Thanks @maillet282 , really appreciating your detailed reply. It's never to late to contribute Sounds like this is an established practice at an medical emergency service/paramedic? Our regional fire brigade first responders have now been trained with 4S-C-ABC(R)DE Scene: assess scene, number of patients Safety: risk for first responders, patients and by-standers Situation: injury mechanisms Support: call for other services/assistance (para medics, police, fire brigade, heli, etc.) C: Critica Bleeding A: Airway B: Breathing C: Circulation Rapid trauma assessment D: Disability E: Exposure We don't do triage, but handing over to the paramedics - usually at "D".
Forgot I’m the C there is the BIFT acronym B- bleeding control( other than what was done in M) I- IV Access F- Fluid resuscitation T- Tourniquet assessment
In case some of you are unaware, MARCH stands for: Massive hemorrhage, Airway, Respiration, Circulation, Head injury/hypothermia. Compare this to the more common First Aid acronym ABCDE... Airway, Breathing, Circulation, Disability, Exposure ...and you begin to see the reason that MARCH is making inroads in traumatic injury care, for instance the TCCC and TECC protocols. The major problem in this, is where such specialised and technical trauma care training can be given to licenced persons only, due to the medical care laws in some countries (including the UK), and you begin to realise why MARCH / TCCC / TECC are not making better inroads in First Aid training; example: Needle decompression/reinflation, intubation, etc.
Thanks @RogerStenning for highlighting both schemes here. If I compare it side-by-side it doesn't seem to have major differences in addressing the most critical life functions: Address massive bleeding: X or C - M Secure airway: A - A Provide breathing: B - R Provide circulation (CPR): C - C Address any other major issue: D - H Take care of not immediately life threatening issues: E - _ So the most important thing is to stop massive hemorrhage to "keep the red stuff" inside the body, followed by making sure that the red stuff circulates to have it carry oxygen to the cells and co2 from the cells - ideally provide fresh oxygen through external ways (resuscitator). Did I miss something?
You're welcome No, I think you hit the nail on the head, especially with the last para; while everything's incorporated in both protocols, MARCH emphasises - with good reason, IMHO - the halting of massive blood letting from the victim, before addressing respirational issues (doesn't matter if they're linked, such as a GSW through a lung, for example), as blood is nowhere as easily replaced as air: Air's all about us (well, unless you're underwater, and that's a WHOLE new ballgame!), whereas replacing blood is a rather specific logistical exercise in the first place (bottles of plasma et al are usually in rare supply when you're in the middle of No and Where). I DO think there's a middleground in training between ABCDE and MARCH, though; while addressing the immediacy of MARCH, and meeting the requirements of ABCDE, I think it IS possible to provide 'civilians', that is, people not in the uniformed and/or emergency services, with the training to meet the initial requirement of ensuring where possible that a victim's golden hour is extended to where professional support can get to the victim, and provide more comprehensive and effective long-term care prior to hospitalisation and ER/A&E Traumacare. Such training would emphasis bleed reduction, respiration, and bonecare, whilst omitting the more specialised and all-too-often licencable procedures such as Needle decompression/reinflation, intubation, etc. For want of a better name, we might call this protocol MARCH-LITE. MARCH-LITE would likely be a two-day course, with the standard FA topics, and some additional sections including, for a sample of cases, where and when to use wound packing and/or pressure, TQs, splints, eye irrigation (and what to use for that) and so on, so as to provide a more rounded trauma first aid set of skills to average members of the public who want to better help people around them, before an ambulance or similar professional help can arrive. This would have to be a certificated course, valid for at most two years, to provide for people who are bang up-to-date with current procedures that meld, and aide directly, with EMT etc standards of treatment. Thoughts?
In the US and some parts of Canada, Toronto for sure they have whats called stop the bleed programs. That train civilians in the MARCHE acronyms as well as the use of TQ and combat gauze and the liko of packing materials. the MARCHE acronym can definitely be used for the “layman” first aider ( i say layman in the term of a non medical professional) you just need to instruct that they are not authorized to conduct delegated medical acts per laws in the respective country of residence/occupancy great example is me. Im fully authorized to do some medical acts such as needle decompression( just did a round robin for 18 students on just that today) as well as surgical airways, narcotic admin, atbx admin and so on as long as im in a military setting. But can adapt the march to work on civi streets and simply make due with out the delegated medical acts
I really LOVE your idea @RogerStenning of MARCH-LITE. Unfortunately, here in Germany most courses for civilians have a broader scope (including how to detect and "address" heart attacks and strokes - as a layman you can't do anything with those internal issues other than calling 911 [112]). Why "unfortunately"? Well, most organizations like red cross and others address massive bleeding with pressure bandage only. Talking about tourniquets is "strictly forbidden" and not part of their training course. I do get a refresh course (as a company first responder) every two years and I choose different medical training providers and ask every time: why are TQs are not being part of the course. I hear different excuses ... like no time, no priority, other issues happen far more often, etc. The dumbest (sorry!) argument I heard was in my last course: laymans can forget to write down the time when the TQ was applied. In a civilized environment that should be able to keep the golden hour it simply doesn't matter if a TQ was applied for 25 or 90 minutes, so does the lack of putting down the exact time. Yes, it takes some time and training to apply a TQ correctly. And yes, it does save lifes. And no, paramedics will not be on-scene within three minutes - so for a massive hemorrhage there is no alternative to a TQ. Sorry for the rant ...
You bring up a very important point @maillet282: what can medical professionals or medical trained members of aid organizations apply when not on duty / on a call - usually without their advanced material. That's an area that one needs to think and consult lawyers upfront as it is highly dependent on local laws, regulations, expectations from public and legal systems (judges), etc. E.g. I'm trained in advanced first aid (member of volunteer fire brigade), but I'm not allowed to intubate a person when I'm not on a call, even if I have a nasopharyngeal airway with me (read: it's generally okay to put something ON patients, but not okay to put something IN patients). This includes things like medications (e.g. ibuprofen) and also simple things like wound disinfection - a no-go as in case of a allergic reaction I would be fully responsible and can be charged with "medical crime". This brings me to: what do we carry and use - as trained medical [semi-] professionals - when we are not on duty? -> continue discussion here: https://www.edcforums.com/threads/what-do-you-carry-and-use-as-trained-medical-semi-professionals-when-not-on-duty.142069/
So for R in your comparison. R is not providing breaths it’s treating penetrating chest trauma, needle decompression of tension Pneumothorax type interventions. unfortunately in a battle field situation when bullets are flying and people are dying. There is no time to do AR or CPR and unfortunately you will need to triage who are going to survive or not
If there's Pneumothorax, and if your regulations/laws permit non-paramedic/non-licenced persons to do that, yes, needle decompression is king. If you AREN'T, then it's back to basics and whever you can do to make the patient comfortable until professional help arrives - that's the situation we have here in the UK, dammit.
