Researched and written by Mike Shertz, MD/18D, not AI
🕖 Reading Time, 3 minutes
The Airway, Breathing, Circulation model fails in root cause analysis: The ultimate goal of having an open airway is to oxygenate blood, which is best done while still in the body. Stopping massive bleeding must be the first priority because failure to do so would render the remaining priorities pointless if the casualty dies of massive hemorrhage.
There are different versions of MARCH, which, with the exception of one, add additional lower-level priorities to the mnemonic. Each has value, but they can become complicated to remember.
I prefer the simple MARCH version, though my next favorite is S-MARCH-RV, which I learned from another SF medic, as it places the highest priority of casualty evaluation on S – security, as the first letter because the most important priority in all tactical casualty care is to keep everyone safe.
The versions of MARCH are nearly as numerous as the medics who apply it.
MARCH-E (Everything else) Popular with the Canadians
MARCH-H (Head injuries)
MARCH-HE (Head injuries & Everything else)
MARCH-E (Eye injuries)
S-MARCH-RV (Security, Recovery position, Vital signs)
There is also a CBRN variant, MARCHE2, where the 2 indicates the mnemonic is squared in its entirety and each letter has two components. First, the original, for example massive hemorrhage, but then second, the accompanying CBRN, for example Mask, which we have written about separately.
MARCH-PAWSB (Pain control, Antibiotics, Wound dressings, Splinting, Burn treatment)
MARCH-PAWS-RAVINES (See PAWSB above, and add to it:)
R Resuscitate: with whole blood and reduce tourniquets as soon as possible
A Airway and Cric care package: Sedation, capnography, tube depth, cuff pressure, sterile suction
V Ventilate and oxygenate using PEEP / lung protective strategies
I Initiate telemedicine consult and early evacuation
N Nursing care: I&Os, Oral hygiene, turn casualty
E Environmental Considerations: pad pressure points of the litter, Earplugs for flight, medication for motion sickness
S Surgical procedures: cricothyroidotomy, thoracostomy, escharotomy, fasciotomy, lateral canthotomy, amputation, debridement, delayed primary closure, shunting
