Course Overview
The doctrine, the framework, and what this training prepares you to do
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 accomplishes, and how to get the most from the lessons that follow.
The MED-01 Student Companion Guide is a 16-page field reference that pairs with this course: the MARCH-PAWS sequence, 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.
The Framework at a Glance
| Letter | Addresses | Phase |
|---|---|---|
| M | Massive Hemorrhage | MARCH — life threats, in order |
| A | Airway | |
| R | Respiration | |
| C | Circulation & Shock | |
| H | Head Injury & Hypothermia | |
| P | Pain | PAWS — sustainment, only after MARCH is complete |
| A | Antibiotics | |
| W | Wounds | |
| S | Splinting |
The arrow only runs one direction. Every MARCH letter is addressed before the first PAWS letter begins — there is no going back and forth between phases.
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 providers are not credentialed medical professionals. The research is unambiguous: the three leading causes of preventable trauma death are hemorrhage (roughly 90% of potentially survivable battlefield deaths), airway obstruction, and tension pneumothorax. MARCH 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 — evacuation 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 sources agree, the content reflects consensus doctrine. Where they differ, 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 MARCH-PAWS sequence 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 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 discipline extends to the transition from MARCH to PAWS. PAWS starts only after the entire MARCH sequence is complete. Do not begin pain management while a tension pneumothorax is unaddressed. Do not dress wounds before you have assessed circulation. Completing the sequence before moving forward is the core skill this course builds.
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 check 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, in a consistent structure: a bottom line up front, substantive content on assessment and intervention, case examples from realistic austere scenarios, knowledge checks placed throughout (not just at the end), 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 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, and why the other wrong options are also wrong.
After completing the course, return to individual lessons as reference when preparing gear or practicing skills. The checklists are designed to be memorizable, not just readable — treat them as training targets you can recite without looking at the page.
MARCH-PAWS as taught here covers interventions a trained, prepared civilian can reasonably perform in an austere environment without medical licensure. Advanced interventions from 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 appropriate training, credentials, and medical authorization. These sections are marked with an amber warning block throughout the course and are included for completeness and handoff communication, not as instruction to perform the skill. Always seek the highest level of care available.
Related Courses
MED-02 — Medical HistorySAMPLE and OPQRST for trauma and medical patients; builds the history that supports every MARCH-PAWS decisionView Course →
MED-03 — DCAP-BTLS Secondary AssessmentSystematic head-to-toe physical assessment after MARCH-PAWS is completeView Course →
MED-06 — Patient Care DocumentationTCCC card completion, handoff reports, and documentation practices for prolonged field careView Course →
↑ Back to MARCH-PAWS Tactical Trauma