Treatment Priorities for the Tactical Medic
Table of Contents
What Is the MARCH/H Algorithm?
The MARCH/H algorithm is a vital pneumonic used in trauma and tactical medicine to guide first responders, EMTs, paramedics, and combat medics through life-saving steps in high-stakes emergencies. It emphasizes rapid prioritization of the most time-sensitive injuries and interventions to preserve life in situations like active combat, mass casualties, natural disasters, or critical trauma scenes.
M – Massive Hemorrhage
The first priority is controlling massive bleeding, especially from compressible extremity wounds. Medical responders focus on using:
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Tourniquets
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Hemostatic agents
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Direct pressure
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Pressure dressings
Uncontrolled hemorrhage is one of the leading preventable causes of death in trauma, making this step crucial.
A – Airway with Cervical Spine Stabilization
Airway assessment must come quickly, ensuring the patient can breathe. Techniques include:
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Head-tilt/chin-lift or jaw-thrust maneuver
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Placement of basic or advanced airways (e.g., OPA, NPA, or endotracheal tube)
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Maintaining cervical spine precautions in trauma patients
R – Respiration and Ventilation
With the airway secured, responders check if the patient is breathing effectively. This includes:
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Assessing chest rise and lung sounds
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Providing oxygen support or ventilation as needed
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Performing needle decompression for suspected pneumothorax
C – Circulation and Hemorrhage Control
Circulatory shock must be recognized and corrected. This includes:
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Monitoring pulse, blood pressure, skin signs
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Establishing IV or IO access
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Administering fluids or blood products if necessary
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Continuing bleeding control
H – Hypothermia Prevention
Even in warm climates, trauma patients are susceptible to hypothermia, which worsens outcomes. Responders must:
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Use blankets, foil wraps, and warmed fluids
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Minimize exposure while assessing injuries
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Maintain patient core body temperature
H – Head Injury
Head trauma requires close observation for:
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Changes in mental status
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Pupil reactivity
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Neurological deficits
Field assessments like AVPU or Glasgow Coma Scale can guide decisions. Head injuries may not always show external signs, making this step critical in the algorithm.
Conclusion
The MARCH/H algorithm is a simple but powerful tool that prioritizes lifesaving care in the most chaotic environments. From the battlefield to the highway, systematically addressing Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia, and Head Injury ensures trauma patients receive prompt, organized, and effective treatment when seconds matter most.
Stay Response Ready.