The MARCH Algorithm. Definitive 2026 Reference.
DoD TCCC MARCH-PAWS. JTS Prolonged Casualty Care MARC²H³-PAWS-L. Civilian TECC MARCHE. Joint En Route Care. The full operational map of every framework that actually matters — and how the 2026 updates change what you carry, what you teach, and what you do.
Why this reference exists.
Every tactical medicine course, every trauma kit insert, every patrol-officer cheat sheet leads with MARCH. The acronym has become the universal language of preventable death — a 30-second mental rack-and-stack that survives stress, hypoxia, and decision fatigue when nothing else will.
The problem is that "MARCH" is no longer one thing. The U.S. military uses one version for Tactical Field Care, a different and longer one for Prolonged Casualty Care, and a third for En Route Care. The civilian world runs TECC's MARCHE. Wilderness, austere, and disaster medicine communities have built their own extensions. Instructors and unit medics mix and match letters depending on the threat, the scope of practice, and the available equipment.
The result is real-world confusion. Patrol officers trained on TECC MARCHE hand casualties off to medics trained on TCCC MARCH-PAWS who hand off to flight crews trained on MARCH-PAWS-L who hand off to a Role 2 surgical team that wants nothing more than a clean MIST report. Letters get dropped. Interventions get missed. Time gets burned arguing about whether "E" stands for "Everything Else" or "Eye injury."
This reference fixes that. It is the single most comprehensive working document on the MARCH algorithm and its current operational variants, mapped against the 01 May 2026 CoTCCC guidelines, the JTS Prolonged Casualty Care Clinical Practice Guideline, and the current C-TECC framework.
Train against the published source documents. This reference exists to clarify, compare, and connect them.
The origin and logic of MARCH.
Where MARCH came from
MARCH was codified in the early days of Tactical Combat Casualty Care because Dr. Frank Butler and the original CoTCCC working group needed an assessment sequence that mapped directly to the three leading causes of preventable battlefield death.
Analysis of combat fatality data from Vietnam through the early Global War on Terrorism established the same three killers, in the same order, in nearly every dataset:
- Massive hemorrhage from extremity and junctional wounds
- Tension pneumothorax
- Airway obstruction
Hemorrhage was the largest killer by an order of magnitude — modern reviews of combat fatalities from 2001 onward attribute the overwhelming majority of potentially survivable deaths to hemorrhage. The MARCH sequence was engineered around this fact: hit the biggest killer first, in the simplest way possible, and work down the list.
That logic has not changed. Every variant of MARCH discussed in this document follows the same priority hierarchy. What changes is the depth and complexity of intervention permitted at each step based on threat phase, provider scope, and operational duration.
The universal logic behind every variant
Before the variants get confusing, anchor on this: every MARCH-style algorithm is solving the same physiology problem in the same order. The letters change because the operational context changes, not because the underlying medicine changes.
- M is always hemorrhage. Stop the bleeding or the rest is theater.
- A is always airway. A casualty who cannot move air cannot be resuscitated.
- R is always respirations or breathing. Find and decompress tension pneumothorax. Confirm air movement and rate.
- C is always circulation. Pulses, perfusion, shock, fluid management.
- H is always hypothermia and/or head injury. Cold casualties bleed and clot worse. TBI casualties decompensate fast.
Everything after H is contextual. The longer the timeline, the more letters the algorithm grows. That is the entire conceptual key to making sense of this reference.
MARCH-PAWS — the 01 May 2026 algorithm.
The core operational algorithm taught across all four TCCC tiers — All Service Member, Combat Lifesaver, Combat Medic/Corpsman, and Combat Paramedic/Provider. Executed primarily during Tactical Field Care, the phase that begins once the immediate threat is suppressed or the casualty is behind cover.
Hemorrhage
Stop the bleeding before anything else.
Hemorrhage control precedes everything else, including airway, except in the rare casualty without active bleeding.
- Life-threatening extremity hemorrhage: Apply a CoTCCC-recommended limb tourniquet. Place high and tight on the proximal third of the limb (upper arm near the axilla, upper thigh near the groin). Never apply over a joint. Tighten until distal pulse is eliminated and bleeding stops. Mark the time on the tourniquet and on the TCCC Casualty Card.
- Junctional hemorrhage (groin, axilla, neck base): Apply direct pressure followed by a CoTCCC-recommended junctional tourniquet or wound packing with a hemostatic dressing followed by sustained pressure.
- Compressible wounds not amenable to tourniquet: Wound packing with a CoTCCC-recommended hemostatic dressing, followed by a pressure dressing.
- Non-compressible truncal hemorrhage: Recognize it. Expedite evacuation. There is no field intervention that controls non-compressible torso bleeding outside of surgical capability.
Tourniquet reassessment and conversion. Tourniquet reassessment is no longer a best practice — it is an absolute requirement. Every applied tourniquet must be reassessed for continued indication, proper placement, and effectiveness. The 2026 guidelines extend tourniquet reposition and conversion authority to the ASM and CLS level under defined conditions. Document time of application, conversion, and removal on the TCCC Casualty Card.
TXA window eliminated. The 3-hour administration window for tranexamic acid has been removed. TXA is now indicated for casualties anticipated to need significant blood transfusion, regardless of time from injury.
- Tourniquet placed over a joint (no compression of the underlying vessel)
- Tourniquet not tight enough — bleeding continues underneath
- Failure to reassess after movement, repositioning, or evacuation
- Confusing arterial bleeding with venous oozing and skipping the tourniquet
Open it. Position it. Confirm it.
The CoTCCC simplified the airway management sequence in Tactical Field Care, better defined the recovery position, eliminated extraglottic airways from the TFC sequence, narrowed indications for surgical cricothyroidotomy, and established a requirement for frequent reassessment of SpO2, EtCO2, and airway patency.
- Conscious casualty with patent airway: Let them choose their position of comfort. Most will self-select an airway-preserving posture.
- Unconscious casualty without obstruction: Place in the recovery position. The 2026 guidelines define this explicitly — head tilted back, chin away from the chest, dependent positioning to allow drainage.
- Airway obstruction: Open with manual maneuvers (chin lift, jaw thrust). Suction blood and secretions. Insert a nasopharyngeal airway (NPA) if needed and tolerated.
- Failed positional and NPA management: Proceed to surgical cricothyroidotomy. The 2026 guidelines tightened the indications — surgical airway is appropriate when positional and NPA management fail in a casualty with imminent airway compromise. Confirm placement with bilateral chest rise and waveform capnography.
Equipment standards. Capnography is now expected in any kit that contains a surgical cricothyroidotomy setup. BVM devices in TCCC kits should be 1000 mL adult size.
- Reflexive NPA placement in a casualty who only needs positioning
- Failure to reassess airway after movement or repositioning
- Surgical cricothyroidotomy attempted without confirmation of failed positioning
- No capnography to confirm tube placement
(Breathing)
Find tension pneumo. Decompress.
Identify and treat tension pneumothorax. Identify open chest wounds. Manage breathing inadequacy.
- Penetrating chest trauma: Apply a CoTCCC-recommended vented chest seal to all open and sucking chest wounds. Check the back. Check the axilla. Casualties have died because the seal was applied to the entry wound and the exit wound was never identified.
- Suspected tension pneumothorax (progressive respiratory distress, decreased breath sounds, hemodynamic instability after penetrating torso trauma): Perform needle decompression. CoTCCC recommends a 10-gauge, 3.25-inch needle catheter at the 4th or 5th intercostal space at the anterior axillary line, or at the 2nd intercostal space at the midclavicular line as an alternative. Reassess after decompression. Repeat decompression is appropriate if signs return.
- Inadequate ventilation: Support with BVM ventilation.
TBI ventilation targets. The oxygen saturation target for moderate-to-severe TBI was raised to ≥ 92% (up from > 90%). Ventilatory support is now indicated for moderate-to-severe TBI casualties failing this target. Non-TBI target remains ≥ 90%.
- Missed exit wounds and posterior wounds
- Needle decompression at the wrong landmark, too short a needle, or insufficient depth
- Confusing positional respiratory distress with tension pneumothorax
- Failure to reassess after intervention
Recognize shock. Restore perfusion.
Recognize shock. Establish IV/IO access. Manage hypovolemia. Reassess every hemorrhage control intervention.
- Reassess all hemorrhage control. Tourniquets, packed wounds, pressure dressings — every one of them gets a second look. Bleeding controlled at minute 2 may not be controlled at minute 20.
- Assess for shock: Mental status changes and weak or absent radial pulse are the field-expedient markers.
- Vascular access: 18-gauge IV or larger. IO access (sternum, humeral head, proximal tibia) if IV fails or is impractical.
-
Fluid resuscitation for hemorrhagic shock:
- Preferred: Cold-stored low-titer O+ whole blood.
- Alternatives in order: Plasma + PRBCs 1:1, plasma alone, PRBCs alone.
- If blood unavailable: Crystalloid (LR or Plasma-Lyte A) titrated to palpable radial pulse and improving mental status. Avoid normal saline as primary resuscitation fluid.
- Endpoint: Palpable radial pulse and improving mental status. For TBI casualties, target SBP ≥ 110 mmHg.
- TXA: 2g IV/IO slow push over 10 minutes for casualties anticipated to need significant transfusion. No time window.
- Skipping the hemorrhage reassessment step
- Over-resuscitating with crystalloid
- Failing to recognize early shock in compensating young casualties
- Delaying TXA in casualties who clearly need it
+ Head Injury
Two killers under one letter.
Trauma-induced hypothermia is not a function of ambient temperature alone. Casualties bleed, lose vasomotor tone, and lose endogenous heat production. Hypothermia drives the lethal triad — coagulopathy, acidosis, hypothermia — and worsens every other intervention.
- Minimize cold exposure. Remove wet clothing as feasible.
- Apply a CoTCCC-recommended HPMK or equivalent active warming system to every casualty, regardless of ambient temperature.
- Insulate from the ground. Cold ground is a heat sink.
- Warm IV fluids when possible.
The 2026 guidelines elevated TBI management to a focus area for the update.
TBI 2026 targets and protocols.
- SpO2 target ≥ 92% for moderate-to-severe TBI
- SBP target ≥ 110 mmHg for casualties with TBI
- Hypertonic saline for signs of cerebral herniation: 250 mL of 3% or 5% IV/IO over ≥ 10 min, OR 30 mL of 23.4% IV/IO over ≥ 10 min followed by saline flush. Repeat in 20 min if no response, max 2 doses. NOT for prophylactic use.
- Ventilatory support indicated for moderate-to-severe TBI casualties failing oxygen saturation targets.
- Cervical spine consideration is mechanism-based, not blanket. Penetrating neck trauma without neurologic deficit does not mandate c-spine precautions in the tactical environment.
- Treating hypothermia as a temperate-climate-only concern
- Skipping HPMK because the casualty "feels warm"
- Missing TBI signs in casualties with concurrent intoxication or fatigue
- Failing to target the elevated SBP and SpO2 thresholds for TBI
The PAWS extension.
The second half of the standard TCCC mnemonic. PAWS is taught alongside MARCH in every TCCC course and runs in the same Tactical Field Care phase — the interventions that follow once the immediate life threats are addressed.
Management
Three-option analgesia framework.
- Mild-to-moderate pain, still in the fight: Meloxicam 15 mg PO daily and acetaminophen 1000 mg PO every 8 hours (Combat Wound Medication Pack, CWMP).
- Moderate-to-severe, NOT in shock or respiratory distress: Oral transmucosal fentanyl citrate (OTFC) 800 µg.
- Moderate-to-severe, IN shock or respiratory distress: Ketamine 50 mg IM/IN, or 20 mg slow IV/IO push. Repeat every 20–30 min as needed.
Document all medications, doses, and times on the TCCC Casualty Card.
Change 25-1 — cefadroxil / ceftriaxone.
- PO route preferred when able to swallow: Cefadroxil 1g PO daily, or cephalexin 500 mg PO every 6 hours as alternative.
- Unable to take PO: Ceftriaxone 1g IV/IO/IM daily.
Indicated for all penetrating wounds where definitive surgical care is delayed.
Inspect, dress, document.
Look for wounds not identified during the primary survey. Dress and document. Cover exposed bowel with a moist, sterile dressing or a sterile water-impermeable covering. Do not attempt reduction if there is evidence of ruptured bowel or active bleeding.
Burns: Cover with dry, sterile dressings. Calculate burn TBSA. Initiate fluid resuscitation per the USAISR Rule of Tens for burns > 20% TBSA.
Penetrating eye trauma (2026 update). Cover with a rigid eye shield. Do not apply pressure. Do not attempt to remove impaled objects. Administer systemic antibiotics.
Stabilize fractures. Bind unstable pelves.
Splint suspected fractures, including unstable pelvic injuries with a CoTCCC-recommended pelvic binder. Splinting reduces bleeding from fracture sites, reduces pain, and prevents secondary injury during movement.
Where MARCH lives in the TCCC phases.
MARCH is executed primarily in Tactical Field Care. The full TCCC phase structure determines what you do, what you don't, and what equipment scope is available at each stage.
Active threat, casualty and provider exposed. Return fire. Direct casualty to self-aid if possible. Apply limb tourniquet for life-threatening extremity hemorrhage only. Move to cover.
Threat suppressed or behind cover. Execute the full MARCH-PAWS algorithm. This is where the bulk of TCCC interventions happen.
En route to higher care. Continue MARCH-PAWS. Add advanced interventions (advanced airway, blood products, ventilator support) as platform and provider scope allow. Reassess everything.
MARC²H³-PAWS-L — when evacuation runs into hours and days.
When the timeline stretches from minutes to days because of distance, weather, denied airspace, contested logistics, or maritime operations, TCCC alone is insufficient. The JTS Prolonged Casualty Care Clinical Practice Guideline addresses this with an expanded algorithm.
The full expansion
Hemorrhage control plus dynamic triage. PCC scenarios frequently involve mass casualties and recurring re-triage.
Same priority as TCCC. Reassessment over time becomes the dominant skill.
Sustained ventilatory monitoring. Capnography. Trend over time.
Resuscitation strategy across hours. Reassessment of all hemorrhage control.
Telemedicine consultation, casualty status reporting, resupply coordination via PACE plans, HF, satellite. Communications becomes a clinical intervention in austere or denied environments.
Active warming sustained over hours or days. HPMK plus passive insulation plus warmed fluids.
In desert, jungle, and shipboard operations, particularly under ballistic or chemical protective ensembles. Active cooling, fluid management, removal from heat sources.
Pressure injury prevention, Foley catheter placement and management, bowel care, oral care, eye care, wound dressing changes. Casualties die of preventable nursing failures over time.
Multimodal analgesia and sedation protocols over extended timelines.
Sustained antibiotic scheduling and route adaptation as PO tolerance changes.
Wound progression management. Dressing changes. Burn resuscitation. Nursing protocols.
Long-duration splint care. Skin checks. Repositioning to prevent neurovascular compromise.
Resupply planning. Medication scheduling. Manpower rotation. Equipment failure contingencies. Movement of the casualty within and across positions. Logistics decisions made at hour 4 determine whether the casualty survives to hour 48.
Orange letters indicate the expansion beyond standard TCCC MARCH-PAWS.
When does PCC trigger?
The JTS guidance is principles-based, not time-stamped. A useful working rule: PCC thinking starts the moment your evacuation timeline exceeds your TCCC consumables and your single-provider attention capacity. For most operational planners, that point is somewhere between 2 and 6 hours of field-holding time. In maritime SOF, in remote arctic operations, in contested airspace scenarios, that timeline can extend to 72+ hours.
PCC is not a substitute for TCCC. TCCC is the prerequisite. PCC is the next page in the playbook.
TECC MARCHE — the civilian analog.
Tactical Emergency Casualty Care translates the battlefield evidence into the civilian operational environment — law enforcement, fire-based rescue task forces, civilian EMS, and active threat response. Maintained by the Committee for Tactical Emergency Casualty Care (C-TECC).
The MARCHE letters
Same priority hierarchy as TCCC.
Civilian scope often retains SGAs.
Same intervention priorities.
Adapted to civilian scope and resources.
Same dual priority.
Pediatric and geriatric considerations. Pregnancy. Comorbidities. Routine medical issues. Mental health. Legal documentation, consent, chain of evidence, crime scene considerations. The civilian realities that have no analog in pure combat trauma.
Civilian-specific TECC modifications
Recovery position in Direct Threat Care (Hot Zone): The current C-TECC BLS/ALS guidance, published 02 January 2025, established that unresponsive casualties with signs of life should be placed in the recovery position even during the Direct Threat phase — a departure from prior "hands-off" hot zone doctrine.
Pediatric considerations: C-TECC published Pediatric TECC Guidelines on 15 January 2025. Tourniquet thresholds, fluid resuscitation, and airway sizing are all weight- and age-adjusted.
Triage frameworks: TECC operations integrate with START, SALT, and JumpSTART (pediatrics) — rather than military triage categories. The triage framework sits alongside the MARCHE algorithm, not inside it.
NAEMT TECC course materials often render this as P-MARCH-PAWS to make the leading patient-assessment / PPE / positioning step explicit.
Will 2026 TCCC changes translate to TECC?
| 2026 TCCC Change | Translation Likelihood |
|---|---|
| Tourniquet reassessment as a standard requirement | High |
| Recovery position emphasis | Already adopted |
| Eliminating SGAs from TFC airway sequence | Mixed |
| Capnography with surgical airway kits | High |
| TXA window elimination | High |
| TBI SpO2 target ≥ 92% | High |
| Hypertonic saline for herniation signs | High |
| Antibiotic protocol changes | Medium |
| ASM/CLS tier-specific authorities | Low |
| TCCC Triage Supplement A | Low |
For agency medical directors: treat the May 2026 TCCC update as a leading indicator. Plan for a multi-year protocol revision cycle. Do not authorize unilateral adoption of military scope expansions in civilian practice.
Joint En Route Care MARCH-PAWS.
The Joint Trauma System Joint En Route Care Clinical Practice Guideline (current FY26 edition) covers the patient care continuum during evacuation across all platforms — ground, rotary-wing, fixed-wing, and maritime. The En Route Care framework uses MARCH-PAWS as its organizing algorithm and emphasizes standardization, interoperability, and effective communication during patient hand-offs.
The En Route Care variant is structurally identical to TCCC TFC MARCH-PAWS. What changes is the operational context:
- Movement-related challenges: Vibration, noise, lighting, restricted access to the patient, equipment securement.
- Platform constraints: Oxygen supply duration, suction capability, power for monitors, temperature control.
- Altitude physiology: Pneumothorax expansion, gas embolism risk, hypoxia in unpressurized aircraft.
- Hand-off discipline: MIST report (Mechanism, Injuries, Signs, Treatment) at every transition.
The En Route Care guideline reinforces that MARCH-PAWS reassessment is continuous during transport, not a single execution at the start of the evacuation. Every transition — loading, in-flight, landing, off-loading, transfer to receiving facility — is an opportunity for missed bleeding, displaced tubes, lost lines, or dropped temperature.
Less common but operationally relevant variants.
P-MARCH-PAWS
The leading P stands for PPE, Patient assessment, or Patient positioning depending on the source. Forces the provider to step back before MARCH and verify scene safety, PPE, and threat status. Functionally identical to MARCH-PAWS once the P is addressed.
MARCH-PAWSB
Seen in some PHTLS-derived materials. The B is Burns, broken out as its own explicit letter rather than folded under W. Not a formal CoTCCC or C-TECC variant. Appears where burn casualties are operationally common — industrial response, aviation rescue, urban fire.
XABCDE / X-MARCH
The X is exsanguinating hemorrhage (functionally MARCH's M), followed by ATLS-style Airway, Breathing, Circulation, Disability, Exposure. Some European SOF programs render this as X-MARCH to bridge ATLS and MARCH frameworks.
CABC
Catastrophic Bleeding, Airway, Breathing, Circulation. Functionally identical to MARCH for the first four steps but does not include hypothermia or the extended PAWS interventions in the core acronym. Paired with separate hypothermia and TXA reminders.
PedMARCH / Ped-MARCHE
MARCH with explicit pediatric weight-based adjustments at each step. Tourniquet thresholds, fluid volumes, airway sizes, and medication doses all change. The C-TECC Pediatric TECC Guidelines (January 2025) are the authoritative civilian source.
MARCH-E (Wilderness)
Wilderness Medical Society programs use MARCH with an explicit E for Environment — heat, cold, altitude, water immersion, envenomation, prolonged exposure. Some sources fold this under PCC's hyperthermia letter; others treat it as its own framework.
Which algorithm should you run?
The right algorithm is the one that matches the threat phase, your scope of practice, and your evacuation timeline. The provider trained in one framework can functionally execute the others — the underlying medicine is the same.
| Scenario | Algorithm |
|---|---|
| Combat trauma, US military, evac within hours | TCCC MARCH-PAWS |
| Combat trauma, US military, evac > 4–6 hours | TCCC → PCC MARC²H³-PAWS-L |
| Combat trauma, en route via MEDEVAC | Joint En Route Care MARCH-PAWS |
| Civilian active threat, law enforcement first on scene | TECC MARCHE — Direct Threat Care |
| Civilian active threat, EMS in warm zone | TECC MARCHE — Indirect Threat Care |
| Civilian active threat, en route to hospital | TECC MARCHE — Evacuation Care |
| Pediatric civilian trauma | Pediatric TECC MARCHE |
| European or NATO multinational operation | XABCDE / X-MARCH |
| Wilderness / austere medical | MARCH-E or MARC²H³-PAWS-L depending on duration |
| Mass casualty event, civilian | TECC MARCHE + START / SALT / JumpSTART triage |
The 2026 TCCC changes mapped to MARCH.
The 01 May 2026 CoTCCC update did not change the MARCH sequence. It changed specific recommendations inside several letters. For training officers and program managers, here is the working delta.
Care Under Fire / Care Under Threat
Essentially unchanged from 2024.
Triage
Prior direction to remove weapons and communications equipment from casualties with altered mental status was replaced with a reference to Supplement A — Triage in TCCC, with more refined recommendations for Role 1 triage.
Massive Hemorrhage
- Tourniquet reassessment is now an absolute requirement.
- Tourniquet reposition and conversion authority extended to ASM and CLS levels under defined conditions.
- Documentation of time of application, conversion, and removal explicitly required on the TCCC Casualty Card.
Airway
- Simplified airway management sequence in TFC.
- Recovery position better defined (head tilted back, chin away from chest).
- Extraglottic airways eliminated from the TFC airway sequence.
- More specific indications for surgical cricothyroidotomy.
- Frequent reassessment of SpO2, EtCO2, and airway patency required.
Respirations
- SpO2 target raised to ≥ 92% for moderate-to-severe TBI.
- Ventilatory support indicated for moderate-to-severe TBI casualties failing the oxygen saturation target.
Circulation
- TXA 3-hour window eliminated.
- Whole blood resuscitation preference reinforced.
- TBI SBP target ≥ 110 mmHg.
Head Injury
- Hypertonic saline protocol updated: 250 mL of 3% or 5% IV/IO over ≥ 10 min, or 30 mL of 23.4% IV/IO over ≥ 10 min with saline flush. Repeat in 20 min if no response, max 2 doses. Not for prophylactic use.
Pain
Three-option analgesia framework retained (CWMP, OTFC, ketamine).
Antibiotics
Cefadroxil PO (preferred) or cephalexin PO (alternative) when able to swallow. Ceftriaxone IV/IO/IM when unable to take PO.
Wounds — Eye Trauma
Updated guidance for penetrating eye trauma. Rigid eye shield, no pressure, no removal of impaled objects, systemic antibiotics.
MIST and the handoff discipline.
MARCH without documentation is half a system. The TCCC Casualty Card (DD Form 1380) is the authoritative documentation tool. PCC operations add the PCC Card and telemedicine consultation logs. TECC operations use the patient care report (PCR) consistent with civilian EMS standards and may add agency-specific tactical casualty cards.
The MIST report is the standard handoff structure:
Mechanism of injury. What happened, what weapon system, what forces, what environment.
Injuries sustained. Anatomic locations, severity, suspected internal injuries.
Signs and symptoms. Vitals trend. Mental status. Clinical findings.
Treatments rendered, with times. Tourniquet times. Medications and doses. Procedures and confirmation.
Every interagency, intra-team, and inter-platform handoff uses the MIST format. It survives noise, hypoxia, and stress better than any other handoff structure tested in operational settings.
Training implications and next steps.
Update your training scenarios
- Lead with positioning and recovery position rather than reflexive NPA placement.
- Build in tourniquet reassessment and conversion as a graded checkpoint.
- Confirm BVMs in training kits are 1000 mL.
- Confirm capnography is in every kit that contains a surgical airway setup.
- Update analgesia and antibiotic protocols to the current options.
For civilian agency leaders
- Treat the 2026 TCCC update as a leading indicator, not an authorization.
- Coordinate with your state EMS office, regional medical direction, and agency medical director on protocol revisions.
- Plan for a multi-year update cycle. Some 2026 changes will reach your scope of practice in 2027. Others in 2028, partially, or not at all.
For unit medics and training officers
- Build your training calendar around the gap between published guidelines and authorized scope.
- Front-load the changes that are scope-neutral (reassessment discipline, capnography, recovery position).
- Hold the changes that require medical director authorization until protocols catch up.
Source documents
Always train against the current published versions:
- TCCC Guidelines, 01 May 2026 — CoTCCC, Joint Trauma System
- Prolonged Casualty Care Guidelines — JTS Clinical Practice Guideline
- Joint En Route Care Guidelines FY26 — JTS
- TECC Guidelines for BLS/ALS Clinicians, 02 January 2025 — C-TECC
- Pediatric TECC Guidelines, 15 January 2025 — C-TECC
Verify currency on Deployed Medicine for TCCC, on the JTS Clinical Practice Guidelines library for PCC and En Route Care, and on the C-TECC website for civilian guidance.
Train against the current standard.
MED-TAC delivers TCCC and TECC training aligned to the 01 May 2026 CoTCCC guidelines. Individual certification through full unit training packages. CoTCCC-recommended kits sourced from authorized manufacturers and master distributors.
Ships from MED-TAC International, Pembroke Pines, FL — clinician-founded, veteran-led, SDVOSB-certified.