TCCC training commonly uses mnemonic priority algorithms to keep teams aligned under stress and to reduce “treatment drift” (doing what feels urgent rather than what prevents death).
These mnemonics are not a replacement for clinical judgment. They are a commitment to a sequence: treat what is most likely to kill first, reassess, then move down the list.
MARCH (priority order)
A common expansion is:
- Massive hemorrhage
- Airway
- Respiration
- Circulation
- Hypothermia / head injury
The point is not memorizing letters; it is holding onto a priority structure when attention is fragmented.
PAWS (follow-on / stabilization priorities)
After the immediate MARCH threats are addressed, many curricula introduce PAWS-like reminders for problems that commonly degrade outcomes later:
- Pain management and humane care
- Antibiotics when indicated by protocol
- Wounds (dressing, protecting, preventing contamination)
- Splinting and packaging for movement
Different programs expand PAWS differently. The stable principle is that once hemorrhage/airway/breathing threats are controlled, secondary deterioration becomes the enemy: pain-induced stress, infection risk, hypothermia, and preventable worsening during evacuation.
Multiple casualties and triage
MARCH/PAWS assumes you have the time and hands to run an ordered assessment loop. When you have multiple casualties or ongoing threat, triage becomes the outer loop: decide who receives attention first, then apply MARCH/PAWS within that allocation.
See: Triage and Evacuation Precedence.
Reassessment as a skill
The biggest failure mode of mnemonics is treating them as a one-time checklist. In TCCC, reassessment is part of the algorithm: every phase change, movement, or new symptom is a reason to loop back.
See also: Phases of Care.
See also: Decision-Making Under Constraint.