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MARCH proceeds in order: Massive hemorrhage → Airway → Respiration → Circulation → Hypothermia/Head. After bleeding control, airway patency and respiratory assessment are next. This includes airway adjuncts, suction, chest seals, and needle decompression if needed. Circulation management follows. Hypothermia prevention is later but should not be neglected. Secondary surveys occur only after life threats addressed. Strict adherence to MARCH reduces preventable deaths under battlefield stress.

Bounding overwatch ensures security by alternating movement and suppressive fire. While one element covers, the other moves the casualty. This method maintains tactical tempo and reduces vulnerability. It is not for appearance, medical reassessment, or litter strap management. Bounding is a doctrinal tactic integrating medical and tactical priorities, ensuring that evacuation does not compromise the mission or create additional casualties. Pre-mission rehearsals and role assignments make execution smooth and effective under stress.

Junctional hemorrhage is not amenable to limb tourniquets. Hemostatic wound packing with direct, sustained pressure is lifesaving. Specialized junctional devices may supplement if available. Oxygen, oral fluids, or pain medications are secondary and cannot replace bleeding control. Hemorrhage management remains the top priority under MARCH. Rapid control, hypothermia prevention, and TXA administration, followed by evacuation, are critical steps in survival.

Modern TCCC guidelines recommend multimodal analgesia bundles. Oral transmucosal fentanyl citrate (OTFC) provides rapid pain relief, and acetaminophen adds a safe, non-opioid adjunct. This combination minimizes opioid dose while improving pain control. Morphine alone risks hypotension and respiratory depression. Diazepam is not an analgesic. Steroids are not used in trauma pain. OTFC plus acetaminophen balances effectiveness and safety, improving casualty comfort and cooperation during evacuation while supporting mission continuity.

Absent breath sounds with hypotension and chest trauma strongly indicate tension pneumothorax. Needle decompression relieves pressure, restoring venous return and improving oxygenation. Oxygen may help but does not treat the cause. Transport without decompression risks death en route. Opioids delay lifesaving intervention. Needle decompression must be performed at 4th/5th ICS AAL (or 2nd ICS MCL if trained), with a long catheter to reach the pleural space. Continuous reassessment is essential, as recurrence is common.