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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.

Noble Slave FPV drone injury pattern diagrams showing distribution of wounds (data in article)

FPV Drone Casualties in Ukraine: What Limited Data Suggests, and What We Still Don’t Know

Actual casualty data from Ukraine is sparsely published. Whether that’s because they want to limit its propaganda value, because the medical providers are already overworked saving lives, or simply because active war zones are difficult to collect detailed data in …

Crisis Medicine math showing two IO needles plus lidocaine equals question mark

IO Pain Control: What the Research Says About Using Lidocaine Before the Flush

Studies suggest IO flushing is uniformly painful -especially tibial sites – and lidocaine may help, data remains limited. Many EMS protocols recommend administration of lidocaine through intraosseous access before flushing to decrease the associated pain, but how effective is this? …

A cartoonized version of the newly marketed SEAL spray, appearing to have been drawn in crayon

Evaluation of SEAL Hemostatic Spray: Marketing Claims vs. Published Data

Recently, both a Special Forces Medic and a civilian fire paramedic asked me about a new hemostatic product being actively marketed on social media: SEAL Hemostatic Wound Spray. Like many things on social media, you have to check the veracity: …

A security video still showing a lobby with desks covered with spurting blood and a clear trail of blood leading to a suspect about to die from blood loss by the revolving door

Brazilian Bank Robbery: Lethality of penetrating neck wounds

Fatal Penetrating Neck Wounds 🕖 Reading Time, 4 minutes Originally published Feb 25, 2023, but updated based on recent events and questions from students.  This video of an attempted bank robbery in Brazil shows that some injuries are just too …