The MARCH algorithm is laid out differently from Advanced Trauma Life Support (ATLS) which uses Airway, Breathing, and Circulation (ABC’s) as the order of treatment to instead use Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head Injury for prioritizing lifesaving treatments.

The “C” portion of the MARCH acronym refers to the broad topic of Circulation. In the context of MARCH, circulation covers a wide gamut of responsibilities, from assessing for hemorrhagic shock to administering blood transfusions to non-blood-based fluid replacements like Tranexamic Acid (TXA). However, the “C” phase is also an opportunity to “SEE”, i.e. Not just LOOK at our patient, but to really SEE our patient.

In TCCC, we use the “C” phase to expose and reassess the need and effectiveness of our previous efforts and “SEE” the overall view of our patient’s status. In the “C” (or “See”) portion, we use a discriminate eye to determine and answer the following:

1. Does the method of injury indicate that we should stabilize the pelvis?

2. If we used a tourniquet, did the injury need it?

3. How is our tourniquet placement? If you performed a hasty tourniquet application in a care under fire circumstance, can we apply a new device now two to three inches above the wound directly on the skin?

4. Can we safely perform a tourniquet conversion to a pressure dressing if the situation warrants it?

5. Have we marked times of application on the tourniquet(s) we applied or converted?

6. Do we see signs of hemorrhagic shock such as altered mental status in the absence of brain injury?

7. Do we need to gain IV access?

8. Is fluid replacement or TXA applicable?

9. Field blood transfusion?

10. Blood product administration?

11. Is blood loss even the culprit behind the symptoms we are observing with our patient?

The circulation phase is where these deeper dive questions get answered, and we must use the “C” phase to “See” the answers.

Tools to Aid in Circulation

TacMed Solutions™ offers a variety of products built to help with this circulatory emergencies including the TacMed™ Vascular Access Kit (VAK), the Compact Syringe Kit, the Field Blood Transfusion Kit, the Saline Lock Kit (SLK), the IV Evaporative Cooling System (IVECS™), and more. To stock your kit with these essential tools, check out TacMed Solutions™ at tacmedsolutions.com/collections/m-a-r-c-h-tccc/circulation.

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