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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 of the burly chest of an operator with an American flag and CAT tourniquet staged on the exterior of his gear, center line

Tourniquet environmental wear: is time of the essence?

CAT Environmental Breakage 🕖 Reading Time, 3 minutes We receive frequent questions about shelf-life and environmental degradation of tourniquets. There has been some discussion in the US Department of Defense about declaring a five-year self-life for new, unused commercial tourniquets …

Neck wound qualifies as junctional hemorrhage

Junctional Hemorrhage: The next frontier for hemorrhage control

The term “junctional hemorrhage” refers to injuries and bleeding occurring at the transition zones between the extremities and the torso. 🕖 Reading Time, 4 minutes The term first appeared in the medical literature in December 2009. Although not an extremity, …

The destroyed exterior of the Marriott Hotel in Jakarta after the 2003 bombing

A hotel stay: reflections on the challenges managing casualties in a high-risk environment

Researched and written by Mike Shertz, MD/18D, not AI 🕖 Reading Time, 5 minutes There is nothing like a brief stay in 2020 Portland, Oregon, when it looked nearly war-torn to force you to rethink your security and tactical medical …