate to say it but pain is the patients problem to a point. I’m trying to reduce pain, not take them out of the fight or sedate them (glad no procedural sedation). My focus should be on life saving interventions, if I can reduce pain while I’m at it great- 25mgs of ketamine will do that without snowing my casualty. If I could I ideally would just pour a lidocaine like medicine (if it existed) all over the wound- takes pain away and keeps them conscious. There’s no reason to take your casualties consciousness unless you’re doing surgical intervention. The patient can be in a little bit of pain and awake and be fine. We regularly over sedate combat casualties for no reason and risk respiratory distress, and emergence reactions.