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MARCH Acronym 

Massive hemorrhage, Airway, Respirations, Circulation, and Hypothermia or Head trauma (MARCH) is the acronym taken from the Tactical Combat Casualty Care (TCCC) Handbook. TCCC was created by the Committee on Tactical Combat Casualty Care, a committee within the US government. Since TCCC training has been implemented, a broader range of skills can used by lay-persons, in dangerous areas to save more lives. 

Each first aid kit for civilians should include the following: x4 tourniquets, x2 thermal blankets, 2-4 military hand warmers, x2 pairs of surgical gloves, x2 combat gauze (hemostatic agent), x2 Kerlix bandage, x1 permanent marker, x2 elastic ACE bandage, x1 surgical tape, x4 chest seals, x1 medical scissors (for cutting clothes). 

Cost break-down:

Item	Cost
Tourniquet	$31.58 per tourniquet
Thermal blanket	$2.25 per blanket
Hand warmers	$18.00 per box (40 count)
Gloves	$6.47 per box
Combat gauze	$15.98 (two count)
Kerlix bandage	$8.95 per pack (12 count)
Permanent marker	$1.99 per pack (4 count)
ACE elastic bandage	$9.99 per pack (6 count)
Surgical tape	$13.24 per carton (12 count)
Chest seal	$17.60 (2 count)
Trauma shears	$15.95 (2 count)
IFAK bag	$14.99

Estimated total cost per first-aid kit: $220.59

Components of MARCH

MASSIVE (EXTERNAL) BLEEDING 

Refer to Training Videos Here: 

Applying a Tourniquet: https://youtu.be/r9qVan-1Gog?si=ZxP-CQhbgN9zcrb5

Packing a Wound: https://youtu.be/weUahV0iIJ4?si=zVRohvQyVaqhwV3v

The goal is to stop external (arterial) bleeding with the use of a tourniquet or with combat gauze. 

1. Place a tourniquet over the clothes, high and tight. Tighten the tourniquet until bleeding stops. If bleeding doesn’t stop, apply a second tourniquet side-by-side to the first. 
2. If tourniquet is not applicable: Pack the wound with hemostatic gauze. Apply 3 minutes of direct pressure. If wound is still bleeding, take out gauze and repack with new hemostatic gauze. Hold direct pressure again for 3 minutes.

AIRWAY 

Refer to Training Videos Here:

Recovery Position: https://youtu.be/TRQePNmR66w?si=LOAMl_KwUbNFfAYi

The goal is to make sure nothing is obstructing the patient’s airway 

1. If patient is talking and breathing normally, airway is open. Place patient in any position that protects the airway.
2. If patient is unconscious: Place patient in the recovery position (above).
3. Frequently reassess patient’s airway for changes 

RESPIRATIONS

The goal is to ensure adequate and functional respirations 

1. If a chest wound is present: exposure the area, wipe the area dry, and apply a vented chest seal to the wound.
   1. Log roll the patient (place the patient on their side) and check for an exit wound (in back and armpits). If present, place another chest seal over the exit wound 

CIRCULATION

Reassess the tourniquet application and reapply if necessary. 

1. Reassess if tourniquet is necessary. Expose the area of the wound and remove the tourniquet – if arterial bleeding is present, reapply tourniquet.
   • If a tourniquet is still needed, reapply the tourniquet under the clothes, approximately 2-3 inches above the wound (and not on a joint).
   • Note tourniquet reapplication, and/or removal time 
2. If bleeding continues:
   1. Tighten the tourniquet until bleeding stops or apply a second tourniquet side-by-side to the first until bleeding stops 

HYPOTHERMIA

Minimize heat loss due to trauma and burn patients 

1. Minimize contact with cold surface and outside temperatures 
2. Remove any wet clothing and replace it with dry clothing when possible 
3. Apply a blanket to the patient’s torso, under the arms, and up into the armpits. 
4. If available, close the patient in an enclosure bag (such as a sleeping bag). If not available, place an emergency blanket over the patient 
5. Keeping the patient warm should happen as quickly as possible!

HEAD INJURY 

Assess for a potential head injury and reassess the patient as necessary. 

1. Monitor patient as necessary and wait for help to arrive. 

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