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Understanding the MARCH Protocol in TCCC
In Tactical Combat Casualty Care (TCCC), the MARCH protocol is a step-by-step sequence for managing trauma in high-threat or austere environments. It prioritizes life-threatening conditions in the order most likely to kill a casualty. Following MARCH ensures nothing critical is missed under stress.
While dedicated primarily to military personnel, it can be modified for civilian public safety use, hence the C-TECC standards.
M – Massive Hemorrhage
Uncontrolled bleeding is the leading preventable cause of combat death.
- Apply a tourniquet high and tight on the limb. Yes, we know about the other landmarks too, but this is meant for a broader audience.
- Use hemostatic gauze and pressure dressings for junctional wounds.
- Reassess for hidden bleeding during patient movement.
A - Airway
Ensure the casualty can breathe effectively.
- Use manual maneuvers (chin lift/jaw thrust) if needed.
- Insert a nasopharyngeal airway (NPA) for semi-conscious patients.
- Surgical airway (cricothyrotomy) may be necessary if obstruction persists. A VERY advanced technique.
R – Respiration
Address penetrating chest trauma and prevent tension pneumothorax.
- Apply vented chest seals to all open chest wounds.
- Monitor for signs of respiratory distress.
- Perform needle decompression if indicated and trained. Another advanced technique.
C – Circulation
Control shock and maintain blood flow to vital organs.
- Initiate IV/IO access if needed for fluid resuscitation.
- Use blood products when available; avoid excessive crystalloids.
- Keep the casualty warm to prevent hypothermia-induced coagulopathy.
H – Hypothermia / Head Injury
Even in hot climates, trauma patients can become dangerously cold.
- Use hypothermia prevention wraps or blankets.
- Protect the brain—avoid hypotension and hypoxia in head injuries.
- Reassess neurological status regularly.
Why It Matters:
The MARCH protocol is designed for rapid, repeatable decision-making in chaotic environments. Whether you’re carrying a basic IFAK or a full advanced trauma kit, organizing your interventions according to MARCH dramatically improves survivability when every second counts.
At MED-TAC International, our kits are built with MARCH in mind—ensuring you have the right tools, in the right order, to execute life-saving care under fire.