In high-pressure trauma situations, a structured assessment framework can be the difference between a good outcome and a preventable loss. In tactical, military, and austere environments, injuries often present differently to everyday civilian callouts — and the priorities shift fast. That’s where MARCH PAWS comes in.

MARCH PAWS is a tactical trauma assessment mnemonic used to prioritise life-threatening injuries in the order they’re most likely to kill a patient. It’s widely taught in tactical medicine programs and is commonly associated with military care models, but it’s also increasingly relevant for paramedics and emergency responders who want a clear, trauma-first approach under high stress.

In this guide, we’ll explain what MARCH PAWS means, break down each step with tactical context, compare it with civilian frameworks like DRSABC, and walk through realistic training scenarios. We’ll also link you to MyMedEquip’s clinical reference tools, including MARCH PAWS reference cards designed for fast recall when time and clarity matter most.

Key Takeaways

• MARCH PAWS is a tactical trauma framework used to prioritise the most immediate life threats first.
  
• The framework begins with Massive Haemorrhage, recognising that catastrophic bleeding is one of the fastest killers in trauma.
  
• MARCH PAWS is most useful in tactical, military, remote, or high-risk environments, where the threat or setting changes clinical priorities.
  
• Civilian frameworks like DRSABC still play an important role — the key is knowing when each is appropriate.
  
• Waterproof reference tools, like MyMedEquip’s MARCH PAWS cards, help responders apply the framework consistently under stress.
  
  

Summary Table: MARCH PAWS at a Glance

What is MARCH PAWS?

MARCH PAWS is a tactical trauma assessment framework used to prioritise and treat life-threatening injuries in the order they are most likely to kill a patient.
It guides clinicians through Massive haemorrhage, Airway, Respiration, Circulation, Head injury/Hypothermia, Pain management, Antibiotics, Wounds, and Splinting, helping ensure critical problems are managed first under high stress.

MARCH PAWS is most commonly taught in tactical and military medicine, but its trauma-first logic is also valuable for paramedics and responders working in high-risk, remote or time-critical environments. It provides a clear sequence to follow when the scene is chaotic, resources are limited, or evacuation may be delayed.

Breaking Down Each Letter

M — Massive Haemorrhage

In tactical trauma care, catastrophic bleeding is treated first because it can kill within minutes. The priority is to identify major bleeds fast and stop them immediately.

Tactical focus:

• Rapid bleed identification (visual then glove sweep)
  
• Immediate haemorrhage control before prolonged assessment
  
• Interventions must be fast, simple, and effective
  

Common interventions:

• Tourniquets
  
• Pressure dressings
  
• Wound packing (including haemostatic options where appropriate)
  
  

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A — Airway

Once catastrophic bleeding is controlled, the next priority is ensuring the airway is open and protected.

Tactical focus:

• Positioning and manual airway techniques first
  
• Basic airway adjuncts where within scope
  
• Airway decisions may change depending on threat level and evacuation time
  

Common interventions:

• Head tilt/chin lift or jaw thrust (as appropriate)
  
• Airway adjuncts such as NPA/OPA (scope-dependent)
  
  

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R — Respiration

Respiratory compromise can deteriorate quickly in trauma, particularly with chest injuries. The focus is early recognition and simple corrective actions.

Tactical focus:

• Assess work of breathing and chest rise
  
• Identify and manage open chest wounds
  
• Maintain oxygenation where possible
  

Common interventions:

• Chest seals for open pneumothorax
• High flow Oxygen
  
• Ongoing reassessment of breathing effort and symmetry
  

 

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C — Circulation

In tactical care, “Circulation” focuses on shock recognition and ongoing haemorrhage reassessment. A key concept is that bleeding may restart or be missed under pressure.

Tactical focus:

• Re-check bleeds
  
• Monitor perfusion and signs of shock
  
• Avoid unnecessary delays on scene
  

Common checks/actions:

• Pulse quality, skin signs, capillary refill trends
  
• Reassessment of bandages and tourniquets
  
• Minimise excessive crystalloid use (context-dependent)
  
  

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H — Head Injury / Hypothermia

This step often combines two crucial priorities: early neurological red flags and preventing heat loss, which directly worsens trauma outcomes.

Tactical focus:

• Monitor changes in consciousness and pupil response
  
• Prevent heat loss early, even in mild conditions
  
• Treat the patient, not the temperature outside
  

Common interventions:

• Trend AVPU/GCS
  
• Thermal blankets/insulation
  
• Minimise exposure and keep the patient dry
  

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P — Pain Management

Pain affects patient physiology and can reduce cooperation and assessment accuracy. In tactical settings, pain control must be safe, practical and within scope.

Tactical focus:

• Pain reduction supports better patient control
  
• Non-pharmacological options matter in austere settings
  

Examples:

• Immobilisation
  
• Reassurance and positioning
  
• Analgesia if authorised and available
  

 

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A — Antibiotics

In tactical or military environments, wounds may involve contamination and delayed evacuation. Antibiotics are considered where protocols allow.

Tactical focus:

• Higher infection risk
  
• Greater emphasis in prolonged field care contexts
  
• Protocol-driven decisions
  

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W — Wounds (Secondary Survey)

Once immediate life threats are addressed, conduct a methodical secondary assessment. In tactical care, missed injuries are a major risk.

Tactical focus:

• Full body sweep for hidden bleeding
  
• Assess the back, groin, axilla, and behind knees
  
• Reassess interventions already applied
  

 

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S — Splinting

Splinting improves comfort, reduces complications, and protects the patient during movement or long evacuation times.

Tactical focus:

• Quick immobilisation for transport
  
• Control movement to reduce bleeding and pain
  

Examples:

• Limb splinting
  
• Securing and stabilising fractures for extrication

MARCH PAWS vs DRSABC (When to Use Each)

Both MARCH PAWS and DRSABC are structured frameworks designed to reduce missed steps under pressure — but they’re built for different contexts.

When DRSABC is most appropriate

DRSABC is the standard civilian first aid and pre-hospital approach because it begins with Danger. In everyday environments, your first priority is making the scene safe, then moving through responsiveness, airway, breathing and circulation.

DRSABC is ideal for:

• civilian medical events (collapse, breathing issues, chest pain)
  
• low-threat trauma scenes
  
• public settings where hazards are controlled or minimal
  
• general first aid and early responder situations
  
  

When MARCH PAWS is most appropriate

MARCH PAWS is designed for trauma-heavy, high-risk environments where the main threat to life is often catastrophic bleeding, and assessments must be performed quickly while conditions may be unstable. It prioritises haemorrhage control first because uncontrolled bleeding is one of the fastest preventable causes of death in trauma.

MARCH PAWS is ideal for:

• tactical or military environments
  
• high-threat scenes (or scenes that may become unsafe quickly)
  
• remote or austere settings with delayed evacuation
  
• major trauma and multi-casualty incidents
  
• responders working with trauma kits, IFAKs, or bleed control equipment
  

The practical takeaway

• Use DRSABC when the primary risk is environmental danger and you need a broad medical approach.
  
• Use MARCH PAWS when the situation is trauma-dominant and you need to prioritise catastrophic bleeding and trauma physiology first.
  

For clinicians operating in high-pressure environments, having a quick-reference prompt can make a real difference. MyMedEquip’s clinical reference cards help responders apply the right framework consistently when stress and time pressure are high.

Tactical Medicine Applications

MARCH PAWS is most commonly associated with military and tactical medicine, but its principles extend well beyond combat settings. Any situation involving major trauma, time pressure, limited resources, or delayed evacuation can benefit from a structured trauma-first framework.

Military and Combat Medicine

This is where MARCH PAWS is most widely taught and applied. Military medics use it to prioritise immediate life threats in traumatic injuries where rapid haemorrhage control and airway management are critical.

Common contexts include:

• blast injuries
  
• penetrating trauma
  
• prolonged field care
  
• delayed evacuation environments
  

Tactical Paramedics and Law Enforcement Support

Tactical paramedics and specialist medical support teams may use MARCH PAWS during high-risk operations where the scene can change rapidly and care must be delivered alongside operational priorities within either direct or indirect threat.

Examples include:

• tactical entries
  
• high-threat arrests
  
• armed offender incidents
  
• protective security operations
  
  

Remote, Austere, and Wilderness Response

In rural Australia, remote regions, and outdoor settings, transport times may be extended. In these environments, MARCH PAWS helps responders maintain the correct priorities when care may be prolonged.

Examples include:

• bush accidents and farm trauma
  
• hunting and remote property injuries
  
• search and rescue
  
• off-road and camping incidents
  

Industrial and High-Risk Worksites

Worksites with heavy machinery, cutting tools, or remote operations can produce serious injuries where haemorrhage control is a priority before definitive care is available.

Examples include:

• mining and construction
  
• agriculture and forestry
  
• transport depots
  
• remote infrastructure sites
  

Training and Simulation for Students

For paramedic students and clinicians developing trauma confidence, MARCH PAWS is a useful framework to practise structured thinking during simulated high-stress cases. It improves recall, reduces missed steps, and helps build strong trauma habits early.

Training Scenario 

A 32-year-old male is injured during a remote property incident. He has a deep laceration to the medial upper thigh from equipment, is pale and sweating, and there’s visible heavy bleeding. The scene is controlled but evacuation time is extended due to distance.

Using MARCH PAWS:

• M (Massive haemorrhage): Apply a tourniquet or pressure dressing immediately and reassess for ongoing bleed.
  
• A (Airway): Confirm airway is patent and the patient can speak.
  
• R (Respiration): Check chest rise, work of breathing, and look for additional trauma.
  
• C (Circulation): Assess perfusion (pulse quality, skin signs) and monitor for shock.
  
• H (Head injury/Hypothermia): Check responsiveness and prevent heat loss early using a thermal blanket.
  
• Continue through PAWS once immediate life threats are controlled and the patient is stabilised for transport.
  

This scenario highlights why MARCH PAWS works so well in trauma-first settings: it keeps priorities clear when time, blood loss, and fatigue can derail decision-making.

Explore More Clinical Reference Tools

If you’d like to strengthen your trauma knowledge and improve on-scene recall under pressure, explore MyMedEquip’s range of Clinical Reference Cards and Emergency Protocol Guides. These durable, wipe-clean cards cover key trauma frameworks, structured assessments, and responder mnemonics designed for real operational environments.

→ View the Clinical Reference Cards & Emergency Protocols Collection

Shop MARCH PAWS Reference Cards

For fast, consistent decision-making in trauma-first environments, MyMedEquip’s MARCH PAWS reference cards provide clear prompts you can follow under stress. They’re built for rugged daily use, waterproof, and ideal for training, simulation, and operational response.

→ Shop MARCH PAWS Reference Cards

Final Thoughts

MARCH PAWS is a practical, trauma-first framework designed for environments where serious injury, time pressure and limited resources can make decision-making difficult. By working through catastrophic bleeding first, then airway, breathing and circulation, it helps responders focus on the interventions most likely to prevent avoidable death.

For paramedics, tactical medics, and students building trauma confidence, the value of MARCH PAWS is consistency — it provides a clear sequence to follow when stress is high and scenes are unpredictable. With regular practice and reliable clinical prompts, you can apply the framework quickly, reduce missed steps, and deliver better trauma care when it matters most.

FAQs Answered:

1. How do MARCH PAWS reference cards help with tactical trauma assessment under pressure?

MARCH PAWS reference cards act as a rapid on-scene prompt when stress, noise, low light, and time pressure make it easy to miss steps. In tactical trauma, the order of priorities matters, and a reference card helps you consistently move through Massive haemorrhage, Airway, Respiration, Circulation, Head injury/Hypothermia, then into Pain, Antibiotics, Wounds and Splinting once life threats are managed.

The MyMedEquip wallet ID MARCH PAWS Trauma Reference Card is designed for quick access and fast recall, making it particularly useful during training, simulation, and real-world trauma responses where cognitive load is high.

2. When should you use MARCH PAWS instead of DRSABC, and how can a reference card help with quick recall?

DRSABC is a strong civilian framework and is ideal when scene safety and general medical concerns are the main concern. MARCH PAWS is most useful when the situation is trauma-dominant, particularly where catastrophic bleeding and rapid deterioration are likely, or where the environment is remote, austere, or high-risk.

A reference card helps because it removes hesitation and keeps you aligned to the correct order under pressure. Instead of trying to remember the full sequence mid-scene, the MyMedEquip MARCH PAWS card provides the framework at a glance so you can stay focused on assessment and intervention.

3. Can tactical medics use a MARCH PAWS reference card for training scenarios and simulations?

Yes. MARCH PAWS reference cards are ideal for training and simulation because they reinforce correct sequencing and build consistent muscle memory. Tactical medics often use them during scenario-based learning to practise:

• rapid haemorrhage control decision-making
  
• chest injury checks
  
• shock recognition
  
• secondary survey discipline
  

The MyMedEquip wallet ID card is especially practical for training because it’s compact, durable, and easy to keep on-hand between sessions.

4. Where can I buy a MARCH PAWS trauma reference card in Australia?

You can purchase the MARCH PAWS trauma reference card directly from MyMedEquip in Australia. The wallet ID format is designed for quick access, and it’s built for operational conditions, making it suitable for paramedics, tactical responders, and students wanting a reliable prompt for trauma assessment.

5. Who supplies durable, waterproof MARCH PAWS reference cards for paramedics and first responders in Australia?

MyMedEquip supplies durable, waterproof clinical reference cards for Australian paramedics and first responders, including the wallet ID MARCH PAWS Trauma Reference Card. These cards are designed to withstand day-to-day use in pre-hospital settings and remain legible and practical in wet, dirty, or high-wear environments.

6. Is the MyMedEquip wallet ID MARCH PAWS Trauma Reference Card suitable for paramedic students and trainees?

Absolutely. Paramedic students and trainees benefit from having a clear trauma framework they can follow during practice, simulations, and early placements. The MyMedEquip wallet ID MARCH PAWS card helps learners build structured trauma thinking early, supports better recall under stress, and complements classroom learning by keeping the framework accessible in real time.