Back to Tactical Medicine

MARCH Algorithm

Systematic approach to tactical casualty assessment and treatment prioritization

MARCH Protocol Overview

A systematic, priority-based approach to casualty care in tactical environments, focusing on the most life-threatening conditions first.

M - Massive Hemorrhage

CRITICAL
0-30 seconds

Control life-threatening bleeding immediately

Interventions

  • Apply direct pressure to bleeding wounds
  • Use hemostatic agents (QuikClot, Celox)
  • Apply tourniquets for extremity bleeding
  • Pack wounds with hemostatic gauze
  • Elevate bleeding extremities if no fractures

Required Equipment

Combat Application Tourniquet (CAT)
Hemostatic agents
Emergency trauma dressings
Pressure bandages
Tape

Critical Points

  • Tourniquets should be applied 2-3 inches above the wound
  • Tighten until bleeding stops completely
  • Document time of tourniquet application
  • Multiple tourniquets may be needed for single limb

Quick Reference Card

Rapid assessment and treatment priorities

M
Massive Hemorrhage
Control life-threatening bleeding immediately
0-30 seconds
A
Airway
Secure and maintain patent airway
30 seconds - 2 minutes
R
Respiration
Assess and treat breathing problems
2-5 minutes
C
Circulation
Maintain circulation and treat shock
5-10 minutes
H
Hypothermia
Prevent and treat hypothermia
Ongoing

Implementation Notes

Assessment Approach:

Follow MARCH systematically, but address immediate life threats as discovered. Multiple steps may need simultaneous attention.

Documentation:

Record all interventions, times, and casualty response. Use tactical combat casualty cards when available.

Reassessment:

Continuously reassess casualty status. Priorities may change as situation evolves or new information becomes available.

Environmental Factors:

Consider tactical situation, available resources, evacuation timeline, and environmental hazards throughout care.

Back to Tactical Medicine
TCCC ProtocolsTECC Guidelines