During the circulation phase of MARCH-PAWS, what should be ensured first?

During the circulation phase of MARCH-PAWS, ensuring that no untreated sources of massive bleeding are present is the top priority. This phase focuses on the critical assessment and management of the casualty's circulation, particularly because uncontrolled bleeding is a leading cause of preventable death in traumatic injuries. Identifying and managing sources of significant hemorrhage is essential to stabilize the casualty and prevent further deterioration.

Effective hemorrhage control techniques may include applying direct pressure, utilizing tourniquets, or packing wounds with hemostatic dressings. Addressing massive bleeding promptly is vital in the tactical environment, where every second counts, and rapid interventions can significantly impact survival rates.

While considerations like ensuring the casualty's comfort, evacuating bystanders, and maintaining their awareness are important for overall care and situational safety, they are secondary to the immediate threat of life-threatening bleeding that needs to be addressed first in the circulation phase.