Tactical emergency care for law enforcement: M.A.R.C.H. By:

In the fourth of a nine-part series, Robert Carlson from Brave Defender Training Group explains the M.A.R.C.H. algorithm, a key component of Tactical Emergency Casualty Care (TECC) and Tactical Combat Casualty Care (TCCC) programs.

The M.A.R.C.H. algorithm prioritizes care for injuries based on the severity and potential for rapid fatality. Carlson provides detailed instructions on addressing each aspect of the algorithm to ensure the best chance of survival for casualties, especially in tactical or combat scenarios.

Key learning points

1. The MARCH algorithm is critical for prioritizing treatment in emergency situations, focusing on the most life-threatening issues first.
2. Addressing massive arterial bleeding is the first step and is vital in the direct threat care phase. Use tourniquets or wound packing to control bleeding.
3. Ensuring the patient’s airway is open is crucial. Techniques include head tilt-chin lift, recovery position or using a nasal pharyngeal airway (NPA) if necessary and safe.
4. Look for and seal any penetrating chest wounds to prevent tension pneumothorax. Use chest seals or occlusive dressings to manage these injuries.
5. After controlling immediate threats, address non-life-threatening bleeding and prevent shock. Also, prevent hypothermia by keeping the patient warm, as blood loss affects body temperature regulation.

Questions for discussion

1. How can law enforcement officers effectively integrate the M.A.R.C.H. algorithm into their standard operating procedures during active shooter or mass casualty events?
2. What are the most effective training methods to ensure all first responders are proficient in using the M.A.R.C.H. algorithm under stress?
3. What are the essential tools and supplies that should be included in a first responder’s medical kit to effectively implement the M.A.R.C.H. algorithm?
4. Under what circumstances should a nasal pharyngeal airway be avoided, and what alternative methods can be employed for airway management?
5. How can feedback from real-world applications of the M.A.R.C.H. algorithm be used to improve future training and protocols for tactical emergency casualty care?