MARCHE Assessment ⎮Tactical Environment⎮
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- Опубликовано: 12 сен 2024
- The MARCHE algorithm is a series of steps that help medical providers identify, prioritize and treat life threatening issues. While this assessment has traditionally been taught in the tactical or combat medical scenario, more and more areas of medicine are beginning to implement it as their primary assessment technique. This video is a short introduction to the MARCHE assessment and the interventions that should be performed in each step.
Check out deployedmedici... for up to date TCCC and TECC guidelines.
I’d like to see you do an active shooter scenario from a civilian standpoint for temporary care and evacuation. I know you could just use this video as a basis but this is from a tac medic perspective I’d like to see some improvised care techniques as well
Read up on some of the after action reports from October 1st in Las Vegas.
@@FlankerJackChannel I know what to do I’m asking prepmedic to make a video to inform others
@@DEATER155 I agree we need more education on this subject and the material out there is thin and generally bad
ruclips.net/video/ua1S-FCrtEI/видео.html
Statistics show (01/OCT where none of the TQ's improvised by EMT's worked) that while some are easy, most interventions are exceedingly difficult to improvise, and often fail. TQ's for example, almost never work under these circumstances. You're better off getting used to carrying a few things on your person (ie: not in the car). You can make a profound impact with a CAT or other CoTCCC recommended TQ and 2 vented chest seals. You can also save someone's life just by keeping them really warm, especially if they have/had any serious injuries or are showing signs of shock. You can address airway just as well with the recovery position as with an NPA (and avoid the scope of practice convos, lol). If you find that you're not carrying your CoTCCC recommended TQ, then you could try the SWAT TQ, which is a smaller, neat rectangle; though, they aren't the industry standard for some good reasons. But, it's still better than not carrying one at all, especially if you keep an eye on it & PRACTICE application. It can also double as a pressure dressing
Anyway, I know that didn't exactly address your question, but I hope it helps. Cheers
My bad if I misjudged your guys experience I think I missed the comments
I studied this video and now am a SWAT medic for my local SWAT team. Thanks for the great product.
MORE OF THIS!!! Prolonged field care would be great!!
To be honest no one is more than an hour or two away from an emergency room in the United states. Prolonged field care isn't really something that's reasonable to consider.
@@FlankerJackChannel Okay but what if you are in the wilderness/any austere environment where evac is not possible/delayed? Not everyone lives in cities or in the vicinity of cities and should know the complications of PFC to help the patient survive.
I spent 5 hours on the side of a mountain with a STEMI patient a couple months back. Also have had to hike in several miles for patients. PFC is absolutely applicable in parts of the US
Or in a middle of a peer to peer battle in Ukraine. Please make a video on PFC
EMS is fantastic once they know you need help and your location. It’s before that that’s the problem.
Love this stuff !! Im a retired Army PA and have forgotten a lot of field/tactical/emergency medicine since retiring. I decided to see about going back to get my EMT-P and it looks like in TX I will be able to get equivalency for a lot of the courses. Civilian medicine is SO much different from being a unit provider in the military. Your videos have not only encouraged me to do something outside of an office, but I am using them to help refresh my skillset. Keep up the great work.
I was an 11B starting my first EMT courses next month. I feel like I forgot a lot of the first aid I learned but these videos help refresh my memory.
Thank you form Ukraine. Your videos helps a lot!
Be Safe.!!!
Stay safe wish you all the best
Greetings from Malaysia. I work as A Medical Assistant similar to PA in USA, and this video gives a clean and comprehensive view of the algorithm. It is very well put and clear instructions. Thank you for your videos. Good Job.
I prefer a more aggressive blood sweep. Really rake those fingers over the casualty especially on the back and junctionally. Even if you don’t see the hole, there’s a good chance your fingers are gonna find it that way
Here in Spain, at least in the Spanish Marines, as we don’t have paramedics like in the US, only nurses and doctors are certified to give any kind of fluid pe analgesic. We use instead of MARCHE, MARCHA, where the A is for Analgesics and other cares, but as we normally only have (at most), 1 person with the course of combat sanitary (3 months only), and not even he has “permission” to do anything, we just leave at MARCH. When we finish, we just go though it from the beginning until is time to evacuate. Thanks for the video.
When I was in the Navy I always taught MARCH PAW, P-pain management, A-antibiotics, W-wound care. I've even heard acronyms P-MARCH-P. People tend to modify the acronym to best suit their situation.
Thank you form Ukraine!!!
日本人です。
救護に関わる仕事をしています。
普段の生活と、何かしらの脅威に晒された状態の救護は、違うものだと思います。
しかし、この動画はとても勉強になります。素晴らしいの一言に尽きます。
I am American.
I agree with your statement.
Personally, when doing the blood sweep I would start at the neck, move to the axillary, then the groin, and then the legs and then the arms. Address as needed. Then secure the airway and then once you're in respiratory that's when you would take a look under the armor and seal anything on the torso.
Totally valid. Honestly some people don’t even put the blood sweep in the massive hemorrhage section of March. I like to do a full body 10 seconds sweep to look for blood but also start a mental catalog of major injuries. Personally I think there are ton of ways to do it so long as you have a method and stick to it every time so as not to miss anything
Who knew so many of ‘us’ there are out there! Still not enough with all the craziness going on but cool to see so many prior fmf corpsman, 68w’s putting in their input and wanting to keep their knowledge. I know pmarchp in my sleep and try to keep my med bag up to date. You never know and it’s a great skill to have. 1st mardiv fmf corpsman ctm grad ‘15 here. Primum non nocere!
Our newest algorithm that we’re using is MARCHPAWS, P is for pain meds, A is for antibiotics, WS is for wounds and splinting… Great video, love the content
Forsure! For civilian EMS and SWAT medicine MARCHE simply stands in for the primary assessment (life threats) which used to be ABCDE. We still hit a secondary survey, vitals, detailed assessment, splinting, meds and reassessment later in care. I am pretty sure that acronym would be a mile long though 😂
I know the H stands for hypothermia (but in my opinion hypothermia could be treated as part of circulation) so I say the H stands for either head injuries or head to toe assessment. Which would be an entire secondary assessment.
@@chrishugs6173You gotta think of the trauma triad of death, where hypovolemic shock leads to hypothermia, which can affect the coagulation cascade.
@@chrishugs6173H is for head injury/hypothermia
Hey would really like to see a video on the different blast injuries and management of like blast lung. Thank you so much for the great video.
What you can also do when it comes to circulation is pinch your patients fingers and toes real quick while your doing your assement. If they stay yellow then blood flow isn’t reaching those extremities
That's great Assessment ,
Is possible to see land mines scenario I keep watching your great vedios and reviews , I am a Paramedic from North East Syria . Thank you for your efforts
Great video as always! We use the same algorithm in wilderness situations.
Tactical medicine is who wilderness medicine got it from.
in the UK we use DCRABC as the primary assessment, then we have other reminders for secondary assessments
Danger
Catastrophic bleed
Responsiveness (AVPU, alertness, voice response, pain response, unresponsive)
Airwave
Breathing
Circulation
MARCH is way easier to remember and implement.
@@borrago I don’t necessarily agree, ours used to initially be DR ABC. DR was easy to remember as it’s a medical mnemonic and DR reminds of “doctor” and ABC is easy to remember as it means “the very basics”, the C between D and R was later added to account for catastrophic bleeds but the mnemonic made sense and was easy to remember as “the very basics of a primary medical assessment”
In germany we use cABCDE
c critcal bleeding
A Airways
B Breathing
C Circulation
D Disability
E Exposure
@@dafqlllll very interesting...disability and exposure?
What if i am a civilian and do a chest seal and im suspecting a tension pneumothorax, but im not trained to do a needle chest decompression..
Should i lightly remove the chest seal and re-apply it?
Thank you and cheers from Germany!
Burping the wound. Lift the seal up, clean any blood away with gauze ( chest seals will provide square gauze ) and then reapply at the bottom of an exhale. It's called "burping" the wound.
@@claytonphillips7976 yea thanks bro🤙 i read about that after posting that question, thanks for answering!
When it comes to sunken chest seals you should reiterate a quick wipe or two of getting as much blood out of the way helps the chest seal to stick to the body better.
I think Jack Carr might have watched your videos while writing his newest part of the Terminal List Book Series as a quick Refresher :)
Thanks for the informative video, Sam. Never know when you may need to rely on this information.
They also taught us to always use an NPA in case the patient went unconscious or for some reason is sealing his tongue. Better safe than sorry.
(updated field medicine algorithm) = MARCH-V-PAWS which stands for; M=Massive hemorrhage / A=Airway / R=Respiration / C=Circulation / H=Head/Hypothermia. V is for Vital signs P=pain medicine A=Antibiotics W=Wounds S=splinting. March ordered from quickset lethal to slowest lethal. Reassess interventions after every single movement.
Thanks man! Great info as usual! Question maybe a bit out of line, would you recommend duct tape for an improvised chest seal? Provided I have nothing but a plastic bag and tape for an emergency... Thank you in advance!
You could BUT only seal three sides. Leaving the 4th side unsealed allows air to escape the chest, decompressing the air building up in the pleural space. Search for chest seals and there are videos on the how and why.
@@SpecialK6685 Thanks man!
He beat me to it lol
2ND on the Duck tape! Improvised if you don't not have a vented chest seal. Tear 4 pieces, fold 1( piece together on itself) then stick the other 3 over the wound and first piece. Will give you a 3 sided chest seal.
Yes, but a commercial device will ensure it sticks. Problems I've had is that dirt, blood, and other types of stuff keep tape from sticking. So always reassess your interventions.
Hey there, I really appreciate the video a lot, just wanna say thanks for your time for helping other to understand better your carrer path. In addition, I have a question, what does it mean the "SORT" patch ? Thank you so much for your time and response.
Special operations response team
@@PrepMedic Thank you so much, I hope you have a good week and blessings.
Hey Sam, I’d love a video on active shooter response/mvc/wilderness response for civilians, I’m currently trying to get involved in my city’s CERT program and would like to get my EMR or EMT certification as well. I’d just like to be in the position to help as much as possible before the professionals arrive.
Yo, you kinda skimmed around the pelvic bleed/wound and I realized I know very little about how to treat those! I also realized I've never seen someone TQ the pelvis and that seems like a pretty concerning area to know more about how to treat.
It made me interested in further studies in this career path. 😌
Not sure how helpful this info is but Another thing we were taught is you are going to have to roll the patient in some form or another, wether that’s for the heated blanket or the using the litter or stretcher etc. roll your patient on their side and into your lap. At this point we were taught to perform “piano keys” looking for any breaks or steps in the spine (spinal ingury which there isn’t much you can do for but having it annotated is good for follow on care) and “credit card swipe” checking the anus for bleeding which can be a sign of internal bleeding. Then when you are done with this phase and you roll the patient back onto their back eventually you have to move the patient that least amount of times and still get good aid.
Great video as always! I’m a huge fan of your work! Quick question for you Sam!
If I had something I would like you to review, could I figure out a way to get the item to you? I am in Canada and I have a GREAT piece of medical kit I would love to get your insight on!
Thanks! Keep up the great work!
Adam
Not sure how helpful this is but when I was in the infantry they taught us to put one hand over the other and do what’s called a “tiger claw” in case the wound wasn’t bleeding, your finger would sink into the hole where the bullet went allowing you to pin point it. This was supposed to be helpful for night time environments as well when you can’t see anything.
Can we get a more in depth version of this? I'd like to see differences in the algorithm between army medics and civilian ems.
You should show and tell people how to use a needle D. Especially when it comes to the lungs. I was taught under the armpit between the 2nd and 3rd intercostal space, or you could use the patients own shove it in their armpit high and tight and whereever their pinky landed on their rib cage is where you would insert the needle D
Super video
Really good life-saving information if you’re trained in that. I have a suggestion, stop fighting for government.
The government doesn’t create these scenarios, they just make money off of em. Knowing this information is still critical for a lot of people if they ever get caught in a live fire for example.
Thank you.
Thank you!!!!! Get on EMS20/20 podcast!
I literally did this exact speech in my speech class last week minus the tactical gear
Video was really helpful, thank you for the quick details and important subjects to pay attention too.
Watching this before my tier 3 TCCC-MP test out lol
Good video guy..'but' I could not read the captions anywhere fast enough to get halfway!! I think it would really help if you slowed tem down.Thanks.
Out of curiosity what medications are you guys giving?? Are you using Ketamine or are you stuck with opioids?? You are guys using TXA at all?? Does your department like using Calcium products after blood administration? And is it cold stored blood or do you guys have a prescreening program for walking blood banks?
Sees one UF pro vid. Ya I could do that 💯😂💜 just jokes all the love and thanks for the vid😁
Is there a reason you Airway & breathing isn’t first?
I understand controlling the bleed is important for this scenario however was always trained Airway first.
Because it’s doesn’t matter if you have an airway and the patient is breathing if they don’t have any blood to oxygenate. Airway first is how we trained it for years but MARCH or CAB is becoming more popular in the civilian world as well
This was an interesting & informative video although idk why the RUclips algorithm recommended this to me as Im no where near this line of work medical nor tactical.
God I love marche
Would you consider doing a “react” type video to some scenes from the show Seal Team?
I use deployed medicine
Great video! I do have a few questions. Does the time you treat hemorrhage relative to a full physical assessment change between a tactical environment and a standard Urban EMS environment? My understanding is that you treat each problem when you reach each step whether it's MARCH or ABCDEF, correct? You're not waiting to treat massive hemorrhage until you do the blood sweep?
As far as I know (just a fan as of now, not prof. trained yet) treat all of the massive hemorrhage that you can see, then blood sweep to make sure there's no more of it, then move on to the other steps. Idk whether you should follow it step by step to a tee though.
Don't delay treating an obvious major bleed, treat first then continue assessment and look for more/missed bleeding
In theory you treat each problem as the appear under ABCDE(FG) and MARCH(E), but if a patient has a massive bleeding you treat it right away, and if a patient doesn't breathe / blocked airway you treat it right away. He/she won't survive without blood or O2. But then you go back and reevaluate each step in the algorithm.
We used MARCH in the Norwegian army, but now that i'm in EMS we use ABCDE, but they honestly blend together.. If we know we are going to a trauma patient, we will probably think massive internal or external bleeding pretty fast, but if its medical and the patient has pneumonia, massive bleeding is really not that big of a concern.. That being said, always stay on your toes and reevaluate, a lot of the time the call we get from the dispatcher isn't the full picture and we are going in halfway expecting one thing and being met by another.
Long winded answer, but I hope you got something from it :)
@@TacticalNorwegian I appreciate the response. I'm a fairly new EMT that got some conflicting information during my schooling, so I'm trying to figure out some real world experience. Thank you
If you see a major bleed treat it first before anything else. Chances are if you see it just walking up to the patient then it is the worst life threat. After that a blood sweep should only take you 5-10 seconds. Military teaches blood sweep in C and not in M so 🤷♂️
"sir sir do you know where you're hit?"..."yeah, on the left shoulder OUCH godammet"
Some of the local FD are issuing body armor to FD personal to make rapid entry in a mass shooting incident.
Yeah, body armor is becoming pretty standard through EMS and fire.
Awesome vid! Great explanations!
Where can i get that vest and its extensions such as for the shoulders and the stomach?
Did you say "warm zone" or "warn zone?"
Warm
At what stage of the MARCHE are you looking for spine or back skeletal injuries? Especially after a HAHO/HALO operation.
Hello I am new to the tac med world
And I wonted to ask
In case of a casaulty who
Is not breathing
Has massive hemorrhage
What do we prioraise first
Thanks!!!
We like it!
@PrepMedic Do You Think A Web-tex First Aid Pack Is Good?
No idea. Never heard of them
@@PrepMedic Are you a SWAT paramedic )
Yes
This video is very useful 👍👍
Fantastic video
I just bilaterally chest dart everyone, carry pounds of quick clot roll them in it like dough, and tourniquet all four limbs. Then you cant miss anything:)….. jking aside good content thanks for free high quality info greatly appreciated.
I started reading and I was like W T F ????? Lol
The recovery position... Holy shit. I watched someone die in front of me thinking there was nothing I could do. He drown in his blood from a punctured lung and I could have stopped that from happening but I didn't.
Another reason I say teach first aid in school
Punctured lung probably led to pneumothorax anyway, and blood would clot in the airway. It's a very serious injury that requires the gear mentioned in the video.
So, if I got this right, the MARCHE-order is similar to the CABCDE-order? Or do I overlook something here?
Thank you
Great video. Did you mean to say algorithm...or acronym?
It’s the March algorithm. Even though it is also an acronym
@@PrepMedic I've never heard algorithm used in this context. Fair play.
Thanks for another great video can I ask a question is there any danger using sternum rubs? Are there certain situations you shouldn't do it? I woke a drunk person up (didn't know he was drunk at the time just unconscious) a few months ago with it as he was flat out on his back and in a dangerous place and got attacked
I know this comment is old but keeping them awake is definitely important for knowing their condition, keeping in mind AVPU and the Glasgow coma scale etc. as well as getting any info from the casualty you can for treatment like possible pain localization in trauma casualties. I think it's situational, not a common practice in tactical field care that I've heard. If there is crepitus, you would obviously avoid sternum rubs as a means to assess their response to painful stimuli but anyone unconscious before or after arrival, it is a method of assessment. Pinching earlobes is another method, stuff like that.
Is this how it’s done in the civilian sector because in the Military we follow the P-MARCH-PAWS algorithm and in respirations we have a little “r” and a big “R”.
For EMS we simply use MARCH as a primary assessment (life threats). We still go through a secondary survey that covers detailed assessment, telemetry, vitals, meds, reassessment etc…
Which military?
So I have determined that TCCC is like rings on a tree. You can determine the time the person or trainer learned it just by what acronym they use. MARCHE was the earliest from like 09 to 14. Then it was PMARCHP from around 14 to 18. 2018 everybody started getting into the PFC deal and we started pushing MARCH PAWS. My last instructor rotation before I bounced in 2020 SMARCHEPAWSRAVINES was the new hotness because people were trying to mash PFC into TCCC because it was sexy and SOCOM was doing it. Now on tye civilian LE side its a hodgepodge of the different above acronyms that change from course to course. Bottom line, I worked off plain MARCH on three deployments and it was effective. They all get you to the same place more or less.
@@andyfrist1957 Sounds much better than “Airways First, Then Bleeders”…
I never knew why hospitals were cold af. Now I know... They're trying to kill me. 😂 Occums Razor.
GREAT STUFF!
Superb👊🏻
Hi. What's the name of the shoulder armor you are using? I couldn't find it anywhere
The shoulder pads is what is killing me😂
Agency policy says we do it, so we do it 😅
Excellent information but I'm getting weary of everyone adding extra letters to existing algorithms or reinventing the wheel every few years.
(MARCH) Missive hemorrhage, Airway control, Raspatory support, Circulation, Hypothermia, Evacuation is not a new concept for addressing trauma patients. Your sweep's for "sites of missive hemorrhage" is a bit off IMO. Why not start with a search of the largest likely bleeders of GSW that responders are capable of treating, such as femoral, carotid and brachial?
If you see a major bleed walking up to the patient you treat it without further assessment. However with armor and winter clothes it’s not hard for blood loss to be missed, hence a blood sweep in areas not immediately visible. The sweep also helps start a mental catalog of major injuries that will need to be addressed later. It should take 5-10 seconds at the most.
Tq Sam.
Hi PM if we worm the patient this way would'nt he get heat stroke, in my country hot summer day gets to 35 deg C, normal day 28 - 31
Humans regulate body temperature via shifting blood volume around. When there isn't enough blood we become hypothermic even in warm/hot environments. This leads to coagulopathy and acidosis concerns, basically a viscious cycle.
@@classicambo9781 Thanks m8 didn't know that
in which part would you fit a traction splint in femur fractures? C or E?
I think you could make a case for either. Traditionally a femur fracture isn’t considered “life threatening” until it is bilateral but you can still lose 1-2 liters per leg.
@@PrepMedic This is exactly why I asked this question. Thanks 😃
usually in cqb which places are most vulnerable, which case studies, graphics could you give me informing most of the places where the police are shot? Do you know hoplite armor?
hoplite is really solid, i would recommend it
Would you elevate the feet for shock in this situation?
Elevating the legs for shock is old school and really isn’t done anymore.
Are you allowed to carry a firearm on the job?
what job ?
You are saying “we are gonna see if he has massive head trauma” and then not explaining to the audience how you can do that. When I was in they taught us one of the first things you can do early on of your assessment of the March algorithm is take a tissue or white fabric fold it in four dip one of the corners of it into the patients ear (as if the blood out of the ear wasn’t a sign) and put it to the side while you continue March. When you come back to it after 3-4 minutes you unfold the fabric and if there’s a red ring around a yellow one that’s a sign of the spinal fluid separating from the blood; which means spinal injury. Raging B0n3r will also be a sign.
The halo sign is a waste of time and not used commonly in the real world. It works fine in a classroom but falls apart pretty quickly in the field. It also isn’t a sign of a spinal injury, it is the sign of a basliar skull fracture. Priapism is a sign of a spinal injury however and is a valid assessment finding.
Seems like the acronym changes every other year. From HABCs to MARCH, now MARCHE lol.
@prepmedic awkward, accidentally deleted my whole comment. As long as you have a thought process doing the sweep so early. Also maybe this is a point mil and civ medicine differ. But I guess what do I know…
intro song name
You also don’t tell the audience another way you can tell if the patient has mass head trauma is if you see raccoon eyes.
A basliar skull fracture isn’t what is meant by “massive head trauma” in the MARCH algorithm.
I won't be packing wounds if there is still a bad guy doing bad guy things. I love my guys, but bad guy needs to be down and that patient needs to be at the CCP before I needle-d (which usually takes a while to show s/sx) or pack wounds. Unless you meant to make the assumption that you already established the CCP and bad guy is no longer doing bad guy things... right?
That was literally one of the first things I said in the video 😂
@@PrepMedic lol
Why are you wearing Multicam? This seams silly.
Because it’s the uniform that the Sheriff’s office wanted us in so we matched them 🤷♂️. Not our choice unfortunately.
I follow the ABCDEFGHIJKLMNOPQRSTUVWXYZ method
I am just a civilian but I have had first aid, wilderness first aid, Stop the Bleed, and so on since a teenager. I had to certify first aid for my work and it was a joke class. I remember he was covering ABCs *airway breathing circulation, and in a break I brought up MARCH/MARCHE and he looked at me like I was speaking a foreign language. He hadn't heard of it - fine, but he stuck to his Red Cross like training and said ABCs or nothing. I stopped listening to the class at that point. I passed near perfect score and then complained to my HR they were wasting money on that training company- he also breezed though the 2days (8 hrs each) in nine hours.
If this matters to you so much, get an EMS job. No one cares that you aced your CPR class that everyone takes.
Is it necessary to play dress up like you’re delta force or something? 🤣