By Tyler Thomson
Imagine this situation. You are first on the scene and the patient needs immediate medical attention, so you call an ambulance. The dispatcher informs that the EMS is on its way, but in 10-15 minutes. The patient bleeds, cries for help and loses consciousness. And after?
In many communities, it is very common for law enforcement to be the first response, or co-response, to EMS incidents: wellness checks, vehicle collisions, seizures, ongoing CPR, and penetrating trauma. If you don’t know where to start when caring for a patient until EMS arrives, the acronym MARCH, as described below, will serve as the basis for treating the patient.
Massive bleeding (bleeding control) is the most preventable cause of death in tactical scenarios and the second leading cause of death in prehospital settings. A person can bleed to death in about five minutes or less.  Officers can control extremity bleeding with the rapid deployment of CoTCCC-approved tourniquets, pressure bandages, and compression gauze. The ability to control bleeding is the most important skill to practice continuously, as this is all too common.
The Tactical Combat Casualty Care Committee (CoTCCC) is an approving authority for Tactical Medical Trauma Equipment. Careful research should be done when purchasing a tourniquet to ensure that it is approved by this organization.
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Airway management is relatively simple. If you can move the patient, roll them onto their side, bend one knee outward, and place their hands under their head. This is the “recovery position”, which can open the patient’s airway and protect their airway in case of vomiting. If necessary, insert a nasopharyngeal airway (NPA) to prevent the patient’s tongue from obstructing their airway. If a patient is having a seizure, moving them to the recovery position is your best option.
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Breathing regular and adequate are essential to the survival of the patient because the respiratory arrest is quickly decompensated in cardiac arrest. Treating a stab or gunshot wound to the chest with a ventilated chest seal on the entry and exit wounds of the chest. These seals will keep the lungs inflated as best they can, allowing the patient to breathe much longer. Remember that if there is an entry wound, there is probably also an exit wound. Be sure to check both sides of the body when applying breast seals.
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Traffic has little application in law enforcement. Typically, this is a reference to EMS securing IVs and pushing medications. However, rapid responses to patients in cardiac arrest can have a remarkable effect. Keep up to date with your CPR certification and abilities. Be prepared to perform CPR and to tether and defibrillate (shock) the patient with an AED. Statistical data proves that maintaining as few chest compression interruptions as possible during CPR leads to higher positive patient outcomes. 
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Head injuries/hypothermia is a two-part category. If you suspect a patient has a head injury, exercise caution and perform minimal but deliberate movements of the patient’s head, neck, and torso. Moving the patient should only be done to remove the patient from an emergency and hazardous environment. Additionally, a risk-benefit decision must be made whether to move the patient to the recovery position to protect their airway or to remain in their position to protect their spine.
Hypothermia can be a problem for someone with severe blood loss or spinal injuries, even in hot weather. Perform all procedures on the patient, then lay down a reflective emergency blanket.
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The acronym MARCH is not a complete guide for the outpatient, but rather the basis for practicing the management of life-threatening conditions with your local EMS agency. Law enforcement officers, EMTs and paramedics training together will build relationships and positively impact the community.
1. Stop bleeding month. American Institute of Safety and Health.
2. Christenson J, et al. (2009.) Chest compression fraction determines survival of patients with community-acquired ventricular fibrillation. Traffic, 120:13, 1241–1247.
About the Author
Tyler J. Thomson is an emergency response and management professional. He has experience in various aspects of emergency response, management and military service. Tyler is passionate about serving the local community and advancing the future of emergency services.
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