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MARCH: Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia Prevention

The easy to remember mnemonic MARCH reminds us of the priorities in treating casualties during TECC and TCCC situations. MARCH provides a framework to address immediate life threats and gives an organized approach to begin a casualty evaluation. The MARCH mnemonic is preferable to the ABCDE model because it takes into consideration the reason you need an airway and to be breathing is to circulate blood to the casualty’s brain. Recognizing that, the first step in our casualty evaluation should be to look for massive hemorrhage.

Once past massive hemorrhage, A-R-C is loosely approximated by A-B-C. H- is a reminder that a large number of traumatic casualties arrive at the emergency department or medical treatment facility hypothermic which dramatically increases their death rate.

The MARCH mnemonic can be applied to any patient, as the initial casualty evaluation usually rules out massive hemorrhage.

a photo showing a patient with a hole in their chest with blood blowing out of the hole with each exhalation. This sucking chest wound also blows, which is a sign of not dying of tension pneumothorax

A sucking (and blowing) chest wound is the sound of not dying

Video used with permission by Andrew Dennis, DO FACS, FACOS, Cook County Trauma Burn Unit, Chicago Il 🕖 Reading Time, 6 minutes Sucking chest wounds are dramatic, but rarely life-threatening. The sound of sucking & blowing is the sound of not dying …

Regular and super-absorbant tampons compared to two 4x4s, their rough equivalent; a roll of training combat gauze; and a roll of Kerlix Gauze.

Heavy flow is not massive hemorrhage: Tampons don’t belong in IFAKs

🕖 Reading Time, 6 minutes Recently we posted a video outlining the challenges of using hemostatic granules as compared to gauze. In response, we were surprised by how many people advocated for tactical tampons to control massive hemorrhage in a …