APPENDIX B: M A R C H

MASSIVE HEMORRHAGE

- Address major hemorrhage threats and sending interventions
- Mark all bleeding on dressings
- Pre-stage loose tourniquet above prior arterial bleed for easy application during transport if re-bleed occurs

AIRWAY

- Ensure that the airway is secured for flight with bilateral lung sounds and EtC02 monitoring.
- Cuff inflated and confirmed with manometer/ secured appropriately
- Prepare emergency airway device (BVM with mask, re-intubation, supraglottic, surgical airway)

RESPIRATION

- Perform Breathing assessment
- Check recent arterial blood gas and compare results against current ETCO2 monitoring

**Ensure collaborative assessment for chest expansion and bag valve compliance

- Placing the patient on the transport ventilator should be weighed with oxygen consumption.

CIRCULATION

- Roll the casualty to assess posterior prior to transport!
- Visually inspect perineal area for hemorrhage and injury.
- Assess all junctional areas for bleeding.
- Assess and mark all distal and central pulses, consider doppler prior to transport if necessary.
- Ensure a minimum of two IV access and flush saline locked sites to ensure patency. If using IO, ensure continuous security of the device.

**Place pelvic binder or junctional tourniquets for all thoracic and abdominal injuries, as well as any traumatic lower leg amputations.

- If necessary, ensure arterial catheter security and continuity, and arterial pressure monitoring system. Best practice to be secured with suture and adequate dressing.

HYPOTHERMIA

Ensure wet clothing is removed and place patient in an Absorbent Patient Litter System or HPMK if available. If only sheets or blankets are available, place one underneath and on top of patient for full coverage.