Page 15 - ATP-P 11th Ed

The acronym MARCH/PAWS is recommended to guide the priorities in the Care Under
Fire (control of life-threatening hemorrhage only) and Tactical Field Care phases:
Massive hemorrhage – Control life-threatening bleeding.
Airway – Establish and maintain a patent airway. SECTION 1
Respiration – Decompress suspected tension pneumothorax, seal open chest
wounds, and support ventilation/oxygenation as required.
Circulation – Establish IV/IO access and administer fluids as required to treat
shock.
Head injury/Hypothermia – Prevent/treat hypotension and hypoxia to prevent
worsening of traumatic brain injury and prevent/treat hypothermia.
Pain – Administer appropriate analgesia or sedation to manage pain.
Antibiotics – Administer battlefield antibiotics for early prevention of infection.
Wounds – Assess and dress additional wounds and check prior interventions.
Splinting – Splint all fractures or provide support to limb dressings.
Basic Management Plan for Care Under Fire
1. Return fire and take cover.
2. Direct or expect casualty to remain engaged as a combatant if appropriate.
3. Direct casualty to move to cover and apply self-aid if able or when tactically feasible,
move or drag casualty to cover.
4. Try to keep the casualty from sustaining additional wounds.
5. Casualties should be extricated from burning vehicles or buildings and moved to places
of relative safety. Do what is necessary to stop the burning process.
6. Stop life-threatening external hemorrhage if tactically feasible:
a. Direct casualty to control hemorrhage by self-aid if able.
b. Use a CoTCCC-recommended limb tourniquet for hemorrhage that is anatomically
amenable to tourniquet use.
c. Apply the limb tourniquet over the uniform clearly proximal to the bleeding site(s).
If the site of the life-threatening bleeding is not readily apparent, place the tourni-
quet “high and tight” (as proximal as possible) on the injured limb and move the
casualty to cover.
7. Airway management is generally best deferred until the Tactical Field Care phase.
Basic Management Plan for Tactical Field Care
1. Establish a security perimeter in accordance with unit tactical standard operating
procedures and/or battle drills. Maintain tactical situational awareness.
2. Triage casualties as required. Casualties with an altered mental status should have
weapons and communications equipment taken away immediately.

4 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 5