The Commons · First minutes
In a serious injury, doing everything at once is impossible. S-MARCH offers an order for noticing the threats that can take a life quickly and focusing on the next useful action while professional help is on the way.
A sequence is not a substitute for training.
S-MARCH grows from military and tactical trauma care. Some versions begin with security; for everyday use, think of the first letter as safety. The sequence can help a trained bystander remember priorities, but it does not authorize advanced medical procedures. Call 911, follow the dispatcher’s instructions, use protective equipment when available, and provide only the care you have been trained to give.
CPR, first aid, AED, and Stop the Bleed courses turn words on a page into skills. This brief is a memory aid for that training, not a replacement for it.
S · Safety
Pause long enough to see whether the scene is safe to enter. Traffic, fire, unstable structures, electricity, weapons, chemicals, floodwater, and other hazards can create another casualty. Do not move into an unsafe area. Call 911 as soon as it is safe, put the phone on speaker if directed, and ask someone specific to bring an AED or bleeding-control kit.
M · Massive bleeding
Look quickly for life-threatening external bleeding. Blood that is flowing continuously, spurting, pooling, or soaking through clothing requires immediate action. A Stop the Bleed course teaches three core skills: firm direct pressure, wound packing, and applying a tourniquet to an appropriate limb injury. Use the methods and equipment you have been trained to use, then continue monitoring until responders take over.
A · Airway
Check whether the person can speak or respond and whether air appears to be moving. If the person is unresponsive, not breathing normally, or only gasping, tell the dispatcher and begin the CPR or airway care you have been trained to provide. Do not place an object or your fingers blindly into the mouth. Visible obstructions and choking require the age-appropriate techniques taught in a recognized first-aid course.
R · Respiration
Watch the chest and listen for difficulty breathing. Uneven movement, severe shortness of breath, blue or gray skin, or a worsening level of responsiveness requires immediate professional care. Tell 911 what you see and follow instructions. Procedures such as needle decompression, airway insertion, or assisted ventilation require specific training and should not be improvised from written guidance.
C · Circulation and shock
Continue checking responsiveness, breathing, skin appearance, and any bleeding you have already controlled. Pale, cool, clammy skin; weakness; confusion; rapid breathing; or declining responsiveness may signal shock. Keep the person from becoming chilled, reassure them, and avoid unnecessary movement. Do not give food or drink. Be ready to begin CPR and use an AED if they become unresponsive and stop breathing normally.
H · Head injury and heat loss
Report loss of consciousness, confusion, repeated vomiting, seizure, unequal pupils, worsening headache, weakness, or unusual behavior to responders. Avoid unnecessary movement, especially when a neck or spine injury may be possible, unless remaining in place is unsafe. Protect the person from the ground, wind, rain, and cold with a blanket or other covering. Trauma can lower body temperature even when the weather does not feel cold.
Then begin again.
S-MARCH is not a one-time checklist. Conditions change. Bleeding can restart, breathing can worsen, and the scene can become unsafe. Return to the beginning, keep 911 updated, note meaningful changes, and stay with the person until professional responders assume care.
The sequence does not ask you to become the medic. It helps you protect the moment until the medic arrives.