Understanding Haemorrhagic Shock and the Crucial Role of the CABC/MARCH Approach in Pre-hospital Trauma Care


Hemorrhagic shock is a serious condition that happens when the body loses a lot of blood quickly. It’s commonly seen in situations like on the battlefield or during a major accident. In this article, we’ll explore what happens in the body during hemorrhagic shock, the importance of a quick response through the CABC (Circulation, Airway, Breathing, and Cervical spine protection) / MARCH (Massive haemorrhage, Airway, Respiration, Circulation, and Hypothermia) approach, and how this method improves chances of survival.

Section 1 – The Progression of Haemorrhagic Shock:

Hemorrhagic shock happens in four stages:

  1. Compensated Shock: This is the first stage when the body realizes it’s losing blood. The heart beats faster, and blood vessels narrow to maintain blood supply to vital organs like the brain and heart.
  2. Decompensated Shock: At this stage, the body can’t longer keep up with the blood loss. The heart rate is rapid, blood pressure drops, breathing quickens, and the person may become confused or lose consciousness.
  3. Irreversible Shock: By now, even if the lost blood volume could be replaced, the damage to the body’s organs is so severe that survival is unlikely.
  4. Refractory Shock: In this final stage, organ damage has happened, and recovery is impossible [^1^].

Section 2 – The CABC/MARCH Approach:

The CABC/MARCH approach is like a step-by-step guide to help someone injured and losing blood.

  • C/Massive Hemorrhage: The first step is to stop the bleeding. This is done using tools like tourniquets, packing wounds, or special dressings to help the blood clot.
  • A/Airway: Next, we ensure that the person can breathe by opening the airway.
  • B/Respiration: If an injury in the chest makes it hard for the person to breathe, we treat it. This could be done using a needle to relieve pressure or applying a seal to close a chest wound.
  • C/Circulation: We address problems with blood flow, which could include giving fluids if needed.
  • H/Hypothermia: Lastly, we ensure the person is kept warm, as getting too cold can worsen things [^2^].

Section 3 – Improving Survival Rates:

Evidence shows that following the CABC/MARCH approach can save lives. A study found that soldiers treated using this approach had a significantly higher survival rate[^3^].


[^1^]: Gutierrez, G., Reines, H. D., & Wulf-Gutierrez, M. E. (2004). Clinical review: hemorrhagic shock. Critical care, 8(5), 373–381.
[^2^]: Eastridge, B. J., Mabry, R.

L., Seguin, P., Cantrell, J., Tops, T., Uribe, P., Mallett, O., Zubko, T., Oetjen-Gerdes, L., Rasmussen, T. E., Butler, F. K., Kotwal, R. S., Holcomb, J. B., Wade, C., Champion, H., Lawnick, M., Moores, L., & Blackbourne, L. H. (2012). Death on the battlefield (2001-2011): implications for the future of combat casualty care. Journal of Trauma and Acute Care Surgery, 73(6 Suppl 5), S431–S437.
[^3^]: Butler, F. K., Holcomb, J. B., Schreiber, M. A., Kotwal, R. S., Jenkins, D. A., Champion, H. R., Bowling, F., Cap, A. P., Dubose, J. J., Dorlac, W. C., Dorlac, G. R., McSwain, N. E., Timby, J. W., Blackbourne, L. H., Stockinger, Z. T., Strandenes, G., & Weiskopf, R. B. (2020). Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care: TCCC Guidelines Change 14-01 – 2 June 2014. Journal of special operations medicine: a peer reviewed journal for SOF medical professionals, 14(3), 13–38.

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