(MARCHE)2: Integrating TCCC MARCH with CBRN First Response

After initial assessment of casualty in CBRN-threat environment for the presence or absence of CBRN symptoms using the CRESS algorithm (and donning of PPE by first responders if present), the integrated assessment and management of TCCC and CBRN injuries can proceed.

The acronym (MARCHE)2 integrates these two processes using the established TCCC MARCH algorithm (Massive Hemorrhage, Airway, Respirations, Circulation, Hypothermia) with CBRN priorities of Mask, Antidotes, Rapid spot decontamination, Countermeasures, Extraction and Evacuation. Combining these two approaches gives the acronym (MARCHE)2 or “MARCH-squared.”

Similar to TCCC, (MARCHE)2 can be broken into phases of care from highest threat (care under fire or active CBRN threat), to intermediate threat (tactical field care or warm zone casualty management), to lowest threat (PFC/evacuation or care of decontaminated casualties in cold zone). Figure 4 below.