Course Overview

The doctrine, the framework, and what this training prepares you to do

Bottom Line Up Front

Most preventable trauma deaths follow a predictable pattern: uncontrolled bleeding kills first, airway obstruction kills second, tension pneumothorax kills third. MARCH-PAWS is a doctrinal sequence that forces you to address those threats in the right order, every time, under pressure. This lesson explains where the framework comes from, why the sequence is non-negotiable, what each phase is designed to accomplish, and how to get the most from the lessons that follow.

Student Companion Guide — Member Download

The MED-01 Student Companion Guide is a 16-page field reference that pairs with this course. It contains the MARCH-PAWS sequence reference, phase-by-phase checklists, critical numbers and thresholds, a failure mode catalogue, a blank assessment worksheet, and doctrinal sources — formatted to carry during practical exercises and scenario training.

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Where MARCH-PAWS Comes From

Doctrine and Origin

MARCH-PAWS is an evolution of the military’s Tactical Combat Casualty Care (TCCC) protocol, adapted for austere environments where evacuation may be delayed, resources are limited, and the providers are not credentialed medical professionals. The underlying research is unambiguous: the three leading causes of preventable death in trauma are hemorrhage (accounting for roughly 90% of potentially survivable battlefield deaths), airway obstruction, and tension pneumothorax. The MARCH sequence addresses them in that order.

PAWS extends the framework past the immediate life-threat phase. Once the patient is stabilized, the provider shifts to sustaining them: managing pain (which left untreated contributes to shock progression), preventing infection, managing wounds before they deteriorate, and immobilizing fractures to reduce ongoing blood loss and secondary injury. In prolonged care situations — where evacuation is hours or days away — PAWS is what keeps a stabilized patient from deteriorating.

This course draws on TCCC doctrine, the DHS Austere Emergency Medical Support Field Guide, the CONTOMS TEMS Medic Handbook, and the Layperson’s Guide to Prolonged Casualty Care. Where those sources agree, the content reflects consensus doctrine. Where they differ for scope or skill level, this course follows the most conservative, lowest-risk approach appropriate for a prepared civilian without a medical license.

The Non-Negotiable Sequence

Why Order Matters

The sequence of MARCH-PAWS is not a suggestion. It is an imposed priority structure designed to override the instinct to treat what you can see or what the patient is complaining about loudest. In a traumatic emergency, what is most visible is not always what is most lethal.

A casualty screaming in pain from a broken arm is breathing. A casualty who has gone quiet and pale is bleeding out. The sequence forces you to address massive hemorrhage before you address anything else — before airway, before breathing, before pain — because nothing else you do will matter if the patient bleeds to death while you work on something less immediately lethal.

This principle extends to the transition from MARCH to PAWS. PAWS is started only after the entire MARCH sequence has been completed. Do not begin pain management while a tension pneumothorax is unaddressed. Do not dress wounds before you have assessed circulation. The discipline to complete the sequence before moving forward is the core skill this course is designed to build.

Why Sequence Discipline Saves Lives

The problem with treating what you see first

A casualty presents with a visibly mangled lower leg and a wound to the upper thigh that is bleeding heavily but not spurting. The leg injury is obvious and distressing. The thigh wound is less dramatic. An untrained responder will often address the obvious injury first.

The MARCH sequence prevents this error. Massive hemorrhage is assessed and controlled first across the whole body before anything else is addressed. The blood sweep — a rapid head-to-toe assessment for unrecognized bleeding — happens immediately after treating obvious hemorrhage. The thigh wound, which may involve the femoral artery, gets found and controlled before the provider ever looks at the broken leg. The sequence is not about what looks worst. It is about what kills fastest.

How to Use These Lessons

Getting the Most From This Course

Each lesson covers one component of MARCH-PAWS in depth. The structure of each lesson is consistent: a bottom line up front that summarizes what matters most, substantive content on assessment and intervention, case examples drawn from realistic austere scenarios, a knowledge check, and a summary checklist. Read the lessons in order the first time through. Each builds on the prior one.

The knowledge checks are not decoration. They are designed to expose the specific failure modes and misconceptions that occur most often at each step. If you miss a question, read the feedback carefully — it tells you exactly what the wrong answer costs you in a real scenario.

After completing the course, return to the individual lessons as reference when you are preparing specific gear or practicing specific skills. The summary checklists at the end of each lesson are designed to be memorizable, not just readable. Treat them as training targets: you should be able to recite the key decision points for each MARCH-PAWS component without looking at the page.

Scope of This Training

MARCH-PAWS as taught here covers the interventions a trained, prepared civilian can reasonably perform in an austere environment without medical licensure. Advanced interventions that appear in TCCC doctrine — needle decompression, surgical airways, IV/IO access, prescription analgesics, prescription antibiotics — are described so you understand what they are and when they are indicated. They are not within civilian scope without the appropriate training, credentials, and medical authorization. Throughout this course, advanced skills are marked with an amber warning block. Those sections are included for completeness and handoff communication — not as instruction to perform the skill. Always seek the highest level of care available. This training exists to bridge the gap when that care is not immediately available.