Military Trauma Standard
The MARCH
Protocol Guide
MARCH is the sequence used by military medics and tactical first responders to prioritize life-threatening trauma. Learn each phase — and equip yourself with the exact gear to execute it.
M
Massive Hemorrhage Priority 1
Uncontrolled bleeding is the #1 preventable cause of death in trauma. Stop it first — everything else is secondary until the bleeding stops.
→
A
Airway Management Priority 2
A blocked or compromised airway will kill faster than most injuries. Assess, open, and protect the airway immediately after hemorrhage control.
→
R
Respiration Priority 3
Assess breathing quality and treat life-threatening chest injuries including tension pneumothorax and open sucking chest wounds.
→
C
Circulation Priority 4
Manage shock, assess circulatory status, and establish IV/IO access if trained. Treat for hemorrhagic shock even without obvious bleeding.
→
H
Hypothermia / Head Injury Priority 5
Prevent heat loss immediately — trauma patients lose temperature rapidly and hypothermia worsens coagulopathy. Assess and protect the head.
→
M
Priority 1 — Act within 3 minutes
Massive Hemorrhage
Uncontrolled external bleeding is the #1 cause of preventable death in trauma. Before airway, before breathing — stop the bleeding. Every second of active hemorrhage reduces the survivable window.
The 3-Minute Rule
A person can bleed out from a major arterial wound in as little as 3 minutes. Do not wait for EMS. Apply a tourniquet high and tight on the first attempt — incorrect placement wastes critical time.
Response steps
01
Identify the bleed
Expose the wound fully. Look for arterial spurting (bright red, pulsing) vs venous bleeding (dark, continuous).
02
Apply tourniquet (limb wound)
Place 2–3 inches above the wound. Tighten until bleeding stops. Note time of application.
03
Pack junction/junctional wounds
For groin, axilla, or neck: pack the wound with hemostatic gauze (e.g. QuikClot, Combat Gauze). Apply firm direct pressure for 3–5 minutes.
04
Secure with pressure dressing
Apply an ETD or Israeli bandage over the packed wound. Confirm bleeding has stopped before moving to A.
Signs of massive hemorrhage
Bright red, spurting blood — arterial involvement, most urgent
Rapid, pooling blood — venous hemorrhage, still life-threatening
Pale, clammy skin — early shock indicator
Rapid weak pulse — compensatory tachycardia
Altered mental status — late sign, blood loss > 30%
Saturated clothing / pooling — visible volume loss
Gear for this phase — shop UMG components
Shop Massive Hemorrhage Gear
Tourniquets, hemostatic agents, and pressure dressings — sourced from NAR and verified suppliers.
A
Priority 2 — After hemorrhage control
Airway Management
A blocked airway kills within 4–6 minutes. Once bleeding is controlled, verify the airway is patent and protected. An unconscious casualty cannot protect their own airway.
Conscious vs Unconscious
Conscious patients can usually maintain their own airway — position them and monitor. Unconscious or altered patients need active intervention: chin-lift/jaw-thrust, recovery position, or an NPA adjunct.
Response steps
01
Check responsiveness
Call out, tap the shoulder. If unresponsive, assume airway compromise.
02
Open the airway
Head-tilt / chin-lift (no spinal precaution needed in tactical environments). Jaw-thrust if spinal injury suspected.
03
Clear obstructions
Look and finger-sweep for blood, vomit, teeth, or foreign objects. Do not perform blind finger sweeps.
04
Insert NPA if indicated
Lubricate the NPA and insert into the right nostril. Contraindicated with significant facial trauma / suspected basilar skull fracture.
05
Position and monitor
Place unconscious breathing patients in the recovery position. Continuously monitor for changes.
Signs of airway compromise
Stridor / gurgling sounds — partial obstruction, act immediately
No chest rise — complete obstruction or apnea
Cyanosis (blue lips/fingertips) — severe hypoxia
Unconsciousness — inability to protect own airway
Facial or jaw trauma — structural airway compromise
Vomit or blood in airway — aspiration risk
Gear for this phase
Shop Airway Components
NPAs, airway adjuncts, and access tools. Know your gear before you need it.
R
Priority 3 — Chest threats kill fast
Respiration
Once the airway is open, assess breathing quality. Penetrating chest wounds, tension pneumothorax, and open chest wounds are all immediately life-threatening and require specific interventions.
Tension Pneumothorax Warning
A tension pneumothorax collapses the lung and shifts the mediastinum — it will kill in minutes if untreated. Decompress immediately with a needle decompression at the 2nd intercostal space, midclavicular line. This is a skill requiring training.
Response steps
01
Assess rate and quality
Count respirations for 10 seconds × 6. Look for symmetry of chest rise, use of accessory muscles, and abnormal sounds.
02
Expose and inspect the chest
Cut away clothing. Look and feel for open wounds, paradoxical movement, and tracheal deviation.
03
Seal open chest wounds
Apply a vented chest seal (HyFin® Vent or similar) over all penetrating wounds — front and back. Vent seals prevent tension pneumothorax.
04
Needle decompression if indicated
Suspected tension PTX with rapid deterioration: decompress with a 14g 3.25" needle at 2nd ICS MCL. Training required.
Signs of respiratory compromise
Sucking chest wound — open pneumothorax, seal immediately
Tracheal deviation — late sign of tension PTX
Absent breath sounds (one side) — pneumo or hemothorax
Paradoxical chest movement — flail chest
Rapid deterioration post-sealing — burp the seal, re-assess
Resp rate <8 or >30 — treat aggressively
Gear for this phase
Shop Respiration Components
Vented chest seals, needle decompression kits, and trauma dressings for thoracic trauma.
C
Priority 4 — Manage shock
Circulation
After hemorrhage control and chest threats are addressed, assess circulatory status. Traumatic shock kills silently. Even without visible bleeding, internal hemorrhage and distributive shock are real threats.
Treat for shock proactively
In trauma, assume shock until proven otherwise. Do not wait for hypotension — by the time BP drops, you're dealing with decompensated shock. Lay the casualty flat, elevate the legs (unless head or spinal injury), and keep them warm.
Response steps
01
Check pulse quality
Radial pulse: present = systolic >80. Carotid only = systolic >60. Absent = cardiac arrest.
02
Assess skin perfusion
Check capillary refill (should be <2 sec), skin color (pale/mottled/ashen), and temperature (cool/clammy = shock).
03
Control any unaddressed bleeding
Reassess all wound sites. Check tourniquet effectiveness and re-pack if required.
04
IV/IO access if trained
Establish large-bore IV access. Administer fluids per protocol. In civilian settings, focus on rapid evacuation over fluid resuscitation.
05
Position for shock
Lay flat, elevate legs 8–12 inches unless contraindicated. Prevent heat loss — see H phase.
Signs of circulatory failure
Rapid weak pulse (>100 bpm) — compensatory tachycardia
Capillary refill >2 seconds — reduced perfusion
Pale, cool, clammy skin — peripheral vasoconstriction
Altered consciousness — late shock indicator
No radial pulse — systolic likely <80mmHg
Extreme thirst / anxiety — early subjective shock signs
Gear for this phase
Shop Circulation Components
Splints, wound care, PPE, and circulation support components.
H
Priority 5 — Prevent the lethal triad
Hypothermia & Head Injury
Trauma patients lose heat rapidly — shock, wet clothing, and blood loss all accelerate this. Hypothermia worsens coagulopathy and acidosis, completing the "lethal triad." Prevent it aggressively from the moment care begins, not at the end.
The Lethal Triad
Hypothermia + Acidosis + Coagulopathy form a self-reinforcing cycle that makes hemorrhage uncontrollable. Wrap the patient early — even before all other interventions are complete. Hypothermia prevention starts at first contact, not last.
Hypothermia response
01
Remove wet clothing
Wet clothing conducts heat away 25× faster than air. Cut away if necessary — do not let modesty delay this step.
02
Wrap with heat-reflective blanket
Use a foil/mylar blanket (HPMK) to wrap the entire body including the head. Trap residual body heat immediately.
03
Insulate from the ground
Conductive heat loss to cold ground is significant. Place any insulating layer (pack, clothing, litter) between casualty and ground.
04
Monitor temp and mental status
Mild hypothermia: shivering, confusion. Severe: absent shivering, arrhythmia risk. Rapid evacuation is the definitive treatment.
Head injury assessment
01
AVPU assessment
Alert / Verbal / Pain / Unresponsive. Document and track changes over time — deterioration = worsening ICP.
02
Check pupils
Unequal pupils (anisocoria) or fixed-dilated pupils indicate intracranial pressure. This is a neurosurgical emergency.
03
Protect and position
Head injury alone: elevate head of stretcher 30°. Combined head + hypotension: prioritize flat position. Do not hyperventilate.
Gear for this phase
Shop Hypothermia & Head Injury Gear
HPMKs, thermal blankets, and head wound supplies. Don't let the lethal triad finish what the wound started.
