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MoonDog
17 February 2008, 17:11
Has the introduction of MARCH into the medical trauma mix changed the concepts of TCCC as it is applied by operators down range?

DY
17 February 2008, 17:27
Are you referring specifically to MARCH, or to the general concept of bleeding before airway?

TigerDad
17 February 2008, 17:30
Has the introduction of MARCH into the medical trauma mix changed the concepts of TCCC as it is applied by operators down range?


Can someone please explain to this old dog what TCCC and MARCH mean - I did a search and saw the acronyms used several places but did not see one that explained what they mean.

Here in Fort Worth, TCCC means Tarrant County Community College - of course March is that wonderful time of the year when Basket Ball fans go Mad.

TigerDad :confused:

Sharky
17 February 2008, 17:42
TCCC- Tactical Combat Casualty Care


MARCH- Massive Hemmorhaging, Airway, Respiration, Circulation, Hypothermia and Head Injury


I'll let the experts explain further.

MoonDog
17 February 2008, 17:55
General(?). Back in the day, airway was important unless there was getting ready to be an immediate shortage of blood. (Heh, if trauma 3 was easy.......)

From what I can find, it doesn't appear that it changes what gets yanked out of an aid bag first. But, I need my brothers to verify or correct PRN.

"Air goes in and out and blood goes round and round. If it ain't, fix it!"

DY
17 February 2008, 18:22
General(?). Back in the day, airway was important unless there was getting ready to be an immediate shortage of blood. (Heh, if trauma 3 was easy.......) Exactly. Only now it is sanctioned. TCCC is now gaining a legitmiate recognition through the momentum of Pre-Hospital Trauma Life Support. So the text books, and evaluations like trauma III will eventually be forced to change. It's hapenning slowly- one of the strange evils of war. So there's the sanctioning, sort of.

The practicality of it, I suppose is that non-medics now know this without having been confused with differing standards of testing verses reality like us medics have. They get their down and dirty straight from Combat Life Saver courses and pre-deployment training under the guidelines of TCCC.

Has it changed what comes out of the aidbag first in real world? Probably not. But MORE people are doing it because 'first responder", or "rescuer" type training has expanded to all servicemembers.

Sharky
17 February 2008, 18:26
General(?). Back in the day, airway was important unless there was getting ready to be an immediate shortage of blood. (Heh, if trauma 3 was easy.......)

From what I can find, it doesn't appear that it changes what gets yanked out of an aid bag first. But, I need my brothers to verify or correct PRN.

"Air goes in and out and blood goes round and round. If it ain't, fix it!"




"It's basic plumbing. Keep the blood in and the air going in and out." Heard that a few times at DMOC. But yes, at least in the DMOC course, massive bleeds get priority over the airway. Key word being massive.

MoonDog
17 February 2008, 19:56
You got it Sharky.

Question comes from mentoring some young medics going to the box. Another medic and I were helping conduct LTT and realized these young medics had been "flash fried" at Ft. Sam, and shipped to their parent units. (Which means they knew which side of the band aid was sticky.)

Well meaning MDs and PAs had attempted to correct this and presented didactic info full of acronyms and in depth information.

When it came time for the medics to provide care, the other medic and I realized these young medics needed to know a great deal more of what to do, and a lot less on why to do it.

So, I thought I'd check myself before I wreck myself. :D

VR,
MoonDog

DY
17 February 2008, 20:31
Sorry Moondog, for the convoluted response to a simple quetion. Glad you got your answer in spite of my leisure activity on a Sunday. :)

MoonDog
17 February 2008, 20:53
Thanks for the info, and drive on with ur bad self. :D

Sharky
17 February 2008, 23:06
When it came time for the medics to provide care, the other medic and I realized these young medics needed to know a great deal more of what to do, and a lot less on why to do it.






That was the great thing about DMOC. As a shooter, I dont really care so much about the "why", although it was covered a bit. I do care about the "what". Based on WHAT I see, I know WHAT needs to be done. The "why" was covered just enough to make the "what" make sense. When there is a lot of "what" to be done, the "why" helped to prioritize the "what".

Know what I mean? :D


Edited to add that there were some medics there who knew a lot about "why", but didn't know much more about the "what" than the rest of us. One of the senior medics was pulled aside by one of the E-8's and asked about how much he knew comparatively speaking about QuikClot before and after the course. His response was that he thought he knew what there was to know about it and found out that he really didn't know shit.

Expatmedic
18 February 2008, 00:17
His response was that he thought he knew what there was to know about it and found out that he really didn't know shit.

Time and time again, the more I learn the more I realize how little I know. Always good and humbling.

MoonDog
18 February 2008, 07:09
Sharky, spot on Brother.

Why is nice in the clinics and while playing trivial pursuit. Medics (like the E-8) waste a lot of time learning big words to impress the MDs and PAs (while standing around the clinic and playing tivial pursuit). I've never had a wounded troop ask me about the Kreb cycle or the nephron.

Medics get paid to reverse the dying process as close to the time of injury as possible. Anything else is eye wash and ass kissing.

Edit: Please replace Sr. Medic for E-8.

IMUA
18 February 2008, 12:45
What Sharky said in #11 +1!

BREAK///BREAK...

Paladin...get off the couch, young'in:D

Keep The Faith...

kato

foggy7
20 February 2008, 12:38
I'm in a position where I would like to bring up the MARCH concept in professional discussion - but I don't think I can, 'cause I can't find any reference material. Somebody somewhere has to have published this, or you all wouldn't be having this conversation. So even though the question has been asked before, I'll ask again - Is there anything available that can be pointed to as reference? I can jack my jaw all I want with my bubba's, but if I talk to my boss, he's gonna ask...

"Slow, Noisy, and Harmless"

DY
21 February 2008, 00:25
Foggy. I see you are in Baltimore. Go to Shock Trauma and ask for the Air Force CSTARS guy. He will square you away.

BREAK///BREAK

Damn my outside voice.

Global Med
21 February 2008, 00:48
Foggy7,

Are you familiar with the concepts of TCCC? If not, there is plenty of info on it on the net and I would start there. Once you do that MARCH will make more sense to you since it is just an acronym used in reference to the treatment priorities of TCCC.

foggy7
21 February 2008, 14:08
Paladin: WILCO, thank you, sir.

Global Med: Yes sir, thanks. I guess we actually are employing the MARCH concept even now - it is simply an acronym, as you say. I apologize if I seemed "hooked" to the acronym. That wasn't my intent. I have a personal habit of digging into language. Not a bad thing, I think; just my thing...

"Slow, Noisy, and Harmless"

009and.5
9 March 2008, 20:17
MoonDog, I am in SOCMSSC right now and there have been a few changes to TCCC in the last year.

One is that you don't convert a tourniquet to a pressure dressing unless the patient has a radial pulse or BP of 80. They have also done away with the trendelenburg position for hypovolemic shock. The last major change is that they recommend a three sided occlusive dressing or one with a valve instead of a four sided one.

All of the principals are the same but they are tweaking things from results of different studies.

DY
9 March 2008, 21:55
foggy: The primary reference for TCCC is the Pre-Hospital Trauma Life Support manual, 6th edition.

009: Whast the ration behind doing away with trendelenburg?

009and.5
15 March 2008, 12:25
Paladin, they said that it doesn't accomplish much venous return . The position also inhibits the abdothoracic pump and makes it difficult to breath when the intestines fall back onto the diaphram.

This one burst my bubble when I heard it also. I guess I'll just have to keep re-learning how to do things.

Sean

EMSDoc
16 March 2008, 03:04
Hey everyone,

Simple physiology will explain why massive bleeding takes precendence over airway.

A person circulates his or her entire blood volume -- 6 Liters -- in about a minute.

If your patient has a massive hemorrhage he or she will bleed to death in 1-2 minutes if it is not stopped immediately.

The brain can do without oxygen for about 4-6 minutes before it suffers anoxic brain injury.

Therefore what will kill the patient first is bleeding out. I don't care what acronym is needed to remember that -- but if you encounter a massive hemorrhage in a patient stop it ASAP. Their life will depend on it.

EMSDoc :cool:

P.S. There are a few good prospective studies that show the trendelenburg position does not improve outcomes either in CPR or in shock. It was a nice thought though! Kind of like pushing a lot of saline into a bleeding person so their BP looks "normal" but then there are no RBCs to carry O2, and the increased pressure makes them bleed more, and then their blood stops clotting because it has been replaced it with salt water... but I digress ;)

USMC_ANGLICO
16 March 2008, 04:37
Even beyond simple physiology, common sense tells you to stop the bleeding first.

So...EMSDoc....what you are trying to say is that the blood goes round and round

and

the air goes in and out, and any deviation from that i should fix right??

Oh thats right, i teach this crap too.


OB

IMUA
16 March 2008, 12:00
Let me get this straight...you have time to post here, but NOT to give a brother a call?:D

Apology for the hijack.

KTF...

Kato

EMSDoc
17 March 2008, 00:34
Anglico --

Not so important who is teaching it... as long as the guys in the field are getting the best training and medical care possible.

We're all on the same team brother.

EMSDoc :cool:

USMC_ANGLICO
17 March 2008, 03:05
Doc, relax brother, just being a sarcastic dick, no harm meant.

I agree, the proper training with the proper practical application should be the only priority and that the training is given in abundence to my brothers in arms.

Anyone who has been around the military for any period of time i imagine would agree that the advances in getting pertinent, practical, tactical medical training to the lower level (non-medical) troops has been leaps in the right direction. i know there was nothing like DMOC or OEMS or any of the other training courses out there for us grunt types when i first came in.

To anyone who participates in the act of saving a life on the battlefield, which includes those instructors out there, good on ya and Keep the Faith

OB

IMUA....PhoneCON inbound on Monday.....can't say i'll be sober, it is St Patty's ya know......

EMSDoc
17 March 2008, 03:31
Good deal man... I thought you might have taken my post wrong. Oops! :rolleyes: I very much respect the job all you guys are doing out there, and appreciate your service. I'm civilian, but I am dedicated to offering whatever help and education I can to keep my military and LEO friends safe. I also enjoy learning from those with more "under fire" experience than I have (though I do work at an inner city ER ;)).

Have a great time tomorrow at the Irish Pub.

Doc :cool:

Balls
15 April 2008, 20:11
Gents,

I don't have near the experience of anyone else that has posted thus far. However, I am a wannabe 18D and was the only Marine in my Battalion selected to attend the TCCC course. I didn't have the A&P background of the corpsmen, but I learn quickly and actually finished in the top 10%.

TCCC was an amazing course and easy to learn if you have the desire and a solid CLS background. I learned a lot and wish that the military would take more time to teach this to combat troops.

The following is a PPT link to the TCCC course. Very useful.
www.cs.amedd.army.mil/clsp/slides/TC3.ppt

IMUA
16 April 2008, 21:50
Hey Brother...

"I learned a lot and wish that the military would take more time to teach this to combat troops"...they do! Itas called DMOC. PM me if you wish.

Keep The Faith...



Kato

djcmed
18 April 2008, 06:57
Just to pitch in an go back on thread. MARCH came out of the UK and was concieved as part of a review on SFTC following a review of OEMS.

The guy who came up with the acronym never really meant it to go outside of that course. However it was adopted by the latter and found favour. You could just simply mix up the ABC to CABC. As someone pointed out earlier, it doesnt really matter. God made blood red for a reason. I am sure we can all work that one out.

Regards

exTablessB
20 April 2008, 18:59
Not to get too wrapped around the axles on acronyms, but thought I'd pass this along. I teach CLS using MARCH and prefer BAT (big Bleeds, Airway, Tension pneumo) but just heard another that keeps security first: SCAB (Security, Circulation, Airway, Breathing).

Balls
22 April 2008, 16:27
IMUA,

PM Sent. I'm interested in whatever you've got. Thanks borther.

S/F
-Dave

aiiifish
27 April 2008, 12:21
Balls, I work at MSTC at Camp Shelby, I have some links to TC3 powerpoints from several sites and we will have some up on our site soon. I will post them when I get back to work.

Balls
4 June 2008, 04:59
I've got the TCCC and CLS powerpoints. In addition to a fair amount of other stuff.......but I'd defiantely be interested in whatever you've got. :D

Thank you.

Merc82nd
7 July 2008, 09:14
Question. Is there a .mil address that I can pull some of the lastest TTPs on TCCC and CLS as well as classess in those areas? I have a few already, but they are all 2005-2006ish and I am sure the book has been rewritten. If anyone has the 07/08 material on hand, I'd be much appreciated.



Edit: I just realized that I can find some on the AMEDD site.