Forget ABCs in Trauma... it's now MARCH

DrParasite

The fire extinguisher is not just for show
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As I was attending ConEd class last night over trauma, I was introduced to a new acronym: MARCH. This comes from the TCCC, and is being taught to EMS providers.

The Airway -> Breathing -> Circulation has changed to massive hemorrhage, airway, respiratory, circulation and head injury/hypothermia


This was new to me, but apparently it's been floating around for a few years now (the EMS1 article is from 2017).

Has anyone heard of this? any thoughts on if this will be beneficial to both providers and patients in general?
 

CCCSD

Forum Deputy Chief
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Been in use for years in TACMED. However, there are many variations, just like stroke acronyms.
 

Tigger

Dodges Pucks
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Our paramedic program started teaching “CAB” in a while ago for trauma and even the NR skill sheets have long emphasized looking for massive hemorrhage immediately. Last year our guidelines started including MARCH in the applicable trauma areas but our stop the bleed for EMS classes introduced it four or five years ago.

Off to our biannual active threat/Rescue Task Force training this afternoon, we shall see what acronyms are in play this year.
 

VentMonkey

Family Guy
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I feel like all of these acronyms come and go. Some may stick a bit longer than most, but how many providers truly stop themselves in their tracks to remember the “current life-saving acronym”?

I have heard of MARCH, and I am sure if it’s being or been published in the new civilian trauma guidelines then it’ll become more normalized.

Will it add any benefits to trauma care over the “ABCDE” acronym of yesteryear? Kind of hard to say without data.

Kind of like the addition of calcium being added to the Trauma Diamond some years back. I’m not sure if it’s yielding any remarkable benefits.

Sort of on the same topic, I am curious to know if anyone is aware of civilian first responders applying pelvic splints of some sort (commercial or other).

It’s not too common where I am, but given it’s practicality, potential for immediate benefit, simplicity, and fairly low risk of harm in most adults, I’m surprised it’s not as commonly seen in the world of “basic” trauma care. Afterall, it is but a rather large splint.
 

Seirende

Washed Up Paramedic/ EMT Dropout
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Sorry, yes. Basically fire and/ or EMS. Specifically at the EMR/ EMT level.

I seem to remember that we covered using a pelvic binder in EMT class in WI, but I may be misremembering which level. I know what you're talking about, for pelvic ring fractures

Edit: just websearched, we have it as a skill for EMR on up
 

Tigger

Dodges Pucks
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We overly push pelvic binders here. We are supposed to put them on any high mechanism, unresponsive trauma patient. Also any trauma arrest, and last year they (medical direction) wanted them for hard/distended abdomens in high mechanism trauma. We are told that we cannot actually assess to determine if the pelvis is unstable, I think hemodynamically stable patient whose pelvis is grossly intact does not need a binder—but neither me nor medical direction has much evidence to go with.

Also as promised, yesterday we learned;

MARCH R* PAWS

There were FIVE Rs. Something about reassess, redo, relook, idk I’m not going to remember.

PAWS: Pain management, antibiotics, wound care, splinting.

I understand a systematic approach. But not everything needs an acronym.
 

E tank

Caution: Paralyzing Agent
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I think the implication of acronyms to new folks is that all the things we do to take care of patients has to be 'in series' as opposed to 'in parallel'. What that means is that we do a lot of things at the same time to stop someone from dying and if those interventions are not separated by a few seconds in their correct order, it's OK. Algorithms are a thing in medicine, but they're only reflections of what is intuitive reflex, cluster intervening by the seasoned veteran.

When was the last time you actually thought intentionally about each and every action/intervention you took to save someone's life (if you are a seasoned veteran)? The patient probably either had the best possible chance and died or he did well.

Once things get managed and the patient is not going to DRT, that's when critical thinking and advanced differential diagnoses come in and there's no acronym for that...
 

Tigger

Dodges Pucks
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I think the implication of acronyms to new folks is that all the things we do to take care of patients has to be 'in series' as opposed to 'in parallel'. What that means is that we do a lot of things at the same time to stop someone from dying and if those interventions are not separated by a few seconds in their correct order, it's OK. Algorithms are a thing in medicine, but they're only reflections of what is intuitive reflex, cluster intervening by the seasoned veteran.
I think this is very true. I try to have my students and interns use the acronyms and other tools as checklists after they’ve done their assessment, thereby not making their assessment only by acronym.

By the end of the call, you should be able to answer every part of SAMPLE and OPQRST and go back through each part of MARCH and be able to say to yourself “yep I hit it all.”

I don’t really use any of these anymore, but I think when you’re new this is a useful strategy.
 
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