EMS News - AHA 2025 Guideline Updates

The American Heart Association (AHA) has released its 2025 updates to the Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) guidelines, introducing several important changes for both healthcare professionals and everyday responders. 

These evidence-based guidelines outline best practices that improve survival from cardiac arrest and other life-threatening cardiovascular emergencies.

A Quick Note for EMS Providers

These updates aim to streamline care, reduce variability in the field, and improve the chain of survival across diverse patient populations. 

Many of the changes emphasize consistency, simplified decision-making, and the continued integration of lay rescuers into time-critical care. 

At the same time, these updates are written to be accessible to the general public, who play a vital role in early recognition and CPR.

The 2025 release builds on the 2020 guidelines, refining previous recommendations and adding new guidance in areas that had not been previously addressed. 

Image from Circulation - AHA / ASA Journals

Below is a summary of several take-home messages and key updates that EMS Providers - and the public - should be aware of:

• Unified Chain of Survival: A single model now applies to all cardiac arrests, regardless of patient age or location, providing a consistent framework for recognizing emergencies and delivering timely interventions.

• Systems of Care: Greater focus on community preparedness, telecommunicator CPR (e.g., 911 Dispatchers), early warning systems, and health equity. 

• Remain in Place: It is recommended that resuscitation should be conducted where the patient is found, as long as high-quality cardiopulmonary resuscitation (CPR) can be administered safely and effectively.

• Position and Location of CPR: Quality chest compressions are improved by optimizing the rescuer’s hand placement, body mechanics (i.e., posture), and the patient’s position. When possible, CPR should be performed on a firm surface to maximize compression effectiveness. 

• Bariatric Patients: CPR for adult cardiac arrest patients with obesity should be provided by using the same techniques as for the average weight patient.

• Pediatric CPR: The two-thumb encircled or one-hand compression techniques are favored on the the two-finger method.

• Mechanical CPR: The routine use of mechanical CPR devices is not recommended for adults in cardiac arrest. However, mCPR may be considered in specific settings where the delivery of high-quality manual compressions may be challenging or dangerous.

• Assisted Ventilations: It is still considered reasonable for both professional rescuers and lay responders to give breaths - when they are willing and able to do so with an appropriate barrier device - to improve oxygenation during cardiopulmonary resuscitation at a ratio. of 30:2 for adults.

• Choking Response: the updated sequence begins with 5 back blows, followed by 5 abdominal thrusts for all patients (e.g., adults & pediatrics), and continuing to alternate until the object is removed or the person becomes unresponsive.

• Opioid Overdose Response: The guidelines reinforce the importance of rapid naloxone administration and recommends supporting public access to opioid emergency response kits. The BLS algorithm explicitly shows where naloxone fits for suspected opioid overdose during respiratory and cardiac arrest.

Additional updates covering resuscitation education, systems of care, and post-cardiac arrest management are provided in the Highlights of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Image from Circulation - AHA / ASA Journals

Why These Changes Matter

Cardiac arrest remains a leading cause of sudden death. Even small improvements in CPR technique or response consistency can dramatically impact survival. The 2025 updates aim to:

• Improve clarity during high-stress emergencies
• Increase bystander willingness to act
• Standardize care across EMS, hospitals, and the community
• Enhance oxygenation and compression effectiveness
• Support faster opioid overdose interventions

For EMS providers, these recommendations reinforce strong fundamentals, situational awareness, and the life-saving importance of early naloxone access.

What You Can Do Next

Whether you are an EMS professional or a member of the public, you play a vital role in improving survival from cardiac arrest. Here are a few ways to stay prepared:

• Review the full AHA 2025 guideline highlights
• Refresh your CPR, AED, or First Aid training
• Make sure your workplace or community organization has access to naloxone and CPR equipment
• Share these updates with colleagues, friends, or family

Understanding MARCH - Preventing Hypothermia & Managing Head Injuries

From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers

Preserve and Protect After Stabilization

The final step in the MARCH sequence - Hypothermia & Head Injury - focuses on two conditions that can rapidly worsen outcomes if not addressed early. 

After bleeding is controlled, the airway secured, respiration managed, and circulation assessed, providers must work to preserve core body temperature and protect neurological function.

Uncontrolled heat loss accelerates shock, impairs clotting, and undermines every prior intervention. Likewise, traumatic brain injury can progress quickly without vigilant monitoring and early management. 

Protecting a patient from heat loss and preserving the brain is essential for preventing secondary injury and supporting long-term survival and neurological recovery.

Image retrieved from tccc.org.ua

H – Hypothermia

Trauma-induced hypothermia is a major contributor to mortality in both military and civilian trauma.

Even in warm climates, a patient can quickly lose body heat through evaporation, convection, and exposure.

Hypothermia worsens the “lethal triad” of trauma - acidosis, coagulopathy & hypothermia - impairing clotting and promoting continued bleeding.

Image retrieved from tccc.org.ua

Recognition of Hypothermia

Look for early indicators, especially when there is significant blood loss or environmental exposure:

• Shivering or muscle tremors (may disappear as hypothermia worsens)
• Pale, cool, or mottled skin
• Slurred speech or confusion
• Slowed respirations or heart rate
• Core temperature below 95°F (35°C)

Environmental factors such as wind, wet clothing, cold ground, or prolonged evacuation time accelerate heat loss, even in mild weather.

Image retrieved from tccc.org.ua

Hypothermia Prevention and Management

• Remove wet clothing when tactically feasible and replace with dry layers.
• Insulate from the ground using a poncho, sleeping pad, or casualty blanket.
• Cover the casualty completely, including the head, to reduce radiant heat loss.
• Use hypothermia prevention kits (e.g., Blizzard Survival Blanket, Ready-Heat™ Active Warming Blanket) if available.
• Warm IV fluids or blood products when resources allow.
• Monitor core temperature if devices are available, especially in prolonged field care scenarios.

Image retrieved from tccc.org.ua

Key Point: Preventing heat loss is just as vital as stopping bleeding - once the casualty is cold, outcomes worsen rapidly.

Image retrieved from tccc.org.ua

H – Head Injury

The “H” in MARCH also stands for Head Injury, emphasizing early recognition and management of traumatic brain injury (TBI), a leading cause of preventable death and long-term disability in prehospital trauma.

Image retrieved from tccc.org.ua

Recognizing Head Trauma

Watch for the following signs and symptoms:

• Decreasing level of consciousness or responsiveness
• Unequal or dilated pupils
• Repetitive questioning, confusion, or agitation
• Persistent vomiting or seizures
• Irregular breathing patterns (Cheyne-Stokes or slow respirations)
• Obvious penetrating or blunt trauma to the skull or face

Image retrieved from tccc.org.ua

Management Principles

• Maintain airway and oxygenation. Keep SpO₂ > 90% and avoid hypoxia, which worsens secondary brain injury.
• Prevent hypotension. Maintain systolic BP ≥ 90 mmHg to ensure cerebral perfusion.
• Positioning: If spinal injury is not suspected, elevate the head 30° to promote venous drainage.
• Avoid hyperventilation unless there are signs of herniation (e.g., blown pupil, rapid deterioration).
• Control external bleeding with gentle pressure; do not compress depressed skull fractures or insert dressings into open cranial wounds.
• Monitor for changes in mental status using tools like AVPU or GCS if time and environment allow.

In the tactical environment: head injuries often coexist with blast or penetrating trauma. Managing hypoxia and hypotension early has been shown to double the odds of survival in severe TBI (Eastridge et al., 2012).

Image retrieved from tccc.org.ua

Key Takeaway for EMS and Tactical Providers

The 'H' in MARCH is about preservation and protection - maintaining the physiological stability of a casualty who has already survived the most immediate threats. 

Hypothermia prevention and head injury management require vigilance, insulation, and gentle handling. In tactical medicine, saving a life doesn’t end with hemorrhage control, it continues with keeping that life viable during evacuation.

In short: preserve the heat, protect the brain

Image retrieved from tccc.org.ua

Conclusion of the MARCH Series

The MARCH sequence - Massive Hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head Injury - originated in Tactical Combat Casualty Care and remains the foundation of modern field trauma management. 

This structured approach guides responders to address the most preventable causes of death in the order they matter most. In this series, each component of MARCH is explored in turn, offering practical guidance for EMS and tactical providers operating in dynamic, resource-limited environments. 

From controlling catastrophic bleeding to protecting core temperature and neurological function, the series outlines a clear, evidence-informed pathway for stabilizing trauma patients and improving survivability in the prehospital setting. 

Train Hard. Stay Prepared. Save Lives.

Further Reading:

American College of Surgeons Committee on Trauma. (2022) Advanced Trauma Life Support (10th Ed). Chicago, IL: American College of Surgeons.

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, MA: Pearson Education

Butler, F. K. (2017) Tactical Combat Casualty Care: Beginnings. Wilderness & Environmental Medicine 28 (2S): S12-S17. 

Retrieved from https://pubmed.ncbi.nlm.nih.gov/28284483/ on October 8, 2025

Butler, F. K., Bennett, B., & Wedmore, C. I. (2017) Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emergency Medicine Clinics of North America 35 (2): 391-407. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28411934/ on October 8, 2025

Committee on Tactical Combat Casualty Care (2023) Tactical Combat Casualty Care (TCCC) Guidelines for Medical Personnel. Defense Health Agency, Joint Trauma System. Retrieved from https://jts.health.mil on October 8. 2025

National Association of Emergency Medical Technicians NAEMT (2020) TECC: Tactical Emergency Casualty Care Course Book (2nd Ed). Burlington, MA: Jones & Bartlett Learning

National Association of Emergency Medical Technicians NAEMT (2023) Tactical Emergency Casualty Care (TECC) Guidelines. NAEMT Education Division

National Association of Emergency Medical Technicians NAEMT (2025) 

PHTLS: Prehospital Trauma Life Support, Military Edition eBook (10th Ed). Burlington, MA: Jones & Bartlett Learning

Understanding MARCH - The Role of Circulation

Image retrieved from tccc.org.ua

From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers

After addressing massive hemorrhage, airway, and respiration, the next priority is Circulation, the body’s ability to deliver oxygenated blood to vital organs and tissues.

In trauma, the circulatory system can be compromised by shock, internal bleeding, or poor perfusion, even when obvious external hemorrhage has already been controlled.

Within the tactical environment, circulation assessment focuses on recognition and management of shock, maintaining perfusion, and preventing secondary injury. The goal is to identify subtle but deadly deterioration before it progresses beyond recovery.

C – Circulation

In tactical casualty care, circulation assessment differs slightly from the traditional EMS approach. The emphasis is on speed, simplicity, and practicality in resource-limited or high-threat conditions.

Blood pressure cuffs and monitors may not be available, so providers rely on physical signs and simple indicators to evaluate perfusion. The presence of a radial pulse and normal mental status are key field markers of adequate circulation.

Principles of Circulatory Assessment and Management

1. Check for Pulse and Perfusion

• Radial Pulse: Presence suggests systolic blood pressure above roughly 80 mmHg, generally adequate for perfusion in tactical settings.

• Weak or Absent Pulse: May indicate hypovolemia or shock; assess for additional signs of poor perfusion such as pallor, clammy skin, or delayed capillary refill.

• Mental Status: A sudden change in consciousness (e.g., confusion, lethargy) is often an early sign of inadequate cerebral perfusion.

Remember: weak radial pulse + altered mental status = shock until proven otherwise.

Image retrieved from tccc.org.ua

2. Identify and Manage Non–Life-Threatening Bleeding

Once major bleeding has been controlled, systematically check for and address secondary bleeding sites that may have been overlooked during the initial MARCH sequence. 

Apply direct pressure, pressure dressings, or hemostatic agents as needed.

Image retrieved from tccc.org.ua

3. Treat for Shock

Shock - a state of inadequate tissue perfusion - can occur from blood loss (hypovolemic), cardiac injury, or tension pneumothorax.

In tactical medicine, hemorrhagic shock is the most common.

• Lay the casualty supine, if tactical conditions allow. 

• Keep the patient warm, hypothermia worsens coagulopathy and shock (addressed further in Part Five).

• Provide fluids only when indicated by TCCC or TECC guidelines

If in shock (weak/absent radial pulse or altered mental status):

• Administer whole blood if available; otherwise, 1:1:1 blood component therapy (plasma, platelets, red cells).

• If blood products are unavailable, give Hextend or Lactated Ringer’s solution, titrating only to restore a palpable radial pulse or improved mental status (per TCCC guidance).

If the casualty is not in shock and has a palpable radial pulse and normal mental status: no IV/IO fluids are indicated.

Avoid over-resuscitation, too much fluid can dislodge clots and worsen bleeding.

4. Establish IV/IO Access When Appropriate

In tactical field care, IV or intraosseous access is indicated for:

• Fluid resuscitation in shock
• Medication administration (e.g., analgesics, antibiotics, TXA).

If available, administer Tranexamic Acid (TXA) within three hours of injury for casualties at risk of significant hemorrhage. Early TXA administration has been shown to reduce mortality from bleeding.

5. Continuous Reassessment

Circulation is dynamic, especially in prolonged field care or delayed evacuation.

• Regularly recheck:
• Pulse quality and rate
• Mental status
• Skin color, temperature, and moisture
• Wound sites for renewed bleeding

Document all findings and interventions clearly for handoff to the next echelon of care.

Image retrieved from tccc.org.ua

Key Takeaway for EMS and Tactical Providers

Circulation management is about detecting shock early, maintaining perfusion, and preventing deterioration. 

In the tactical environment, sophisticated monitoring tools are often unavailable, but trained observation remains powerful. 

The provider’s mindset should be:

Feel for the pulse, read the patient, and keep the blood where it belongs.

Image retrieved from tccc.org.ua

Coming Up Next: Part Five – Hypothermia and Head Injury

The final step in the MARCH sequence focuses on protecting what you’ve fought to preserve, preventing hypothermia and managing head injuries to maintain survivability after initial stabilization.

In Part Five, we’ll discuss how temperature control, positioning, and neurologic assessment all play critical roles in keeping your casualty alive until evacuation and definitive care.

Because in tactical medicine, saving a life isn’t just about stopping the bleeding—it’s about keeping that life sustained.

Further Reading:

American College of Surgeons Committee on Trauma. (2022) Advanced Trauma Life Support (10th Ed). Chicago, IL: American College of Surgeons.

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, MA: Pearson Education

Butler, F. K. (2017) Tactical Combat Casualty Care: Beginnings. Wilderness & Environmental Medicine 28 (2S): S12-S17. 

Retrieved from https://pubmed.ncbi.nlm.nih.gov/28284483/ on October 8, 2025

Butler, F. K., Bennett, B., & Wedmore, C. I. (2017) Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emergency Medicine Clinics of North America 35 (2): 391-407. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28411934/ on October 8, 2025

Committee on Tactical Combat Casualty Care (2023) Tactical Combat Casualty Care (TCCC) Guidelines for Medical Personnel. Defense Health Agency, Joint Trauma System. Retrieved from https://jts.health.mil on October 8. 2025

National Association of Emergency Medical Technicians NAEMT (2020) TECC: Tactical Emergency Casualty Care Course Book (2nd Ed). Burlington, MA: Jones & Bartlett Learning

National Association of Emergency Medical Technicians NAEMT (2023) Tactical Emergency Casualty Care (TECC) Guidelines. NAEMT Education Division

National Association of Emergency Medical Technicians NAEMT (2025) 

PHTLS: Prehospital Trauma Life Support, Military Edition eBook (10th Ed). Burlington, MA: Jones & Bartlett Learning

Understanding MARCH - The Relevance of Respiratory Assessment

Image retrieved from tccc.org.ua

From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers

After controlling massive hemorrhage and ensuring a patent airway, the next priority in the MARCH sequence is Respiration. 

Effective breathing is critical for oxygen delivery and carbon dioxide removal. When trauma impairs the chest wall or lungs, hypoxia and shock can develop rapidly - even when the airway is clear.

In tactical or prehospital settings, respiratory compromise is often caused by thoracic injury, such as a gunshot, stab wound, or blast trauma. 

These injuries can lead to life-threatening conditions like tension pneumothorax or open chest wounds, both of which are preventable causes of death when identified and treated early.

This article - the third in a five-part series - will focus on that next critical step: 

R – Respiration

Respiration refers to the body’s ability to move air into and out of the lungs and to exchange gases at the alveolar level. 

Any disruption - mechanical, anatomical, or physiological - can cause hypoxia and threaten survival. 

The responder’s task is to rapidly assess, seal, decompress, and support breathing as needed.

Image retrieved from tccc.org.ua

Principles of Respiratory Management

1. Assess the Casualty’s Breathing

Begin by evaluating rate, depth, and effort of respirations. Look, listen, and feel for:

• Asymmetrical chest rise or movement

• Difficulty speaking, gasping, or labored breathing

• Cyanosis around lips or fingertips

• Tracheal deviation, jugular venous distention, or subcutaneous emphysema

• Penetrating trauma to the chest or upper abdomen

If you’re operating in a tactical environment, conduct this assessment as efficiently as safety allows—rapid but systematic.

2. Expose and Inspect for Chest Injuries

Visually inspect the anterior, lateral, and posterior thorax for entry and exit wounds, contusions, or deformities. In low-light or confined spaces, gloved hands may detect what the eyes can’t.

• Sucking chest wounds (open pneumothorax) occur when air enters the pleural space through a chest wall defect.

• These must be sealed immediately with a vented or occlusive chest seal to prevent the progression to tension pneumothorax.

Modern products like the HyFin® Vent Chest Seal or FoxSeal™ are designed for field reliability and are standard in most tactical trauma kits.

Image retrieved from tccc.org.ua

3. Manage a Tension Pneumothorax

A tension pneumothorax occurs when air becomes trapped in the pleural space and cannot escape, collapsing the lung and compressing the heart and great vessels.
Signs may include:

• Severe respiratory distress

• Decreased or absent breath sounds on one side

• Hypotension and tachycardia

• Tracheal deviation (a late sign)

Image retrieved from tccc.org.ua

Intervention:

If tension pneumothorax is suspected and equipment/training allow, perform needle decompression:

• Use a 14-gauge, 3.25-inch (8.25 cm) needle or catheter.

• Insert into the 5th intercostal space, anterior axillary line (or 2nd intercostal space, midclavicular line if indicated).

• Listen for escaping air and observe for improvement in breathing and perfusion.

Always reassess, if symptoms recur, repeat decompression or prepare for chest tube insertion at higher care levels.

Image retrieved from tccc.org.ua

4. Support Oxygenation and Ventilation

If available and appropriate, administer supplemental oxygen to maintain SpO₂ above 94%. 

For inadequate respirations, assist with bag-valve-mask (BVM) ventilation while maintaining airway alignment. In prolonged field care, consider monitoring SpO₂ and ETCO₂, if resources allow, to guide ongoing management.

5. Continue Monitoring and Reassessment

The chest is dynamic, bleeding, air leakage, or mechanical disruption can recur with movement or time. Reassess chest rise, breath sounds, and patient condition frequently during evacuation.

Key Takeaway for EMS and Tactical Providers

Thoracic trauma demands vigilance. While hemorrhage and airway compromise often draw attention first, unrecognized respiratory failure can kill just as quickly. The tactical provider must be proficient in identifying chest injuries, applying chest seals, and performing needle decompression when indicated.

In short: find the holes, seal the leaks, relieve the pressure, and keep the oxygen moving.

Coming Up Next: Part Four – Circulation

Once bleeding is controlled, the airway is secure, and breathing is restored, it’s time to assess circulation—the body’s ability to perfuse vital organs. 

In Part Four of our MARCH series, we’ll explore recognition and management of shock, fluid resuscitation strategies, and maintaining perfusion in both field and tactical environments.

Because after oxygen, the mission is to keep it flowing where it matters most.

Further Reading:

American College of Surgeons Committee on Trauma. (2022) Advanced Trauma Life Support (10th Ed). Chicago, IL: American College of Surgeons.

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, MA: Pearson Education

Butler, F. K. (2017) Tactical Combat Casualty Care: Beginnings. Wilderness & Environmental Medicine 28 (2S): S12-S17. 

Retrieved from https://pubmed.ncbi.nlm.nih.gov/28284483/ on October 8, 2025

Butler, F. K., Bennett, B., & Wedmore, C. I. (2017) Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emergency Medicine Clinics of North America 35 (2): 391-407. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28411934/ on October 8, 2025

Committee on Tactical Combat Casualty Care (2023) Tactical Combat Casualty Care (TCCC) Guidelines for Medical Personnel. Defense Health Agency, Joint Trauma System. Retrieved from https://jts.health.mil on October 8. 2025

National Association of Emergency Medical Technicians NAEMT (2020) TECC: Tactical Emergency Casualty Care Course Book (2nd Ed). Burlington, MA: Jones & Bartlett Learning

National Association of Emergency Medical Technicians NAEMT (2023) Tactical Emergency Casualty Care (TECC) Guidelines. NAEMT Education Division

National Association of Emergency Medical Technicians NAEMT (2025) PHTLS: Prehospital Trauma Life Support, Military Edition eBook (10th Ed). Burlington, MA: Jones & Bartlett Learning 

Understanding MARCH - The Importance of Airway Management

Image retrieved from tccc.org.ua

From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers

Following the control of massive hemorrhage, the next lifesaving priority in the MARCH algorithm is Airway. 

Without a patent airway, oxygen cannot reach the lungs, and death from hypoxia can occur within minutes. 

While exsanguination kills fastest, airway obstruction follows closely - especially in cases of head or neck trauma, decreased consciousness, or maxillofacial injury.

In tactical environments, airway management must be both rapid and situationally appropriate. Providers balance lifesaving intervention with operational safety - sometimes working under fire or in low-light, resource-limited conditions. 

This article - the second in a five-part series - will focus on that next critical step: 

A – Airway Management

A patent airway is one that is open and unobstructed, allowing air to move freely in and out of the lungs. Even a partial obstruction can reduce oxygen delivery and lead to hypoxia, brain injury, or cardiac arrest. 

According to the National Safety Council (2023), foreign-body airway obstruction remains the fourth leading cause of unintentional death in the United States - emphasizing the universal need for early recognition and decisive management.

Image retrieved from tccc.org.ua

Principles of Airway Management

1. Assess the Airway Early

Assessment begins with observing the casualty’s level of consciousness, respiratory effort, and ability to speak or make sounds. 

The simple question, “Can the patient talk?” remains one of the fastest airway assessments available. 

Look and listen for:

• Gurgling, snoring, or stridor
• Facial or neck trauma
• Blood, vomitus, or foreign bodies in the mouth
• Absent or inadequate respiratory effort

In tactical settings, assessment must be efficient and, if under threat, may need to wait until the situation is secure enough to act safely. 

Image retrieved from tccc.org.ua

2. Basic Airway Maneuvers

If the airway is obstructed or compromised, begin with manual positioning techniques:

- Head-Tilt/Chin-Lift: For non-trauma patients who are unconscious and without suspected spinal injury.

- Jaw-Thrust: For trauma patients or when spinal injury cannot be ruled out.

- Recovery Position: For semi-conscious patients who can maintain their own airway but may vomit.

These simple maneuvers are often enough to restore airway patency temporarily and can be performed quickly even under fire or during evacuation. 

Image retrieved from tccc.org.ua

3. Airway Adjuncts

When manual techniques are insufficient, adjunctive devices can maintain airway patency:

- Nasopharyngeal Airway (NPA): Preferred in tactical and field care. Well tolerated in conscious or semiconscious patients and effective even with facial injuries (unless contraindicated by basilar skull fracture).

- Oropharyngeal Airway (OPA): Used only in unconscious patients without a gag reflex. Easy to insert and effective when bag-valve-mask (BVM) ventilation is required.

Advanced airways (e.g., supraglottic devices, endotracheal intubation, or surgical cricothyrotomy) may be indicated in prolonged field care or when BVM ventilation fails, but such interventions should align with provider scope and environment. 

4. Clear and Control the Airway

If obstruction is caused by a foreign body, blood, or vomitus, clear it quickly:

- Perform the abdominal thrusts in conscious choking patients.

- Use suction, if available, to remove debris or fluids.

- If foreign-body airway obstruction persists in an unresponsive patient, begin CPR following standard resuscitation protocols.

In tactical contexts, effective airway control often means doing the basics well—not overcomplicating care but ensuring the airway remains open during extraction and evacuation. 

5. Ongoing Monitoring and Reassessment

Airway status can change rapidly. A casualty who was breathing adequately moments ago may deteriorate due to swelling, bleeding, or decreased consciousness. 

Reassess frequently- especially after movement or as the tactical situation changes. 

Key Takeaway for EMS and Tactical Providers

Airway management is the second priority in the MARCH sequence, but it’s equally vital to survival. The tactical provider’s goal is to establish and maintain a patent airway using the simplest effective method appropriate to the situation. 

In many cases, that means manual maneuvers and an NPA—reserving advanced interventions for when time, equipment, and safety allow.

In every case, the principle remains: “Keep it open, keep it simple, keep reassessing.” 

Coming Up Next: Part Three – Respiration

With bleeding controlled and the airway secured, attention turns to respiration—assessing and managing chest injuries that can silently compromise ventilation and oxygenation. 

Part Three of our MARCH series will explore the recognition and treatment of life-threatening thoracic trauma, including tension pneumothorax and open chest wounds.

When the airway is open but the chest can’t move air, the mission shifts to restoring the breath.

Further Reading:

American College of Surgeons Committee on Trauma. (2022) Advanced Trauma Life Support (10th Ed). Chicago, IL: American College of Surgeons.

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, MA: Pearson Education

Butler, F. K. (2017) Tactical Combat Casualty Care: Beginnings. Wilderness & Environmental Medicine 28 (2S): S12-S17. 

Retrieved from https://pubmed.ncbi.nlm.nih.gov/28284483/ on October 8, 2025

Butler, F. K., Bennett, B., & Wedmore, C. I. (2017) Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emergency Medicine Clinics of North America 35 (2): 391-407. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28411934/ on October 8, 2025

Committee on Tactical Combat Casualty Care (2023) Tactical Combat Casualty Care (TCCC) Guidelines for Medical Personnel. Defense Health Agency, Joint Trauma System. Retrieved from https://jts.health.mil on October 8. 2025

National Association of Emergency Medical Technicians NAEMT (2020) TECC: Tactical Emergency Casualty Care Course Book (2nd Ed). Burlington, MA: Jones & Bartlett Learning

National Association of Emergency Medical Technicians NAEMT (2023) Tactical Emergency Casualty Care (TECC) Guidelines. NAEMT Education Division

National Association of Emergency Medical Technicians NAEMT (2025) 

PHTLS: Prehospital Trauma Life Support, Military Edition eBook (10th Ed). Burlington, MA: Jones & Bartlett Learning 

National Safety Council. (2023) Injury Facts: Choking Statistics. Retrieved from https://injuryfacts.nsc.org on October 8, 2025