What is the first step in the MARCH protocol?

The MARCH protocol is a systematic approach used in tactical combat casualty care to manage trauma in a prioritized manner. The first step in this protocol is massive hemorrhage control, which takes precedence due to the life-threatening nature of uncontrolled bleeding. Addressing hemorrhage promptly can significantly increase the likelihood of survival, as severe blood loss can lead to shock and death within minutes if not controlled.

Once massive hemorrhage is managed, subsequent steps can focus on airway assessment, respiration, circulation, and head injury management. Prioritizing hemorrhage control first acknowledges that addressing the most immediate threat to life is essential before moving on to other considerations in patient care. This reflects a foundational principle in trauma management: stabilizing the most critical conditions first can provide the best chance for overall survival and recovery.