Rather than typical "ABC" approach to trauma assessment, TCCC prioritizes massive hemorrhage
MARCH acronym is used to prioritize treatment:
M - Massive hemorrhage
Emphasize early recognition of significant bleeding. Apply limb tourniquets high, tight, and early. For junctional injuries, utilize direct pressure or hemostatic agents while waiting for OR.
A - Airway
Consider triage given limited management resources. May require surgical airway if significant facial or oropharyngeal injuries are present.
R - Respiration
Recognize and manage pneumothoraces with needle or chest tube thoracostomy. Consider chest seals for chest cavity wounds.
C - Circulation
Reevaluate for peripheral pulses, tourniquets that need to be replaced, and hemorrhage management deferred during "M." Consider eFAST exam.
H - Head/Hypothermia
Evaluate for head injury, including mental status and GCS. Treat hypothermia.
M - Massive hemorrhage
Emphasize early recognition of significant bleeding. Apply limb tourniquets high, tight, and early. For junctional injuries, utilize direct pressure or hemostatic agents while waiting for OR.
A - Airway
Consider triage given limited management resources. May require surgical airway if significant facial or oropharyngeal injuries are present.
R - Respiration
Recognize and manage pneumothoraces with needle or chest tube thoracostomy. Consider chest seals for chest cavity wounds.
C - Circulation
Reevaluate for peripheral pulses, tourniquets that need to be replaced, and hemorrhage management deferred during "M." Consider eFAST exam.
H - Head/Hypothermia
Evaluate for head injury, including mental status and GCS. Treat hypothermia.
Emphasize early recognition of significant bleeding. Apply limb tourniquets high, tight, and early. For junctional injuries, utilize direct pressure or hemostatic agents while waiting for OR.
Consider triage given limited management resources. May require surgical airway if significant facial or oropharyngeal injuries are present.
Recognize and manage pneumothoraces with needle or chest tube thoracostomy. Consider chest seals for chest cavity wounds.
Reevaluate for peripheral pulses, tourniquets that need to be replaced, and hemorrhage management deferred during "M." Consider eFAST exam.
Evaluate for head injury, including mental status and GCS. Treat hypothermia.
Tactical combat casualty care
Mass casualty incident triage
Prisoners of war
Commercial in-flight medical emergencies
Sign out tools
Los Angeles Community Resources For Patients
Tactical field care
Critical care documentation