Law enforcement response to EMS incidents using tactical medicine
M.A.R.C.H. is a guide for early intervention and care for life-threatening bleeding, airway compromise and inadequate breathing
By Tyler Thomson
Imagine this situation. You arrive first on scene and the patient needs immediate medical care, so you call for an ambulance. Dispatch advises that EMS is en route, but 10 to 15 minutes out. The patient’s bleeding, crying for help and fading in and out of consciousness. What’s next?
In many communities, it is very common that law enforcement is the first response, or co-response, to EMS incidents: welfare checks, vehicle collisions, seizures, CPR in progress and penetrating trauma. If you’re not sure where to start when caring for a patient until EMS arrives, the acronym M.A.R.C.H, as described below, will serve as a foundation for patient treatment.
Massive hemorrhage (bleeding control) is the most preventable cause of death in tactical scenarios and the second leading cause of death in the prehospital setting. A person can bleed to death in about five minutes or less.  Officers can control extremity bleeding with the rapid deployment of CoTCCC-approved tourniquets, pressure bandages and compression gauze. The ability to control bleeding is the most important skill to continually practice, as this situation is all too common.
The Committee on Tactical Combat Casualty Care (CoTCCC) is an approving authority of tactical medical trauma equipment. Careful research should be done when purchasing a tourniquet to ensure it is approved by this organization.
Airway management is relatively straightforward. If you can move the patient, roll them onto their side, bend one knee outward and place their hands underneath their head. This is the “recovery position,” which can open the patient’s airway and protect their airway in case they vomit. If necessary, insert a nasopharyngeal airway (NPA) to keep the patient’s tongue from obstructing their airway. If a patient is having a seizure, moving the patient into the recovery position is your best option.
Respirations that are regular and adequate are critical for the patient’s survival because respiratory arrest rapidly decompensates to cardiac arrest. Treat a stabbing or gunshot wound to the chest with a vented chest seal over the entry and exit wounds of the chest. These seals will keep the lungs inflated as best they can, allowing the patient to breathe that much longer. Remember, if there is an entrance wound, there probably is an exit wound as well. Make sure to check both sides of the body when you are applying chest seals.
Circulation has little application in law enforcement. Typically, this is a reference to EMS securing IVs and pushing medications. However, quick responses to cardiac arrest patients can have a remarkable effect. Keep current on your CPR certification and abilities. Be prepared to perform CPR and attach and defibrillate (shock) the patient with an AED. Statistical data proves, maintaining as few chest compression interruptions as possible during CPR is leads to higher positive patient outcomes. 
Head injuries/hypothermia is a two-part category. If you suspect a patient has a head injury, be careful and make minimal but deliberate movements of the patient’s head, neck and torso. Moving the patient should only be done to remove the patient from an emergency and dangerous environment. In addition, a risk-benefit decision must be made to either move the patient into the recovery position to protect their airway or have them remain in their position to protect their spinal column.
Hypothermia can be an issue for someone with significant blood loss or spinal injuries, even if the weather is warm. Perform all interventions on the patient, then place a reflective emergency blanket on them.
The M.A.R.C.H. acronym is not an all-inclusive guide to the out-of-hospital patient, but rather the foundation to train with the care of life-threatening conditions with your local EMS agency. Law enforcement officers, EMTs and paramedics training together will build relationships and positively impact the community.
1. Stop the Bleed Month. American Safety & Health Institute.
2. Christenson J, et al. (2009.) Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation, 120:13, 1241–1247.
About the author
Tyler J. Thomson is an emergency response and management professional. He has experience in various aspects of emergency response, management, and military service. Tyler has a passion for serving the local community and advancing the future of emergency services.