In the Field
MARCH gets the casualty through the first 10 minutes. MARCH PAWS gets them through the first 24 hours. After massive hemorrhage, airway, respiration, circulation, and hypothermia are addressed, the casualty still has unmanaged pain, an open wound that needs cleaning and dressing, a fracture that needs splinting, antibiotic decisions to make, and ongoing reassessment. MARCH PAWS gives a structure to the period between immediate life-saving intervention and definitive evacuation. It is especially useful in Prolonged Casualty Care where the casualty may be held for hours or days before reaching a surgeon.
Common Mistake
Treating MARCH PAWS as a checklist completed once, rather than a recurring cycle. The casualty's status changes; vital signs drift; tourniquets need reassessment; pain medications need redosing; wounds need re-evaluation. MARCH PAWS should be re-run at intervals throughout extended care, with documentation on the DD 1380 or supplementary forms. The other mistake is doing the secondary survey while the primary survey items are still inadequately addressed. PAWS does not begin until MARCH is stable.
Technical Detail
MARCH PAWS expansion: M (Massive hemorrhage), A (Airway), R (Respiration), C (Circulation), H (Hypothermia), P (Pain management), A (Antibiotics), W (Wound care), S (Splinting and Sucking chest wound management). Used in TCCC ASM/CLS, CMC, and CPP curricula as the structure for prolonged field care management. Pain corresponds to TCCC 2026 Section 11 (CWMP, ketamine, esketamine). Antibiotics corresponds to Section 12 (cefadroxil PO, ceftriaxone IV or IM). Wound care includes irrigation, dressing changes, and inspection per Section 13. Splinting follows Section 16. Each PAWS item has TCCC doctrinal guidance that maps directly to the algorithm letter.
