Being trained and prepared for the aftermath of a violent encounter is just as important as training for the encounter itself. The MARCH algorithm is the backbone of Tactical Combat Casualty Care (TCCC), providing a prioritized sequence for treating casualties when professional medical care is not immediately available. For the armed civilian, understanding MARCH is as essential as understanding how to run a firearm — a gunshot wound without immediate hemorrhage control is just as lethal whether it happens in a warzone or a parking lot.
The MARCH Algorithm
MARCH is a mnemonic that orders trauma interventions by lethality timeline — treating the things that will kill the fastest first:
- M — Massive Hemorrhage
- A — Airway
- R — Respiration
- C — Circulation
- H — Hypothermia / Head Injury
This ordering is not arbitrary. Exsanguination from extremity hemorrhage can kill in minutes; airway compromise and tension pneumothorax follow close behind. Circulatory shock and hypothermia develop over longer timelines but become lethal if unaddressed during extended field care or delayed evacuation. The algorithm ensures that treatment effort is directed where it saves the most lives in the shortest time.
M — Massive Hemorrhage
Massive hemorrhage is the leading preventable cause of death in both military and civilian trauma. The primary intervention is the tourniquet, applied high and tight on an extremity. The CAT (Combat Application Tourniquet) remains the gold standard — it is the tourniquet included in both the MED-T and MED-H fill kits and the one most widely validated in combat and civilian use. The SAM XT Tourniquet offers an alternative with its TRUFORCE Buckle system designed to reduce application variability under stress.
Tourniquet application must be trained to standard, not merely understood in theory. Proper training includes self-application with the dominant and non-dominant hand, application on a casualty in various positions, and timed drills under stress. See CAT Tourniquet Application: Training to Standard for detailed training guidance.
For hemorrhage that cannot be controlled by tourniquet — junctional wounds to the neck, axilla, or groin — wound packing with hemostatic gauze is the critical intervention. QuikClot Combat Gauze (impregnated with kaolin to accelerate clotting) is packed directly into the wound cavity and held under pressure. Standard wound packing gauze is used for non-junctional wounds. Elastic wrap bandages then provide sustained pressure over the packed wound. The principle is simple: find the bleeding, pack the hole, apply pressure, and hold it.
Every layer of a prepared citizen’s loadout should carry hemorrhage control capability. A tourniquet rides in EDC pocket or ankle carry, another stages on the war belt, and additional tourniquets stage on the plate carrier. Redundancy matters because tourniquets fail, get used on a first casualty, or cannot be accessed from certain positions.
A — Airway
Once life-threatening hemorrhage is controlled, airway patency is the next priority. An unconscious casualty’s tongue can occlude the airway; blood, vomit, or debris can block it. The primary field intervention is the Nasopharyngeal Airway (NPA) — a flexible rubber tube inserted through the nostril to maintain an open air passage. Both the MED-T and MED-H fill kits include a pre-lubricated 28 French NPA.
NPA insertion is a trained skill. An improperly sized or incorrectly inserted NPA can cause further injury or fail to maintain the airway. Positioning the casualty (recovery position for unconscious patients) is equally important. For the armed civilian, airway management beyond the NPA — surgical cricothyrotomy, for instance — is outside the standard scope without significant additional medical training, but understanding when an NPA is indicated versus when the casualty needs a higher level of care is essential triage knowledge.
R — Respiration
A patent airway means nothing if the lungs cannot function. Penetrating chest trauma — the kind produced by gunshots and fragmentation — can cause pneumothorax (collapsed lung) and tension pneumothorax, where air trapped in the pleural space compresses the heart and remaining lung, rapidly causing death.
Two interventions address this:
- Chest seals — NAR HyFin Vent Compact Chest Seals are applied over penetrating chest wounds. The vented design allows trapped air to escape while preventing additional air from entering. Both entry and exit wounds must be sealed, which is why kits include chest seals in pairs.
- Needle decompression — When a tension pneumothorax develops despite chest seals (evidenced by increasing respiratory distress, tracheal deviation, and absent breath sounds on one side), a 14-gauge Enhanced ARS needle is inserted into the chest wall at specific anatomical landmarks to release trapped air. Both the MED-T and MED-H kits include two ARS needles. This is a life-saving intervention, but it requires training and, in many jurisdictions, medical authorization. The MED-H fill kit requires Medical Device Authorization for purchase specifically because of this component.
Chest seal application and needle decompression fundamentals are covered further in Chest Seal and Airway Management Integration, which addresses how these supplies integrate into a carried loadout.
C — Circulation
After hemorrhage control, airway, and respiration, circulatory assessment addresses shock — the systemic failure of blood to adequately perfuse organs. Field indicators include altered mental status, weak or rapid pulse, pale or cool skin, and delayed capillary refill.
Civilian field care for circulation is largely supportive: maintain hemorrhage control, keep the casualty warm, elevate the legs if possible, and prepare for evacuation. IV access and fluid resuscitation are within the scope of trained paramedics and combat medics but outside the standard civilian IFAK capability. The critical civilian action at this stage is recognizing the signs of shock, understanding that the casualty’s condition is deteriorating, and accelerating the timeline to definitive care.
H — Hypothermia / Head Injury
Hypothermia is the silent killer in trauma. Blood loss reduces the body’s ability to thermoregulate, and even moderate environmental exposure accelerates heat loss in a wounded patient. Hypothermia worsens coagulopathy (the blood’s ability to clot), creating a lethal feedback loop: the patient bleeds more because they are cold, and they get colder because they are bleeding.
Field management is straightforward: get the casualty off the ground, remove wet clothing, cover them with whatever insulation is available (space blankets, sleeping bags, jackets), and minimize exposure. Head injuries are assessed through neurological checks — pupil response, level of consciousness, verbal responsiveness — and documented on the casualty card.
Both the MED-T and MED-H kits include DD Form 1380 Combat Casualty Cards, which allow documentation of interventions and casualty status across all three phases of TCCC: Care Under Fire, Tactical Field Care, and Tactical Evacuation Care. Documentation matters because the information recorded on the card travels with the casualty to definitive care and directly affects treatment decisions by receiving medical personnel.
The Three Phases of TCCC and Where MARCH Fits
The MARCH algorithm operates within the three-phase TCCC framework:
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Care Under Fire (CUF) — The casualty and responder are under active threat. The only medical intervention is tourniquet application for massive hemorrhage while returning fire, achieving fire superiority, or moving to cover. This is where tourniquet selection and trained self-application matter most.
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Tactical Field Care (TFC) — The threat has been neutralized or the casualty has been moved to cover. This is where the full MARCH algorithm is executed, working systematically from M through H.
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Tactical Evacuation Care (TACEVAC) — The casualty is being moved to a higher level of care. Interventions are reassessed, documentation is completed, and the casualty is prepared for handoff.
For a deeper treatment of the TCCC framework and its civilian translation, see TCCC Fundamentals for the Armed Civilian.
Building MARCH Capability Into Your Kit
The principle behind T.REX’s medical fill kits is that MARCH capability should be portable, organized, and immediately accessible — not buried in a backpack. Both the MED-T and MED-H fill kits are explicitly designed to cover M, A, and R in a single pouch. The difference is scale: the MED-T is a compact trauma kit suitable for belt-mounted or chest-rig-mounted carry, while the MED-H is a larger kit with doubled supplies for extended field care or treating multiple casualties.
The prepared citizen’s medical capability should layer just like the rest of the loadout, as described in Building a Coherent Loadout from EDC to Full Kit:
- EDC layer: a tourniquet and pocket IFAK covering M (hemorrhage) and basic wound management- Belt layer: a dedicated medical pouch with full MARCH capability (MED-T fill or equivalent) staged on the war belt
- Carrier layer: additional tourniquets staged on the plate carrier and a larger kit (MED-H fill) for extended care or multiple casualties
- Vehicle/range layer: a full trauma bag with redundant supplies, additional hemostatic gauze, and items beyond the immediate scope of MARCH (burn dressings, splints, larger volume of wrap)
The goal is that no matter where a casualty event occurs — at the door of a vehicle, in a parking lot, on the range, or inside a structure — hemorrhage control is within arm’s reach and the full MARCH sequence can be executed within the timeline that matters.
Training Is the Equipment
Owning the gear does not equal capability. A tourniquet in a pouch that has never been applied under stress is a prop. The MARCH algorithm is a skill set, and like any skill set, it degrades without practice. Hands-on training from a qualified instructor — whether through a TCCC course, a Stop the Bleed class, or a civilian-oriented tactical medicine program — is the prerequisite for carrying any of this equipment with the expectation that it will work when needed.
The honest assessment for any armed citizen is this: the probability of needing to render trauma care at some point in life is significantly higher than the probability of needing to fire a weapon defensively. Both deserve the same seriousness of preparation.