Control of bleeding leads the MARCH/PAWS priorities in Tactical Combat Casualty Care

Bleeding first, every time: the core idea behind MARCH/PAWS

If you’ve ever trained for tactical care, you’ve heard the name MARCH. It’s not a fancy slogan so much as a practical way to sequence life-saving steps in one chaotic moment. The backbone of the approach is simple and brutally effective: stop the massive bleeding before you move on to anything else. That priority—controlling hemorrhage—often makes the difference between life and death on the ground, under fire or in any austere setting.

Let me explain how this works in a real, usable way. MARCH isn’t a checklist you mutter to yourself in a quiet room. It’s a live, improvisational guide that helps you act fast, cleanly, and with confidence when every second counts. And yes, you’ll hear the PAWS addition tossed into conversations as well. The idea there is to reinforce the same core truth: bleeding control is the gatekeeper to everything else that follows.

What MARCH really means, in plain language

• M for Massive Hemorrhage: This is the emergency you don’t ignore. A limb bleeding badly or any uncontrolled bleeding demands immediate action. The goal is to reduce blood loss right now—before it steals the casualty’s life.

• A for Airway: Once the bleeding is under control, you turn to keeping the airway open and clear. A blocked airway—whether from blood, a bite, or a swallowed object—can kill just as fast as bleeding if you’re not careful.

• R for Respirations: Breathing matters. If the casualty can’t breathe well, oxygen delivery collapses, and the clock keeps ticking. You assess rate, depth, and effort, and you intervene if needed.

• C for Circulation: After bleeding control and airway/respiration checks, you consider overall circulation and ensure there’s enough perfusion to vital organs.

• H for Head injury/Hypothermia: Traumatic brain injury and cold, which sabotages clotting and recovery, enter the picture here. It’s a reminder that the body’s systems are connected—fix one problem, and you may affect others.

The practical takeaway is straightforward: the first, most urgent job is stopping the bleed. Everything else can wait just a moment until bleeding is under control. If you do that right, you buy time and give your casualty a real chance.

PAWS: a subtle reminder that the same priority applies

Some teams refer to a PAWS variant alongside MARCH. In many places, the “P” still signals the same core action: pressure applied to the source of bleeding. Whether you call it MARCH or PAWS, the emphasis stays the same: control the hemorrhage first. It’s a reminder that even when you’re juggling airway adjuncts, splints, chest seals, or rapid evacuation plans, nothing should take precedence over stopping the loss of blood.

What tools and tactics actually help you stop the bleed

If you’re new to this or you want to sharpen your hands-on instincts, here are the common tools you’ll reach for, in roughly the order you’d use them in a typical scenario:

• Tourniquets (the big-leverage option): A proven, life-saving device when applied correctly to an extremity with heavy bleeding. The Cat Tourniquet and SOF-T are popular choices in many teams. The trick isn’t to admire the tool; it’s to know how to place it high on the limb, tighten it firmly, and note the time of application.

• Hemostatic dressings: When you can’t or shouldn’t apply a tourniquet, these dressings—think Combat Gauze or QuikClot—help the blood clot at the wound site. They’re especially useful for junctional bleeds (where a tourniquet won’t reach) or wounds on the trunk or groin.

• Direct pressure and packing: Sometimes the simplest method is the most overlooked. Clean hands, gloves on, direct pressure over the wound, plus gauze or bandages packed into the cavity to tamp down bleeding.

• Chest seals and airway adjuncts: After the bleed is under control, you shift to maintaining the casualty’s breathing and preventing life-threatening chest injuries from complicating the situation. Basic airway devices—oropharyngeal airways, properly sized masks—come into play when needed.

• Splints and immobilization: If there are broken bones or suspected fractures, you stabilize what you can without moving the casualty into more danger than necessary.

• Temperature management: Keeping the body warm isn’t flashy, but it matters. Hypothermia can worsen bleeding by impairing clotting. A simple blanket or microclimate layer can help preserve the body’s natural responses.

What the sequence looks like in real life

Think of a scenario you might encounter in the field: a casualty with severe leg bleeding after a contact event. You sprint to the scene, quickly assess, and your first move is to apply a tourniquet high on the leg. You twist the device until the blood stop signal appears, then you monitor the clock. With the massive bleed under control, you move to secure an airway once you ensure that pack or helmet won’t be blocked by your own gear. You check breathing, look for signs of distress, and treat any chest or lung concerns as they arise. Only after those steps do you focus on fractures, continued bleeding elsewhere, and the possibility of moving the casualty for evacuation.

That order—bleeding first, then everything else—fits how the body copes under stress. It’s not just about mechanics; it’s about psychology, too. The person who’s bleeding less feels a surge of relief, and you gain that critical window to assess, decide, and act rather than freeze.

Common mistakes and how to avoid them

Like any high-stakes skill, it’s easy to slip into a pattern that sounds reasonable but doesn’t save time or lives. Here are a few missteps that come up in training and real-world practice, plus simple ways to avoid them:

• Delay in bleeding control: It’s tempting to check vitals or look for a perfect wound description before acting. Quick action beats perfect information. If you can stop the bleed within seconds, you’ve already bought precious minutes.

• Overthinking tourniquet use: Some folks hesitate to apply a tourniquet because they fear limb damage. In reality, a properly placed tourniquet saves lives. You can worry about tissue issues later; now is not the time.

• Underutilizing hemostatic dressings: If you’ve got a fast bleed, you don’t want to “wash” the wound with time while the blood pools. Pack in the dressing, apply steady pressure, and re-check.

• Neglecting hypothermia prevention: Cold casualties drift toward worse outcomes. A blanket, a heat pack, or even a simple reflective wrap can be the quiet, powerful defender of clotting.

• Skipping evacuation planning: Stopping the bleed is crucial, but you still have to get the casualty to care. Think about the evacuation route, the safest method, and who’s responsible for monitoring the patient during movement.

A moment of realism: the human side of rapid care

Let’s be honest: acting under pressure is as much about mental stamina as it is about technique. You’ll feel the adrenaline, hear the muffled thumps of a distant blast, and still you have to move with precision. That’s why drills matter. Rehearsals aren’t about memorizing a script; they’re about turning knowledge into muscle memory so when the moment comes, your hands know what to do, even if your heart is hammering.

If you’re curious about how people train for this, you’ll often see hands-on sessions with realistic mannequins, realistic bleeding effects, and teamwork drills that mimic a scenario you might run into outside a controlled environment. The goal isn’t theater; it’s trust—trust in your training, trust in your teammates, and trust that you’ll do the right thing when every second counts.

Putting it all together: why bleeding control is the defining priority

In the end, the message is simple, almost blunt: control the bleeding first. It’s the initial act that stabilizes the casualty long enough for the rest of the care to unfold. The MARCH sequence exists to remind you to sequence actions so you spend your time where it saves lives most.

That’s not just a note for students or professionals; it’s a principle that translates beyond the field. In any high-stakes setting—search and rescue, industrial safety, or even emergency medicine—treating the most life-threatening issue first creates space for everything else to fall into place.

If you’re building your toolkit for this kind of care, start with the basics and grow from there. Practice applying a tourniquet correctly, learn how to pack a wound with a hemostatic dressing, and stay familiar with when to escalate to advanced airway or breathing support. The aim isn’t to memorize a ritual; it’s to become the kind of responder who can read the room and act decisively.

A final thought: stay curious, stay calm, and stay ready

The field of tactical casualty care is as much about preparation as it is about courage. The rule that bleeding comes first isn’t a strict rule for the moment; it’s a philosophy that keeps you focused where it matters most. Train with intention, question what you don’t know, and practice with real gear in safe, controlled environments.

If you carry that mindset forward, you’ll not only understand the MARCH/PAWS priorities—you’ll embody them when it counts. And when the situation is critical, that clarity can be the difference between a difficult moment and a life-saving turning point.