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Home > Topics > Trauma
February 20, 2014
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The Question
by EMS1 Community

Is there a problem with replacing ABC with MARCH in a civilian setting?

Check it out and add your own thoughts in the comments

By EMS1 Staff

A question posted recently on Quora asked, “Is there a problem with replacing ABC with MARCH in a civilian EMS/first aid setting?”  Ted Conbeer, a former Wilderness First Responder, gave his opinion on the topic. Check it out, and add your own thoughts in the comments.

I think there are two main problems with replacing ABC (Airway, Breathing, Circulation) with MARCH (Massive bleeding, airway, respiration, circulation, hypothermia) in a civilian/urban setting.

Mechanism of injury and availability of advanced treatment

On the battlefield, truly massive (i.e. immediately life-threatening) bleeding is far more common than in a typical urban (or even wilderness) setting. In particular, amputations (from IEDs) just aren't that common in your typical American city. "Bleeding out" from an amputated limb or a major artery will quickly cause respiratory and circulatory distress, but you need to prioritize treating the cause of the distress - the bleeding - above the symptoms if you hope to save the patient.

By contrast, in an urban setting (with the possible exception of a car crash), cardiovascular emergencies are far more common to be the cause of first aid (civilians aren't as young or healthy as soldiers). Even in the cases of major trauma, the ready availability of advanced life support (e.g. an ambulance or ER) make it extremely unlikely that a patient will "bleed out" before reaching a place where he can receive a blood (plasma) transfusion. In other words, unless a patient is bleeding from his femoral or carotid artery, massive bleeding just isn't as important in urban first aid, and can be handled once the pros arrive. On the other hand, a blocked airway will cause death before the paramedics arrive.

Difficulties with inexperienced civilian first responders

If first responders were perfectly trained, the protocol for prioritizing care (ABC or MARCH) wouldn't affect the care the patient received: the "best" responders will apply their judgment and prioritize the biggest problem. Of course, most responders don't have a lot of experience to draw from, and therefore can't be expected to do anything but follow the protocol they know, or at least the one they remember.

I don't have any research at hand, but I'll go off anecdotal evidence that civilians on the whole are poor judges of what constitutes "massive" bleeding... I cracked open my head 5 years ago and was amused at my friends' reactions to the blood and their concern that I would bleed to death if I didn't get to a hospital. Had I been unconscious with a blocked airway, I could have choked to death while my friends applied pressure to the top of my skull to stop what they perceived as "massive" bleeding.

About the author

"The Question" section brings together user-generated articles from our Facebook page based on questions we pose to our followers, as well as some of the best content we find on Quora, a question-and-answer website created, edited and organized by its community of users who are often experts in their field. The site aggregates questions and answers for a range of topics, including public safety. The questions and answers featured here on EMS1 are posted directly from Quora, and the views and opinions expressed do not necessarily reflect those of EMS1.
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