TCCC Guidelines 2026: What Changed, What It Means, and How to Stay Current
Tactical Medicine • TCCC • CoTCCC Guidelines
TCCC Guidelines 2026: What Changed, What It Means, and How to Stay Current
The CoTCCC has issued multiple significant updates since 2024 — including a complete airway management overhaul, a landmark antibiotic change from ertapenem to ceftriaxone (Change 25-1), new tourniquet repositioning and conversion rules (Proposed Change 25-2, driven by Russo-Ukrainian War data and now written into the 01 May 2026 TCCC Guidelines), and revised TBI and analgesia sections. One thing did not change: the TXA 3-hour limit. Here is everything you need to know to stay mission-ready in 2026.
Update Your Kit to Match Current TCCC Guidelines
MED-TAC carries equipment for every phase of TCCC care — from CUF to TACEVAC, including CoTCCC-recommended tourniquets and hemostatic dressings.
Hemorrhage Control Airway Management IFAK KitsWhat Is TCCC and Why Does It Matter?
Direct answer: Tactical Combat Casualty Care (TCCC) is the U.S. military standard for prehospital trauma care in combat environments. It is an evidence-based framework that dictates how casualties are assessed and treated from the moment of wounding through evacuation to a medical treatment facility. Maintained by the Committee on Tactical Combat Casualty Care (CoTCCC) under the Joint Trauma System (JTS), TCCC has become the most consequential advancement in battlefield medicine in modern history.
The story of TCCC begins not on a modern battlefield, but in a recognition born out of loss. Analysis of Vietnam-era combat deaths established that a staggering proportion of fatalities were occurring before casualties ever reached a surgeon. Hemorrhage, airway compromise, and tension pneumothorax — conditions that skilled hands can address in the field — were the killers.
In 1996, Drs. Frank Butler, John Hagmann, and George Butler published the foundational TCCC article in Military Medicine, formally integrating combat tactics with evidence-based trauma care for the first time. The core insight was both simple and revolutionary: the best trauma care is useless if the person providing it becomes a casualty themselves, and most combat deaths happen before evacuation. TCCC was built around those two realities.
The CoTCCC was funded in 2001 as a U.S. Special Operations Command Biomedical Research Program, the year major combat operations began in Afghanistan, and today sits within the Joint Trauma System. Since then, it has operated as the scientific engine behind guideline evolution — reviewing battlefield data, commissioning research, and issuing changes through the Journal of Special Operations Medicine (JSOM).
The Three Phases of TCCC
TCCC organizes care into three operationally distinct phases:
- Care Under Fire (CUF): Minimal interventions — tourniquet application and returning fire — while actively engaged with a threat.
- Tactical Field Care (TFC): The workhorse phase. When relative cover is available, the medic conducts a systematic MARCH assessment and initiates definitive prehospital interventions.
- Tactical Evacuation Care (TACEVAC): Sustained care during movement to a Role 2 or Role 3 facility. (Note: airway responsibilities in this phase have been formally transferred to the Committee on Enroute Combat Casualty Care as of Change 24-1.)
The Impact: By the Numbers
The 75th Ranger Regiment trained every soldier in TCCC — not just medics. Among its 419 battle casualties in Iraq and Afghanistan (2001–2010), none of the 32 fatalities was potentially survivable with additional prehospital care, and the authors called this data-driven, command-directed approach the model for improving prehospital trauma care (Kotwal et al., Archives of Surgery, now JAMA Surgery, 2011). The lesson has never been clearer: TCCC works, and keeping current with its guidelines is a life-or-death professional obligation.
What Changed in the TCCC Guidelines for 2025–2026?
Direct answer: The CoTCCC published two formal changes and one proposed change between 2024 and early 2026, and the current TCCC Guidelines (dated 01 May 2026) incorporate all three. Change 24-1 overhauled airway management by removing supraglottic airways from Tactical Field Care. Change 25-1 replaced ertapenem with ceftriaxone 2g as the parenteral antibiotic of choice. Proposed Change 25-2 addresses tourniquet reassessment standards informed by Russo-Ukrainian War casualty data. The 2026 Guidelines also revise TBI management, analgesia and penetrating eye trauma antibiotics. The TXA window was not revised: the 2026 Guidelines still say "as soon as possible but NOT later than 3 hours after injury." Together these are significant updates to the TCCC standard, building on the hemorrhage control revolution of the mid-2000s.
| Change | Category | Previous Guideline | Updated Guideline | Rationale |
|---|---|---|---|---|
| 24-1 | Airway — Device | Supraglottic/extraglottic airway (EGA) recommended in TFC | EGA removed from TFC; recovery position for unconscious casualties | No evidence of increased survival vs. BVM; very high mortality with prehospital advanced airway insertion without significant sedation; no protection against battlefield airway injuries; environmental limitations |
| 24-1 | Airway — Positioning | Jaw thrust for unconscious casualties | Recovery position, head tilted back (chin away from chest); "Sit-Up and Lean-Forward" for conscious maxillofacial trauma | Extended position maximizes airway patency; simplified for high-stress environments |
| 24-1 | Airway — Cric Device | Control-Cric preferred for cricothyroidotomy | Control-Cric no longer the preferred device; 2026 Guidelines specify a bougie-aided or standard open surgical technique with a flanged, cuffed cannula under 10 mm outer diameter; continuous EtCO₂ capnography to verify placement | No cric technique or device has shown clear superiority; documented military prehospital cric success rates are unacceptably low, so placement must be confirmed |
| 24-1 | Airway — NPA | NPA recommended in TFC airway sequence | NPA moved to Respiration/Breathing section; considered with BVM ventilation for impaired ventilation and uncorrectable hypoxia with SpO₂ <90% (<92% with moderate/severe TBI in 2026) | Subject-matter-expert feedback and a small in-hospital BVM study suggest benefit during BVM ventilation |
| 24-1 | Airway — BVM | Standard BVM ventilation | 1,000 mL resuscitator BVM specified for ventilation in SpO₂ <90% with uncorrectable hypoxia | Standard adult BVMs often exceed recommended tidal volumes; smaller bags deliver volumes closer to AHA/ERC targets with lower peak airway pressure |
| 25-1 | Antibiotics — Parenteral | Ertapenem 1g IV/IO/IM once daily | Ceftriaxone 2g IV/IO/IM once daily | Point-of-wounding organisms in Ukrainian front-line cultures (Group A Strep, MSSA, C. perfringens) are covered by ceftriaxone; panel cited spectrum, side effects, stability, dosing, cost and emerging multidrug-resistance data |
| 25-1 | Antibiotics — Oral | Moxifloxacin 400mg | Cefadroxil 1g PO once daily (preferred); cephalexin 500mg PO every 6 hours (alternative) | Spectrum, side effects, stability, dosing, and cost advantages; antibiotic stewardship |
| TXA (no change) | Hemorrhage Control — TXA | 2 g slow IV/IO push as soon as possible but NOT later than 3 hours after injury | Unchanged in the 01 May 2026 TCCC Guidelines: as soon as possible but NOT later than 3 hours after injury | No CoTCCC change document removes the 3-hour limit. A July 2025 Army lessons-learned paper reports Ukrainian CRITICAL study data suggesting benefit up to 12 hours, but the CoTCCC has not adopted it |
| 25-2 (in 2026 Guidelines) | Hemorrhage Control — Tourniquet | "Replacement" tourniquet terminology; limited guidance for non-medical personnel | Term changed to "repositioning"; all tourniquets must be reassessed, ideally within 2 hours, including by non-medical personnel; ASM/CLS personnel should not convert beyond 2 hours without direction from CMC/CPP or other advanced medical personnel | Russo-Ukrainian War data: excess ischemic complications from non-indicated tourniquet use and prolonged evacuation times |
Change 24-1: Airway Management Overhaul — What Actually Changed?
Published in the Journal of Special Operations Medicine (Shaw et al., Spring 2025), TCCC Change 24-1 represents the most significant revision to airway management doctrine since TCCC was formalized. The CoTCCC spent years challenging every dogmatic assumption, and the conclusions were counterintuitive to anyone trained in civilian EMS.
Supraglottic airways (SGAs) are out of Tactical Field Care. The I-gel and LMA-Supreme have been removed from the TFC algorithm. Why? An extraglottic airway will not be tolerated unless the casualty is deeply unconscious, and the CoTCCC does not recommend rapid sequence induction (RSI) for combat medics after a military case series in which most RSI patients in hemorrhagic shock went into pulseless arrest. Studies suggest survival with prehospital extraglottic airways in trauma is comparable to or worse than with bag-valve-mask ventilation (most of that evidence comes from cardiac arrest, not trauma). The devices also offer no protection against burns below the epiglottis or injuries that disrupt airway anatomy, gel-filled devices are vulnerable to environmental extremes, and air-filled cuffs pose problems during aeromedical evacuation (Shaw et al., 2025).
Recovery position is now first-line for unconscious casualties. If a casualty is unconscious but has no traumatic airway obstruction, place them in the lateral recovery position with the head tilted back and the chin away from the chest. Change 24-1 cites evidence that head extension produces the greatest improvement in airway patency. The jaw thrust is no longer recommended in this context.
The Control-Cric is decommissioned as the preferred device. In a randomized manikin study of 25 Navy corpsmen, the Control-Cric was slower than the Tactical CricKit and the bougie-assisted technique (mean 184 vs. 117 and 135 seconds), succeeded in 48% of attempts vs. 76% for bougie-assisted, and was preferred by none of the users (Dorsam et al., Prehosp Emerg Care, 2019; manikin study, n=25). The 2026 Guidelines specify a bougie-aided or standard open surgical technique using a flanged, cuffed cannula under 10 mm outer diameter. After any cricothyroidotomy, continuous capnography is now mandatory to confirm and monitor tube position — a critical patient safety addition.
Change 24-1 also formally removes TCCC airway management recommendations from the Tactical Evacuation Care (TACEVAC) phase entirely. That responsibility now belongs to the Committee on En Route Combat Casualty Care (CoERCCC). If you're writing SOPs for enroute care, reference the FY26 CoERCCC Guidelines, not the TCCC document.
Change 25-1: Why Did CoTCCC Abandon Ertapenem?
In late 2025, the CoTCCC issued TCCC Change 25-1, replacing ertapenem with ceftriaxone 2g as the recommended parenteral antibiotic — one of the most consequential pharmacological changes in TCCC history.
The rationale comes down to understanding what is actually on the wound at the point of injury versus what grows in a hospital days later. As summarized by Crisis Medicine, war wounds from casualties on the Ukrainian front line, cultured a median of 7 hours after wounding, showed the point-of-wounding organisms to be:
- Group A Streptococcus
- Methicillin-sensitive Staphylococcus aureus (MSSA)
- Clostridium perfringens (the cause of gas gangrene)
Ceftriaxone 2g covers all three appropriately. Ertapenem — a carbapenem — was always the stronger weapon, but the concern became: at what cost? A systematic review of 22 studies of patients injured in Iraq and Afghanistan put the rate of multidrug-resistant organisms at 86%. Acinetobacter baumannii, common during the Global War on Terror, is generally hospital-acquired: in a 2025 Ukrainian dataset 91% of identified A. baumannii were carbapenem-resistant, yet in the point-of-wounding cultures it appeared in only 1 of 100 casualties. The Change 25-1 panel based its choice on spectrum, side effects, stability, dosing, cost and emerging multidrug-resistance data (Wisniewski et al., 2025).
As Crisis Medicine summarized in February 2026: "Ceftriaxone provides appropriately broad coverage for point of wounding bacteria, while also maintaining antibiotic stewardship with a goal of reducing antibiotic-resistant infections."
Oral antibiotic update: Moxifloxacin has been replaced by cefadroxil 1g (preferred) or cephalexin 500mg (alternative), for the same stewardship and spectrum rationale.
The FDA label directs IV administration by infusion over 30 minutes; the Crisis Medicine field summary describes 2g IV/IO push over 3–5 minutes, so follow your medical director's protocol. Never reconstitute or co-administer with calcium-containing solutions (e.g., LR) — ceftriaxone precipitates (FDA label). Flush lines with 10–20 mL NS before and after. For IM administration: reconstitute the 2g vial with 4.2 mL of diluent (NS or 1% lidocaine without epinephrine) and inject well within a relatively large muscle (FDA label). Peak plasma concentration via IV/IO in ~30 minutes; IM absorption is delayed in hypotension — another reason to prefer IV/IO in the hemodynamically compromised casualty.
TXA: The 3-Hour Limit Still Stands in the 2026 Guidelines
Tranexamic acid (TXA) entered the TCCC Guidelines in 2011 (Change 11-02) with a "not later than 3 hours after injury" limit, and that limit has not changed. The TCCC Guidelines, 01 May 2026 still direct 2 g slow IV/IO push "as soon as possible but NOT later than 3 hours after injury" for casualties likely to need a blood transfusion or with signs of significant TBI. We found no CoTCCC change document that removes the 3-hour window. A July 2025 U.S. Army Center for Army Lessons Learned paper states that "the three-hour window for TXA administration has been removed" and reports that the Ukrainian CRITICAL study (24 hospitals, more than 12,000 patients) found about an 18% reduction in 28-day mortality, with benefit up to 12 hours. We could not locate a peer-reviewed publication of CRITICAL, and the CoTCCC has not adopted it — until the CoTCCC publishes a change, the TCCC standard remains 3 hours.
The key survival principle hasn't changed: give it as early as possible. In a pooled analysis of the CRASH-2 and WOMAN trials (40,138 bleeding patients), the survival benefit fell by about 10% for every 15 minutes of delay and was gone after 3 hours (Gayet-Ageron et al., Lancet, 2018). The same Army paper reports that Ukrainian forces credit TXA with a 33% reduction in hemorrhage deaths; that figure has not been independently published.
Proposed Change 25-2: Tourniquet Reassessment Standardization
Published in the Journal of Special Operations Medicine (March 2026), Proposed Change 25-2 addresses a problem the Russo-Ukrainian War made impossible to ignore: too many tourniquets applied when not medically indicated, and too many ischemic complications from tourniquets left too long due to extended evacuation timelines.
The proposed changes, now incorporated into the 01 May 2026 TCCC Guidelines:
- Replace the term "replacement" with "repositioning" — a more precise description of what occurs.
- Establish a clear 2-hour reassessment window for all service members (non-medical).
- Limit tourniquet conversion beyond 2 hours to medical personnel only, with proper assessment criteria.
- Expand lifesaving capability to non-medical responders through plain-language, time-based guidance developed with input from NATO and partner nations.
This is a significant doctrinal shift. It means every service member — not just medics — needs to understand tourniquet assessment criteria. The days of "apply and forget" are explicitly over.
TCCC vs. TECC: What Is the Difference?
Direct answer: TCCC (Tactical Combat Casualty Care) is the U.S. military's combat trauma standard, maintained by the CoTCCC under the Joint Trauma System. TECC (Tactical Emergency Casualty Care) adapts those same principles for civilian high-threat environments — active shooter events, terrorism, and mass casualty incidents. TECC is maintained by the Committee for Tactical Emergency Casualty Care (C-TECC) and is used by law enforcement, civilian EMS, and first responders.
| Feature | TCCC | TECC |
|---|---|---|
| Primary Audience | U.S. military personnel, all service members, combat medics/corpsmen | Civilian law enforcement, EMS, fire, first responders, security |
| Governing Body | Committee on TCCC (CoTCCC) / Joint Trauma System (JTS), DHA | Committee for Tactical Emergency Casualty Care (C-TECC) |
| Phases of Care | Care Under Fire (CUF) → Tactical Field Care (TFC) → Tactical Evacuation Care (TACEVAC) | Direct Threat Care (DTC) / Hot Zone → Indirect Threat Care (ITC) / Warm Zone → Evacuation Care (EC) / Cold Zone |
| Assessment Framework | MARCH-PAWS (Massive hemorrhage, Airway, Respiration, Circulation, Head injury/Hypothermia, Pain, Antibiotics, Wounds, Splinting) | X-ABCDE or MARCH, scope-dependent |
| Airway in Hot/CUF Phase | Tourniquet only; no airway intervention under fire | DTC: hemorrhage control priority; recovery position for unresponsive |
| Advanced Airway (TFC/ITC) | No SGA (removed Change 24-1); cric with capnography if needed | Supraglottic airways remain optional in ITC/Warm Zone for qualified providers |
| Ketamine/TBI | TBI does not preclude ketamine (2024 and 2026 Guidelines); 2026 adds a dedicated moderate/severe TBI section | Ketamine explicitly OK for TBI (no longer contraindicated); 0.3–0.4 mg/kg IN/IM |
| Calcium | 1 g calcium IV/IO after the first transfused blood product (in the TCCC Guidelines since Change 21-01) | 1g CaCl or 3g CaGlu with blood products for hemorrhagic shock (Jan 2025) |
| Pediatric-Specific Guidance | Adapted within general TCCC framework | Separate Pediatric TECC guidelines published January 2025 |
| Primary Reference | Deployed Medicine / JSOM | C-TECC.org |
Key TECC-Specific Updates: January 2025
C-TECC published its updated TECC Guidelines for BLS/ALS Clinicians on January 2, 2025, and the companion Pediatric TECC Guidelines on January 15, 2025. The most clinically significant changes:
- Recovery position in DTC (Hot Zone): Unresponsive casualties with signs of life should be placed in the recovery position even during the Direct Threat phase.
- Ketamine for TBI — no longer contraindicated: This is a major pharmacological update. Prior dogma held that ketamine raised intracranial pressure and was contraindicated in TBI. Current evidence does not support that concern. TECC 2025 states ketamine "is no longer contraindicated in traumatic brain injury," with an initial dose of 0.3–0.4 mg/kg IN/IM or 0.1–0.2 mg/kg IV/IO.
- Calcium for hemorrhagic shock: When blood products are available per protocol, administer 1g 10% Calcium Chloride (13.65 mEq/10mL) or 3g 10% Calcium Gluconate slow IV push. Low ionized calcium on admission is common in shocked trauma patients and is associated with higher mortality, although prospective trials showing that replacement improves outcomes are still needed (Vasudeva et al., J Trauma Acute Care Surg, 2021; systematic review).
- Tourniquet conversion after 2 hours: If evacuation is delayed beyond 2 hours and the casualty is responding to resuscitation (improving mentation, returning peripheral pulses), consider tourniquet downgrade. Expose the wound, place a new tourniquet directly on the skin at least 2–3 inches above the most proximal injury (never over a joint), and loosen but leave the original in place. Do not repeat if the first attempt fails.
- Pediatric adaptations: Separate pediatric guidelines now address age-specific communication, assessment, and post-trauma management — critical for law enforcement and EMS operating in school or community mass casualty scenarios.
For the full civilian tactical medicine picture — including how these guidelines integrate with existing TCCC and TECC updates covered in our 2025 overview — the baseline framework remains consistent across both systems.
The MARCH Algorithm: Still the Foundation — How Do the 2025–2026 Updates Affect Each Step?
Direct answer: MARCH remains the organizational backbone of TCCC assessment and care in Tactical Field Care. Every 2024–2026 update maps directly to a specific MARCH step, and understanding which step each change belongs to is the fastest way to integrate new guidance into your muscle memory and SOPs.
For a comprehensive breakdown of the MARCH algorithm itself, see our dedicated article: The MARCH Algorithm in Tactical Combat Casualty Care. Here we focus specifically on how the 2025–2026 updates interact with each step.
| MARCH Step | 2025–2026 Update | Operational Implication |
|---|---|---|
| M — Massive Hemorrhage | TXA: as soon as possible, NOT later than 3 hours (unchanged in 2026). Change 25-2 (in the 2026 Guidelines): every tourniquet reassessed, ideally within 2 hours, by all service members. | Don't delay TXA; the 3-hour limit still applies. Reassess every tourniquet as early as feasible — not just medics. |
| A — Airway | Change 24-1: Remove EGA from TFC. Recovery position for unconscious. "Sit-Up and Lean-Forward" for conscious maxillofacial trauma. No jaw thrust. Capnography mandatory after cric. | Simplify airway kit. Practice recovery positioning. Eliminate EGA from muscle memory and IFAK loadout. Add capnography to cric kits. |
| R — Respiration | NPA repositioned to Respiration section (SpO₂ <90% + BVM). 1,000 mL BVM specified. 2026: SpO₂ target ≥92% for moderate/severe TBI. | NPA is a respiratory adjunct, not an airway device. Carry a 1,000 mL BVM. Decompress suspected tension pneumothorax promptly, and reconsider it in refractory shock. |
| C — Circulation | No 2026 change to fluids: cold-stored low-titer O whole blood first, 1 g calcium after the first product (since Change 21-01). Analgesia (separate section) revised in 2026: suzetrigine added to the Combat Wound Medication Pack, intranasal esketamine added, OTFC/fentanyl removed from initial management. | Know your unit's blood product access. Update analgesia protocols to the 2026 regimen. |
| H — Hypothermia / Head Injury | 2026 adds a moderate/severe TBI section: SBP >100 mmHg, SpO₂ ≥92%, 1–2 units of plasma if no hemorrhage, EtCO₂ 35–45 mmHg, hypertonic saline only for herniation. TBI does not preclude ketamine (TCCC 2024 and 2026; TECC 2025). | Ketamine remains acceptable with suspected TBI, used with caution. Early aggressive hypothermia prevention. Evacuate moderate/severe TBI to neurosurgical capability, ideally within 5 hours. |
| Antibiotics (end of TFC) | Change 25-1: Ceftriaxone 2g IV/IO/IM (replaces ertapenem 1g). Cefadroxil 1g oral (replaces moxifloxacin). Prophylaxis recommended for all invasive procedures. | Remove ertapenem and moxifloxacin from kits. Stock ceftriaxone 2g vials. Reconstitute only with a calcium-free diluent (e.g., NS). Give prophylaxis whenever an invasive procedure is performed. |
What Do These Changes Mean for Your Training and Equipment?
Direct answer: The 2024–2026 TCCC guideline updates require concrete changes to your IFAK loadout, your unit's SOPs, and your personal training focus. The changes are not cosmetic — removing ertapenem from kits, eliminating EGA devices, adding capnography for cric procedures, and building 2-hour tourniquet reassessment into drills are all tangible action items.
Kit Implications
- Remove ertapenem, add ceftriaxone 2g: Reconstitute ceftriaxone 2g vials with a calcium-free diluent such as NS (never LR or other calcium-containing solutions, per the FDA label); the Crisis Medicine field summary uses 10 mL NS per gram for IV use, so carry enough NS. If carrying calcium-containing fluids (LR), ensure separate line or dedicated flush protocol.
- Remove moxifloxacin, add cefadroxil 1g: The Change 25-1 panel chose cefadroxil on spectrum, side effects, stability, dosing and cost. Cephalexin 500mg every 6 hours is the listed alternative.
- Remove SGA/EGA devices from TFC IFAK: If your kit was stocked with I-gel or LMA-Supreme, remove them from TFC loadouts. They remain appropriate for some TECC providers in the Indirect Threat Care phase.
- Add capnography capability: Continuous EtCO₂ monitoring is now required after any cricothyroidotomy. Miniaturized capnography devices (e.g., Nonin, Nellcor, or compatible handheld units) should be part of any kit from which a cric may be performed.
- TXA availability: Because benefit falls with every minute of delay and ends at 3 hours, faster delivery matters. The Army's 2025 lessons-learned paper describes work with international partners on a TXA auto-injector that could be included in next-generation IFAKs. Until then, ensure accessible TXA in all medical kits.
- 1,000 mL BVM: The smaller BVM is now specified. If your kit has a 1,500 mL BVM, replace it.
Training Implications
- Drill recovery positioning: The lateral recovery position with head in extended (neutral-plus) position needs to be a reflexive skill. Practice it in PPE, at night, with simulated bulky casualties.
- Capnography competency: If your providers perform cricothyroidotomies, they must now train to continuous EtCO₂ monitoring. This is a new psychomotor skill requirement and must be evaluated.
- Tourniquet reassessment drills: Build tourniquet reassessment scenarios (as early as feasible, ideally within 2 hours) into every TFC exercise. Non-medical service members need clear, scripted decision criteria for when to reassess, reposition, or call for medical assistance with conversion.
- Antibiotic reconstitution practice: Ceftriaxone reconstitution is not complicated, but it differs from ertapenem and must be practiced. Include drug reconstitution in simulation labs.
- TBI pain management: The TCCC Guidelines state that TBI does not preclude ketamine. If your protocols still withhold it for suspected TBI, update them, and train providers on the 2026 dosing and on caution with sedating analgesics in TBI.
How MED-TAC Training Integrates These Updates
At MED-TAC International Corp., our TCCC All Combatants and TCCC Medical Provider courses are continuously updated to reflect current CoTCCC guidelines. We don't wait for annual curriculum cycles — when the CoTCCC publishes, we update. Our courses currently incorporate all Change 24-1 and Change 25-1 content, including hands-on ceftriaxone reconstitution, recovery positioning under simulated stress, and capnography integration in surgical airway labs.
When updating your unit or agency SOPs for 2026, verify each of the following: (1) Ertapenem removed, ceftriaxone 2g added; (2) Moxifloxacin removed, cefadroxil 1g added; (3) EGA removed from TFC airway algorithm; (4) Recovery position added as first-line for unconscious without obstruction; (5) Capnography mandated post-cric; (6) TXA as soon as possible and not later than 3 hours (unchanged in 2026); (7) Tourniquet reassessment (ideally within 2 hours) and ASM/CLS conversion limits documented for all personnel; (8) 1,000 mL BVM specified in kit list.
How Do You Stay Current with TCCC Guidelines?
Direct answer: Official CoTCCC guideline updates are published through the Joint Trauma System, the Deployed Medicine platform, and the Journal of Special Operations Medicine. Changes are not automatically broadcast — staying current requires active engagement with authoritative sources. Here are the primary channels every tactical medicine professional should monitor.
Official Sources
- Deployed Medicine App (deployedmedicine.com): The official, DoD-sanctioned platform for current TCCC guidelines, cards, and education materials. Available on iOS, Android, and Google platforms. This is the authoritative source — not third-party summaries or outdated PDFs.
- Joint Trauma System (jts.health.mil): The CoTCCC committee page, Clinical Practice Guidelines (CPGs), and related publications are hosted here.
- Journal of Special Operations Medicine (jsomonline.org): Formal TCCC changes are published here with their rationale and evidence review, making them citable scientific documents.
- TCCC and Combat Casualty Care Podcast: Official CoTCCC audio updates — available in all major podcast applications. Excellent for staying current with proposed changes and working group discussions before they are formally published.
- C-TECC (c-tecc.org): For TECC-specific updates, the C-TECC website hosts all current guideline documents.
Training That Keeps You Current
Reading guidelines is necessary but not sufficient. Prehospital trauma care is a perishable psychomotor skill. The only way to maintain proficiency — and to actually integrate guideline changes into performance — is deliberate, regular training.
MED-TAC offers training programs aligned with the latest JTS-endorsed guidelines:
- TCCC All Combatants (Tier 1 / ASM level): Core life-saving skills for non-medical personnel. Updated to include current tourniquet reassessment criteria and recovery positioning.
- TCCC Medical Provider: Comprehensive course for medics, paramedics, nurses, and physicians. Incorporates Change 24-1 airway updates, Change 25-1 antibiotic protocols, and Prolonged Casualty Care considerations.
- Continuing education and unit training: Contact MED-TAC for customized unit training programs incorporating scenario-based simulation for 2026 guideline integration.
Monitor the JSOM PubMed feed and Deployed Medicine for "proposed changes" — the CoTCCC publishes working group papers before a change reaches the Guidelines (Proposed Change 25-2 appeared in March 2026 and was in the 01 May 2026 Guidelines). Incorporating proposed changes into training early means your team is never behind the curve.
Frequently Asked Questions About TCCC Guidelines
Q1: What is the latest version of the TCCC guidelines?
The current TCCC Guidelines are dated 01 May 2026. They incorporate Change 24-1 (airway management, published in JSOM Spring 2025), Change 25-1 (ceftriaxone and cefadroxil, published December 2025) and the tourniquet repositioning and conversion rules from Proposed Change 25-2 (published March 2026), plus new TBI, analgesia and penetrating eye trauma sections. The TXA limit is unchanged: as soon as possible but NOT later than 3 hours after injury. Always verify the current version at Deployed Medicine — the official DoD source for current TCCC materials.
Q2: What antibiotic does TCCC now recommend?
Under TCCC Change 25-1 (late 2025): ceftriaxone 2g IV/IO/IM once daily (parenteral) and cefadroxil 1g (oral, preferred) or cephalexin 500mg (oral, alternative). Ertapenem 1g and moxifloxacin 400mg have been removed from TCCC recommendations. Never reconstitute or co-administer ceftriaxone with lactated Ringer's or any calcium-containing solution.
Q3: How often do TCCC guidelines change?
There is no fixed annual cycle. The CoTCCC issues changes based on the accumulation of sufficient evidence, battlefield experience, and working group review — which can happen at any time. The CoTCCC change history lists about 36 formal changes from 2010 through 2025, or roughly two to three a year on average, with the busiest years (2011–2014) during the Iraq and Afghanistan conflicts and recent changes driven by Russo-Ukrainian War data. Subscribe to the Deployed Medicine changelog and the JSOM to receive notifications immediately upon publication.
Q4: What is the difference between TCCC and TECC?
TCCC is the U.S. military's prehospital trauma standard, governed by the CoTCCC under the Joint Trauma System (JTS). TECC adapts those principles for civilian high-threat environments and is maintained by the C-TECC. The core MARCH framework and hemorrhage-first philosophy are shared, but the phases, nomenclature, advanced airway options, and some pharmacological recommendations differ. See the comparison table in the TCCC vs. TECC section above for a full side-by-side breakdown.
Q5: Do civilian EMS agencies use TCCC?
Many do, particularly those serving law enforcement tactical teams or operating in high-threat environments. However, civilian EMS typically uses TECC as the direct-application framework, since it is designed for civilian scope-of-practice and legal environments. The CoTCCC has worked closely with civilian trauma initiatives including the Hartford Consensus and the White House Stop the Bleed campaign to ensure battlefield advances translate to civilian streets. Many urban EMS systems have adopted TCCC-derived hemorrhage control, tourniquet use, and TXA protocols.
Q6: Where can I get TCCC certified?
TCCC training is formally structured through the National Association of Emergency Medical Technicians (NAEMT), endorsed by the Joint Trauma System and the American College of Surgeons. NAEMT lists three courses: TCCC-ASM (Tier 1, 7 hours, all service members), TCCC-CLS (Tier 2, 40 hours, Combat Lifesaver) and TCCC-CMC (Tier 3, 63 hours, combat medics and corpsmen). MED-TAC International Corp. offers TCCC All Combatants and TCCC Medical Provider courses with all 2025–2026 guideline updates incorporated. Contact MED-TAC to schedule training for your unit or agency.
Q7: What is the CoTCCC and who is on it?
The Committee on Tactical Combat Casualty Care (CoTCCC) is the scientific body responsible for developing, reviewing, and updating TCCC guidelines. It operates under the Defense Health Agency's Joint Trauma System (JTS) and reports through the Defense Committee on Trauma (DCoT). Membership includes combat medics, corpsmen and pararescuemen, trauma surgeons, emergency physicians, critical care and operational medicine physicians, and physician assistants, with tri-service representation. The current Chair, CAPT Travis Deaton, MC, USN, is listed by the JTS at jts.health.mil. The committee convenes regularly to review proposed changes, with formal changes published in the Journal of Special Operations Medicine.
Train to the Standard That Saves Lives
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