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.
When Deputy Just responded to a call regarding gunfire, she didn’t know there was a victim until she heard the 911 operator giving care instructions to bystanders. She arrived near-simultaneously with four other officers. As they provided security, she began …
Although not as convenient as evaluating the “Go / No Go” presence of a casualty’s radial pulse, their “shock index” is a much more sophisticated snapshot of their hypovolemic status. Shock index is a ratio of the trauma patient’s heart …
Triage systems are used by prehospital providers to “sort” casualties into essentially those who are dead or will likely die despite treatment, those with injuries that don’t really require prehospital treatment, and those with injuries that are immediately life-threatening and …
In June 2020, the TCCC Committee submitted a proposed change to hypothermia management for combat casualties. They noted there had been no review of hypothermia management in TCCC in the previous 14 years.1 So what changed? The proposed hypothermia management …
Burns over 20% total body surface area (TBSA) result in increased capillary permeability and intravascular fluid deficits that are most severe at 24-hours post-burn. Cardiac output decreases rapidly post-burn. With correct fluid resuscitation, cardiac output returns to normal values 12 …
Airway control remains the top priority for field treatment of burn casualties.1 Hypovolemic and distributive shock can occur in burned patients but they are usually a late consequence. An inhalational burn injury can double a casualty’s burn mortality.2 Upper …