M.A.R.C.H P.A.W.S And Trauma
When it comes to a quick efficient trauma assessment on a patient I have found that using the M.A.R.C.H P.A.W.S acronym is the simplest.
- M is for massive hemorrhage
- A is for airway management
- R is for respiratory
- C is for circulation
- H is for hypothermia/head injuries
- P is for pain management
- A is for Antibiotics
- W is for wound management
- S is for splinting.
This acronym is designed to identify and treat injuries quickly and efficiently. Trauma patients should be fully exposed. Once you identify an injury, treat before continuing assessment. This is taught in Tactical Combat Casualty Care and Tactical Emergency Casualty Care.
First, life threatening bleeding can be addressed quickly with the use of tourniquets which are readily available. EMS, Fire, and Police department personnel are usually carrying these with them.
Airway management has multiple interventions to include head tilt chin lift/jaw thrust, nasopharyngeal airway, cricothyrotomy with these procedures based on patient condition and certification level of the providers. Within the respiratory phase you look listen and feel. It also includes the needle decompression skill, chest seal placement and establishing SPO2 monitoring.
Moving on to circulation you are quickly checking radial pulse to assess for shock. The presence or absence of a radial pulse is a great indicator as to whether a patient is in shock or not. Establishing an IV or IO also occurs during circulation. We should also be performing any fluid resuscitation that may be necessary. In MARCH PAWS it calls for blood as the first fluid choice for trauma patients.
Then hypothermia/head injuries. We are referring to hypothermia in terms of blood loss and its affect on the clotting factors within the body. It is much easier to prevent hypothermia than to treat it. It is simple to place a blanket over your patient. With head injuries we should be getting a GCS and checking pupils. Changes in mentation or pupils could indicate potential head injuries. The great thing about the MARCH algorithm is that if you get lost you can start from the beginning.
When you need to re-assess a patient start at the beginning. As we move patients or as time goes on things can change or need to be redone.
The PAWS part of the acronym is for once you have the patient stable or when your initial assessment is completed. Start with pain management and treat your patient according to your protocols. While we don’t typically address antibiotics in the field is just strengthens our knowledge of what this patient will need. We will then address any additional wounds that have not been taken care of. Lastly, we will splint as needed. As mentioned, this acronym is taught in the above-mentioned course. The US military teaches various levels of this course based on the need of the service member and their respective jobs. Every single service member will understand MARCH PAWS. This concept has been proven to save lives.
James Martin
MSgt. USAF, NRP
Refrences:
https://pubmed.ncbi.nlm.nih.gov/29256201/#:~:text=The%20mnemonic%20stands%20for%20massive,device%20as%20a%20treatment%20checklist.
https://usacac.army.mil/sites/default/files/publications/17493.pdf
