The MARCH Protocol: How to Treat Trauma Casualties in Five Steps
Used by NATO combat medics, MARCH is the simplest mnemonic for keeping a critically injured person alive long enough to reach help. Five letters, in order, no exceptions.
Why one mnemonic, not a list
Under acute stress, people forget priorities. MARCH solves this by giving you exactly five things to do, in exactly this order. Skip a step and the patient bleeds out, suffocates, or dies of shock long before any clever intervention matters. This is the order of operations every military medic uses, simplified for civilians.
M — Massive bleeding
Blood loss kills in 3–5 minutes. Before you check anything else, find every wound that is bleeding heavily — pulsing, bright red, soaking through clothes within seconds. Apply direct pressure with your hand. If the wound is on a limb and pressure fails, apply a tourniquet 5 cm above the wound (never on a joint). Write the time on the patient's forehead with a marker. Tourniquets save lives; forgetting one is on for hours costs the limb.
A — Airway
Can the patient breathe? Look for: blood, vomit, broken teeth, swelling, or the tongue blocking the throat in an unconscious person. Clear visible obstructions with a finger sweep. Tilt the head back gently (only if no neck injury suspected). If the patient is breathing but unconscious, recovery position — on their side — keeps the airway open.
R — Respiration
Is breathing effective? Watch the chest. Slow, shallow, or noisy breathing is a warning. A penetrating chest wound that sucks air as the patient inhales (a "sucking chest wound") needs a non-occlusive seal — tape three sides of a plastic square over the wound, leave the fourth open as a one-way valve. If breathing stops entirely and you are trained, begin rescue breaths.
C — Circulation
Reassess for bleeding you might have missed in the chaos of step M. Check the back, the armpits, the groin — places where wounds hide under clothing. Cold, pale, clammy skin with rapid weak pulse is shock. Lay the patient flat, raise their legs 30 cm, keep them warm.
H — Hypothermia (and head)
Even in summer, casualties lose body heat fast — blood loss drops core temperature, shock impairs circulation. Hypothermia worsens bleeding (the blood will not clot properly below ~35°C). Cover the patient with anything insulating. Concurrent: check for head injury — unequal pupils, confusion, loss of consciousness — and protect the neck if you suspect spinal trauma.
What MARCH is not
This is not a substitute for emergency medical training. A 4-hour combat first-aid course from any Red Cross or military veterans' organisation will turn this list into reflex. The list above is for when help is more than 30 minutes away and you must act now.
The single most useful thing you can do this week: watch a 6-minute MARCH protocol demonstration on YouTube. Pick one made by a current or former combat medic, not a survivalist channel.