The letter A in our MARCH algorithm stands for Airway. When discussing airway in MARCH, we also lump breathing into it (probably because MABRCH doesn’t sound right…). Contrary to the more common civilian equivalent treatment algorithm, known widely as the ABCs (which stands for Airway, Breathing, and Circulation), the MARCH system places life-threatening bleeding as its primary focus before any airway issues.

But why? Quite simply, you can go without oxygen for a far longer time and survive than you can with a life-threatening bleed. For example, in 2016, Aleix Segura Vendrell of Spain held his breath for an impressive 24 minutes and 3 seconds while floating in a pool. While this time drastically exceeds what most could achieve, it illustrates the cardiovascular system’s fantastic ability to use and circulate oxygenated red blood cells efficiently. Since these red blood cells live in our blood, and they are the body’s mechanism for carrying oxygen in your body, we must be hyper-vigilant in keeping as many of them inside of an injured person as we can!

After we have controlled any life-threatening bleeding, what can we do for an injured person’s airway and breathing? First, we want to make sure that the airway has no obvious obstructions, is open, and in a position that allows air to pass easily. The technique you use to open the airway depends on the circumstance you find yourself in and what level of training you have, but here are some basic methods:

• First, check to see if the person is breathing! Is the person alert or talking? If yes, that’s easy; they are!
• Look at the person’s chest to see if we can observe it rising and falling.
• If the person is not breathing and is unresponsive, we can do basic airway techniques to open the Airway, like the head tilt chin lift technique or the jaw thrust technique if you suspect a neck or spine injury.
• Place the person in the recovery position.

Some more advanced techniques allow the higher trained provider to secure the airway. These devices and methods “secure” the airway by ensuring that the patient’s airway will remain open for them to continue breathing on their own or allow you to breathe for the patient if you need to. Most of these devices require advanced training and certification to use. Still, the Nasopharyngeal Airway (aka an NPA, nose hose, or nasal trumpet) can be taught relatively easily to less trained rescuers. Some of the airway securing devices and methods available for advanced providers:

• Nasopharyngeal Airways (NPA)
• Oropharyngeal Airways (OPA)

• Endotracheal Tubes
• Supraglottic Airways (I-Gel, King Devices, LMA’s)
• Surgical Airways (TacMed Surgical Airway Kit, Cric Key)

Once the airway is secured or opened, the two most common techniques for assisted breathing or breathing for your patient include:

• Rescue breathing with a face shield (commonly taught in CPR)

• Using a device like a Bag Valve Mask (BVM)

These methods use positive pressure to push air through the airway and into the injured person’s lungs to help oxygenate red blood cells. Those same red blood cells we worked so hard to keep inside of the victim during the M portion of a MARCH! Ultimately, stopping life-threatening bleeding in the M portion of MARCH, opening the airway, and breathing for the victim (if needed) in the A portion, equip our patient with the best chance for a positive outcome.

For more airway product information, check out tacmedsolutions.com/collections/m-a-r-c-h-tccc/airway.

Tactical Combat Casualty Care (TCCC) emerged in 1996 by special operations forces stemming from lessons learned during previous conflicts with large scale adoption by US and allied forces after the events of September 11, 2001. Tactical Combat Casualty Care guidelines are evidence-based and battlefield-proven to reduce deaths at the point of injury (POI). Department of Defense (DOD) and most NATO allies require TCCC training for deploying forces because it combines effective tactics and medicine to reduce preventable death. TCCC teaches first responders to treat casualties in the proper order, treating the most critical situations first. This is accomplished by using the MARCH algorithm for easy memorization for seasoned medical providers as well as immediate responders using self-aid and buddy aid. There are many variations of the MARCH algorithm that adds tasks both before and after, but the base to prevent most preventable death is MARCH.

The MARCH algorithm is laid out differently from Advanced Trauma Life Support (ATLS) which used Airway, Breathing, and Circulation (ABC’s) as the order of treatment. MARCH stands for Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head injury. This order prioritizes bleeding control as the first step since morbidity and mortality linked to massive hemorrhage can happen in some cases twice as fast compared to airway and breathing complications.  

What is Massive Hemorrhage?

Massive hemorrhage is the number one potentially survivable cause of death at the POI. This includes life threatening bleeding from a compressible wound and/or extremity injuries. More than 90 percent of 4,596 combat deaths after September 11, 2001 were a result of hemorrhage-associated injuries. There are many opinions and definitions of what should be considered massive hemorrhage. They include color of the blood and rate of loss but most of these are hard to qualify and quantify under the stress of the scenario combined in some cases with the operational environment and tactical context. There is always a focus of bright red bleeding vs dark red and while one is more important that the other, they both should be addressed immediately. Additionally, penetrating trauma is not selective and commonly injures both arteries and veins which present externally as a mix of bright red and dark red blood.  The nature of serious bleeding leaves little time to consult the paint chart obtained from the local hardware store to compare colors and develop an appropriate treatment plan. Apply pressure! Pressure stops all bleeding.

Massive Hemorrhage in the Extremities

The hasty application of a tourniquet is the recommended management for all life-threatening extremity hemorrhage during the care under fire (CUF) phase. It should be placed immediately over clothing, if necessary, proximal to the wound and high and tight. During the tactical field care phase, the deliberate application of a tourniquet is addressed when the threat has been suppressed and/or aid is being rendered behind cover to ensure proper hemorrhage control. In this phase, the tourniquet is placed against the skin, 2 to 3 inches above the wound. In either scenario the application time is written on the tourniquet at some point before the patient is evacuated or handoff is performed. Additionally, if one tourniquet is not able to control the bleeding, a second tourniquet can be placed adjacent to the first to obtain occlusion. Splinting and immobilizing the extremity after a tourniquet and pressure dressing have been applied will assist with hemostasis but should only be done after all life threats have been addressed using the MARCH algorithm and other associated treatment protocols.

External Compressible Hemorrhage

Bleeding that is not amenable to limb tourniquet use should be treated first using direct pressure in the TFC Phase until a hemostatic dressing can be applied to pack the wound. Once the bleeding is controlled, pressure should be maintained according to the manufacturer’s recommendation using manual compression, pressure dressings, or other commercially available devices.

Tools to Stop Massive Bleeding

TacMed™ Solutions offers a variety of products built to help stop the bleed including the SOF® Tourniquet, OLAES® Hemostatic Bandage, OLAES® Modular Bandage, BLAST® Bandage, ChitoGauze®, Combat Gauze, and more. Two prominent products are the SOF® Tourniquet and the OLAES® Hemostatic Bandage. The SOF® Tourniquet sets the benchmark for prehospital tourniquets with purposeful upgrades to allow for smoother and faster one-handed and two-handed applications for the most effective bleeding control. The OLAES® Hemostatic Bandage is the world’s most versatile trauma bandage by combining the globally recognized OLAES® Modular Bandage with battle tested HemCon® ChitoGauze® PRO to create the most comprehensive trauma bandage for multiple injury profiles.

Stock Your Kit to Prepare for Uncontrolled Bleeding

To stock your kit with essential tools to stop massive hemorrhaging, check out TacMed™ Solutions at tacmedsolutions.com.

Tactical Medical Solutions™ got it’s start by creating the original SOF® Tourniquet in 2003 and has created components and custom kits to meet customer specifications and mission needs ever since. With a primary focus on military and law enforcement applications, we have created custom kits for not only them, but also consumer organizations and small businesses in many other cross-over markets from the outdoor and overland markets to concealed carry and arborist communities.

TacMed Solutions holds an ISO 13485 certification and can provide medical devices and related services that consistently meet customer and applicable regulatory requirements. Our capabilities range from support in selecting products specific to your mission needs, designing your brand’s printed labels and packaging, creating custom nylon solutions, and more.

SwitchBack Outdoor Safety took advantage of the customization capabilities of TacMed™ Solutions. Aaron Paris, owner of SwitchBack Outdoor Safety, reached out wanting to build out custom emergency trauma kits for his company. His company aims to provide education and equipment for those who desire to take the road less traveled, so we were able to aid in customizing two medical kits that helped align with his goal.

“I really like working with TacMed because of the ease of being able to make kits adjustable to our needs and our customer’s needs,” Aaron said. Our partnership with SwitchBack Outdoor Safety, a key leader in the overlanding and off-road community, led to the creation of the SOS Trauma Kit and the SOS First Aid Kit and refill packs for each. “I have worked with other companies in this space and though they gave a custom kit, the attention to detail just wasn’t there and there was a lack of willingness to be as modular. For us, this was a 180 in some ways and it gave it a much more professional appearance.”

Solutions are part of our culture, not just part of the name.

To learn more about our capabilities in creating a custom kit for your specific needs, check out: tacmedsolutions.com/pages/customizations

To learn more about SwitchBack Outdoor Safety, check out: www.switchbacksafety.com/product-category/first-aid