Written by Tyler Thompson
Imagine this situation. You first arrive at the scene of the accident and the patient needs immediate medical care, so you call an ambulance. Dispatch advises that EMS is on its way, but 10 to 15 minutes. The patient bleeds, screams for help, disappears into consciousness and loses consciousness. What’s Next?
In many communities, it is very common for law enforcement to be the first response, or joint response, to EMS incidents: care checks, vehicle collisions, seizures, CPR in progress and penetrating trauma. If you are unsure where to begin when caring for a patient until EMS arrives, the acronym MARCH, as defined below, will serve as the basis for patient treatment.
massive bleeding (Bleeding control) is the most preventable cause of death in tactical scenarios and the second leading cause of death in a prehospital setting. A person can bleed to death in about five minutes or less.  Officers can control limb bleeding through the rapid spread of CoTCCC certified tourniquets, pressure bandages and pressure gauze. The ability to control bleeding is one of the most important skills that must be practiced consistently, as this situation is very common.
The Tactical Combat Injury Care Commission (CoTCCC) is an accrediting authority for tactical medical trauma equipment. Careful research should be done when purchasing a tourniquet to ensure that it is approved by this organization.
Airlines Management Relatively simple. If you can move the patient, roll him on his side, bend one knee outward and place his hands under his head. This is the “recovery position”, which can open the patient’s airway and protect the airway in the event of vomiting. If necessary, enter the oropharyngeal airway (NPA) to prevent the patient’s tongue from obstructing the airway. If the patient is having a seizure, moving the patient into a recovery position is your best option.
breathing Regular and adequate therapy is necessary for the patient’s survival because respiratory arrest quickly turns into cardiac arrest. Treat a stab wound or gunshot wound to the chest with a morbid chest seal over the entry and exit wounds to the chest. These seals will keep the lungs as inflated as possible, allowing the patient to breathe for longer. Remember, if there is an entrance wound, there will likely be an exit wound as well. Be sure to check the sides of the body when placing the chest seals.
Rotation It has little application in law enforcement. Usually this is a reference to the EMS that secures intravenous injections and push-pull medications. However, the rapid responses of cardiac arrest patients can have a noticeable effect. Stay up-to-date with your CPR certification and capabilities. Be prepared to perform CPR and attach and defibrillate (shock) the patient to the AED. Statistical data demonstrate that maintaining as few interruptions of chest pressure as possible during CPR leads to higher positive outcomes for patients. 
Head injuries / hypothermia It is a two-part category. If you suspect a patient has a head injury, be sure to make simple but deliberate movements of the patient’s head, neck and torso. The patient should only be transported to remove the patient from an emergency and hazardous environment. In addition, a decision must be made about the risks and benefits of either moving the patient into the recovery position to protect the airway or having the patient remain in the position to protect the spine.
Hypothermia can be a problem for someone with severe blood loss or spinal injuries, even if the weather is warm. Perform all interventions on the patient, then place a reflective emergency blanket on him.
The MARCH acronym is not a comprehensive out-of-hospital patient guide, but rather the basis for training in the care of life-threatening conditions with your local EMS agency. Together, training law enforcement officers, EMTs and paramedics will build relationships and positively impact society.
1. stop the bleeding month. American Institute of Safety and Health.
2. Christenson G. et al. (2009.) Chest compression fraction determines survival in out-of-hospital patients with ventricular fibrillation. Circulation, 120:13, 1241-1247.
About the author
Tyler J. Thomson is an emergency response and management specialist. He has experience in various aspects of emergency response, administration and military service. Tyler has a passion for serving the local community and advancing the future of emergency services.