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(MARCHE) 2
Assessment at the Dirty CCP (Warm Zone)—(MARCHE) Treat life threats ONLY
2
Decontamination and treatment can be a synchronous process. Reassess CRESS.
TCCC CBRN
M.A.R. Reassessment (Massive M.A.R. Reassessment
Hemorrhage, Airway, Respirations) (Mask, Antidote, Rapid Decon)
• Stop all external hemorrhage. • Check mask seal
• Advanced airway prn • Assess response to antidote and reassess
• Treat tension pneumothorax CRESS
• Ventilator support (PEEP support, pressure • Reassess need for rapid Spot decon
monitoring, etc)
Circulation Countermeasures
• Pulse Check • Nebulized or inhaleradministered
• Skin Check medications such as albuterol or
• Assess for Shock corticosteroids
• IV/IO access if needed immediately • IV/IO Drips (hydroxocobalamin, atropine,
• Fluid resuscitation per TCCC guidelines naloxone, etc.)
only if absent radial pulse • Suction the airway
• Treat lifethreats ONLY
• Specific countermeasures may be found in
CBRN CPG Part II
Hypothermia
• Package the casualty
• Protect from the lethal triad: Hypothermia, acidosis, and coagulopathy.
Head Wounds
• Determine whether the casualty’s altered mental status is due to a chemical agent or trauma.
Evacuation
• Determine Evacuation Priority
• Fill out the CBRNE Casualty Card or TCCC Casualty Card
• Move the patient for further decontamination or to the evacuation platform.
Re-evaluation—(Cold Zone) TACEVAC or Prolonged Field Care (MARCHE) 2
Re-triage patient: has the patient’s condition changed due to the decontamination process?
2
Reassess: Are immediate life threats addressed? CRESS and (MARCHE) prn.
Conduct secondary assessment/survey.
Ensure documentation is filled out and transported with the patient.
Communicate with receiving medical personnel about the decon status and treatment.

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