Treatment Priorities for the Tactical Medic
MARCH/H: A Life-Saving Algorithm in Trauma Care
The MARCH/H algorithm is a helpful pneumonic used by medical professionals to prioritize and guide treatment for casualties in trauma and combat casualty care situations. The acronym reminds providers to focus on the most important and time-sensitive interventions in effort to effectively preserve human life.
M – Massive Hemorrhage: Control of massive external hemorrhage from compressible sites should be the initial focus of trauma evaluation and treatment. Tourniquets, hemostatic dressings, and direct pressure are key tools to control life-threatening bleeding.
A – Airway with cervical spine stabilization: The airway must be secured quickly while maintaining neutral stabilization of the cervical spine when trauma is suspected. Endotracheal intubation or supraglottic airway placement may be needed.
R – Respiration and ventilation: Ventilation and oxygenation must be assessed and assisted as needed. Needle or surgical chest decompression may be indicated at this phase of the algorithm for tension pneumothorax.
C – Circulation with hemorrhage control: Shock must be rapidly identified and treated through fluid resuscitation, blood product transfusion, and hemorrhage control measures, as outlined in the “M” step.
H – Hypothermia prevention: Patients with trauma are at high risk for hypothermia, which can worsen outcomes. Aggressive warming measures should be initiated early to prevent hypothermia.
H – Head injury: Patients with potential head trauma should be evaluated for signs of head injury such as changes in mentation, motor function, and pupil reactivity.
By systematically working through the MARCH/H algorithm, medical providers can quickly identify and treat life-threatening injuries in trauma patients, maximizing their chances of survival. The acronym serves as a valuable reminder of priorities in traumatic emergency settings such as combat zones, disasters, and mass casualty incidents.
Conclusion
The MARCH/H algorithm is a simple yet powerful tool that can guide trauma care and save lives. When time is critical and resources are limited, following the sequential steps of this pneumonic ensures that providers focus their initial interventions on the most immediately life-threatening conditions.
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