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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.

Is a Traction Splint for a Femur Fracture Really Worth the Weight and Cube?

BLUF: In a fixed medical facility, keeping a traction splint on hand is reasonable. In a rucksack or aid bag, the evidence does not support carrying one. Most femur fracture casualties have other injuries that contraindicate traction splint use anyway. …

Three photographs showing tourniquets applied to lower extremity wounds, tw of which were not medically necessary

Tourniquets in the Sahel: What a New Study Reveals About Preventable Amputations

Only 5.3% of tourniquets placed by national military forces in Burkina Faso were both medically necessary and appropriately placed. 50% of all their amputations were a byproduct of unnecessary tourniquets. Researched and written by Mike Shertz, MD/18D, not AI 🕖 …

three images: a golden hour box in it's protective bag/cooler, a temperature reading on an open box, and a photo showing the blood contained in a golden hour box

Golden Hour Boxes: What the Data Actually Says About Blood Storage in the Field

Despite their frequent use by the military, “golden hour boxes“ have little independent published literature confirming their capabilities. 🕖 Reading Time, 4 minutes Researched and written by Mike Shertz, MD/18D, not AI These easily portable boxes will generally maintain two …

Israeli study 24% tqt complication rate

Tourniquet Complications: When a Catchy Title Doesn’t Tell the Whole Story

Researched and written by Mike Shertz, MD/18D, not AI 🕖 Reading Time, 5 minutes A retrospective study at Israel’s largest Level 1 trauma center reviewed 84 adult casualties who received prehospital tourniquets between 2010 and 2020. The goal: identify tourniquet-related …

Is administering calcium with blood causing hypercalcemia and increasing mortality?

Recently there has been an increase in discussions regarding hypercalcemia and trauma patients. Preliminary evidence suggests being traumatically injured and having an abnormally high calcium level is just as detrimental as hypocalcemia. 🕖 Reading Time, 4 minutes Researched and written …

a beat up cardboard box labeled "expired blood" with the headline, Expired Blood Products in Military Trauma: Is There a Place for Them in Your PACE Plan?

Expired Blood Products in Military Trauma: Is There a Place for Them in Your PACE Plan?

From 2002 to 2019, in US CENTCOM, 1,491 units of expired blood products were administered to casualties. This represented 0.4% of all blood products administered during that period.1 Is this safe, and if so, should it be part of your …