M.A.R.C.H. Assessment

Hey everybody, my name is Mike McElmeel, I'm a full-time paramedic, reserve police officer and retired military. I want to talk to you guys today about the M.A.R.C.H. assessment tool. Most of us carry some sort of IFAC or trauma management equipment when we're on the range but how are we going to manage the patient between the time we have some sort of catastrophic injury and the time of emergency medical services show up to our location. So we're gonna talk about the M.A.R.C.H. assessment. So it's a pneumonic, starts off with M, M stands for massive hemorrhaging. We're going to mitigate the massive hemorrhaging with tourniquets, if that hemorrhaging is to the extremity, so life-threatening bleeding, spurting, pooling, soaking the clothes or a traumatic amputation. And if it is not an extremity, we're going to manage that using a pressure dressing. There's many kinds of commercially available pressure dressings or we can simply use gauze to pack that wound and an ACE wrap of some kind and get that pressure on there and hold pressure 'till emergency services come up. So that's massive hemorrhaging, that's our M. A is airway, as we've probably all learned or seen there's a lot of public service CPR classes out there. We need to open the airway. So you're going to use the head tilt, chin lift method or if you expect that there's some sort of head, neck or back trauma, you might use the jaw-thrust method. You're gonna get that airway open, help them maintain that if they need it, if they have an open airway if they're talking to you, then we're good to go and then you may put them in the recovery position, just lay them on the side so they don't aspirate on any fluids or anything that may be leaking out of their mouth. So the next part of the M.A.R.C.H. assessment is respirations and this is pretty important as massive hemorrhaging is the number one cause of preventable death in kind of a military police scenario or context, pneumothorax has been reported to be the number one preventable injury that may cause death in like a mass shooter civilian context. So we want to look, listen and feel, we want to see if the chest is rising or falling equally. And if it is not, we need to suspect that we have that pneumothorax where one lung is collapsing due to pressure coming in from another opening in the chest cavity, so nature is going to follow the path of least resistance if we have a penetrating injury or an entry and exit wound of some sort, every time that individual breathes in, air is going to rush in and start collapsing the lung. It's more of a slow developing problem but ultimately it can turn into life-threatening as it puts pressure on the heart. So we want to get that hole plugged and keep that from happening. Definitive treatment is going to be done in a hospital. So we want to keep it from getting any worse by putting inclusive dressing on top. There's a variety of commercially available occlusive dressings or you can simply use a bag or the wrapper off your your pressure dressing or anything else or tape. We just want to plug that entry wound and if there's an exit wound, plug that as well to keep any more air from coming in. So that's our R. C is circulation. We're going to go ahead and check for a pulse, radial pulse. We can assume that their perfusion is good. It's adequately perfusing the brain and if we don't feel a radial pulse here, we may look for a carotid pulse here. If we don't feel a carotid pulse, we may initiate CPR if we're trained to do that. And then the last part of the assessment is H, which stands for hypothermia. Losing a lot of blood or massive hemorrhaging is gonna kinda negate the body's ability to maintain homeostasis or their temperature. So people are going to be cold if they lose a lot of blood. So we need to get them warmed up, cover 'em with blankets, a shirt, keep their head warm, towels, whatever you have on the range to keep them warm, right? And then just keep reassessing using that algorithm and fixing your interventions. Make sure your tourniquets are tight. Make sure your pressure dressings are doing their job and wait till EMS gets there or until somebody with higher medical care kind of relieves you. So that's our M.A.R.C.H. algorithm. Massive hemorrhaging, controlling the airway, checking for respirations, circulation and lastly hypothermia.