The MARCH Approach: Find & Treat
In high-stress trauma situations, having a clear, effective assessment framework can make all the difference. While most first responders are familiar with the DRSABCDE framework, here at TacMed, we don't believe this is always ideal for trauma scenarios. Enter the MARCH primary survey - a superior alternative that combines assessment and treatment in a practical "treat as you find" approach.
Why MARCH Over Traditional Frameworks?
The MARCH primary survey prioritises life-threatening issues in order of urgency, starting with massive haemorrhage before airway management. As you probably know by now, team TacMed is big on bleeding control, and this framework supports our view that stopping major haemorrhage must be the first priority in trauma care. After all, without blood, having a clear airway becomes irrelevant.Â
Breaking Down MARCH
M - Massive Haemorrhage
- First priority: Control life-threatening bleeding
- Focus on "oh shit" bleeding - neck, armpits, groin, extremities
- Treat immediately with direct pressure, tourniquets, wound packing and and haemostatic agents
- Recommended gear: CAT tourniquet, SOF tourniquet, Quikclot Combat Gauze, Emergency Bandage, OLAES Modular Trauma Bandage and SAM Junctional Tourniquets for groin or axilla wounds.
A - Airway
- Assess for actual or potential obstructions
- Listen for wheezing, stridor, hoarse voice
- For unconscious patients: perform a thorough assessment and appropriate interventions.
- Recommended gear: Nasopharyngeal airways, Pocket BVM, Guedel Airway Kit, Tactical Suction Device, and TacMed Oxygen Delivery Kit.
R - Respiration
- Check breathing presence and adequacy
- Expose the chest - look, listen, feel
- Assess for tension pneumothorax, rib fractures, flail segments
- Apply chest seals, needle decompression as needed
- Recommended gear: HyFin Chest Seals, ARS needle decompression kits, Halo Chest Seals, and i-Gel Supraglottic Airway
C - Circulation
- Reassess bleeding interventions
- Fully expose and properly dress wounds
- Control non-life-threatening bleeding
- Assess the abdomen and pelvis for injuries
- Take baseline vital signs
- Start IVs, manage pain, splint fractures and treat burns
- Recommended gear: SAM pelvic binders, Slishman Traction Splint, SAM Splint, Triangular Bandages, Wound Dressings, Stethoscope, Finger Pulse Oximeter.
H - Head Injury/Hypothermia
- Assess for head trauma - pupils, GCS, mental status
- Prevent hypoxia and hypotension (maintain BP >90-100mmHg)
- Avoid hyperventilation
- Actively prevent hypothermia - remove wet clothing, use warming techniques
- Remember: Trauma patients below 34°C have ~60% mortality
- Recommended gear: Slishman Pressure Wrap, Conforming Bandage, and Thermal Emergency Blanket for preventing heat loss.
SMARCH Variation
A useful variation is SMARCH, where the 'S' stands for Scene Security/Safety - reminding us to maintain situational awareness throughout the assessment. If you want to learn more about this topic, check out our dedicated blog [ Situational Awareness ]
Key Takeaways
The MARCH framework isn't necessarily a linear process. The systematic approach will ensure you don't miss any critical injuries from point of injury to hospital handover, however it's important to remember to continuously reassess your interventions and patient status along the way.
As always, we appreciate all of you who are sharing our content with your colleagues, friends, and family. By raising awareness and being emergency prepared, we can all make a difference, when it matters most – saving lives and preventing tragedy.
Need advice on selecting the right trauma first aid gear or kits for your role? Reach out to us via phone 1300-862-633 or email info@tacmedaustralia.com.au and stay in touch on socials @tacmedaustralia.
Stay Safe,
Team TacMed