Understanding MARCH - A Tactical Approach to Massive Hemorrhage

Image retrieved from tccc.org.ua

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

In prehospital medicine, chaos is a constant. Whether in combat zones, tactical operations, or austere environments, responders need an effective method to prioritize lifesaving interventions. 

The MARCH mnemonic provides that structure. 

Used in Tactical Combat Casualty Care (TCCC) and increasingly adapted into Tactical Emergency Casualty Care (TECC), MARCH guides providers through the sequence of treating trauma in order of urgency:

M – Massive Hemorrhage

A – Airway

R – Respiration

C – Circulation

H – Hypothermia/Head Injury

Each step addresses a preventable cause of death, beginning with what kills fastest. 

This article - the first in a five-part series - focuses on the first and most critical step: 

M - Massive Hemorrhage.

Massive hemorrhage is the leading cause of preventable death in trauma. Life can be lost in minutes from uncontrolled bleeding, making rapid identification and intervention paramount. 

Clinically, a massive hemorrhage may be defined as the loss of more than 50% of circulating blood volume within three hours, but in the field, it’s simpler: if it looks bad, treat it fast.

Principles of Care

1. Control the Bleed Immediately

Identify and manage life-threatening external bleeding before addressing airway or breathing. In tactical settings, hemorrhage control often occurs under fire or while the threat is active, emphasizing the importance of speed and training.

2. Direct Pressure

Apply firm, targeted pressure directly over the bleeding source using a gloved hand and dressing. Direct pressure remains the most reliable method of hemorrhage control and should be maintained until bleeding stops or another intervention takes effect.

Image retrieved from tccc.org.ua

3. Tourniquet Application

If the bleeding is from an extremity and direct pressure fails, apply a commercially approved tourniquet as high and tight as possible, proximal to the wound. Tighten until the bleeding stops and document the time of application. Avoid improvised or untested devices, equipment failure can cost lives.

4. Hemostatic and Pressure Dressings

For junctional or compressible areas (e.g., the groin, axilla, or neck), use a hemostatic dressing and apply continuous firm pressure for at least three minutes or as directed by the manufacturer. Secure with a pressure dressing and reassess frequently.

5. Reassess Constantly

Bleeding control is not a one-and-done task. Reassess interventions after movement, transport, or environmental changes. Tourniquets can loosen, and pressure dressings can shift during casualty movement or extraction.

Key Takeaway for EMS and Tactical Providers

Massive hemorrhage is fast, silent, and deadly - but also the most preventable cause of battlefield and tactical death. 

Responders must adopt a mindset of “Stop the bleed, then everything else.” Consistent training, reliable equipment, and disciplined reassessment make the difference between life and loss in tactical trauma care.

Coming Up Next: Part Two – Airway

Once life-threatening bleeding is controlled, the next critical step is ensuring the casualty can breathe. 

In Part Two of our MARCH series, we’ll examine airway management in tactical and prehospital settings—covering essential assessment, manual maneuvers, airway adjuncts, and when to escalate to advanced interventions.

Because once the bleeding stops, oxygen is your next priority!

Image retrieved from tccc.org.ua

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

The MARCH Mnemonic - A Framework for Tactical Trauma Care

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

When seconds count and conditions are unpredictable, the MARCH mnemonic. provides a clear, evidence-based sequence for trauma management in both tactical and civilian emergency settings.

Standing for Massive Hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head Injury, this structured approach originated in Tactical Combat Casualty Care (TCCC) and has become a cornerstone of modern prehospital and field medicine. 

From the battlefield to the back roads, MARCH helps rescuers- military medics, EMS providers, law enforcement officers, and trained civilians - prioritize interventions in the order most likely to save lives. 

By following this systematic progression, responders can rapidly identify and treat life-threatening conditions while preventing secondary injury and deterioration during evacuation. 

Each installment in this upcoming series explores one element of MARCH, offering concise guidance, field considerations and key takeaways tailored for EMS and tactical responders: 

• Part One: Massive Hemorrhage - Stop the bleed, save the life
• Part Two: Airway - Secure it early, maintain it always
• Part Three: Respiration - Restore the breath, relieve the pressure
• Part Four: Circulation - Preserve perfusion, prevent shock
• Part Five: Hypothermia & Head Injury - Protect the head, protect the brain
  

Whether in an urban response zone, rural rescue, or austere tactical environment, MARCH isn’t just a checklist - it’s a mindset. It empowers providers to think clearly, act decisively, and deliver lifesaving care under pressure.

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

EMS Words of Wisdom - Always Treat The Patient, Not Just The Problem

 

EMS Training Opportunity - Prehospital Trauma Life Support (PHTLS)

 

Colorado Cardiac CPR are offering a PHTLS at the start of March (3 & 4). This is a great opportunity for emergency medical responders, EMTs, Paramedics, Nurses, Physician Assistants and Doctors.

Description: The mission of PHTLS is to promote excellence in trauma patient management by all providers involved in the delivery of prehospital care. PHTLS is developed by NAEMT in cooperation with the American College of Surgeons' Committee on Trauma.

PHTLS is the global gold standard in prehospital trauma education and is taught in over 80 countries. 

Content: The aim of PHTLS courses is to improve the quality of trauma care and decrease patient mortality. 

The program is based on a philosophy stressing the treatment of the multi-system trauma patient as a unique entity with specific needs. 

The course covers the following topics:

• Physiology of life and death
• Scene Assessment
• Patient Assessment
• Hemorrhage Control
• Airway, Breathing, Ventilation & Oxygenation
• Circulation & Shock
• Special Populations

The course emphasizes application of trauma education through case studies, skills practice, and patient simulations.

Date: March 3 & 4, 2025 9:00 AM to 5:00 PM

Cost: $315.00

Discount: 3CPR

Location: Littleton (Broadway & Davies), Colorado

Outcome: Upon successful course completion you will be issued an NAEMT PHTLS provider card and receive 16-hours of CAPCE credits.

For more information and to register, access this link:

https://3cpr.enrollware.com/enroll?id=10735378

EMS Patient Assessment - Imaging Techniques

EMS Providers often transport patients to facilities where imaging techniques like X-rays, MRIs, MRAs, PET scans, and CT scans are used to diagnose injuries or medical conditions. 

While EMS personnel are not responsible for conducting these imaging techniques, understanding the basics can improve their ability to communicate with healthcare professionals and make informed decisions during prehospital care. 

Here's a summary of each imaging technique, including their uses, advantages, and disadvantages:

X-Rays

- What it is: X-rays use electromagnetic radiation to create images of structures inside the body, particularly bones.

- Common Uses:

• Diagnosing fractures or bone injuries.
• Detecting lung conditions like pneumonia or collapsed lungs.
• Identifying foreign objects in the body.

- Advantages:

• Fast and widely available.
• Cost-effective.
• Effective for visualizing bones and detecting gross structural abnormalities.

- Disadvantages:

• Limited ability to show soft tissues like muscles or ligaments.
• Small exposure to ionizing radiation, which can accumulate over time.

- EMS Relevance: X-rays are often used to confirm suspected fractures or major trauma. EMS providers can suspect the need for X-rays when there are signs of bone injury.

MRA (Magnetic Resonance Angiography)

- What it is: MRA is a type of MRI specifically designed to visualize blood vessels using magnetic fields and radio waves.

- Common Uses:

• Diagnosing aneurysms, vascular malformations, or blood clots.
• Evaluating blood flow in arteries and veins.

- Advantages:

• No exposure to ionizing radiation.
• Provides detailed images of blood vessels without the need for contrast dye in some cases.

- Disadvantages:

• Expensive and not always available in all emergency settings.
• May require the use of contrast agents, which can cause allergic reactions or be contraindicated in patients with kidney issues.

- EMS Relevance: Patients suspected of having a stroke or vascular problems may need an MRA to evaluate blood flow in the brain or other areas.

MRI (Magnetic Resonance Imaging)

- What it is: MRI uses strong magnetic fields and radio waves to generate detailed images of soft tissues, including the brain, muscles, nerves, and internal organs.

- Common Uses:

• Diagnosing brain and spinal cord injuries.
• Evaluating joint, ligament, and tendon injuries.
• Detecting tumors or other soft tissue abnormalities.

- Advantages:

• Provides detailed images of soft tissues.
• No exposure to ionizing radiation.

- Disadvantages:

• Expensive and time-consuming (can take 30-90 minutes).
• Not suitable for patients with metal implants or pacemakers.
• Requires patient to remain still, which may be difficult for trauma patients.

- EMS Relevance: Patients with suspected spinal cord injuries or brain trauma may need an MRI, but it is not a first-line imaging technique in emergency situations.

PET Scan (Positron Emission Tomography)

- What it is: PET scans use a small amount of radioactive tracer injected into the body to visualize metabolic processes, often combined with a CT scan to provide detailed images.

- Common Uses:

• Detecting cancer or monitoring the spread of cancer (metastasis).
• Evaluating heart diseases by showing areas of reduced blood flow.
• Assessing brain disorders like Alzheimer's or epilepsy.

- Advantages:

• Provides functional information about how organs and tissues are working, not just their structure.
• Useful in identifying diseases at an early stage before they cause significant structural damage.

- Disadvantages:

• Requires exposure to radioactive material.
• Expensive and time-consuming.
• Not typically used in acute emergency situations.

- EMS Relevance: PET scans are rarely relevant in acute emergency settings. However, they may be used in the evaluation of long-term conditions like cancer or brain disorders. 

EMS providers generally will not encounter this test during emergency transport, but knowing its purpose is helpful for understanding chronic disease management.

CT Scan (Computed Tomography)

- What it is: CT scans use X-rays taken from different angles and computer processing to create cross-sectional images (slices) of the body.

- Common Uses:

• Diagnosing internal bleeding, head injuries, or complex fractures.
• Evaluating abdominal pain (e.g., appendicitis, internal organ injuries).
• Detecting cancers, infections, or blood clots.

- Advantages:

• Rapid imaging, making it ideal for trauma cases and emergencies.
• Provides detailed images of both bones and soft tissues.

- Disadvantages:

• Higher exposure to ionizing radiation than standard X-rays.
• Can be expensive.
• Use of contrast dye in some cases may be contraindicated in certain patients (e.g., those with allergies or kidney disease).

- EMS Relevance: CT is frequently used in trauma cases, especially when internal bleeding or organ damage is suspected. Patients with head trauma or possible strokes are often rushed for a CT scan.

Some Patient Considerations:

- Radiation Exposure: X-rays and CT scans involve radiation, while MRIs and MRAs do not. EMS should be mindful of cumulative radiation exposure, especially in vulnerable populations like children or frequent imaging patients.

- Contrast Dyes: Some imaging techniques (CT, MRI, MRA) may require contrast agents, which have risks for allergic reactions or kidney damage, a factor EMS should consider in the patient’s history.

Conclusion

X-rays and CT scans are the most common imaging techniques EMS will encounter in emergency settings, especially in cases of trauma or fractures.

MRIs and MRAs are more detailed but take longer and are generally not used in acute emergencies due to their longer processing time and specific patient requirements (e.g., no metal implants).

PET scans provide functional data rather than structural data and are mainly used for detecting diseases like cancer or evaluating brain disorders, but not in emergencies.

Understanding these imaging techniques allows EMS providers to better anticipate the diagnostic needs of patients and communicate effectively with hospital teams. 

EMS Legislation - EMTALA: Origins, Functions, Violations, and Compliance

Origins of EMTALA

The Emergency Medical Treatment and Labor Act (EMTALA) was enacted by the U.S. Congress in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). EMTALA was established in response to growing concerns about "patient dumping," a practice where hospitals denied emergency medical treatment or transferred patients without insurance or adequate financial means. 

The primary purpose of EMTALA is to ensure that anyone coming to an emergency department (ED) is stabilized and treated, regardless of their insurance status or ability to pay.

Functions of EMTALA

EMTALA serves several crucial functions in the healthcare system, especially in emergency care settings:

Ensuring Access to Emergency Care: EMTALA mandates that all patients presenting to an emergency department with an emergency medical condition must be given a medical screening examination to determine if an emergency medical condition exists. 

This requirement applies to all patients, regardless of their ability to pay, citizenship, or insurance status.

Preventing Patient Dumping: EMTALA prohibits hospitals from refusing to treat patients in an emergency setting or transferring them to another facility based on their inability to pay. 

If a patient requires treatment to stabilize an emergency condition, the hospital must provide that treatment or transfer the patient only after stabilization and with the patient’s consent or if the benefits of transfer outweigh the risks.

Obligating Hospitals to Stabilize Patients: Once an emergency medical condition has been identified, EMTALA requires hospitals to provide necessary stabilizing treatment. 

This means that hospitals must address and manage a patient’s emergency medical condition to prevent material deterioration.

Ensuring Proper Transfer of Patients: If a transfer to another facility is necessary, EMTALA requires that it be conducted safely. 

The transferring hospital must provide medical treatment within its capacity to minimize risks to the patient’s health and ensure that the receiving facility has accepted the patient along with having the necessary space and qualified personnel to treat them.

Potential Violations of EMTALA

EMS providers ned to be aware of the following potential violations of EMTALA:

Failure to Provide a Medical Screening Examination: Refusing to evaluate a patient who comes to the emergency department is a direct violation of EMTALA. 

This includes not providing appropriate screening to determine if an emergency medical condition exists.

Inappropriate Transfers: Transferring a patient without stabilizing their condition, or without the consent of the patient or a physician certifying that the benefits of transfer outweigh the risks, violates EMTALA. 

This also includes not arranging for appropriate and safe transportation or failing to provide medical records to the receiving facility.

Refusal of Treatment Based on Financial Status: Refusing to treat or delaying treatment of a patient in an emergency situation due to their insurance status or inability to pay is considered patient dumping and a violation of EMTALA.

Improper Documentation: Failure to properly document the reasons for a transfer, including patient consent and the medical necessity for transfer, can result in a violation of EMTALA.

Working Within the EMTALA Legislative Framework

EMS providers play a critical role in ensuring compliance with EMTALA by adhering to the following:

Understand the Scope of EMTALA: EMS providers should be familiar with the basic requirements of EMTALA, including the obligation of hospitals to provide emergency care regardless of a patient’s financial status and the importance of ensuring that patients with emergency conditions are not transferred until stabilized.

Recognize Emergency Medical Conditions: EMS providers should be trained to identify potential emergency medical conditions and understand when a patient needs to be transported to an emergency department. 

It is also crucial to understand the receiving hospital's obligations under EMTALA once the patient arrives.

Proper Communication: EMS providers must communicate effectively with hospital staff when transferring patients to ensure that the hospital is prepared to provide the necessary care. 

They should provide all relevant patient information and medical records to facilitate appropriate treatment upon arrival.

Safe and Appropriate Transfers: When a transfer is necessary, EMS providers should ensure it is conducted safely, with appropriate medical personnel and equipment. 

They should verify that the receiving facility is equipped to handle the patient’s condition and has agreed to the transfer.

Documentation: Thorough and accurate documentation is essential. EMS providers should document the patient's condition, the reasons for transfer, and the communication with the receiving facility. 

Proper documentation helps protect against EMTALA violations and ensures continuity of care.

Stay Updated on EMTALA Requirements: As healthcare laws and regulations evolve, EMS providers should stay informed about any changes to EMTALA. 

Regular training and updates on EMTALA compliance can help ensure that EMS providers are prepared to handle emergency situations in accordance with the law.

By understanding the origins, functions, potential violations, and compliance requirements of EMTALA, EMS providers can help ensure that all patients receive the emergency care they need, regardless of their financial or insurance status. 

Adherence to EMTALA not only protects patient rights but also upholds the ethical standards of emergency medical care. 

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

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

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Ogilvie, W. A., Moy, H.P., & Goldstein, S. (2023) EMS Legal and Ethical Issues. Treasure Island, Florida: StatPearls Publishing. Accessed August 11, 2024

EMS HazMat Emergencies - I Smell A Pool...We Don't Have A Pool...!

The article addresses the dangers of accidentally creating chlorine gas by mixing household bleach and vinegar, a common mistake due to misleading cleaning tips seen on social media. 

Chlorine gas exposure can lead to severe respiratory issues, including tachypnea, cyanosis, wheezing, and potentially fatal pulmonary edema. The Centers for Disease Control (CDC) warns of the risks, highlighting the need for immediate mitigation by removing the victim from the contaminated area and utilizing positive pressure ventilation (PPV) fans for decontamination.

EMS Providers must avoid exposure to chlorine gas without proper protective equipment like SCBA (Self-Contained Breathing Apparatus). They should prioritize ventilating the area and conducting a risk-benefit analysis before attempting rescues. 

The primary treatment for chlorine gas exposure involves removing contaminated clothing, administering oxygen, and using bronchodilators for wheezing. Long-term management may include monitoring for Reactive Airway Dysfunction Syndrome (RADS), a lifelong condition caused by chemical-induced asthma.

Effective communication with medical facilities and poison control is crucial during such incidents. The article emphasizes public education to prevent mixing household chemicals and highlights the historical and industrial uses of chlorine. 

Proper handling and awareness can prevent accidental poisonings and ensure safety in both residential and industrial settings.

Read the full article by accessing the link:

https://www.foamfrat.com/post/i-smell-a-pool-we-don-t-have-a-pool

EMS Pathophysiology - Anemia

Anemia is a condition marked by a reduction in the number of red blood cells (RBCs) or hemoglobin, impairing the blood’s ability to carry oxygen.

Recognizing and understanding the different types of anemia is crucial for EMS Providers, as this knowledge can guide appropriate prehospital care and improve patient outcomes.

Key Types of Anemia

* Iron Deficiency Anemia

• Cause: Inadequate iron intake or absorption, blood loss.

• Characteristics: Microcytic (small) and hypochromic (pale) RBCs.

• Symptoms: Fatigue, weakness, pallor, shortness of breath

• EMS Considerations: Assess for sources of bleeding (e.g., gastrointestinal), monitor vitals, consider oxygen therapy if indicated.

* Vitamin B12/Folate Deficiency Anemia

• Cause: Insufficient dietary intake or absorption of Vitamin B12 or folate.

• Characteristics: Macrocytic (large) and normochromic (normally colored) RBCs.

• Symptoms: Fatigue, glossitis (inflamed tongue), neurological symptoms (e.g., numbness, tingling).

• EMS Considerations: Assess neurological status, provide supportive care, monitor for signs of severe anemia.

* Hemolytic Anemia

• Cause: Increased RBC destruction due to autoimmune disorders, infections, or genetic conditions like sickle cell disease.

• Characteristics: Increased reticulocyte count (immature RBCs), jaundice.

• Symptoms: Fatigue, jaundice, dark urine, pain (especially in sickle cell crises).

• EMS Considerations: Pain management (especially for sickle cell crises), hydration, oxygen therapy, rapid transport for severe cases.

* Aplastic Anemia

• Cause: Bone marrow failure leading to decreased production of RBCs, white blood cells (WBCs), and platelets.

• Characteristics: Pancytopenia (reduced levels of all blood cells).

• Symptoms: Fatigue, frequent infections, easy bruising, bleeding.

• EMS Considerations: Monitor for signs of infection or bleeding, avoid invasive procedures when possible, supportive care, rapid transport.

* Anemia of Chronic Disease

• Cause: Chronic infections, inflammatory diseases, malignancies.

• Characteristics: Normocytic (normal size) and normochromic (normal color) RBCs, often with low iron availability.

• Symptoms: Fatigue, weakness, symptoms related to the underlying chronic condition.

• EMS Considerations: Assess and manage symptoms of the underlying condition, provide supportive care, monitor vitals.

General EMS Management of Anemia

• Assessment: Conduct a thorough history and physical examination. Look for signs of pallor, jaundice, tachycardia, hypotension, and other symptoms indicative of anemia.

• Oxygen Therapy: Administer oxygen as needed to improve tissue oxygenation. IV Access and Fluids: Establish IV access for potential fluid resuscitation, especially in cases of acute blood loss.

• Monitor Vitals: Continuously monitor vital signs to detect any signs of deterioration.

• Pain Management: Provide appropriate pain relief, particularly for patients with conditions like sickle cell disease.

• Transport: Ensure rapid and safe transport to the appropriate medical facility for further evaluation and treatment.

Understanding the types and causes of anemia can help EMS Providers deliver better care and make informed decisions in the prehospital setting, ultimately improving patient outcomes.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

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

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell 

EMS Research - Chest Decompressions: The Driver of CPR Efficacy

The study aims was to optimize cardiopulmonary resuscitation (CPR) efficacy by investigating the relationship between key CPR metrics: compression rate, depth, and recoil velocity.

The goal was to model the impact of these variables on CPR effectiveness, particularly through their influence on end-tidal carbon dioxide (ETCO2), which is a marker of perfusion.

The study emphasizes the crucial role of chest recoil in CPR effectiveness. The findings suggest that CPR guidelines should prioritize maximum chest recoil to improve hemodynamics and increase the chances of survival during cardiac arrest.

The research advocates for an increased focus on chest recoil in CPR training and guidelines, potentially leading to improved outcomes in cardiac arrest scenarios by enhancing the quality of perfusion during resuscitation efforts.

Further Reading:

Chandran, K., AlgazeGonzalez, I.M., Wang, S., & Davis, D.P. (2024) Chest Decompressions - the Driver of CPR Efficacy: Exploring The Relationship Between Compression Rate, Depth, Recoil Velocity & End-Tidal CO2. Taylor & Francis Online Accessed May 25, 2024

EMS Particular Patient Populations - Spina Bifida

When responding to patients with spina bifida, EMS providers should be aware of the following key points:

1. Understanding Spina Bifida:

   • Spina bifida is a congenital condition characterized by incomplete closure of the spine during fetal development. It can result in varying degrees of spinal cord and nerve damage, leading to physical and neurological impairments.
   • There are different types of spina bifida, including spina bifida occulta (mild, hidden form), meningocele (meninges protruding through a spinal defect), and myelomeningocele (most severe form, with the spinal cord and nerves protruding through an open spinal defect).

2. Neurological Impairments:

   • Patients with spina bifida may experience neurological impairments such as paralysis or weakness in the lower limbs, loss of sensation, bladder and bowel dysfunction, and hydrocephalus (build-up of fluid in the brain).
   • Assess the patient's neurological status, including motor function, sensation, and reflexes, and be prepared to manage any associated complications, such as urinary retention or neurogenic shock.

3. Skin Integrity:

   • Patients with spina bifida, particularly those with myelomeningocele, are at increased risk of skin breakdown and pressure ulcers due to impaired sensation and mobility.
   • Inspect the patient's skin for signs of pressure injuries, and provide appropriate padding and positioning to prevent further skin damage during transport.

4. Bladder & Bowel Management:

   • Bladder and bowel dysfunction are common complications of spina bifida, requiring ongoing management and monitoring.
   • Be prepared to address urinary retention, urinary tract infections, and fecal incontinence, and provide appropriate interventions, such as catheterization or bowel management techniques.

5. Orthopedic Considerations:

   • Orthopedic deformities, such as scoliosis (curvature of the spine), clubfoot, or hip dislocation, may occur in patients with spina bifida and may require surgical correction or orthotic devices.
   • Be aware of any orthopedic issues that may affect the patient's mobility and positioning during transport, and provide appropriate support and accommodations as needed.

6. Hydrocephalus Management:

   • Hydrocephalus is a common complication of spina bifida, resulting from impaired cerebrospinal fluid (CSF) circulation and absorption.
   • Monitor the patient for signs and symptoms of increased intracranial pressure, such as headache, vomiting, or changes in consciousness, and provide timely interventions, such as ventricular shunting or CSF drainage, if necessary.

7. Psychosocial Support:

   • Living with spina bifida can have a significant impact on the patient's emotional well-being, as well as on their family members and caregivers.
   • Provide emotional support and reassurance to the patient and their caregivers, and connect them with appropriate community resources and support networks as needed.

8. Collaboration with Healthcare Providers:

   • Communicate with the patient's primary care provider or specialists, such as neurosurgeons, orthopedic surgeons, urologists, or rehabilitation specialists, to obtain relevant medical history and treatment information.
   • Provide a detailed report to the receiving healthcare facility to ensure that the patient's ongoing medical needs are addressed and that appropriate follow-up care is arranged.

By being knowledgeable about the unique challenges and needs of patients with spina bifida, EMS providers can deliver compassionate and effective care that supports optimal outcomes and enhances the patient's overall well-being.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

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

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell