Tactical Combat Casualty Care (TCCC)** has transformed trauma treatment by implementing evidence-based practices, moving away from the outdated “ABCs” method to the M.A.R.C.H. algorithm. For those unfamiliar with M.A.R.C.H., here are the essentials you need to know.

Traditionally, trauma care followed the “Airway, Breathing, and Circulation (ABC)” approach. However, the evidence-based insights that guided the Committee on Tactical Combat Casualty Care (CoTCCC) to embrace the M.A.R.C.H. algorithm have significantly improved this method.

According to TCCC guidelines, there are three phases of care:

1. Care Under Fire (CUF) phase: The main focus is on any immediate threats to life or safety, such as enemy fire or environmental hazards. Tourniquets are used to manage massive hemorrhage.

2. Tactical Field Care (TFC) phase: This phase starts once the threat has been neutralized and/or the casualty is in a safe location. Assessment and treatment priorities here focus on preventable causes of death as identified by military medical evidence: Major Hemorrhage, Airway, Breathing/Respirations, Circulation, and Head & Hypothermia.

3. Tactical Evacuation Care (TACEVAC) phase: In this phase, efforts are made to move the casualty to a definitive treatment facility. Most interventions are similar to those in standard EMS operations, with a major emphasis on reassessment and hypothermia management.

This article focuses on the second phase—the Tactical Field Care (TFC) phase.

The real work of tactical field care begins with an assessment:

M – Massive Hemorrhage

TCCC guidelines emphasize that massive hemorrhage is the top treatment priority in battlefield trauma because:

• It is more common than any other life-threatening emergency.

• It causes death more rapidly.

• It is more readily treated in the field using tourniquets, hemostatic gauze, pressure bandages, and junctional devices.

Massive hemorrhages must be assessed and addressed swiftly before proceeding to the next step. Look for signs of major bleeding and apply a tourniquet high and tight on the injured limb when necessary. Training for the entire M.A.R.C.H. algorithm is essential until it becomes second nature.

After addressing massive bleeding, re-examine the casualty for any missed major bleeding, especially in critical areas such as the neck, armpits, and groin. Evaluate the patient’s degree of consciousness by talking to them (which also helps assess their airway). Confusion or nonsensical speech can indicate either a head injury or severe hemorrhagic shock.