TCCC MARCH Checklist: Fast Response Fundamentals for Civilians

Tactical Combat Casualty Care (TCCC) introduced a simple framework for handling life-threatening trauma under stress: MARCH. The pillars are:

• Massive hemorrhage
• Airway
• Respiration
• Circulation
• Hypothermia/Head injury

You do not have to be in uniform to benefit from that checklist. Civilians who train on MARCH move faster, make fewer mistakes, and hand off cleaner patients to EMS. This guide keeps the language plain so you can apply the pillars with the gear you already stage in your first aid kits and vehicle IFAKs. If you are building out a comprehensive kit, browse our First Aid & Hygiene category for deeper dives.

Disclaimer: This article is not formal medical training. Complete a Stop the Bleed or TCCC-AC course before attempting these interventions. Always defer to local protocols and licensed professionals when they arrive.

M — Massive Hemorrhage

• Assess and expose quickly. Sweep for arterial bleeds (bright red, pulsing, pooling) and obvious amputations. Follow your gloves with a clean hand to feel under clothing and kit.
• Apply direct pressure immediately. Use a gloved hand, pressure dressing, or whatever clean cloth you have. Keep steady pressure; swapping hands reduces effectiveness.
• Tourniquet extremity bleeds. If the wound is on an arm or leg and pressure alone is not working, place a proven tourniquet at least 2–3 inches above the wound, not over a joint. Crank until bleeding stops and note the time.
• Junctional or torso wounds: Keep the pressure. Pack deep with gauze if trained, then layer on a pressure dressing.
• Hemostatic agents (e.g., QuikClot). Hemostatic gauze has been credited with saving lives, especially in remote settings, but it complicates surgical cleanup. If professional care is reachable quickly, sustained pressure is often enough—reserve hemostatics for situations where transport is delayed or pressure alone appears to be failing.

According to U.S. military data, uncontrolled bleeding accounted for roughly 90% of preventable battlefield deaths in recent conflicts. Wide adoption of tourniquets drove a dramatic drop in those fatalities. One Joint Trauma System review estimated an 85% reduction in extremity hemorrhage deaths once tourniquets became standard issue. The take-away: swift bleeding control saves lives.

A — Airway

• Talk to the casualty. If they can answer clearly, their airway is patent. Keep monitoring.
• Open and maintain. If unresponsive, use a head-tilt–chin-lift unless you suspect spinal trauma, then opt for a jaw thrust.
• Remove obstructions. Clear blood, vomit, or foreign material with gloved fingers or suction if available.
• Adjuncts. If trained, insert a nasopharyngeal airway sized from nostril to ear lobe and lubricate before insertion. Most kits come with lubrication, but if you are without it, saliva can work in a pinch.
• Manual maneuvers. Place the casualty in the recovery position if they are breathing spontaneously and there is no suspected spine injury.

R — Respiration

• Seal chest wounds. Penetrating trauma to the chest calls for a vented chest seal or occlusive dressing. Wipe the area dry, apply the seal, and reassess for new bubbling or hissing. If there is a wound on one side, if the patient is safe to move, check the other side for exit wound.
• Check for breathing inadequacy. Observe rise and fall, listen for diminished sounds, and watch for increasing respiratory distress.
• Needle decompression. Only perform if formally trained and you have approved equipment. Indications include worsening breathing, tracheal deviation, or jugular vein distention after chest injury. In many jurisdictions this remains an ALS skill. Know your local laws.

C — Circulation

• Pulse reassessment. Once bleeds are under control, check radial, femoral, and carotid pulses. A weak or absent radial pulse can signal shock.
• Medication & fluids. In civilian settings, focus on rapid transport. Start IV/IO fluids only if your protocol, equipment, and training allow it. Keep blood pressure just high enough to maintain consciousness.
• Monitor tourniquets. Ensure they remain tight. Anytime the patient is moved, reassess the tourniquet and the site of trauma for bleeding. Add a second tourniquet proximal to the first if bleeding restarts, do not remove the original tourniquet.
• Pain management. Analgesia aids patient compliance if you have authorized medications and training.

H — Hypothermia (and Head Injury)

• Insulate immediately. Trauma patients lose heat fast—even in warm environments. Lay down a barrier between the casualty and the ground, wrap with a blanket, emergency bivy, or survival tarp from your kit.
• Keep them dry. Replace wet clothing with dry layers if possible.
• Protect the head. If a head injury is suspected, monitor for decreased consciousness, unequal pupils, or repeated vomiting. Maintain oxygenation and avoid hypotension.
• Document you’re covering MARCH. Record vitals, interventions, and times. Those notes guide EMS and hospital staff.

Suggested Gear for Your IFAK

• Combat-proven tourniquet (carry at least two)
• Pressure dressings and compressed gauze
• Hemostatic gauze (for prolonged evacuations)
• Nasopharyngeal airway with lubricant
• Vented chest seals
• Emergency blanket or hypothermia wrap
• Trauma shears, gloves, marker, notepad
• Common medications (ibeuprofen, acetaminophen, etc.)

Staging this equipment in your vehicle kit or home first aid cache pays dividends when seconds matter. Combine those tools with deliberate practice—run realistic scenarios, time yourself, and debrief after every training rep.

Keep Studying

MARCH is only the beginning. Invest in a certified trauma class, drill with your family or team, and stage gear in your vehicle just like you stage water or food. The faster you work down that checklist, the sooner you transition to transport and definitive medical care—and the better the odds for the person in front of you.