M.A.R.C.H

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M.A.R.C.H
M.A.R.C.H.
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TASK

• TO EDUCATE ALL SOLDIERS HOW TO SAVE PREVENTABLE
  DEATHS ON THE BATTLEFIELD.
• EXPLAIN HOW TO PREVENT ADDITIONAL CASUALTIES AND
  HOW TO COMPLETE THE MISSION AFTER RECEIVING
  CASUALTIES.

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PURPOSE

• ENABLE ALL SOLDIERS THE SKILLS TO PERFORM
  M.A.R.C.H IN A COMBAT ENVIRONMENT.

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M.A.R.C.H

• THE IDEA OF M.A.R.C.H WAS DEVELOPED BY THE
  SPECIAL OPERATIONS MEDICAL SECTOR
• IT IS NOT JUST DOCTRINE PUT ON PAPER BUT A COMBAT
  TESTED METHOD OF CASUALTY TREATMENT

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CASUALTY CARE

• CARE UNDER FIRE
• TACTICAL FIELD CARE
• CASUALTY EVACUATION CARE

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CARE UNDER FIRE

• SECURITY AND FIRE SUPERIORITY IS YOUR PRIMARY
  MISSION
• IF CASUALTY CAN FUNCTION TELL HIM/HER TO RETURN
  FIRE AND MOVE TO COVER
• TREAT LIFE THREATING BLEEDING ONLY AT THIS TIME
  (TOURNIQUET)
• M.A.R.C.H

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TACTICAL FIELD CARE

• YOU HAVE PUSHED OUT OF THE KILL ZONE
• YOU HAVE MOVED THE CASUALTY INTO
  COVER/CONCEALMENT
• YOU NOW HAVE TIME TO FULLY ASSESS THE CASUALTY
• UTILIZE THE ENTIRE ACRONYM OF M.A.R.C.H

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CASUALTY EVACUATION

• PREPARE 9-LINE MEDEVAC REQUEST BASED ON THE
  NUMBER OF CASUALTIES AND THEIR STATUS
• SECURE AND PROTECT CASUALTY (PLACE ON LITTER AND
  COVER FACE AND WOUNDS FROM DEBRIS AND WIND)
• WARM CASUALTY WITH BLANKETS
• RE-SUPPLY

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MASSIVE HEMORRHAGE

• VISUALIZE ALL ATERIAL BLEEDING
• APPLY DIRECT PRESURE TO THE WOUND
• APPLY TOURNIQUET AT THE HIGHEST POINT OF THE
  EXTREMITY

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MASSIVE HEMORRHAGE

• IF BLEEDING IS NOT ATERIAL TREAT WITH A PRESSURE
  DRESSING
• EXPOSE THE WOUND
• PACK THE WOUND WITH KERLIX
• DRESS WITH ISRAELI BANDAGE OR KERLIX AND AN ACE
  WRAP
• SECURE WITH TAPE
• ELEVATE EXTREMITY

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MASSIVE HEMORRAGE

• IF YOU HAVE AN ARTERIAL BLEED AND CAN NOT
  EFFECTIVELY ADMINISTER A TOURNIQUET, YOU MUST USE
  A HEMOSTATIC AGENT
• HEMCON BANDAGE
• QUICK CLOT

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HEMCON BANDAGE

• EXPOSE THE WOUND
• MAY CUT BANDAGE TO FIT WOUND
• PLACE BANDAGE DIRECTLY ON BLOODY WOUND
• APPLY DIRECT PRESSURE FOR 2-4 MIN
• IF ENEFFECTIVE, REMOVE AND APPLY NEW BANDAGE
• DRESS WITH A PRESSURE DRESSING IF POSSIBLE

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QUICK CLOT

• 3 MAN TEAM
• EXPOSE THE WOUND
• FIND THE SOURCE OF THE BLEED
• ENSURE WOUND HAS A BOWL
• POUR QUICK CLOT DIRECTLY ON THE SOURCE
• PACK WITH KERLIX
• DIRECT PRESSURE FOR 5-10 MIN
• APPLY A PRESSURE DRESSING IF POSSIBLE
• DO NOT POUR QUICK CLOT ON THE SURROUNDING AREA

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AIRWAY

• IF A CASUALTY IS TALKING THEY HAVE AN AIRWAY
• MANIPULATE THE AIRWAY (HEAD TILT CHIN LIFT)
• LOOK, LISTEN, AND FEEL
• ARTIFICIAL AIRWAY (NPA, KING LT, COMBITUBE)
• EMERGENCY CRIC
• ONCE AIRWAY IS SECURED PLACE CASUALTY IN RECOVERY
  POSITION

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AIRWAY (EMERGENCY CRIC)

• YOU WILL ONLY PERFORM AN EMERGENCY CRIC IF YOU
  DETERMINE ALL OF THE FOLLOWING..
• MANIPULATION HAS FAILED
• YOU CAN NOT ADMINISTER AN ARTIFICIAL AIRWAY DUE
  TO TRAUMA AND DISFORMITIES TO THE AIRWAY
• THERE ARE SIGNS OF SMOKE INHALATION OR BURNS
  (CHARRED SKIN OF REDNESS AROUND THE MOUTH OR
  NOSE, SINGED HAIR

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RESPIRATORY(SUCKING CHEST WOUND)

• EXPOSE THE WOUND
• CHECK FOR BOTH ENTRANCE AND EXIT WOUNDS
• PACK WOUND WITH KERLIX OR PATROLEUM GAUZE
• CLEAN AND DRY SURROUNDING AREA
• APPLY OCCLUSIVE DRESSING OVER WOUND
• TAPE ALL 4 SIDES (MEDICAL TAPE OR DUCTAPE)
• POSITION THE CASUALTY FOR COMFORT

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RESPIRATORY(FLAIL CHEST)

• DEVELOPS WHEN TWO OR MORE ADJACENT RIBS ARE
  FRACTURED IN AT LEAST TWO PLACES
• ALSO CAUSED BY SEPERATION OF STERNUM FROM RIBS
• ENSURE AN OPEN AIRWAY
• TREAT BY PLACING A BULKY DRESSING DIRECTLY ON TOP
  OF SEPERATION, ADDING PRESSURE
• ADMINISTER PAIN MEDS (MORPHINE)

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RESPIRATORY(TENSION PNEUMOTHORAX)

• DEVELOPS WHEN AIR FROM THE OUTSIDE ENVIRONMENT
  COLLECTS INSIDE THE PLUERA SPACE.
• OVER TIME THE AIR INCREASES THE PLUERA SPACE AND
  PUTS PRESSURE UPON THE LUNG
• THE PRESSURE WILL THEN COLLAPSE THE LUNG PUSHING
  IT TOWARDS THE UNEFFECTED SIDE.
• WITHOUT TREATMENT THE INJURED LUNG WILL CRUSH
  DOWN ON THE TRACHEA AND EVENTUALLY THE HEART.

• ONCE PRESSURE FROM THE LUNG BUILDS UP ON THE
  HEART IT WILL BE UNABLE TO PUMP CAUSING DEATH

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RESPIRATORY(TENSION PNEUMOTHORAX)SIGNS AND
SYMPTOMS

• WHEN THE LUNG COLLASPES IT IS NO LONGER ABLE TO
  INFLATE (INHALATION)
• THE DIAPHRAM IS UNABLE TO MOVE THAT LUNG
• ACCESSORY MUSCLES BEGAN TO COVER DOWN FOR THE
  DIAPHRAM
• THE CASUALTY BECOMES AGGITATED AND RESTLESS
• THE CASUALTY WILL BEGAN TO PERSPIRE AND SHOW
  SIGNS OF CYANOSIS

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RESPIRATORY(TENSION PNEUMOTHORAX)SIGNS AND
SYMPTOMS CONT.

• THE CASUALTY WILL PRESENT UNILATERAL RISE AND
  FALL OF THE CHEST
• THE INJURED LUNG WILL NOT INFLATE OR DEFLATE
  WHILE THE HEALTHY LUNG WILL
• OVER TIME THE CASUALTY WILL PRODUCE A PROGRESSIVE
  EFFORT OF BREATHING

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RESPIRATORY(TREATMENT FOR A TENSION
PNEUMOTHORAX)NEEDLE DECOMPRESSION

• OCCLUSIVE DRESSING TO BOTH ENTRANCE AND EXIT
  WOUNDS.
• LAY CASUALTY ON THEIR UNEFFECTED SIDE
• FIND LANDMARKS FOR NEEDLE DECOMPRESSION (NEEDLE
  THORENSENTESIS)
• WHILE LAYING ON UNEFFECTED SIDE TAKE UNEFFECTED
  HAND AND PLACE IT UNDER THE ARMPIT ON THE
  EFFECTED SIDE

• MAKE A MARK UNDER THE CASUALTYS PINKY AND
  ALIGNED TO THE MID-AXILLARY LINE
• MARK THIS POINT WITH A PEN
• INSERT A 14G NEEDLE IN THE PLUERA SPACE ON THE
  MARK
• ENSURE TO RIDE THE NEEDLE ON TOP OF THE BOTTOM
  RIB OF THAT INTERCOSTAL SPACE

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RESPIRATORY(NEEDLE DECOMPRESSION)CONT.

• ONCE INSIDE THE PLEURA SPACE YOU WILL HEAR AIR
  ESCAPING THROUGH THE NEEDLE
• LEAVE NEEDLE IN AS LONG AS AIR IS COMING OUT
• IF THERE IS NO REMAINDING AIR (PRESSURE) REMOVE
  THE NEEDLE
• IF SYMPTOMS RETURN REPEAT THE PROCESS FOR NEEDLE
  DECOMPRESSION
• A CASUALTY WITH A CHEST INJURY MAY WANT TO SIT
  UP, THIS RELEAVES PRESSURE FROM THE DIAPHRAM
  REDUCING THEIR PAIN

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CIRCULATION

• FINDING NO RADIAL PULSE INDICATES THE CASUALTY IS
  IN SHOCK
• ELEVATE LEGS TO INCREASE THE BODYS BLOOD VOLUME
• THE CASUALTYS OWN BLOOD IS THE BEST METHOD TO
  INCREASE VOLUME
• AFTER 5 MIN OF ELEVATION RECHECK RADIAL PULSE
• IF RADIAL PULSE IS PRESENT TRANSPORT CASUALTY
  WITH LEGS ELEVATED

• SHOCK INADEQUATE PROFUSION OF BLOOD TO THE
  BODYS TISSUES
• TO DETERMINE IF THE CASUALTY IF PROFUSING
  PROPERLY CHECK THEIR RADIAL PULSE
• IF CASUALTY HAS A RADIAL PULSE THEY ARE PROFUSING
  PROPERLY AND HAVE CLOTTING ABILITY

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CIRCULATION(CONT.)ADMINISTRATION OF HEXTEND

• IF NO RADIAL PULSE IS FOUND AFTER 5 MIN OF
  ELEVATION, KEEP LEGS ELEVATED AND ADMINISTER 500
  CC OF HEXTEND
• MONITOR CASUALTY FOR 30 MIN AND RECHECK RADIAL
  PULSE
• IF RADIAL PULSE IS PRESENT DO NOT ADMINISTER
  ANOTHER BAG OF HEXTEND
• TRANSPORT WITH LEGS ELEVATED

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CIRCULATION(CONT.)ADMINISTRATION OF HEXTEND

• AFTER 30 MIN AND ONE BAG OF HEXTEND NO RADIAL
  PULSE IS FOUND ADMINISTER THE 2ND BAG OF 500 CC
  OF HEXTEND
• MONITOR CASUALTY AND TRANSPORT WITH LEGS ELEVATED
• YOU WILL NEVER ADMINISTER MORE THAN 2 BAGS, 1,000
  CC OF HEXTEND TO A CASUALTY

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CIRCULATIONIV ADMINISTRATION

• WHILE OUT OF SECTOR A CASUALTY WITH BLOOD LOSS
  WILL ONLY RECEIVE HEXTEND
• THE ONLY EXCEPTION TO ADMINISTER NORMAL SALINE
  (NS) OR LACTATED RINGERS (LR) WILL BE FOR A HEAT
  CASUALTY (HEAT EXUASTION OR HEAT STROKE
• ENSURE YOU HAVE ALL NEEDED EQUIPTMENT PREPED FOR
  THE CASUALTY

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CIRCULATIONIV ADMINISTRATION

• INSPECT AND ASSEMBLE IV TUBING AND SOLUTION BAG
• INSPECT TUBING FOR ELASTICITY, SIGNS OF DRY ROT,
  AND HOLES
• INSPECT SOLUTION BAG FOR LEAKS, DISCOLORATION,
  SOLUTION TYPE, AND EXPIRATION DATE
• CONNECT SPIKE TO PORT OF THE BAG KEEPING STERILITY

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CIRCULATIONIV ADMINISTRATION

• AFTER SPIKE IS CONNECTED TO BAG HOLD BAG UP AND
  SQUEEZE DRIP CHAMBER UNTIL IT IS HALF FULL

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CIRCULATIONIV ADMINISTRATION

• WHILE KEEPING THE BLUE STERILE CAP ON AT THE END
  OF THE TUBING, OPEN THE VALVE AND FLUSH THE LINE
  TO ENSURE THERE IS NO AIR LEFT IN THE TUBING
• CLOSE THE VALVE AND SET BAG AND LINE IN A SECURE
  AREA KEEPING STERILITY

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CIRCULATIONIV ADMINISTRATION

• SELECT AN ENTRY SITE
• DURING A COMBAT SITUATION FIND THE BEST VEIN
  POSSIBLE
• USE A CONSTRICTING BAND TO ASSIST YOU IN
  VISUALIZING THE VEIN
• AFTER DECIDING YOUR SITE PREPARE THE NEEDLE AND
  CATH

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CIRCULATIONIV ADMINISTRATION

• INSPECT NEEDLE AND CATH
• ENSURE THE CATH FREELY MOVES OVER THE NEEDLE
• DON GLOVES AND SANITIZE THE AREA

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CIRCULATIONIV ADMINISTRATION

• POSITION THE NEEDLE BEVEL UP AND ½ INCH BELOW THE
  ENTRY SITE
• ANCHOR SKIN WITH YOUR NON-DOMINANT THUMB PULLING
  TAUGHT TO THE LEFT OR RIGHT OF THE ENTRY SITE
• ANCHORING THE SKIN WILL STABILIZE THE VEIN BELOW
  THE SKIN SO IT DOES NOT ROLL ON YOU
• HOLD NEEDLE AT A 30-45 DEGREE ANGLE AND PEIRCE
  THE SKIN

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CIRCULATIONIV ADMINISTRATION

• CHECK FOR BLOOD IN THE FLASH CHAMBER
• DROP NEEDLE DOWN TO 15 DEGREES AND INSERT AN
  ADDITION 1/8 OF AN INCH TO ENSURE PLACEMENT OF
  THE NEEDLE INSIDE THE VEIN
• WHILE MAINTAINING CONTROL OF THE NEEDLE WITH YOUR
  DOMINANT HAND USE YOUR DOMINANT INDEX FINGER TO
  PUSH THE CATHETER INTO THE VEIN
• UTILIZE THE PLASTIC TAB TO PUSH THE CATHETER

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CIRCULATIONIV ADMINISTRATION

• SLOWLY PULL BACK ON THE NEEDLE UNIT UNTIL IT
  CLICKS AND LOCKS THE NEEDLE INSIDE THE PLASTIC
  UNIT
• TAKE YOUR NON-DOMINANT INDEX AND RING FINGER AND
  PLACE THEM SLIGHTLY ABOVE THE TIP OF THE CATHETER
• PRESS DOWN TO OCCLUDE THE VEIN
• REMOVE THE CONSTRICTING BAND

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CIRCULATIONIV ADMINISTRATION

• KEEPING STERILITY UNSCREW THE GREEN CAP AT THE
  END OF THE TUBING AND CONNECT THE TUBING TO THE
  CATHETER HUB
• OPEN THE LINE AND VISUALIZE THE SOLUTION ENTERING
  THE VEIN

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CIRCULATIONIV ADMINISTRATION

• SECURE THE SITE WITH GAUZE AND TAPE
• SECURE LINE TO EXTREMITY USING THE THUMB FOR
  SUPPORT
• WHEN TAPING THE TUBE TO THE EXTREMITY REMEMBER
  NOT TO TAPE ALL THE WAY AROUND THE ARM TO PREVENT
  OCCLUSION OF THE VEIN
• MONITOR CASUALTY AND FLUIDS

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HEAD WOUNDS
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HEAD WOUNDSSIGNS AND SYMPTOMS OFINTERCRANIAL
PRESSURE

• HEADACHE
• CONFUSION AND OR UNCONCIOUSNESS
• DEFORMITY OF HEAD
• BRUISING OF EYES (RACOON EYES)
• BRUISING BEHIND THE EARS (BATTLE SIGNS)
• PUPILLARY CHANGES

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HEAD WOUNDSMANAGEMENT

• RECONFIRM THE CASUALTY HAS AN AIRWAY AND IS
  BREATHING
• TREAT ALL WOUNDS WITH CONSIDERATION
• DO NOT PACK A WOUND ON THE HEAD, USE GAUZE AND A
  LIGHTLY WRAPPED ACE WRAP TO SOAK UP THE BLOOD
• WHEN BLOOD COLLECTS INSIDE THE HEAD THE BRAIN
  DEVELOPS ICP
• ELEVATE THE HEAD TO REDUCE THE RISK OF ICP
• MEDEVAC

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HEAD WOUNDS(CONT.)EYE WOUND MANAGEMENT

• IF A CASUALTY HAS SUSTAINED A WOUND TO AN EYE
  TREAT IT THE SAME AS A WOUND TO THE HEAD
• WHEN COVERING THE INJURED EYE WITH GAUZE AND ACE
  WRAP ENSURE TO WRAP THE UNINJURED EYE AS WELL
• BOTH EYES WORK OFF THE SAME NETWORK OF MUSCLES,
  THE INJURED EYE WILL DEGRADE AND DAMAGE THE
  HEALTHY EYE IF NOT PROPERLY COVERED
• TREAT FOR POSSIBLE ICP