MARCH
đź“– 15 min read âś“ Updated 2026-01-03

MARCH Fundamentals

The priority-based approach to tactical casualty assessment and treatment

The MARCH Algorithm

MARCH is your systematic approach to casualty assessment and treatment during Tactical Field Care. Each letter represents a category of injury, arranged in order of lethality.

Critical Concept: MARCH is ordered by what kills fastest. Massive hemorrhage can kill in minutes. Hypothermia takes hours. Treat in order.

The letters stand for:

  • M — Massive Hemorrhage
  • A — Airway
  • R — Respiration
  • C — Circulation
  • H — Hypothermia / Head Injury

Let’s break down each component.

M — Massive Hemorrhage

The #1 preventable cause of death on the battlefield.

Massive hemorrhage means life-threatening bleeding that will kill the casualty if not controlled immediately. Your first task is always to identify and stop this bleeding.

Assessment

  • Look for blood pooling, soaked clothing, spurting blood
  • Arterial bleeding: bright red, pulsatile
  • Extremity wounds are the primary target for tourniquets

Treatment

For extremity hemorrhage:

  1. Apply tourniquet HIGH and TIGHT — as proximal as possible on the limb
  2. Tighten until bleeding stops
  3. Note the time
  4. If bleeding continues, apply a second tourniquet side-by-side

For junctional hemorrhage (groin, axilla, neck):

  1. Wound packing with hemostatic gauze
  2. Direct pressure for minimum 3 minutes
  3. Pressure dressing to hold

Tourniquet Myth: “Tourniquets cause limb loss.” Reality: Modern TQs are safe for hours. Untreated hemorrhage causes death in minutes. The limb is already lost if the casualty dies.

A — Airway

Ensure the casualty can breathe.

An obstructed airway kills, but it kills slower than massive hemorrhage — that’s why it’s second.

Assessment

  • Is the casualty conscious and talking? Airway is likely clear.
  • Listen for gurgling, snoring, stridor
  • Look for obvious obstruction (blood, debris, tongue)

Treatment

For unconscious casualties:

  1. Head-tilt/chin-lift or jaw thrust
  2. Recovery position if no spinal injury suspected
  3. Insert nasopharyngeal airway (NPA) if available

For conscious casualties with obstruction:

  1. Allow them to assume a position of comfort
  2. Suction if available
  3. Consider NPA if they’re struggling

When NOT to Intervene

If the casualty is talking normally, don’t force interventions. Monitor and move on.

R — Respiration

Assess and treat breathing problems.

Even with a clear airway, the casualty may not be breathing effectively. Look for chest injuries.

Assessment

  • Expose the chest
  • Look for wounds, asymmetry, paradoxical movement
  • Listen for breath sounds (if possible)
  • Feel for tracheal deviation, crepitus

Key Injuries to Recognize

Tension Pneumothorax:

  • Increasing respiratory distress
  • Tracheal deviation (late sign)
  • Absent breath sounds on one side
  • Treatment: Needle decompression

Open Pneumothorax (Sucking Chest Wound):

  • Wound that bubbles or hisses
  • Treatment: Vented chest seal (or improvised three-sided seal)

Massive Hemothorax:

  • Shock + decreased breath sounds
  • Treatment: Chest seal + treat for shock + expedite evacuation

Treatment

  1. Seal all chest wounds with chest seals (vented preferred)
  2. Needle decompression for suspected tension pneumothorax
  3. Position for comfort if conscious
  4. Monitor closely — chest injuries can deteriorate rapidly

C — Circulation

Assess and treat for shock.

By this point, you’ve stopped the bleeding. Now assess if the casualty is already in shock from blood loss.

Assessment

  • Mental status: confused, anxious, unresponsive?
  • Pulse: rapid, weak, thready?
  • Skin: pale, cool, clammy?

Treatment

If shock is present:

  1. Ensure hemorrhage is controlled (reassess tourniquets)
  2. IV/IO access if trained and equipped
  3. TXA within 3 hours of injury (if available)
  4. Fluid resuscitation per protocol
  5. Elevate legs if no contraindications

Permissive Hypotension: In tactical settings, aggressive fluid resuscitation can worsen bleeding. Target a palpable radial pulse rather than “normal” blood pressure unless head injury is present.

H — Hypothermia / Head Injury

Prevent heat loss and assess for TBI.

Hypothermia is the “silent killer” in trauma. Even in warm environments, a bleeding casualty loses body heat rapidly.

Hypothermia Prevention

  1. Remove wet clothing
  2. Place insulation above and below (casualty wrap, blankets)
  3. Cover the head
  4. Consider active warming if available
  5. Minimize exposure time during assessment

Head Injury Assessment

  • Assess level of consciousness (AVPU or GCS)
  • Check pupils for size, equality, reactivity
  • Document baseline and monitor for changes
  • Head injury changes your shock management (maintain normal blood pressure)

Putting It Together

MARCH is meant to be executed rapidly but systematically. A practiced responder can complete a full MARCH assessment in 60-90 seconds.

The MARCH Mantra

  1. Stop the bleeding (M)
  2. Open the airway (A)
  3. Fix the breathing (R)
  4. Treat the shock (C)
  5. Prevent the freeze (H)

When to Reassess

  • After any intervention
  • Every 5-10 minutes
  • Any time the casualty’s condition changes
  • Before and after movement
MARCH card