MARCH – analysis of the tactical medicine protocol

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MARCH – analysis of the tactical medicine protocol
Assisting the wounded. Photo: Youtube.com


One of the main protocols of tactical medicine is the protocol MARCH, which is an algorithm of actions when providing assistance to victims. This protocol was developed by military doctors for use in combat conditions, but it can also be applied in civilian situations where quick and effective assistance to victims is required.



In this article we will look at the basic principles of the protocol MARCH and its application in various situations.

First you need to figure out how the abbreviation stands for MARCH:

M – Massive Hemorrhage / Massive Bleeding;
А – Airway;
R – Respiration;
С – Circulation;
H – Hypothermia.

M – Massive bleeding


This is massive bleeding that can lead to rapid blood loss and poses a threat to the life of the victim. In the tactical medicine protocol MARCH this point is the first and most important.

First of all, let's look at the main signs of massive bleeding and how to identify it.

Let me immediately note that I will not talk about the fact that the main sign of severe blood loss is visually strong bleeding from the victim’s body, but we determine severe blood loss by other signs, namely:

– pallor of the skin;
- cold sweat;
– weak pulse;
– low blood pressure;
– frequent weak pulse;
- loss of consciousness.

If the victim shows signs of massive bleeding, it must be stopped immediately. This can be done using direct pressure on the wound ("finger pressure"), application of a tourniquet, or wound packing.

Direct pressure on the wound - This is the simplest and most effective way to stop bleeding. To do this, apply pressure to the wound with a clean cloth or bandage and hold it until medical help arrives.

Application of a tourniquet - This is a more radical method of stopping bleeding. The tourniquet is applied above the wound on the limb. The time for applying a tourniquet should not exceed 1 hour (I especially draw your attention to this), otherwise tissue necrosis may occur.

Wound tamponade - This is another way to stop bleeding. A swab made of sterile material (a hemostatic agent) is inserted into the wound and pressed against the bleeding vessel.

After stopping the bleeding, it is necessary to assess the condition of the victim and provide him with the necessary assistance. If the victim is unconscious, it is necessary to ensure airway patency and begin cardiopulmonary resuscitation.

Application of a tourniquet
Application of a tourniquet. Photo: Youtube.com

A - Airway


This is the first step in the tactical medicine protocol MARCH, which means ensuring airway patency. This stage is critically important, since obstruction of the airway can lead to respiratory arrest and death of the victim.

Signs of airway obstruction:

- labored breathing;
– wheezing or whistling when breathing;
– blue lips and fingertips;
- loss of consciousness.

If the victim has signs of airway obstruction, they must be eliminated immediately. To do this, you can use the following methods:

– cleansing the respiratory tract from foreign bodies;
– Heimlich maneuver (if the victim has choked);
– use of breathing devices (for example, Ambu bag, nasopharyngeal tube).

Clearing the respiratory tract of foreign bodies - This is the simplest and most effective way to eliminate obstructions. To do this, it is necessary to open the victim’s mouth and examine his oral cavity for the presence of foreign bodies (for example, food, dentures, vomit). If a foreign body is found, it must be removed using a finger or tweezers.

Heimlich maneuver is a method that is used if the victim is choking. It consists of the rescuer wrapping his arms around the victim from behind and delivering several sharp pushes to the abdominal area. This technique helps push the foreign body out of the respiratory tract.

Use of breathing devices - This is a more complex method of ensuring airway patency. It is used when other methods are ineffective or unavailable. Breathing devices allow you to artificially ventilate the victim’s lungs, thereby ensuring the supply of oxygen to the body.

Insertion of a nasopharyngeal airway
Insertion of a nasopharyngeal airway. Photo: Youtube.com

R – Respiration


This is the second step in the tactical medicine protocol. MARCH, which means providing breathing. This is also a critical stage, since respiratory failure can lead to hypoxia (lack of oxygen) and death of the victim. It is at this stage that we are obliged to eliminate lung injuries and prevent the possible development of pneumothorax by applying an occlusive patch.

Signs of breathing problems:

- labored breathing;
– wheezing or whistling when breathing;
– blue lips and fingertips;
- loss of consciousness.

If the victim shows signs of breathing problems, they must be addressed immediately. To do this, you can use the following methods:

– artificial lung ventilation (ALV);
– oxygen therapy.

Artificial ventilation is a method that is used if the victim cannot breathe on his own. Ventilation can be performed using an Ambu bag or other breathing device. The Ambu bag is a hand-held ventilator consisting of a self-expanding bag and a face mask. It allows oxygen or air to be supplied to the victim’s lungs, thereby ensuring the supply of oxygen to the body.

Oxygen therapy is a method that is used to treat hypoxia. It consists of oxygen being supplied to the victim through a mask or nasal catheter. Oxygen helps improve gas exchange in the lungs and increase oxygen levels in the blood.

A fighter checks his lungs for wounds
A fighter checks his lungs for wounds. Photo: Youtube.com

C – Circulation


This is the third step in the tactical medicine protocol. MARCH, which means ensuring blood circulation. This is also a critical stage, since poor circulation can lead to shock and death of the victim.

If the victim has signs of circulatory problems, they must be eliminated immediately. To do this, you can use the following methods:

– stop bleeding (if any);
– applying bandages to wounds;
– immobilization of fractures;
– raising the legs above the level of the heart (in the absence of injuries).

Stop bleeding - This is the most important method of ensuring blood circulation. Bleeding can be external or internal. External bleeding can be controlled by direct pressure on the wound, application of a tourniquet, or wound packing. Internal bleeding is more difficult to stop, but it can be slowed by keeping the victim at rest and elevating the legs above the level of the heart.

Applying bandages to wounds is a method used to prevent further blood loss. Dressings may or may not be sterile, but they must be clean and dry.

Fracture immobilization is a technique used to reduce pain and prevent further tissue damage. Fractures can be open or closed. Open fractures are accompanied by bleeding, so they must first be stopped. Closed fractures are not accompanied by bleeding, but they also need to be immobilized to prevent displacement of bone fragments.

Raising your legs above heart level is a method that is used in the absence of injury. It helps improve blood circulation in the legs and increase blood pressure levels.

The fighter inspects for additional wounds.
The fighter inspects for additional wounds. Photo: Youtube.com

H – Hypothermia


This is the fourth step in the MARCH tactical medicine protocol, which stands for preventing and treating hypothermia. This is a critical step because hypothermia can impair circulation, breathing and other vital body functions.

Signs of hypothermia:

– trembling;
- weakness;
- drowsiness;
– loss of coordination of movements;
– decrease in body temperature below 35 °C.

If the victim shows signs of hypothermia, they must be corrected immediately. To do this, you can use the following methods:

– warming the victim;
– provision of warm clothing and shelter;
– providing warm drinks.

Warming the victim This is the most effective treatment for hypothermia. It can be passive or active. Passive warming involves covering the victim with warm blankets and placing them in a warm room. Active warming involves the use of special devices such as heating pads, heated blankets or heat guns.

Providing warm clothing and shelter is a method used to prevent further cooling. Warm clothing retains body heat, and shelter protects from wind and rain.

Providing warm drinks is a method that helps restore lost fluid and energy. Warm drinks also warm the body from the inside.

The fighter inspects for additional wounds.
Warming the victim. Photo: Youtube.com

After the tactical medicine protocol MARCH has been completed in full and the victim’s condition has been stabilized, it is necessary to proceed to the next tactical medicine protocol – PAWS (Pain, Antibiotics, Wounds, Splinting).

PAWS is a set of measures aimed at relieving pain, preventing infections, treating wounds and immobilizing fractures. This protocol allows you to provide the victim with maximum comfort and safety while transporting to a medical facility or waiting for the arrival of qualified help.

It is important to remember that each case is unique and the protocol PAWS can be adapted to the specific conditions and needs of the victim. We will analyze this protocol in one of the future articles, and in the near future we will delve into a more detailed analysis of the MARCH protocol, where we will talk about what and how we can eliminate the consequences of being injured.
24 comments
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  1. +4
    4 June 2024 06: 20
    Closed fractures are not accompanied by bleeding, but they also need to be immobilized to prevent displacement of bone fragments

    They are also accompanied. A liter - one and a half, or even up to two liters of blood can spill into the soft tissues with a closed hip fracture. For pelvic fractures it is more, for fractures of smaller bones it is less. Slower, of course, compared to an open fracture, but the number can be large. You need to remember this.
    1. +1
      4 June 2024 08: 18
      I apologize, but what you say is correct, but the text says about visual bleeding.
      So everything is correct, fractures are accompanied by internal bleeding, but it is written that bleeding must be stopped in case of an open fracture)
      1. 0
        8 June 2024 21: 07
        It’s well written, but some “signs” are repeated at several points, how can we understand this?
  2. +3
    4 June 2024 08: 53
    Thank you for the article hi Brief and clear.
    Let me clarify a little:
    If the victim is unconscious, it is necessary to ensure airway patency and begin cardiopulmonary resuscitation.

    Still, lack of consciousness is not a reason for cardiopulmonary resuscitation, but lack of spontaneous breathing and pulse is.
    Once the MARCH tactical medicine protocol has been completed... it is time to move on to PAWS... for pain relief...

    After stopping the bleeding and ensuring the airway is open, it would still be a good idea to provide adequate pain relief (since
    pallor of the skin;
    - cold sweat;
    – weak pulse;
    – low blood pressure;
    – frequent weak pulse;
    - loss of consciousness.
    may just be signs of painful shock, and subsequent immobilization will be easier to carry out.
    1. +4
      4 June 2024 09: 22
      1. Thank you for your gratitude) regarding the fact that it’s short - I doubt it) it could be shorter)))) but less informative, in fact, for each point you can give a lot more examples))

      2. Regarding CPR, here the information is generalized, the algorithm is described from what to what. Naturally, each case is individual, so what you say is correct: the absence of a pulse and breathing is a reason for CPR. But here, too, there is a nuance, how and where to check the pulse and remember that the pulse in a state of hypovolemic shock may not be palpable, just as the pulse of someone providing relief from stress may even be on a piece of wood or on the forend of a machine gun) but they said so correctly)

      3. Regarding pain relief, also individually, let’s say during a traumatic amputation of a limb, the MARCH-PAWS protocol breaks down and before reaching the Pain Control section, an anesthetic is administered. The same thing happens with scalping and a number of other wounds.

      But in general, everything is said with reason and the questions are good, respect!!!)
    2. 0
      4 June 2024 09: 54
      Quote: Doccor18
      and subsequent immobilization will be easier to carry out.

      Moreover, immobilization of serious fractures without adequate pain relief leads to a sharp worsening of shock with all that it entails.
  3. +3
    4 June 2024 09: 45
    In MARCH, in section R - Respiration, I did not see methods and methods for diagnosing and eliminating the so-called “closed” (tension) pneumothorax with a closed chest injury. This issue is not covered in any way in the protocol?
    1. +2
      4 June 2024 10: 19
      At the very end of the article I wrote that soon I will describe each of the points in as much detail as possible, starting from stopping bleeding, what and how to stop it, types of tourniquets, etc. and of course we’ll get to pneumothorax and I’ll write everything down in detail. Let's definitely not ignore this
      1. +1
        4 June 2024 10: 20
        Quote: Latvian_Tactical_Medicine
        Let's definitely not ignore this

        OK. We wait.
        1. +2
          4 June 2024 10: 28
          I understand that you have quite good knowledge of tactical medicine and this topic is also quite relevant for you. It’s just that an uninitiated person won’t ask about tension pneumothorax)
          I think you understand, if I sorted out absolutely everything in one article, it would be a huge long read that looks like a book) let’s do it, colleague)
          1. +3
            4 June 2024 15: 12
            So, will we talk about occlusion patches and decompression needles? This is good). And if you explain the usefulness of the “valve”, I think people will be interested.
            As for the nasopharyngeal air duct, we note that it would be good to lubricate it before insertion. And in general, the thing is...delicate. A runny nose, a deviated septum and problems begin. I watched how zealous people stuck it in, it became scary. The Gwedel tube somehow seemed more reliable to me, although I haven’t tried it, I could be deeply mistaken.
            R.S. and I can’t resist asking a slightly provocative question) they mentioned “painful shock”... do you recognize the term?
            1. +1
              4 June 2024 15: 22
              The term “pain shock” itself exists, but I personally do not recognize it for a number of reasons. I’m also thinking about writing an article about states of shock, I think it will be interesting)
  4. -1
    4 June 2024 15: 52
    I’m not familiar with medical terms, but are you sure it’s “massive” bleeding and not extensive?
    1. -1
      4 June 2024 16: 12
      It’s not entirely clear with this painful shock of yours. More precisely, it’s not at all clear, some admit it, others don’t, to the point that there are questions about pain relief, like no one died from pain, why do you need pain relief?
      1. +2
        4 June 2024 17: 11
        Severe pain can cause psychological and emotional reactions such as fear, anxiety and depression. These reactions can also make a person's condition worse and increase the risk of death
      2. +2
        4 June 2024 22: 28
        Quote: Letterhead
        It’s not entirely clear with this painful shock of yours.

        Shock is a complex and multifactorial condition (if you delve into the pathophysiology). In this case, we mean pain syndrome as a sharply aggravating shock. For example, fractures of long tubular bones (femur, tibia). I have seen more than once how, when shifting patients without proper pain relief and immobilization, blood pressure dropped from 100 to 60. This does not add health to the body as a whole. With a burn injury, there is generally a constant pain syndrome. In the first stages of the development of shock (and burn disease in the future), this will be the main mechanism in this case.
    2. 0
      4 June 2024 17: 08
      Pun) Massive Bleeding, so I’m used to calling bleeding massive, not extensive :)
  5. -2
    4 June 2024 19: 43
    Nikolai Pirogov. There was a surgeon whom the Tsar sent to Sevastopol due to the horrific losses of the Russian army. For the first time in the world, he developed the same English-language crap that the author cites in the text. Since then, Pirogov’s system has been and will be studied in all medical academies around the world. Only it is not called tactical medicine, but the provision of medical care during the evacuation stages.
    1. +2
      4 June 2024 21: 30
      Can you provide a reputable source? Where Pirogov developed these protocols :)
      Is this how America was discovered by Christopher Golub and the pyramids were built along with the excavated Black Sea?)
  6. 0
    5 June 2024 00: 10
    Question to the author: what protocols describe actions in case of poisoning?
    1. +1
      5 June 2024 08: 23
      Please clarify what kind of poisoning we are talking about and where?
      1. +1
        6 June 2024 21: 36
        Sorry it took so long. Poisoning is not BOV; during an assault you can pick out anything chemically active. Questions: how to identify, first honey. assistance, evacuation, consequences.
        1. 0
          8 June 2024 21: 12
          Quote: Zagrebun
          Poisoning is not BOV; during an assault you can pick out anything chemically active. Questions: how to identify, first honey. assistance, evacuation

          To begin with, I recommend the book “Harmful Substances in Industry”, it was written specifically for firefighters and safety engineers, that is, a subset of your case - damaged equipment and the injured person lies who needs to be treated.
          And to put it very briefly: evacuation comes first, take it out into the wind, if the clothes stink or look strange - undress, wash, change into clean clothes. This is if the chemical reagent is not identified. It is clear that when dousing with ammonia this is not necessary, but with acids... although the rate of damage there can be such that everything is bad.
  7. 0
    19 June 2024 10: 53
    A very strange system. It feels like it was written purely for “police” operations (clear force dominance over the enemy), when the ambulance is standing, if not around the corner, then at least in the next block.

    Secondly, the system is clearly for already trained orderlies (I understand that “tactical medic” sounds cooler), who is assigned to the group. A simple fighter, on adrenaline, it’s good if he remembers how to properly apply a tourniquet/tourniquet to his comrade.

    Hence the extremely strange emphasis on hypothermia!? But nothing about overheating and burns, which are by an order of magnitude more prevalent during combat.

    Where is SDS???