Tactical Medicine in Combat: An Inside Look at M.A.R.C.H. and TCCC Exclusive Interview with Oleksandr Savenko

1) Can you briefly explain the M.A.R.C.H. and TCCC protocols and why they are critically important in tactical medicine, potentially saving lives in critical situations?

The M.A.R.C.H. protocol is a battlefield medical algorithm designed to save lives in cases of critical injuries. It prioritizes the key life-threatening conditions: M (Massive Hemorrhage) – Severe bleeding A (Airway) – Airway management R (Respiration) – Breathing and tension pneumothorax relief C (Circulation) – Circulatory support and shock management H (Hypothermia/Head Injury) – Prevention of hypothermia and traumatic brain injuries TCCC (Tactical Combat Casualty Care) is a comprehensive approach to battlefield medicine structured into three phases: Care Under Fire – Immediate aid while under active fire Tactical Field Care – Medical assistance in a secure tactical environment Tactical Evacuation Care – Patient stabilization and evacuation These protocols are crucial as they assist medical personnel and combatants in making life-saving decisions during extreme stress, where every second matters.

2) How do these protocols differ from standard emergency medical procedures in civilian settings?

Key differences include: Operational Environment: In civilian settings, emergency responders usually arrive promptly. In contrast, on the battlefield, evacuation can be delayed for hours. Medical Equipment: Tactical medicine relies on specialized items such as tourniquets, occlusive dressings, hemostatic agents, and hypothermia blankets, which are not always found in civilian first aid kits. Coordination: Tactical medicine requires close collaboration between military units and evacuation teams.

3) M.A.R.C.H. stands for Massive Hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head Injury. Can you explain each of these steps and their significance?

M – Massive Hemorrhage Apply a tourniquet 5–8 cm above the wound site or, if time is critical, at the highest point of the limb. Use hemostatic dressings or standard bandages for wound packing. Apply direct pressure to control bleeding. A – Airway Ensure an open airway (chin lift, jaw thrust). If needed, insert a nasopharyngeal (NPA) or oropharyngeal (OPA) airway. R – Respiration Identify and seal open chest wounds with occlusive dressings. Recognize and perform needle decompression for tension pneumothorax. C – Circulation Assess circulatory function and control non-massive bleeding. Implement shock prevention measures. H – Hypothermia/Head Injury Prevent hypothermia by insulating the casualty. Monitor consciousness levels and overall condition.

4) The Tactical Combat Casualty Care (TCCC) protocol consists of three phases: Care Under Fire, Tactical Field Care, and Tactical Evacuation Care. Can you explain more about each phase?

Care Under Fire During this phase, self-aid and buddy aid are the primary interventions, as medics cannot provide full treatment while under fire. The only medical intervention allowed at this stage is the application of a tourniquet. The top priorities for survival are returning fire and seeking cover.

Tactical Field Care
More advanced treatment becomes possible in this phase, including wound packing and airway management. Interventions may involve the use of hemostatic agents, occlusive dressings, and administering intravenous (IV) or intraosseous (IO) fluids.

Tactical Evacuation Care This phase focuses on preparing the casualty for transport, which includes immobilization and supporting vital functions. Continuous monitoring of the casualty occurs throughout the evacuation process.

5) What are the main challenges medics face when providing care under fire, and how do they balance saving lives while ensuring their safety in these intense and high-pressure situations?

One major challenge is the high risk to the medics themselves. They often have limited medical interventions, typically restricted to basic procedures like tourniquet application. In these circumstances, medics must make split-second decisions to protect themselves and the casualties they are trying to save.

6) How does tactical field care differ from standard first aid? What are the key interventions at this stage?

Tactical field care differs from standard first aid by emphasizing hemostatic agents, tourniquets, and wound packing. It is performed under extreme stress and in combat conditions.

7) During the tactical evacuation phase, what are the most important factors to consider for the safe transportation of a casualty?

1. Selecting the safest evacuation route. 2. Stabilizing the casualty before transport. 3. Ensuring effective communication with the evacuation team, providing clear and concise instructions to facilitate the safe transportation of the casualty.

8) In your experience as a paramedic, have there been instances where following the M.A.R.C.H. or TCCC protocols saved lives? Could you share a specific example?

Our group conducted over 300 combat medical deployments, resulting in 94 lives saved by following the TCCC protocols and adhering to the M.A.R.C.H. algorithm.

9) What are the most common misconceptions about combat medicine?

One common misconception is that evacuation is quick and efficient, similar to what we see in movies. Evacuation can take hours or even days, especially amid active combat. Another misconception is that a poor-quality tourniquet is better than having none. However, this is not true—only use tourniquets that meet Tactical Combat Casualty Care (TCCC) recommendations or those manufactured by SICH, a Ukrainian producer.

10) What advice would you give those interested in learning these life-saving skills, whether they are military personnel, medical professionals, or civilians?

1. Enroll in first aid courses such as "Stop the Bleed" and Basic Life Support (BLS).
2. Practice M.A.R.C.H. procedures through real-life simulations.
3. Train to operate effectively under high-stress conditions. Always carry essential items like a tourniquet, gloves, and hemostatic agents, as they can save lives. Train rigorously—during a critical moment, there won't be time to think, only to act! Glory to Ukraine!