MARCH through March: C is for Circulation Management

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March 22, 2024 12:04pm EDT

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C is for Circulation Management

The acronym MARCH (massive hemorrhage, airway, respirations, circulation, head injury/hypothermia) is used by TCCC-trained individuals to help remember the proper order of treatment. Every week in the month of March, we explore one of the letters and the course of treatment it represents.

All information taken from the Tactical Combat Casualty Care Handbook, Version 5.

Importance of Circulation Management

Control of bleeding takes precedence over infusing fluids. Only individuals in shock or those who need intravenous (IV) medications need to have IV access established. Use an 18-gauge catheter and saline lock in a field setting. Give tranexamic acid (TXA) as soon as feasible to casualties in or at risk of hemorrhagic shock. Once a saline lock is established, secure it with transparent wound-dressing film. Administer fluids by a second needle and a catheter through the film dressing. When the infusion is complete, withdraw the needle, leaving the saline lock in place. An intraosseous (IO) device is an alternative route for administering fluids when fluid resuscitation is required and an IV access cannot be obtained. Clinical signs of shock on the battlefield are: 1) unconsciousness or altered mental status not due to coexisting traumatic brain injury (TBI) or drug therapy; and/or 2) abnormal radial pulse.