MARCHE is the order of assessment and treatment used in Tactical Emergency Casualty Care (TECC). The letters stand for Major hemorrhage, Airway, Respirations, Circulation, Head injury and hypothermia, and Everything else. It tells you what to look for first, second and third, so the thing most likely to kill your casualty soonest gets handled first.

The Committee for Tactical Emergency Casualty Care (C-TECC) uses MARCHE in Indirect Threat Care, the phase that begins once a casualty is in an area of relative safety. The military's Tactical Combat Casualty Care (TCCC) follows a nearly identical order, commonly taught as MARCH-PAWS.

This guide walks through each letter, compares MARCHE with MARCH and MARCH-PAWS, and explains why the order matters.

Where does MARCHE fit in TECC?

TECC has three phases: Direct Threat Care, Indirect Threat Care and Evacuation Care (see TECC phases).

Under direct threat, you don't run MARCHE. The June 2015 C-TECC guidelines direct responders to "defer in depth medical interventions if engaged in ongoing direct threat." They also say "TQ application is the primary 'medical' intervention." You stop the threat, move the casualty and control massive limb bleeding.

MARCHE starts in Indirect Threat Care. C-TECC's guidance describes that phase as prioritizing "preventable causes of death" in this order: "Major Hemorrhage, Airway, Breathing/Respirations, Circulation, Head & Hypothermia, and Everything Else." C-TECC also says that in this phase "four different levels of providers were assigned to scope of practice." What you do at each letter depends on your training level, local protocols and medical direction.

M: Major hemorrhage

Find and control life-threatening bleeding first. This is often a check of what was done under threat. Are the tourniquets still controlling the bleeding? Is there bleeding you missed, such as in the groin, armpit or neck, where a limb tourniquet won't work?

Hemorrhage comes first because it kills fastest among preventable causes. The Joint Trauma System's Damage Control Resuscitation guideline states: "Hemorrhage is the leading cause of preventable death on the battlefield." For more, see Tourniquets in TECC.

A: Airway

Once major bleeding is controlled, make sure the casualty can move air. The first steps are simple: talk to them, look, and position them. A casualty who can talk clearly has an open airway for now. Which airway devices you may use depends on your provider level and protocols.

R: Respirations (breathing)

Look for wounds to the chest and back, and for signs that breathing is failing. Penetrating chest trauma can cause an open chest wound or a tension pneumothorax, and a casualty who seemed stable can get worse. See chest seals and penetrating chest trauma.

Advanced interventions, including finger thoracostomy with needle decompression, belong only to providers trained and authorized to perform them. The current TCCC guidelines address decompression for suspected tension pneumothorax. That's military guidance, and it doesn't set civilian scope. See TECC vs TCCC.

C: Circulation

Check for signs of shock and recheck bleeding control. Depending on provider level, this is where advanced circulation care, such as vascular access, may come in. For most officers, circulation means reassessing earlier interventions, packing or dressing any remaining bleeding, and getting the casualty ready to move.

H: Head injury and hypothermia

C-TECC groups head injury and hypothermia under one letter. For head injury, watch for changes in consciousness and protect the casualty from further harm. For hypothermia, prevent heat loss early, even on a warm day.

The Joint Trauma System's hypothermia guideline explains the stakes: "Hypothermia, coagulopathy, and acidosis are the physiological derangements constituting the 'triad of death' in trauma patients." It also notes that trauma-induced hypothermia "can occur even in warm climates." Get the casualty off the ground and covered.

E: Everything else

Once the life threats are handled, deal with everything else. That can mean other wounds, fractures, pain, reassessment, documentation and getting ready for evacuation. It's the catch-all that makes sure nothing is dropped before handoff.

MARCHE vs MARCH vs MARCH-PAWS

These acronyms describe the same core idea with different scopes.

  • MARCH covers the first five priorities: Massive (or Major) hemorrhage, Airway, Respiration, Circulation, and Head injury/Hypothermia. It's the core of both TECC and TCCC.
  • MARCHE is C-TECC's version. It adds E for Everything else, so the civilian framework has a clear place for the rest of the assessment.
  • MARCH-PAWS is widely used in TCCC training. A 2017 Journal of Special Operations Medicine study by Kosequat and colleagues defines it as "Massive hemorrhage, airway, respiration, circulation, head and hypothermia, pain, antibiotics, wounds, and splinting." In that paper, "MARCH" addresses the primary survey, while "PAWS roughly addresses the secondary survey."

A detail worth knowing: the TCCC Guidelines themselves (01 May 2026) don't print the acronym "MARCH-PAWS." Their Tactical Field Care sections run Massive Hemorrhage, Airway Management, Respiration/Breathing, Circulation and Hypothermia Prevention. Next come Traumatic Brain Injury, Penetrating Eye Trauma, Monitoring, Analgesia, Antibiotics, wound inspection and dressing, Burns, fracture splinting, CPR, Communication and Documentation of Care. MARCH-PAWS is a memory aid built on that order.

Does the checklist hold up? Kosequat and colleagues reviewed 465 patient care reports written by 16 pararescuemen (PJs) during a six-month deployment. They found that "98% of all treatments were covered by MARCH/PAWS." That's evidence the sequence covers what military medics actually do. It's a military population, though, so don't read it as a civilian outcome study.

For civilian responders, the difference that matters most is who's in front of you. Military care assumes combatants. TECC has to account for children, older adults, pregnant patients and people on blood thinners. The founding TECC paper (Callaway et al., 2011) noted that TCCC "does not account for or address the effects of chronic medication use, such as beta-blockers and anti-coagulants." Those factors can matter at every letter, not just at the end.

Why does the MARCHE order matter?

Under stress, people fixate on the most visible or most familiar problem. A face wound looks bad. A leg wound under dark pants can be quietly draining out a casualty's blood volume. A fixed order keeps you from treating what grabs your attention instead of what kills first.

The order matters for three reasons:

  • It follows time to death. Massive bleeding can kill in minutes. Airway and breathing problems come next. Hypothermia and head injury make everything else worse over time. The Joint Trauma System's hemorrhage-first framing is the reason M comes before A.
  • It works when you're overloaded. A short, memorized sequence is easier to run with multiple casualties, bad lighting and a threat that may come back.
  • It supports handoff. When everyone on scene uses the same order, the officer, the rescue task force medic and the transporting crew all speak the same language.

The sequence isn't a one-time pass. Evacuation Care puts "major emphasis" on "reassessment of interventions and hypothermia management," according to C-TECC. Every move, every handoff and every change in the casualty's condition is a reason to run it again.

Scope and training

MARCHE tells you what order to think in. It doesn't tell you what you're allowed to do at each letter. That depends on your training level, agency protocols and medical direction.

Also, reading an acronym is not the same as running it under pressure. MARCHE only works if you've practiced it hands-on, with realistic casualties, until the order is automatic.

Frequently Asked Questions

What does MARCHE stand for?

MARCHE stands for Major hemorrhage, Airway, Respirations, Circulation, Head injury and hypothermia, and Everything else. C-TECC uses it as the assessment and treatment order in Indirect Threat Care.

What is the difference between MARCH and MARCHE?

MARCH covers the five core priorities, from major hemorrhage through head injury and hypothermia. MARCHE is C-TECC's civilian version and adds "Everything else." That letter covers the remaining wounds and conditions before evacuation.

What does MARCH-PAWS mean?

MARCH-PAWS is a TCCC training mnemonic: Massive hemorrhage, Airway, Respiration, Circulation, Head injury/Hypothermia, then Pain, Antibiotics, Wounds and Splinting. The PAWS part roughly covers the secondary survey. The acronym itself doesn't appear in the TCCC Guidelines.

Why does MARCH start with bleeding instead of airway?

Because massive bleeding is the fastest preventable killer in traumatic injury. The Joint Trauma System states that "hemorrhage is the leading cause of preventable death on the battlefield." Controlling it first gives the rest of the assessment a chance to matter.

When do you use MARCHE in TECC?

In Indirect Threat Care, once the casualty is in an area of relative safety. Under direct threat, care is limited to threat mitigation, movement and massive hemorrhage control. MARCHE is then repeated during Evacuation Care as you reassess.

Can police officers perform every MARCHE intervention?

No. C-TECC assigns scope by provider level. What any officer may do depends on their training, agency protocols and medical direction.

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