A MARCH assessment is a framework for prioritized trauma care. Each letter in the mnemonic illustrates what should be addressed in the initial care of a trauma patient, in order of importance.
Here is a breakdown of what the mnemonic MARCH stands for:
MASSIVE BLEEDING (or massive hemorrhaging)
Bleeding control is the first thing to remember when approaching any subject who has suffered a traumatic injury. A patient can die from a massive bleed faster than anything else, which is why it’s the first thing to address on the MARCH framework for prioritized trauma care. Look for spurting (arterial) or pooling (venous) blood. Always conduct a blood sweep to ensure no bleeding has been overlooked.
To know what a blood sweep is, click here.
If the patient is bleeding and direct pressure doesn’t correct the issue, it will be necessary to apply a tourniquet. Always apply the tourniquet “high and tight”, which means you apply the tourniquet as high on the affected limb as possible (the rationale being that the bleeding you see might not be the only bleeding occurring). Always document the time the tourniquet was applied and put a “T” on the patient’s forehead (either with a marker or with the patient’s blood) to indicate to oncoming healthcare professionals that there is a tourniquet on the patient that needs to be addressed.
For more information about Stop the Bleed, click here.
Much like a massive bleed, a patient’s inability to breathe will also kill them quickly if not addressed. Perform the Heimlich and give the patient CPR if needed to clear the airway and restore breathing.
To learn how to perform the Heimlich, click here.
To find a class that teaches CPR, click here.
It is critical to address the reason a patient is struggling to breathe. Their airway might be patent, but if they aren’t getting enough oxygen this can lead to more problems. If the patient is depending on their accessory muscles too much to breathe, this can wear them out and their chances of survival drop.
Before we move on to “C” and “H”, it’s important to understand what shock is. Shock is a critical condition that occurs when there’s a sharp decrease in blood flow to the vital organs; those organs don’t get the oxygen they need to resume their normal function, and so they shut down. The final two steps on the MARCH framework address the very real probability that the subject could go into shock as a result of their situation and attempt to prevent that as much as possible.
Optimizing your patient’s circulation is critical, especially if they could potentially go into shock. Lay them flat, maintain their body temperature, and give them fluids as needed.
Hypothermia is a silent killer. If the body’s internal temperature drops too much, it can directly affect the blood’s ability to clot. As the patient continues to bleed out, they go further into shock, worsening their acidosis, which slows their metabolism and the body temperature continues to fall. The patient can go into shock quickly so alleviating as many contributing factors as possible is crucial.
Head injuries are important to address because they can cause the patient to go downhill fast. Constantly assess the mental state of a patient and document any changes (and the time of any changes) to relay to oncoming healthcare professionals.
To see how to assess a patient’s orientation, click here.
How to assess a patient's level of consciousness, click here.
The framework of the MARCH mnemonic is the most critical piece of your education as a first responder. Once you work through the framework and stabilize the patient, start right back at the beginning and reassess. Then reassess again until help arrives.