# Answers

### What are the initial actions that should be taken in the circulation phase of the MARCH-PAWS sequence?

The initial action in this phase should be to ensure that there are no untreated sources of massive bleeding and reassess all previously applied tourniquets and dressings with pressure bandages to ensure bleeding is still being controlled.

### What signs or symptoms are suspicious for pelvic instability?

- Pelvic pain
- Any major lower limb amputation or near amputation
- Physical exam findings suggestive of a pelvic fracture
- Unconsciousness
- Shock

### How do you prevent dislocation of pelvic fragments from external rotation of the lower extremities?

Prevent external rotation of the lower extremities by tying the casualty’s knees and/or feet together.

### Where should you apply a deliberate tourniquet when replacing one that was placed over the uniform, like a high and tight tourniquet from Care Under Fire?

Place a replacement tourniquet directly on the skin, 2-3 inches above the wound.

What are contraindications to converting a tourniquet to wound packing and a pressure bandage?

Answer: Shock, Inability to closely monitor for rebleeding, or Amputation