The M.A.R.C.H. algorithm is laid out differently from Advanced Trauma Life Support (ATLS) which uses Airway, Breathing, and Circulation (ABC) as the order of treatment to instead use Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head Injury for prioritizing lifesaving treatments. Among these critical steps, hypothermia is included in the algorithm’s final phase of care.

Despite advancements in trauma care over the past three decades, trauma remains among the leading causes of death. In penetrating trauma, what you cannot see occurring is the lethal diamond of hypothermia, hypocalcemia, acidosis, and coagulopathy. The lethal diamond is recognized as a significant cause of death in patients with traumatic injuries. Thus, failing to stop any one of the diamond’s complicating factors leads to worsening hemorrhage and eventual death.

If a patient has lost blood, they have lost body heat meaning you are fighting an uphill battle to intervene. If you are not preventing hypothermia, then you are not properly treating your patient. So, what should you do?

According to TCCC Guidelines, these are the steps that you should take:

1. Take early and aggressive steps to prevent further body heat loss and add external heat, when possible, for both trauma and severely burned casualties.

2. Minimize casualty’s exposure to cold ground, wind, and air temperatures. Place insulation material between the casualty and any cold surface as soon as possible. Keep protective gear on or with the casualty if feasible.

3. Replace wet clothing with dry clothing, if possible, and protect from further heat loss.

4. Place an active heating blanket on the casualty’s anterior torso and under the arms in the axillae (to prevent burns, do not place any active heating source directly on the skin or wrap around the torso).

5. Enclose the casualty with the exterior impermeable enclosure bag.

6. As soon as possible, upgrade hypothermia enclosure system to a well-insulated enclosure system using a hooded sleeping bag or other readily available insulation inside the enclosure bag/external vapor barrier shell.

7. Pre-stage an insulated hypothermia enclosure system with external active heating for transition from the non-insulated hypothermia enclosure systems; seek to improve upon existing enclosure system when possible.

8. Use a battery-powered warming device to deliver IV/IO resuscitation fluids, in accordance with current CoTCCC guidelines, at flow rate up to 150 ml/min with a 38°C output temperature.

9. Protect the casualty from exposure to wind and precipitation on any evacuation platform.

These recommendations are from the TCCC Guidelines which can be found at: www.deployedmedicine.com/content/40

Tools to Aid in Hypothermia

TacMed Solutions™ offers a variety of products built to assist preventing and treating hypothermia including the HELIOS® System, Emergency Bivvy, and more. To stock your kit with these essential tools, check out TacMed Solutions™ at tacmedsolutions.com/collections/m-a-r-c-h-tccc/hypothermia.

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.