Being aware of security has a two-fold purpose: first to keep yourself safe and second to improve the casualty’s chances of survival. Getting injured helping the wounded is not combat effective.
Traditional EMS practice is to “ensure scene safety,” before treating a patient. Casualty management in high-risk incidents like active shooter, bombings, and buildings on fire will never be safe. The TECC and TCCC guidelines recognize this and prioritize treatment of only life threatening injuries in these dangerous settings.
Although multiple versions of MARCH exist, we like S-MARCH because Security is a reminder that although we can’t “ensure scene safety,” we can mitigate risk by being aware of where the threats are.
With the increasing frequency of vehicles being used as weapons by violent extremists, and ISIS’s encouragement of it’s followers to rent SUV’s and trucks for this purpose, it is worth reviewing the trauma literature of pedestrians injured by automobiles. First, …