If you've had any form of civilian or basic first aid training, chances are you've heard of the ABCs of patient care. Airway, Breathing and Circulation - In that order of priority. What if someones spurting out blood?
In incidences of trauma, haemorrhages are the leading cause of death in trauma. 31% in-fact. That's why some more advanced courses have started teaching 'C-ABCDE':
- Catastrophic Haemorrhage
Whilst this is certainly preferable than the 'ABCs' - It's also created a lot of confusion for first aiders, and many trainers have reverted back to other numerics such as 'DRABS' which cuts out circulation all-together.
Because of this, We've decided to share The MARCH Algorithm. Designed specifically for trauma scenarios by the British Army and implemented globally, It's a proven method of pre-hospital care that ACTUALLY WORKS!
We'd recommend that you stick with DR ABC(DE) for your everyday first aid situations. However, if you were to come across any incident of trauma (shootings, stabbings, IEDs etc) the MARCH Algorithm will be much more effective in your initial response.
What is the MARCH Algorithm? Let Us Explain.
- Massive Haemorrhage
This is the order in which you should asses and treat any casualty of major trauma.
A massive haemorrhage means a serious, life-threatening bleed. You'll see dark red blood spurting or fast flowing from the wound. With extreme haemorrhage such as from the femoral artery, the patent can lose consciousness in 90 seconds and die within 3 minutes.
Many people think of Massive Haemorrhage as something only experienced in a battlefield context, such as IED Blasts, Bullet wounds etc. However, it's also a common occurrence in our day-to-day lives, and something we should be prepared for.
In the case of a haemorrhage, you need to act fast. Having the correct tools and training will save lives in these incidents. There are three main methods of treatment for haemorrhage:
Tourniquets: Apply to the limb 5inches above the wound, or as high as possible on the limb if you cannot locate the site. Apply as tightly as possible, and note the time of application. If the bleeding doesn't stop, don't remove the TQ but apply another above the first.
You can improvise a TQ using anything that can loop around the limb, such as a belt. However, improvised tourniquets have been found to have no impact on the patient's survival if they didn't incorporate a windless. Wrap the belt around the limb, slide a solid bar/pole under the loop and rotate, keeping the pressure constant.
Wound Packing: Used in Junctional Sites such as armpits/shoulders, groin and neck the process is as easy as stuffing any bandage or (clean) fabric into the wound.
Scoop out any pooling blood and insert your finger into the wound, feeling for where the blood is pumping from. Pack the dressing into the wound using a finger from each hand, keeping pressure on the bleed site at all times. Packing in a NORTH, SOUTH, EAST, WEST rotation will make this easier.
Chest Seals: For any major chest wound (shooting, stabbing etc) apply a chest seal directly over the sucking chest wound, using a vented seal if possible. You can place a gloved hand over the wound to fashion your own seal. Remember to check patients back too!
Same as before, you're looking for anything that might be obstructing the airway simply by looking into the patient's mouth. There are two main methods of opening a patients airway:
Head Tilt, Chin Lift: To be used when a patient has no chance of spinal injuries. Once performed, the airway should remain open without support (continually assess).
Jaw Thrust: To be performed when a patient may have a spinal injury. Once performed, the jaw will have to be held in place by a second person.
The patient's airways MUST be continually assessed. If possible, place the patient in the recovery position and continue obs regularly.
This is essentially the same as breathing to a first aider. After inspecting the airway and potentially opening it if needed, position your head above the patients with your ear hovering over their mouth and face down their chest.
You should stay in that position for 10 seconds; watching, listening and feeling for the patients breathing. They should inhale/exhale twice within that 10 seconds. If they don't, consider CPR.
This is where we address any other bleeding and circulation issues. Bandage any bleeds that need addressing, also take a moment to review the actions you took for massive haemorrhage to ensure they are still effective.
Get the patient to keep the pressure on any bleeds, and bandage where possible. If you do not have a pressure bandage, twist the fabric over each time you pass over the wound - this will apply more pressure. If one bandage bleeds through, apply another on top. If the second bleed's through, reassess your treatment methods.
It's a well-known fact that those suffering from shock or a major bleed will quickly lose body-heat and may well become hypothermic. Even during the 20-minute wait for an ambulance.
Keep the patient warm by giving them extra layers of clothing, wrap your coat around them etc. Wrapping survival foil blankets are a great way to keep the patient's temperature up, it also makes it easier for medics to identify patients through crowds.
If viable, consider moving the patient onto a blanket/jacket if they are on concreate or a cold surface. Only do this if it is medically viable, however.
(BONUS) HEAD INJURY
In addition to Hypothermia, we also tech Head Injury under H of MARCH. This means checking for any trauma to the head and brain. Keep in mind potential brain damage, eye or ear injuries etc. If you see straw-coloured discharge coming from a patient's ears, that's a key sign that they may have sustained a skull fracture and need urgent care.
We could go into a lot more detail about the MARCH Algorithm, it's a brilliant tool that we use every single day to treat trauma patients. It's much simpler than the ABCDE, whilst doing the same job essentially.
If you have any questions, comments or want to share your opinion - get in touch with us @1stLineMedic on all social media channels.