Which is the correct MARCH sequence?

Which is the correct MARCH sequence?

• A. Massive Hemorrhage, Airway, Respiration, Circulation, Head Trauma and Hypothermia
• B. Airway, Massive Hemorrhage, Circulation, Respiration, Head Trauma
• C. Airway, Respiration, Massive Hemorrhage, Circulation, Hypothermia
• D. Massive Hemorrhage, Circulation, Airway, Respiration, Head Trauma

Answer: (A)

The key idea is that in tactical trauma care, the threat that kills first gets addressed first: massive hemorrhage control. If bleeding is not stopped quickly, a patient can deteriorate or die within minutes, making other steps less effective. So the sequence starts with stopping the hemorrhage—using tourniquets, hemostatic dressings, or other rapid bleeding-control methods—before moving on to airway management. Once the bleeding is under control, securing and maintaining an open airway becomes the next priority to ensure oxygen can reach the lungs and tissues. After the airway is secured, you support breathing to guarantee adequate ventilation and oxygenation. With breathing stabilized, attention shifts to circulation to restore perfusion and treat shock, all while keeping hemorrhage control in place. Finally, head trauma and hypothermia are considered, but only after the immediate life-threatening bleed, airway, and breathing issues have been addressed, since these factors can worsen outcomes if bleeding remains uncontrolled. Other sequences that place airway or breathing before stopping the hemorrhage risk allowing life-threatening blood loss to continue, which is why this order is preferred in MARCH.

The key idea is that in tactical trauma care, the threat that kills first gets addressed first: massive hemorrhage control. If bleeding is not stopped quickly, a patient can deteriorate or die within minutes, making other steps less effective. So the sequence starts with stopping the hemorrhage—using tourniquets, hemostatic dressings, or other rapid bleeding-control methods—before moving on to airway management. Once the bleeding is under control, securing and maintaining an open airway becomes the next priority to ensure oxygen can reach the lungs and tissues.

After the airway is secured, you support breathing to guarantee adequate ventilation and oxygenation. With breathing stabilized, attention shifts to circulation to restore perfusion and treat shock, all while keeping hemorrhage control in place. Finally, head trauma and hypothermia are considered, but only after the immediate life-threatening bleed, airway, and breathing issues have been addressed, since these factors can worsen outcomes if bleeding remains uncontrolled.

Other sequences that place airway or breathing before stopping the hemorrhage risk allowing life-threatening blood loss to continue, which is why this order is preferred in MARCH.