{"id":1161,"date":"2026-08-03T10:00:00","date_gmt":"2026-08-03T10:00:00","guid":{"rendered":"https:\/\/medycyna-gorska.pl\/?p=1161"},"modified":"2026-08-03T10:03:11","modified_gmt":"2026-08-03T10:03:11","slug":"march-algorithm-mountain-first-aid","status":"publish","type":"post","link":"https:\/\/medycyna-gorska.pl\/en\/march-algorithm-mountain-first-aid\/","title":{"rendered":"MARCH \u2014 Mountain First Aid Algorithm (vs ABCDE)"},"content":{"rendered":"\n

The MARCH algorithm<\/strong> is a first-aid protocol adapted from combat medicine (Tactical Combat Casualty Care) to mountain rescue. It differs from classic ABCDE by priority \u2014 massive hemorrhage first<\/strong>, because in alpine or avalanche terrain arterial limb bleeding kills in 3 minutes, faster than airway obstruction. This article: what MARCH is, when to use it instead of ABCDE, and how to perform each element step by step.<\/p>\n\n\n\n

MARCH expanded<\/h2>\n\n\n\n
    \n
  • M<\/strong> \u2014 Massive haemorrhage<\/strong> \u2014 stop first<\/li>\n
  • A<\/strong> \u2014 Airway<\/strong> \u2014 clear<\/li>\n
  • R<\/strong> \u2014 Respiration<\/strong> \u2014 ensure gas exchange<\/li>\n
  • C<\/strong> \u2014 Circulation<\/strong> \u2014 pulse assessment, volume replacement<\/li>\n
  • H<\/strong> \u2014 Hypothermia<\/strong> \u2014 prevent further heat loss<\/li>\n<\/ul>\n\n\n\n

    Why MARCH, not ABCDE in the mountains<\/h2>\n\n\n\n

    Classic ABCDE (Airway, Breathing, Circulation, Disability, Exposure) works great in hospital and ambulance \u2014 with equipment, staff, time. In mountains priorities differ:<\/p>\n\n\n\n

      \n
    • Arterial limb hemorrhage<\/strong> = death in 3 min (thigh can lose 1 L blood per minute). In tactical medicine #1<\/li>\n
    • Airway obstruction<\/strong> = 4\u20136 min before irreversible brain damage<\/li>\n
    • Hypothermia<\/strong> = silent danger added to any other trauma in terrain<\/li>\n<\/ul>\n\n\n\n

      In avalanche debris or after a fall the patient may have all three problems simultaneously. MARCH provides the correct intervention order giving best statistical survival chance. Historically from US Navy SEALs experience, then TCCC (Tactical Combat Casualty Care) more broadly, in the last 15 years also in mountain and expedition rescue.<\/p>\n\n\n\n

      M \u2014 Massive haemorrhage<\/h2>\n\n\n\n

      Identification<\/h3>\n\n\n\n
        \n
      • Arterial bleeding \u2014 bright, pulsating, spurting<\/li>\n
      • Continuous venous bleeding \u2014 dark, flowing steadily<\/li>\n
      • Blood pool >500 mL around patient<\/li>\n
      • Soaked dressings or clothing over significant area<\/li>\n<\/ul>\n\n\n\n

        Interventions in order<\/h3>\n\n\n\n
          \n
        1. Direct pressure<\/strong> \u2014 firm at bleeding site for minimum 3 min, don’t lift to check<\/li>\n
        2. Pressure dressing<\/strong> \u2014 rolled gauze or clean cloth + elastic bandage; add more layers if soaked through<\/li>\n
        3. Tourniquet<\/strong> \u2014 when arterial limb bleeding doesn’t stop with pressure. Use CAT (Combat Application Tourniquet), SWAT-T, or improvised wide-tape (min. 4 cm, NOT wire\/string). Apply 5\u20138 cm above wound on bare skin, twist until bleeding stops, record time of application.<\/li>\n
        4. Junctional bleeding<\/strong> (groin\/armpit) \u2014 sites unreachable for tourniquet. Strong pressure with knuckle for 3\u20135 min, then external hemostatic<\/strong> (QuikClot, Celox, Combat Gauze) if available.<\/li>\n<\/ol>\n\n\n\n

          Tourniquet can be left up to 2 hours without irreversible damage<\/strong>. With longer application: crush syndrome risk and limb necrosis below tourniquet rise. DO NOT remove tourniquet in the field \u2014 rebleeding risk and embolism. Record time and inform hospital staff.<\/p>\n\n\n\n

          A \u2014 Airway<\/h2>\n\n\n\n

          Assessment<\/h3>\n\n\n\n

          Patient speaks calmly and answers questions = airway is clear. Snoring, gurgling, silence = airway compromised. In avalanche specifically: remove snow from mouth and nose, check tongue position.<\/p>\n\n\n\n

          Interventions<\/h3>\n\n\n\n
            \n
          1. Remove foreign bodies<\/strong> \u2014 hooked finger sweep, jaw thrust (with suspected cervical spine injury) or head tilt (no suspicion)<\/li>\n
          2. Recovery position<\/strong> \u2014 if unconscious and breathing spontaneously, side position (unless spinal injury suspicion \u2014 log-roll)<\/li>\n
          3. Nasopharyngeal airway (NPA)<\/strong> \u2014 if available, insert nasally; better tolerated than OPA in semi-conscious<\/li>\n
          4. Oropharyngeal airway (OPA)<\/strong> \u2014 only in unconscious without gag reflex<\/li>\n<\/ol>\n\n\n\n

            R \u2014 Respiration<\/h2>\n\n\n\n

            Assessment<\/h3>\n\n\n\n

            Observe chest movement for 10 seconds: rate (normal 12\u201320\/min), symmetry (chest trauma \u2014 pneumothorax), depth, respiratory effort. Auscultate (if stethoscope available) \u2014 silence in lung field suggests pneumothorax. Palpation \u2014 pain, crepitus (rib fractures, subcutaneous emphysema).<\/p>\n\n\n\n

            Interventions<\/h3>\n\n\n\n
              \n
            • Oxygen<\/strong> if available (reservoir mask 15 L\/min)<\/li>\n
            • Open chest wound<\/strong> \u2014 three-sided foil dressing (leave one side unsealed as one-way valve) or Asherman chest seal<\/li>\n
            • Tension pneumothorax<\/strong> (cyanosis, falling pulse, tracheal deviation) \u2014 needle decompression<\/strong> 2nd intercostal space mid-clavicular line or 4th\/5th anterior axillary line (newer guidelines)<\/li>\n
            • Chest stabilization<\/strong> \u2014 for rib fractures, compression hurts but improves ventilation<\/li>\n<\/ul>\n\n\n\n

              C \u2014 Circulation<\/h2>\n\n\n\n

              Assessment<\/h3>\n\n\n\n
                \n
              • Pulse<\/strong> at carotid (conscious patient \u2014 at wrist) \u2014 rate, regularity, strength<\/li>\n
              • Skin color<\/strong> \u2014 pale\/gray\/cyanotic = ischemia<\/li>\n
              • Capillary refill<\/strong> \u2014 nail compression 5 s, count seconds until redness (>2 s = shock)<\/li>\n
              • Consciousness<\/strong> \u2014 disturbances = cerebral hypoperfusion<\/li>\n<\/ul>\n\n\n\n

                Interventions<\/h3>\n\n\n\n
                  \n
                • Trendelenburg position<\/strong> \u2014 supine with legs elevated 30\u201345\u00b0 if no spinal injury<\/li>\n
                • IV fluids<\/strong> (if access) \u2014 Ringer’s lactate or 0.9% NaCl, 250\u2013500 mL bolus, then 500 mL\/h (target: palpable radial pulse)<\/li>\n
                • Maintain warmth<\/strong> \u2014 hypothermia worsens shock (see H below)<\/li>\n
                • Stop all bleeding<\/strong> before volume replacement (“dilutes” blood)<\/li>\n<\/ul>\n\n\n\n

                  H \u2014 Hypothermia<\/h2>\n\n\n\n

                  Last MARCH element \u2014 but equally critical. Every trauma patient in mountains is at hypothermia risk, even in warm season, because combination: lying still, blood loss, metabolic stress, wind exposure = rapid heat loss. Hypothermia added to trauma >3\u00d7 increases mortality.<\/p>\n\n\n\n

                  Interventions<\/h3>\n\n\n\n
                    \n
                  • Insulate from ground<\/strong> \u2014 backpack, pad, branches<\/li>\n
                  • Wind-proof cover<\/strong> \u2014 emergency blanket, bothy bag, tarp<\/li>\n
                  • Replace wet clothing<\/strong> with dry (cut with scissors if needed)<\/li>\n
                  • Chemical warmers<\/strong> \u2014 centrally (chest, armpits, groin); NEVER on extremities<\/li>\n
                  • Warm drinks<\/strong> \u2014 only in conscious, able to safely swallow, NOT in abdominal trauma (surgery risk)<\/li>\n
                  • Monitor core temperature<\/strong> \u2014 if rectal thermometer available<\/li>\n<\/ul>\n\n\n\n

                    Practical workflow: MARCH in 60 seconds<\/h2>\n\n\n\n
                      \n
                    1. Seconds 0\u201310:<\/strong> Look, listen \u2014 is there massive hemorrhage? If YES, apply tourniquet\/dressing (15\u201330 s). If NO, move on.<\/li>\n
                    2. Seconds 10\u201320:<\/strong> Open airway \u2014 remove blockages, recovery position if unconscious<\/li>\n
                    3. Seconds 20\u201330:<\/strong> Assess breathing \u2014 chest movement, rate, symmetry. Pneumothorax\/open wound intervention if visible.<\/li>\n
                    4. Seconds 30\u201345:<\/strong> Pulse, skin color, consciousness. Anti-shock position.<\/li>\n
                    5. Seconds 45\u201360:<\/strong> Thermal insulation \u2014 emergency blanket under back, windbreak.<\/li>\n
                    6. After first minute:<\/strong> Detailed secondary assessment, call for help, evacuation prep.<\/li>\n<\/ol>\n\n\n\n

                      Frequently asked questions<\/h2>\n\n\n
                      \n
                      \n
                      \n

                      When to use MARCH vs classic ABCDE?<\/h3>\n
                      \n\n

                      Use MARCH in the field (mountains, avalanches, fall accidents, emergency landings) where massive hemorrhage is a real threat and you lack hospital support. ABCDE in controlled environments (hospital, ambulance) where you can focus on airway as priority. TOPR\/GOPR rescuers, expedition physicians, and team members with tourniquet access should know MARCH. Civilian urban rescuers typically use ABCDE.<\/p>\n\n<\/div>\n<\/div>\n

                      \n

                      How long can a tourniquet stay on?<\/h3>\n
                      \n\n

                      2 hours without irreversible tissue damage below. Up to 4 hours usually without significant limb necrosis. After 6 hours amputation risk rises. In expedition conditions where evacuation may take >2 h: record application time, inform hospital staff. DO NOT remove tourniquet in field (crush syndrome and rebleeding risk) \u2014 hospital does this in controlled conditions with IV fluids.<\/p>\n\n<\/div>\n<\/div>\n

                      \n

                      What to do with tension pneumothorax in field?<\/h3>\n
                      \n\n

                      Tension pneumothorax (worsening dyspnea, cyanosis, tracheal deviation, falling pulse despite no bleeding) requires needle decompression. Technique: large needle 14G or 16G, perpendicular insertion at 2nd intercostal space mid-clavicular line (traditionally) or 4th\/5th anterior axillary line (newer, safer guidelines). You’ll hear pressurized air escape. Leave needle in place, then evacuate.<\/p>\n\n<\/div>\n<\/div>\n

                      \n

                      Is MARCH necessary on expedition?<\/h3>\n
                      \n\n

                      For expedition team leader, expedition physician, mountain rescuer \u2014 yes. For individual trekker \u2014 basic version: massive hemorrhage recognition and tourniquet\/pressure dressing, airway clearing, recovery position, thermal insulation. Full MARCH with pneumothorax decompression and IV fluids requires medical training (Wilderness First Aid, Wilderness EMT, TCCC courses).<\/p>\n\n<\/div>\n<\/div>\n

                      \n

                      What gear should I have for MARCH on expedition?<\/h3>\n
                      \n\n

                      For full kit: CAT tourniquet \u00d7 2, Combat Gauze or QuikClot (hemostatic) \u00d7 2, sterile gauze \u00d7 4, elastic bandage \u00d7 2, Asherman chest seal \u00d7 1, NPA \u00d7 1, emergency blanket \u00d7 2, bothy bag \u00d7 1, 14G needle \u00d7 1 (pneumothorax decompression \u2014 qualified only), TCCC trauma shears (clothing-cutting). Kit cost: ~200-300 EUR. Worth for remote expeditions or those with medic in team.<\/p>\n\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n

                      References<\/h2>\n\n\n\n
                        \n
                      • Committee on Tactical Combat Casualty Care (TCCC). Tactical Combat Casualty Care Guidelines<\/em>, 2024 update. deployedmedicine.com.<\/li>\n
                      • Butler FK, Holcomb JB, Giebner SD, et al. Tactical Combat Casualty Care 2007: evolving concepts and battlefield experience<\/em>. Mil Med. 2007;172(11 Suppl):1\u201319.<\/li>\n
                      • Zietlow JM et al. Prehospital Use of Hemostatic Bandages and Tourniquets: Wilderness Medical Society Practice Guidelines<\/em>. Wilderness Environ Med. 2015;26(3):411\u2013416.<\/li>\n<\/ul>\n\n\n\n

                        Disclaimer:<\/strong> Full MARCH application requires medical training. Courses: Wilderness First Aid (WFA), Wilderness First Responder (WFR). This article is educational.<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"

                        MARCH: Massive haemorrhage, Airway, Respiration, Circulation, Hypothermia. Why in mountains massive bleeding is priority #1 over airway.<\/p>\n","protected":false},"author":2,"featured_media":682,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-1161","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-aktualnosci"],"_links":{"self":[{"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/posts\/1161","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/comments?post=1161"}],"version-history":[{"count":2,"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/posts\/1161\/revisions"}],"predecessor-version":[{"id":1311,"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/posts\/1161\/revisions\/1311"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/media\/682"}],"wp:attachment":[{"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/media?parent=1161"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/categories?post=1161"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medycyna-gorska.pl\/en\/wp-json\/wp\/v2\/tags?post=1161"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}