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MARCH prioritizes lifesaving interventions in sequence: Massive hemorrhage → Airway → Respiration → Circulation → Hypothermia/Head. Uncontrolled bleeding kills within minutes, making it the top priority. Tourniquet application, wound packing, and pressure dressings come before airway and breathing interventions. Circulation and hypothermia follow. Adherence to MARCH reduces preventable battlefield deaths and standardizes care in stressful conditions.

OTFC provides potent analgesia via buccal absorption, making it fast-acting and suitable for tactical situations. IM morphine has slower onset and more variable absorption. Diazepam is a sedative, not an analgesic. NSAIDs are not effective for severe battlefield trauma and can impair clotting. OTFC, part of the analgesia bundle, balances effectiveness, speed, and safety, improving casualty comfort and cooperation during evacuation.

Preventing secondary brain injury is paramount in TBI management. Even one episode of hypoxia or hypotension significantly increases mortality. Maintain SpO₂ ≥90% and SBP ≥100–110 mmHg. Hyperventilation is reserved only for suspected herniation, not routine care. Corticosteroids worsen outcomes. Confusion is an early TBI sign that should not be ignored. Oxygen supplementation, balanced resuscitation, head elevation (if possible), and hypothermia prevention improve survival while awaiting evacuation to neurosurgical care.

A casualty with a chest seal who develops worsening dyspnea and unilateral decreased breath sounds likely has a tension pneumothorax. Needle decompression at the 4th/5th intercostal space, anterior axillary line, with a long catheter is lifesaving. Recovery position alone does not relieve intrathoracic pressure. Oral fluids are contraindicated in trauma. Delaying until evacuation risks death en route. Rapid decompression, reassessment, and preparation for repeat interventions ensure casualty survivability until definitive chest tube placement at higher care.

Litter teams are slowed and distracted, making them vulnerable. Security elements provide overwatch, suppressive fire, and situational awareness, preventing ambush and protecting both casualties and rescuers. Speed alone cannot guarantee survival without security. Skill practice and CCP elimination are unrelated. Security integration is rehearsed and coordinated, ensuring casualty evacuation contributes to mission success and force protection.