Combat Medic Essentials │ Part 2: The M.A.R.C.H. Algorithm

So we are no longer under effective hostile fire and have achieved fire superiority. Now we can start caring for the victims. This is known as: Tactical Field Care. At this point, we will request a

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al evacuation as soon as possible. We know things are bad, so we start bringing the bird. Next we will begin with the redeployment of resources, if you have not already done so in the Care Under Fire phase. And if a man is carrying delicate items for the mission, we need them in good hands. And in the event that you're giving our guy painkillers and he's high as a kite, we really don't want him hanging on to his gun and his grenades.

We also need ammunition from him for our security team. Remember, this can change at any time. So we're not out of the woods yet. So be careful before you start dealing with your victims. Make sure the location is safe and maintain a 360-degree security perimeter. And as necessary, make a classification of the victims. Oh yes, if you find the victim with polytrauma. In English: Our boy is really screwed, no pulse, no breathing and other vital signs, we don't resuscitate him. No CPR. “Tactical Field Phase”. Now let's move directly to our evaluation. We have our security team.

I like to teach my boys the simple acronym M.A.R.C.H., which stands for massive bleeding, airway management, breathing, circulation, head injury, hypovolemia, and hypothermia. And now let's start with massive bleeding. Basically, massive bleeding is everything you see that's really bad, that's bleeding. You need to cover it. No little boos. But first of all, if our guy put on the tourniquet in the care phase under fire, we double check it, if he's placed correctly, if he's high and tight. Well, everything seems to be in order. If the tourniquet does not hold, place them side by side.

Close it and leave both in place. Okay, he did a good job. I am a good doctor. Now check the collar, check the X-pockets, check the groin. If you see blood, you cut the uniform and expose the blood. If it's bad, you cover it with

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gauze or any other hemostatic agent. Well, do a visual sweep of his body. No bleeding. Well ok. You always talk to your boy. Hello friend, are you okay? It's okay, say "I'm fine." I'm fine. What does that mean for us? That means your airways are open, permeable. We don't need to waste time checking it.

If his words make any sense, like he's saying, "You fucking son of a bitch" or something, PC right, that means it makes sense. He's getting some blood to his brain, he's getting oxygen and that means he's not in shock right now. If he's doing something like, "I become an officer," he's fine, apparently he's losing control. He's not getting enough oxygen to his brain and he's probably in shock. If you haven't done so already, you take away his weapon, radio, grenades, so he doesn't do any damage. We take away their magazines, give them to the security detail, because they need them and that pretty much sums up the massive bleeding

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of our M.A.R.C.H program. protocol.

Now we go to “A”, airway management. If the patient does not talk to us, we must open this airway. We need to clean him up, maybe he has some snus on him. You need to listen here to breathe. We can multitask and see the rise and fall of the chest. He's fine, he's breathing with us. Okay, that's wonderful. If he is unconscious, we must secure the airway. We can do it in multiple different ways. We'll do it with an NPA, nasopharyngeal airway, which is basically a nasal tube. Yes, it is curious to have a tube in his body.

We will remove it from your IFAK. We take an NPA, we take our trusty lubricant. I'm not going to make fun of him because he has lube on his IFAK. It can be used in many different ways. I hope it is used only for the NPA. Level towards the

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ition. Well, we check it. He's fine, he's breathing, amazing. Don't forget to tape it down. What we do if you don't have an NPA is put it in a recovery position, this is the least we can do. The general rule: if he is awake and can't breathe and we force him to stay on his back and he doesn't want it, don't force him.

Maybe he has facial trauma and blood is pooling in his airways. Tilt it on its side. Well. Anything that helps you breathe. If he wants to stand and the tactical situation allows it, he can do so. Whatever helps you breathe. Well, are you okay? Are you comfortable? It's good, awesome. Well, that pretty much sums up part "A" of the M.A.R.C.H.

algorithm

. Now we move on to breathing. Now we go to the "R" part of our M.A.R.C.H.

algorithm

. Breathing. Basically that means that we are going to check if we have any holes in the box.

By box I mean from the nose to the navel, if there is a hole we put an occlusive bandage on it. But first of all, we expose the chest. We'll check the neck. You check your armpits. We look for bilateral breathing, rising and falling of the chest. If we are too stressed to hear or see breathing, we hold hands. You say “no homo” and we feel the need to breathe. Good, good bilateral ascent and descent. Nice. Now we pray a little. We climb. If we see any discoloration on the collarbone, it is probably broken. It won't do us any good if we find out, yes, exactly, it's broken.

We just read it, it's broken. It's OK now. We just walk. Alright. Let's go on one side of the rib cage. You just press a little. We check if he grimaces. If he says "Aaah", stop. Nice. If we find a hole here, use your hand. Put it on. Get an occlusive dressing. Open it. I usually prepare my occlusive dressing with an NCE. Oh, I'm having trouble opening it. What do you do for a living? Don't be afraid to let go. You'll be quicker to take out an occlusive dressing, clean it, and put it on. So yes, this number is a good thing.

Or get a partner. Put your hand here. Anyone can do it. Okay, let's put this on. What do you do for a living? You check. No sucking, no hitting. Okay, we covered the hole. Now let's follow the general rule again. If our patient has trouble breathing and has a hole in his chest, an occlusive bandage is placed. We put two and two together: he has tension pneumothorax. We have to do an ENT. But that's in a later video. All bad things come in twos, so we have an entrance hole and there is probably an exit hole.

Then we have to check the back. We do a “hug as a friend.” Check it. Well. Okay, you don't see anything. Good. If he sees blood, we notice it, but we'll check it later when we check his back. Now we go to circulation “C” from our M.A.R.C.H. protocol. First of all, we check our interventions and whether they are still valid. Well, everything seems to be in order. If we did neck wounds, pocket X wounds, angle wounds, we double-checked it. Yes it is good. And if our hands are bloody, we clean them and sweep away the blood.

If we see blood, we grab our scissors, expose the wound, and then decide what we're going to do with it. If it is a small cut or minor venous blood, don't worry for now. Just keep going. Here I probably see blood, I expose it. It's just a minor cut. So what are we going to do now? It's a minor cut, he has a tourniquet on. So tourniquets are practically useless. So now we decide what we are going to do. We will give you a compression bandage. We are going to convert it. You do not know. We will cover that in the next video.

We finish our blood sweeps. Now we check his pulse. Okay, if we feel the radial, great, he's not in shock. If you don't feel the radial, check the carotid. He is alive. If you don't feel the radial pulse, it means he is in decompensated shock. He's not doing well. He's pretty screwed. Well, he feels the skin. The color, okay. Pink, warm and dry? Awesome. Now what we are gonna do? We have to turn him over to check his back, but first of all what we are going to check is if he has a broken pelvis. We close the book and then open it.

If at any time you see a grimace on his face, we stop immediately. That tells us that his pelvis is broken and we have to move him in another way, but that's in another video. Now we check this. We need to prepare our equipment. We will deliver to you, practically what we need? Our litter, for the heat prepared for hypothermia. Before we saw an entry wound on his chest. We prepared our second halo, we prepared our equipment, but what happened before is that I tore my glove and since I know my friend's sexual preference for women and small farm animals, I will put on a new glove.

Okay, now we'll put it aside. We checked his wound on the lower part, it's fine, nothing was noticeable, we checked his neck. Without steps or deviations. We've already hit him between the legs, so we do the hypothermia part. Okay, one, two, three. Back inside. Now we ask him: Hey friend, how are you? Are you OK? Well. You're assessing his level of consciousness and then you're checking his airway. Yes, he still breathes. I see his chest rise and fall. He still has a radial pulse, nice. LOC ABC is done. No interventions. We moved him, that's like something invasive we did with his body.

And before we made a couple of interventions. Now we have to check if they still hold up. Consult the ANP. He's fine, he's in. It was recorded. Alright. Breathing, check his halo. No sucking, no hitting. Nice. He checks his tourniquet. Yes, he's still holding on. Now let's do some paperwork. Where is his TCCC card? Cat time. Write it down and record it on the TCCC card. And you put this somewhere that he won't lose. In his hand, in his belt. Okay, the TCCC card goes with it. We take note of all the interventions we performed, so that the flight doctor and the hospital surgeon have an easier job.

Now that we put our boy on the stretcher, we checked his level of consciousness, the ABCs, and the interventions. Now we move on to “H,” which stands for hypovolemia, head injury, and hypothermia. For hypothermia, we already have our heat ready. We also have a pre-established blanket. And we cover it the best we can. If not, we improvise. Let's do something. Take your hat, we'll put it on. If he has wet clothes, you change them. Nothing works well if our victim is cold. It causes a little hypothermia. Check the head for head injuries. If it's something minor, we'll just sell it.

But if you see burst pupils, raccoon eyes, which basically means discoloration under his eyes, if you see something coming out of his ears, something out of his nose, that's an indication that he might have a traumatic brain injury. We can't practically do many things for him. If he is not in shock, we can raise his shoulders and head about thirty degrees. Keep him breathing and that's in our toolbox of help that we can give him. Okay, now what? You are not a doctor and you need to cover hypovolemia. We suspect he is going into shock and we have to fight it.

We need to give them an IV or an IV, but do we have the capacity, knowledge and skill? But that's in another video. We pack up the patient, but we can still help. We give him his pack of

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pills, if he can swallow them. Can you swallow? Luckily he can swallow, that's good. Previously, at the M.A.R.C.H. With the protocol we were saving a life, but now we are improving it a little. With the package of combat pills we take care of the antibiotic part and a minor analgesia part. Right now we're just bandaging the burns and small cuts, maybe doing a tourniquet conversion, immobilizing anything that needs to be mobilized, but if you don't know how to do this or anything other than M.A.R.C.H., remember we probably have communications. above, then we call our tactical command or the next level of care, so they can help us, guide us through all the procedures that we can still do to our patient.

Well, now we are waiting for the MEDEVAC, we fill out his TCCC card, we prepare our man for transport, so that our blanket does not fly away in the rotor. You put on those glasses and that's it. The last thing was enemy combatant, sometimes we didn't do a good job and now we had to treat a wounded enemy. Because the rules of engagement dictate it and because it is the right thing to do. But safety comes first, mobilize and secure the enemy, because he is still trying to kill us. Remember to see part 3. Where we cover a couple of basic interventions.