Full-time paramedic, reserve police officer, and retired military Mike McElmeel of Eighteen Zulu LLC talks about the M.A.R.C.H. Assessment tool. Most of us carry some sort of IFAK or trauma management equipment when we’re on the range. But how are we going to manage the patient between the time we have a catastrophic injury and the time emergency medical services arrive?
This is a trauma management mnemonic that should be part of your self-defense toolkit. Mike explains what each letter stands for.
M: Massive Hemorrhaging
M stands for Massive Hemorrhaging and is the #1 cause of preventable death in military and law enforcement contexts. We will mitigate the massive hemorrhaging with tourniquets if the injury is to the extremities, or pressure dressings if the injury is elsewhere.
Open the airway using the head tilt/chin lift method, or if you suspect there is head, back or neck trauma, use the jaw thrust method. Help the patient to maintain the open airway if necessary, and put them in the recovery position — lying on their side — to make sure they do not aspirate any fluids that may be leaking out of their mouth.
Pneumothorax has been reported as the #1 cause of preventable death in a mass shooter/civilian context. Look, listen and feel: Is the chest rising and falling equally? If not, we should suspect a penetrating injury that is causing one lung to collapse. Find the entry and possible exit wound(s) and place occlusive dressings on them to plug the openings.
Feel for a radial pulse (on the wrist) or a carotid pulse (on the throat). If you can’t feel a carotid pulse, initiate CPR if you have been certified to do this in your trauma management training.
A patient who loses a lot of blood will become cold, so we need to get them warmed up however we can — with blankets, towels, covering their head, using whatever is available at the range.