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Stop the Bleed

MARCH

Massive hemorrhage, airway, respirations, circulation, hypothermia and head injury (MARCH) is the acronym used in tactile medicine to remember how to stop life threatening injuries.

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Massive Hemorrhage 

MASSIVE (EXTERNAL) BLEEDING 

***Care under fire***

The goal is to stop external (arterial) bleeding with the use of a tourniquet or with medicated combat gauze. 

  1. Place a tourniquet over the clothes, high and tight. Tighten the tourniquet until bleeding stops. If bleeding doesn’t stop, apply a second tourniquet side-by-side to the first. 

    1. If the situation allows, check a distal pulse. If pulse is still present, apply another tourniquet. ​

  2. If tourniquet is not applicable: Pack the wound with hemostatic gauze. Apply 3 minutes of direct pressure. If wound is still bleeding, take out gauze and repack with new hemostatic gauze. Hold direct pressure again for 3 minutes and repeat steps as necessary and check for site of bleeding in between dressing changes. 

    1. Once ​bleeding is stopped, apply an external bandage or wrap to the area. 

Airway/Respirations

The goal is to make sure nothing is obstructing the patient’s airway and to ensure adequate and functional respirations

  1. If patient is talking and breathing normally, airway is open. Place patient in any position that protects the airway or position of comfort.

  2. If patient is unconscious: Place patient in the recovery position (place patient on their side with one arm extended and one leg bent, see picture).

  3. Frequently reassess patient’s airway for changes.

  4. If a chest wound is present: exposure the area, wipe the area dry, and apply a vented chest seal to the wound.

  5. Log roll the patient (place the patient on their side) and check for an exit wound (in back and armpits). If present, place another chest seal over the exit wound 

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Circulation

Reassess the tourniquet application and reapply if necessary. 

  1. Reassess if tourniquet is necessary. Expose the area of the wound and remove the tourniquet - if arterial bleeding is present, reapply tourniquet.  

    1. If a tourniquet is still needed, reapply the tourniquet under the clothes, approximately 2-3 inches above the wound (and not on a joint).

    2. Note tourniquet reapplication, and/or removal time 

  2. If bleeding continues:

         1. Tighten the tourniquet until bleeding stops or               apply a second tourniquet side-by-side to the               first until bleeding stops 

Hypothermia and Head Injury

Minimize heat loss due to trauma and burn patients 

  1. Minimize contact with cold surface and outside temperatures 

  2. Remove any wet clothing and replace it with dry clothing when possible 

  3. Apply a blanket to the patient’s torso, under the arms, and up into the armpits. 

  4. If available, close the patient in an enclosure bag (such as a sleeping bag). If not available, place an emergency blanket over the patient 

  5. Keeping the patient warm should happen as quickly as possible!

  6. Assess for a potential head injury and reassess patient as necessary. 

    1. Monitor patient as necessary and wait for help to arrive. 

All information above is subject to change and is based on the US Army's Guidelines published in 2017.

 

U.S Army Mil. (2017, May). Tactical Combat Causality Care Lessons and Best Practices. https://api.army.mil/e2/c/downloads/2023/01/19/31e03488/17-13-tactical-casualty-combat-care-handbook-v5-may-17-distro-a.pdf

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