What Every First Responder Should Know About the MARCH Algorithm

During critical situations, the MARCH algorithm can make a significant difference by ensuring that every second is utilized effectively. We are here to break down this critical assessment tool used in tactical environments and increasingly adopted in civilian EMS.

What is the MARCH Algorithm?

The MARCH algorithm stands for:

• Massive hemorrhage
• Airway
• Respiration
• Circulation
• Hypothermia/Head injury

This systematic approach prioritizes life-threatening conditions, ensuring efficient and effective patient care.

Why Use the MARCH Algorithm?

In tactical situations, our primary concern is neutralizing threats to ensure the safety of both responders and patients. However, the principles of MARCH are adaptable to various environments, including EMS. Here’s how it works:

1. Massive Hemorrhage (M)

• Primary Focus: Address life-threatening bleeding immediately.
• Tactical Environment: Neutralize the threat before addressing the injury.
• Civilian EMS: Move the patient out of immediate danger (e.g., traffic, fire).
• Self-Aid: If the patient can, encourage self-application of a tourniquet. In mass casualty situations, provide a kit for self-aid.
• Assessment: Perform a blood sweep to identify bleeding sites, especially where the patient may not be aware of multiple wounds.

Procedure:

• Undo quick release buckles on armor.
• Check for blood on hands after running them over the body, focusing on extremities, neck, and torso.
• Apply a tourniquet for extremity bleeds and pack junctional wounds (neck, armpit, groin) with quick clot gauze.

2. Airway (A)

• Objective: Ensure a clear airway from the nose and mouth to the lungs.
• Unresponsive Patients: Roll them into the recovery position to allow fluid drainage.
• Responsive Patients: Maintain airway position; consider a nasopharyngeal airway for unresponsive patients without fluid obstruction.

Procedure:

• Roll unresponsive patients onto their side.
• Insert a nasopharyngeal airway to maintain airway patency.

3. Respiration (R)

• Focus: Confirm the patient is breathing adequately.
• Stimulation: Open the airway or apply painful stimuli to initiate breathing.
• Rescue Breaths: Use a bag valve mask for rescue breathing if necessary.

Additional Measures:

• Apply chest seals for sucking chest wounds to ensure lung expansion.
• Perform needle decompression for tension pneumothorax to relieve pressure on vital organs and improve hemodynamics.

4. Circulation (C)

• Goal: Ensure adequate blood flow and address internal bleeding.
• Interventions: Start IV or IO lines for fluid resuscitation, apply pelvic binders for suspected pelvic injuries, and initiate blood product infusions if available.

Procedure:

• Insert IV or IO for fluid administration.
• Apply a pelvic binder to stabilize suspected pelvic fractures.
• Begin blood product infusions if the patient is experiencing significant blood loss.

5. Hypothermia/Head Injury (H)

• Hypothermia Prevention: Maintain patient warmth to aid clotting and prevent hypothermia, even on hot days.
• Head Injury Management: Assess for head trauma and consider C-spine precautions if necessary.

Procedure:

• Use thermal insulators like space blankets.
• In heated vehicles, crank up the heat to prevent hypothermia.
• Reassess for head injuries and apply appropriate interventions.

6. Extrication (E)

• Evacuation Plan: Develop a strategy to move the patient to definitive care.
• Considerations: Use devices like mega movers or armored vehicles in tactical situations.

Procedure:

• Plan and execute the evacuation of the patient to a hospital or another medic in a war zone.

The MARCH algorithm is a comprehensive and adaptable approach to emergency care, prioritizing immediate life threats and ensuring systematic patient assessment and intervention. By mastering this algorithm, responders can enhance patient outcomes in both tactical and civilian settings.

If you have any questions about the MARCH algorithm, leave them in the comments below.