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

The Life-Saving Evolution of Tourniquet Use: From Battlefield to EMS

The use of tourniquets has transformed trauma care, moving from a once-feared intervention to a cornerstone of life-saving strategies, both on the battlefield and in civilian emergency response.

Navy Captain (Ret.) Dr. Frank Butler, the architect of Tactical Combat Casualty Care (TCCC), helped shift the perception of tourniquets in the 1990s.

Earlier trauma care teachings viewed tourniquets as dangerous due to the risk of limb loss. However, research from past conflicts, and practical experience, revealed that failure to control extremity bleeding was a leading cause of preventable death.

With the rise of TCCC in military settings, particularly during the wars in Afghanistan and Iraq, the widespread adoption of tourniquets helped save thousands of lives by controlling life-threatening hemorrhage early.

This success led to updated guidelines emphasizing tourniquet conversion, replacing the tourniquet with other bleeding control methods within two hours to avoid complications when possible.

Despite its military success, civilian EMS was initially slow to adopt tourniquet use. That changed following the Hartford Consensus and the creation of the Stop the Bleed campaign after the Sandy Hook tragedy.

These efforts brought battlefield lessons to the civilian sector, empowering both the public and EMS providers to take swift action in bleeding emergencies.

The key takeaway for EMS providers is clear:

👉 Uncontrolled bleeding is a time-sensitive emergency

👉 Tourniquets, when used correctly, are a safe and essential tool in prehospital care

👉 Every EMS provider should be trained, equipped, and ready to use a tourniquet when needed

For a deeper dive into the history, science, and best practices behind tourniquet use, you can read the full article here: 

The Evolution of Tourniquet Use in Trauma Care by Public Safety Group, 2025

EMS Cardiology - The Hs & Ts

EMS Providers should be familiar with the Hs and Ts of Advanced Cardiac Life Support (ACLS).

The H’s and T’s of ACLS is a mnemonic used to help recall the major contributing factors to Pulseless Arrest including PEA, Asystole, VF, and VT.

These are categories of reversible causes that can contribute to cardiac arrest. Here's a brief overview:

1. The Hs:

- Hypovolemia: Assess and address any significant loss of fluid or blood.

- Hypoxia: Ensure adequate oxygenation and ventilation.

- Hydrogen Ions (acidosis): Correct any acid-base imbalances.

- Hyper/Hypokalemia: Assess and treat abnormal potassium levels.

- Hypoglycemia: Check blood glucose levels and provide glucose if necessary.

- Hypothermia: Prevent or treat hypothermia as appropriate.

2. The Ts:

- Toxins: Identify and manage any toxic exposures or drug overdoses.

- Tamponade: Consider cardiac tamponade and perform pericardiocentesis.

- Tension Pneumothorax: Recognize and treat tension pneumothorax by decompression.

- Thrombosis (Coronary or Pulmonary): Administer appropriate medications and interventions for thrombotic events.

- Trauma: Address any traumatic injuries that may have caused or contributed to the arrest.

Understanding and addressing these potential causes during ACLS can improve the chances of successful resuscitation.

However, it's important to note that decisions and interventions should be guided by local protocols, guidelines, and medical direction.