MARCH addresses what will kill your casualty in the next few minutes. PAWS addresses what comes after. Once massive hemorrhage is controlled and the casualty is breathing, their circulation is managed, and tghey have been protected from hypothermia, the work shifts to pain control, infection prevention, wound care, and splinting fractures.
The extension came out of USAF Pararescue and was published in the Journal of Special Operations Medicine in 2017. None of it is lifesaving in the way the MARCH steps are. All of it determines how your casualty does over the hours and days that follow.
🕖 Reading Time, 4 minutes Researched and written by Mike Shertz, MD/18D, not AI Oral transmucosal fentanyl citrate (OTFC) was recently removed from the TCCC guidelines. It wasn’t removed because new literature showed it doesn’t work or causes complications. It …
In war wounds, nosocomial (hospital-acquired) infections are common. This occurs due to initial high wound contamination, extensive devitalized tissue in the wound, multiple surgical interventions, prolonged hospitalizations, and extensive use of early broad-spectrum antibiotics.1 In late 2025, Co-TCCC changed their …
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? …
Estimating burn size is not just a technical detail; it’s a critical component of effective burn management. Researched and written by Mike Shertz, MD/18D, not AI 🕖 Reading Time, 3 minutes Mis-estimation results in over or under-transfer to burn centers, …
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 …
🕖 Reading Time, 4 minutes In 2002, 40 to 50 heavily armed Chechens stormed the Dubrovka Theater in Moscow, taking 850 hostages. Ultimately Russian FSB retook the theater after deploying an “unknown” gas which rendered everyone in the theater unconscious. …
