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TABLE 4 MARCH-P Evaluation System Depending on the START system results, the Orange Team
members could transport the patient to the Green Zone by
Massive hemorrhage
• Evaluate bleeding injuries and apply tourniquet. themselves (yellow card) or request extraction by the Green
o Maintain the tourniquet. Team (orange card) or by motor extraction (red card and
M o Apply a second tourniquet if bleeding does not stop. black card). It is important to complete the evaluation and
• Treat the other bleeding injuries. treatment card to ensure reliable medical communication from
o Use of hemostatic bandage
o Use of compressive bandage the field to the final medical care providers.
Airway
• Unconscious casualty without airway obstruction The PMSCS morbidity and treatment card (Figure 12) in-
o Line up the airway axis. cludes the following information: date and time; location; ca-
– Chin elevation sualty personal identification; whether the patient carries ID;
– Jaw elevation whether the patient is accompanied by a companion and, if
– Sniffing position
o Secure the airway. so, the personal data of the companion; whether the patient is
– Nasopharyngeal cannula (preferred) or oropha- armed and, if so, who will take care of the weapon as well as
ryngeal cannula personal data and ID number; and pertinent medical history
• Conscious casualty with risk of airway obstruction. (e.g., allergies, any cardiac, neurological, metabolic, or respi-
A o Line up the airway axis.
– Chin elevation ratory diseases). The type of injury should be identified by the
– Jaw elevation appropriate number in the body sample image and the proce-
– Sniffing position dure and/or treatment applied, with the color START card and
o Let the patient adopt an airway defense position. the place to which the patient is to be transported. Because
o Secure the airway. this is legal medical information, only physicians or medical
– Nasopharyngeal cannula (preferred) or oropha-
ryngeal cannula specialists are permitted to complete the card and place their
o Emergency cricothyroidotomy if these steps do not medical seal on it.
work
Respiration
• In case of close chest trauma and dyspnea with FIGURE 12 PMSCS Morbidity and Treatment Card.
associated shock or cardiac arrest, suspect
tension pneumothorax and proceed with thorax
R
decompression technique.
• In case of open chest trauma, place the chest seal
and observe for potential tension pneumothorax
development.
Circulation
• In a casualty without neurological impairment, able to
self-protect the airway and swallow, the oral route can
be used for fluid resuscitation.
• In case of circulatory shock, an intraosseous or
intravenous catheter should be placed for fluid
resuscitation until radial pulse is palpable.
C o Recent medical data suggest that permissive hypoten-
sion, when systolic blood pressure is not <70mmHg,
does not show a difference between short- and long-
time mortality. The use of full blood resuscitation
in hemorrhagic shock is preferred over crystalloids
or colloids; its use is at the discretion of the medical
specialist in the field.*
Hypothermia/Head trauma
• Reduce the patient’s exposure to the environment.
• Replace wet clothes for dry ones.
• Use thermal blankets.
H • Assess eyes for equal pupils, pupils’ light reaction,
extraocular movements, and raccoon eyes (periorbital
ecchymosis).
• Check the nose and ears for blood, cerebrospinal
fluids.
Pain
• Consider pain management and its benefit for both
the patient and the team during transport.
• Use morphine, fentanyl, sufentanil, nonsteroidal anti-
inflammatory drugs according to patients’ needs.
• Use of painkillers is at the discretion of the physician
P or medical specialist in the field.
• Keep the following contraindications in mind:
o Unconsciousness
o Allergies
o Hypovolemic shock
o Traumatic brain injury
o Respiratory distress
Source: *Carrick MM, Leonard J, Slone DS, Mains CW, Bar-Or D. Once the evaluation and treatment are done, if the patient
Hypotensive resuscitation among trauma patients. Biomed Res Int. needs further medical attention, extraction is requested using
2016:8901938. Epub 2016 Aug 9. doi: 10.1155/2016/8901938. the MEDEVAC PMSCS for the Orange Zone (Figure 9)

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