What is the first priority in battlefield casualty care according to the MARCH algorithm?

• A. Massive hemorrhage control
• B. Airway management
• C. Breathing assessment
• D. Circulation stabilization

Answer: (A)

Stopping life-threatening bleeding is the top priority in battlefield casualty care. Uncontrolled hemorrhage leads to rapid blood loss and death much sooner than problems with airway or breathing can pose a threat, so the first action is to apply rapid hemorrhage control—using tourniquets for limb or junctional bleeding and hemostatic dressings or direct pressure for other wounds. In practice, you act quickly to stop the bleed, then reassess and continue care, knowing that every minute spent fighting bleeding is a minute saved for the whole patient.

After bleeding is controlled or substantially stabilized, you move on to airway management and breathing, followed by circulation support and protective measures like preventing hypothermia. The hierarchy is built on the evidence that saving a life from hemorrhage has the biggest impact on survival in the field, even before addressing other urgent issues.