By Brandon Butler, Director, TRS
M.A.R.C.H. is the newest of the trauma care acronyms. It is important to keep up with current trends and work to improve your knowledge when it comes to emergency situations. Remember that tactical casualty care is used in lots of incidents; active shooters, vehicle accidents, wilderness survival, and workplace injuries, just to name a few. Remember that this is not an all inclusive article and is more a summary of care. Proper training and skills checks are recommended to keep your skills at a level that saves lives. Stop the Bleed Courses are a great way to get yourself educated in emergency care.
As for M.A.R.C.H., let’s get to it:
M – Massive Hemorrhaging – This is the critical care point, when a person is bleeding out it has to be stopped within a few minutes. The “M” is indicated by bright red spurting blood, which means an artery is bleeding. Tourniquets and wound packing are the go to for this kind of bleeding. Remember on a tourniquet to always go as high as possible regardless of where the wound is, this will ensure the bleed is stopped regardless of the extent of internal damage to the limb.
A – Airway – You can only go so long without oxygenating your blood, so making sure an airway is open and functioning properly is secondary to bleeding out. Tilt the head and open the airway to make sure air can moving.
R – Respiratory – Now check the chest and back for punctures or exit wounds. When the thoracic cavity is compromised, the lungs cannot function properly. How do we fix this? We perform what is called “sealing the box” which is short for sealing up the chest cavity. Specialized bandages called chest seals are readily available for your medical kit. If you don’t have one, any plastic or foil will work. Place it over the hole and tape down. Yes this is a great application for the duct tape you might have in your kit. This will seal the box and allow the lungs to start working properly. You should see breathing improvement very quickly.
C- Circulation – So now we move on to circulation. Check their pulse in three areas: the wrist, underarm, and neck. Each of these give an indication of your person’s condition. Check each until you find the pulse. The presence of a pulse in the wrist indicates the blood pressure above 90, in the underarm it’s above 70, if only found in the neck it’s above 60. Once finding the pressure, count the pulse for 15 seconds and then multiply it by 4. This gives your pressure and heart rate. Unfortunately there is not a lot you can do other than the M.A.R. care steps above, but you may try laying the person on their side in what is called the recovery position. This should help with breathing and maintaining an airway.
H – Heat Loss – Last but not least, heat loss is a big issue with trauma patients. When you lose a lot of blood, your body can’t move heat throughout your body. Picture how a radiator works, moving hot water throughout a house to heat it. The body has the same system. Less blood means less heat moved. Cover your injured person with a blanket, reflective sheet, or clothing. Be sure to insulate them from the ground, as it can suck heat from a person.
M.A.R.C.H. is the basis of trauma care and is intended to extend life until medical responders arrive and can administer advanced care. We offer courses in stop the bleed, civilian active shooter medical response, and Tactical Emergency Casualty Care courses. If you think you want to sign up for, or host one, please let us know. Contact us at firstname.lastname@example.org.