The MARCH mnemonic is a superior model for evaluation of trauma patients compared to the traditional A, B, C model. 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.
Do you know what March is?
If you are not familiar with MARCH, here is what you need to know. Tactical Combat Casualty Care (TCCC) revolutionized our approach to trauma by utilizing evidence-based medicine in replacing the antiquated ABCs with the MARCH mnemonic. The old school approach to trauma was: Airway, Breathing, Circulation (ABC).
What is the M A R C H mnemonic?
The old school approach to trauma was: Airway, Breathing, Circulation (ABC). The evidence-based approach that motivated the Committee on Tactical Combat Casualty Care (CoTCCC) to adopt the M A R C H mnemonic has drastically changed that approach for the better.
What is the March algorithm?
The MARCH algorithm is synonymous with Tactical Combat Casualty Care (TCCC). It is a simple acronym for remembering the necessary steps in priority for saving lives in combat. M-massive hemorrhage, A-airway, R-respiratory, C-circulation, and H-hypothermia. In September 2017, EMS1.com published an article about the concept of the MARCH algorithm.
Does the mnemonic March paws work for first line diagnoses?
each letter corresponds to the following first line diagnoses and treatment protocol terms in order of relevance: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head injury, Pain, Antibiotics, Wounds, Splints. We undertook this study to review the results of using the mnemonic MARCH PAWS and its effectiveness
What does March paws stand for Army?
MARCH PAWS is an acronym of which each letter corresponds to the following first line diagnoses and treatment protocol terms in order of relevance: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head injury, Pain, Antibiotics, Wounds, Splints.
What are the 3 phases of TCCC?
The three phases of TCCC include Care Under Fire, Tactical Field Care and Tactical Evacuation Care.
What are the 4 D's of bleeding?
Massive hemorrhage can be addressed by the four Ds: Detect: find the source of the bleeding. Direct pressure: hold pressure on the source of the bleeding until the clot forms. Devices: if necessary, use equipment such as tourniquets, hemostatic gauze and pressure bandages to supplement direct pressure.
Do you treat bleeding or breathing first?
If the person is unconscious, has difficulty breathing or is bleeding severely, these must be dealt with first, by controlling the bleeding with direct pressure and performing CPR.
What are TCCC guidelines?
The TCCC Guidelines are the standard of care for the modern battlefield. The guidelines cover: Care Under Fire (CUF), Tactical Field Care (TFC), Tactical Evacuation Care (TACEVAC). These recommendations are intended to be guidelines only and are not a substitute for clinical judgment.
How long can a tourniquet be left on army?
Ideally with a tourniquet... Decades of combat have proven that the tourniquet can be left on, in some cases, 48 hours or more without any damage to the limb. And of course, no amputation required.
What are ABCs in EMS?
First responders are trained to assess three essentials of people in an emergency: airway, breathing and circulation, often referred to as the ABCs.
Where does the 2nd tourniquet go?
If the first tourniquet fails to control the bleeding, apply a second tourniquet just above (proximal to) the first. Don't put a tourniquet directly over the knee or elbow. Don't put a tourniquet directly over a holster or a cargo pocket that contains bulky items.
What does March stand for in trauma?
MARCH (massive hemorrhage, airway, respirations, circulation, head injury/hypothermia) is an acronym used by TCCC-trained individuals to help remember the proper order of treatment. Massive hemorrhage.
What happens if you do CPR on someone with a pulse?
NO adverse effects have been reported. Based on the available evidence, it appears that the fear of doing harm by giving chest compressions to some who has no signs of life, but has a beating heart, is unfounded. The guidelines now recommend that full CPR be given to all those requiring resuscitation.
What are the 7 steps of first aid?
Terms in this set (7)Take Charge of the Situation.Approach the Patient Safely.Perform Emergency Rescue and Urgent First Aid. DO NOT MOVE THE PATIENT AGAIN UNTILL STEP 7!!!!!Protect the Patient. ... Check for Other Injuries.Plan What to Do.Carry Out the Plan.
Can you perform CPR on someone who is bleeding?
If you're in any doubt, treat the injury as a broken bone. If the person is unconscious or is bleeding heavily, these must be dealt with first by controlling the bleeding with direct pressure and performing CPR.
What is March used for?
MARCH is used to identify and treat the major causes of preventable death. About 90% of all casualties in combat, die before reaching the hospital.
What is the C in March?
“The C in MARCH refers to shock. After massive hemorrhage, airway and breathing have been addressed, we need to optimize the patient’s circulation. Standard methods for circulation improvement, such as laying the patient flat, maintaining body temperature and careful fluid resuscitation all apply.”
Massive hemorrhage
M doesn't just remind us that bleeding control is the top priority in trauma care, it also clarifies what kind of bleeding control we are talking about. Not all bleeding control is a priority.
Airway control
A reminds us that airway is still key care element for severe traumatic injuries. BLS to ALS, the patient needs a patent airway to survive.
Respiratory support
R is where breathing comes in. If a trauma patient is fighting for air, remember that not only are they not getting enough oxygen in, but they may also be using a lot of that oxygen in their failing struggle to breathe.
Circulation
The C in MARCH refers to shock. After massive hemorrhage, airway and breathing have been addressed, we need to optimize the patient’s circulation. Standard methods for circulation improvement, such as laying the patient flat, maintaining body temperature and careful fluid resuscitation all apply.
Hypothermia
Hypothermia is a critical factor in trauma care that is not often discussed in the EMS.
Head injury
Head injury care is virtually all about making sure that a primary injury (the initial impact) does not turn into a permanent secondary injury (injury caused or worsened by inadequate EMS care). Care for patients with severe head injuries must avoid those H bombs:
About the author
Rom Duckworth is a dedicated emergency responder, author and educator with more than 30 years of experience working in career and volunteer fire departments, hospital healthcare systems, and private EMS.
M.A.R.C.H. Assessment
This is a trauma management mnemonic that should be part of your self-defense toolkit. Mike explains what each letter stands for.
M: Massive Hemorrhaging
M stands for Massive Hemorrhaging and is the #1 cause of preventable death in military and law enforcement contexts. We will mitigate the massive hemorrhaging with tourniquets if the injury is to the extremities, or pressure dressings if the injury is elsewhere.
A: Airway
Open the airway using the head tilt/chin lift method, or if you suspect there is head, back or neck trauma, use the jaw thrust method. Help the patient to maintain the open airway if necessary, and put them in the recovery position — lying on their side — to make sure they do not aspirate any fluids that may be leaking out of their mouth.
R: Respiration
Pneumothorax has been reported as the #1 cause of preventable death in a mass shooter/civilian context. Look, listen and feel: Is the chest rising and falling equally? If not, we should suspect a penetrating injury that is causing one lung to collapse.
C: Circulation
Feel for a radial pulse (on the wrist) or a carotid pulse (on the throat). If you can’t feel a carotid pulse, initiate CPR if you have been certified to do this in your trauma management training.
H: Hypothermia
A patient who loses a lot of blood will become cold, so we need to get them warmed up however we can — with blankets, towels, covering their head, using whatever is available at the range.
