TCCC Explained: The Phases of Care and the MARCH(-E) Algorithm for Tactical Trauma
- Jul 9
- 4 min read
By Ben Krynski, Co-Founder and CEO of BlueRoom Simulations and author of a practitioner guide to Tactical Combat Casualty Care.
Tactical Combat Casualty Care (TCCC) is a set of evidence-informed guidelines for trauma care in combat and tactical settings. It exists to reduce preventable deaths by giving teams a simple, repeatable sequence of priorities that fits the tactical problem, not a hospital ward. In high-threat and austere environments, the first minutes after injury are often the decisive ones.
TCCC is best understood as a framework for decision-making under constraint: limited time, limited resources and an evolving threat. Many civilian tactical frameworks, including TECC-style models, draw from TCCC's logic and adapt it to non-military contexts.
What is TCCC?
TCCC teaches teams to:
Prioritise the most preventable causes of death first
Deliver care in phases based on threat level
Standardise communication and documentation for evacuation and handover
The 3 phases of TCCC
1. Care Under Fire (CUF)
The still-under-threat phase. The priority is tactical survival plus rapid actions that prevent immediate death, while moving toward cover and control.
2. Tactical Field Care (TFC)
Begins when the casualty and team are in relative safety, even if the scene is not fully secure. Care becomes more systematic, typically aligned to MARCH priorities.
3. Tactical Evacuation Care (TEC)
Focuses on monitoring, reassessment, packaging and transport, often with variable evacuation delays and changing platform constraints across ground, air or boat.
The MARCH(-E) algorithm: the core TCCC mental model
MARCH-E is the mnemonic that makes TCCC teachable. It is predominantly associated with TCCC, and the right approach should always match the operational environment rather than a one-size-fits-all trauma acronym.
M - Massive haemorrhage: control life-threatening bleeding first
A - Airway: establish and maintain the airway
R - Respirations: address breathing problems such as chest injury management
C - Circulation: perfusion, shock priorities and reassessment
H - Hypothermia / Head injury: temperature management and brain-injury considerations
E - Everything else: evacuation, medications per protocol, documentation and ongoing tasks
This is not about memorising letters. It is about sequencing: in tactical trauma, the right intervention delivered late can be the wrong intervention.
DRSABCD vs MARCH-E: what is the difference?
If you come from a civilian first-aid, ambulance or workplace safety background, you will know the primary survey as DRSABCD. For many civilians it is a smaller jump to build on DRSABCD than to move straight to MARCH. So why does TCCC lean on MARCH-E instead?
The core difference is priority order and environment. In tactical trauma, catastrophic bleeding control often has to come before everything else. That is why many instructors teach DRSCABCD as a bridge acronym for civilian teams operating in higher-risk contexts: it keeps the familiar DRSABCD structure but pulls catastrophic haemorrhage forward, essentially aligning the C step with the M in MARCH.
DRSABCD is a broad primary survey designed for general emergencies
DRSCABCD is a common tacticalised evolution that acknowledges catastrophic haemorrhage first
MARCH-E is a purpose-built sequencing tool for combat and tactical trauma priorities
If your audience is mostly civilian responders, DRSABCD to DRSCABCD can be a useful stepping-stone. If your audience is tactical teams, or anyone training for high-threat or delayed evacuation, MARCH-E is often the cleaner framework because it is designed around the most preventable causes of death under constraint and forces the correct order of actions.
What good TCCC training looks like
Teams rarely fail because they do not know the theory. They fail because real incidents are messy:
Threat changes what you can safely do
Fine motor skills degrade under stress
Communication breaks down and reassessment gets skipped
Evacuation introduces new failure modes
Effective TCCC programs lean hard into repetition, scenario realism and after-action review, not just classroom slides.
Where mixed reality fits
Well-designed mixed reality training compresses years of rare-but-critical exposure into repeatable reps. Trainees use real weapons, real medical equipment and real manikins inside photorealistic virtual battlefields, so fine motor skills like tourniquet application and chest seals are trained for real, while instructors control threat, casualties and environment in real time. That is exactly what the BlueRoom TCCC Simulator was built for. If you are weighing up headset-based options, see our guide to mixed reality vs virtual reality medical training.
TCCC frequently asked questions
What does MARCH stand for in TCCC?
Massive haemorrhage, Airway, Respirations, Circulation, Hypothermia/Head injury, often extended with E for Everything Else.
What are the phases of TCCC?
Care Under Fire, Tactical Field Care and Tactical Evacuation Care.
Is TCCC only for the military?
TCCC is the military-focused framework, but its logic is widely taught and adapted into civilian tactical models such as TECC, depending on setting, responder scope and threat profile.
Is DRSCABCD the same as MARCH-E?
Not exactly. Both prioritise lifesaving interventions, but MARCH-E is purpose-built for tactical trauma, while DRSCABCD is a tacticalised bridge for people trained on DRSABCD, pulling catastrophic bleeding forward.
How often should teams refresh TCCC skills?
High-stakes skills decay quickly. Many units treat TCCC as a recurrent competency supported by short, frequent scenario reps rather than infrequent, long courses.
Train TCCC in mixed reality
If your team is serious about readiness, the goal is not just certification, it is repeatable performance under pressure. Explore the BlueRoom TCCC Simulator or book a demo.
