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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 hand with dark red fingernail polish

Capillary Refill Time: Theoretical but not sound

🕖 Reading Time, 6 minutes BLUF: “Normal” values vary by age, gender, temperature (both environmental and casualty’s), and lighting conditions. Different providers will see different durations of refill time. With all these adjustments and limitations of how normal is defined, …

Distracting but not life-threatening: Managing abdominal eviscerations

Image from a 14-year-old boy who sustained a penetrating injury to his abdominal wall after impacting the handlebars of his bike. Note the bowel perforation at approximately 7 o’clock on the bowel. This should not be reduced, as it will …

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 Researched and written by Mike Shertz, MD/18D, not AI We receive frequent questions about shelf-life and environmental degradation of tourniquets. There has been some discussion in the US Department of Defense about …