First Response Flow

Overview

Do the most good without becoming a casualty. Use a simple, repeatable flow: secure the scene, find and treat life‑threats fast (MARCH‑E), then expand care and plan evacuation. Pair this with clear communication and documentation.

Skill Level: Basic

Scene Safety

Scan before you touch.

Hazards: Traffic, fire/smoke, electricity, gas, water, unstable structures, rockfall, animals, violence.
Controls: Move yourself and bystanders to safety, don gloves/eye protection if available, turn off ignition/gas/electricity if safe, chock vehicles.
Numbers: Count patients; call for help early if multiple.

📝 Note: If the scene is unsafe and you cannot control it, retreat and call for help.

Primary Survey

Fast check for life‑threats in this order; shout for help or assign tasks as you go.

Responsiveness: AVPU (Alert, responds to Voice, to Pain, Unresponsive).
Airway/Breathing: Is the airway open? Are they breathing? If not, start CPR. Hands‑only chest compressions are appropriate for untrained lay rescuers. Attach an AED if available and follow prompts; minimize interruptions to compressions and resume immediately after shocks per device instructions.
Massive bleeding: Look for and control heavy external bleeding immediately.
Position: Place on back for assessment unless vomiting (recovery position) or trauma suggests spinal care.

MARCH-E Overview

Massive Bleeding

Direct pressure first. If ineffective, apply a tourniquet for limbs or pack/junctional pressure for groin/axilla/neck.

Expose the wound; apply firm, continuous pressure with gauze or clean cloth.
Tourniquet: Place 5–7 cm (2–3 in) above wound (not over joints). Tighten until bleeding stops; note time.
Hemostatic gauze: Pack deep bleeding wounds tightly; hold pressure 3+ minutes.

Airway

Open and maintain the airway.

Responsive: Let them find a position of comfort; avoid forcing supine if breathing worsens.
Unresponsive, no spinal concern: Head‑tilt, chin‑lift; clear visible obstructions.
Suspected spinal: Jaw thrust if trained; avoid head tilt.

Respiration

Assess rate, depth, symmetry; expose and look for chest wounds.

Open chest wounds: Cover with vented chest seal if available; if none, improvise with plastic and monitor for respiratory distress.
Support: Sit up or position of comfort if breathing is painful/difficult.

⚠️ Caution — Tension Pneumothorax Red Flags: Severe chest trauma with worsening breathing, increasing distress, unequal breath sounds, cyanosis, and signs of shock may indicate a tension pneumothorax. Do not attempt needle decompression unless trained and authorized; prioritize rapid evacuation.

Circulation

Check pulse, skin color/temp/cap refill; manage shock.

Lay flat, elevate legs if no trauma contraindication; keep warm; avoid food/drink in unstable patients.
Reassess bleeding; treat pain appropriately if trained.

Hypothermia/Head Injury

Prevent heat loss even in warm weather; monitor brain status.

Wrap in dry insulation, cover head/neck, insulate from ground (hypo kit/bivy if available).
Head injury: Monitor AVPU, pupils, changes in behavior; avoid unnecessary movement.

Everything Else

Secondary head‑to‑toe: Look for other injuries, medical IDs, medications, allergies.

SAMPLE: Symptoms, Allergies, Medications, Past history, Last intake, Events.
Vitals: Level of responsiveness, pulse, respirations, skin; repeat every 5–15 minutes.

☑️ Checklist — First Response

Scene safe or controllable
Call for help early (location, number injured, hazards)
Primary survey with MARCH‑E interventions
Prevent hypothermia; insulate from ground
Secondary survey and vitals; document
Evacuation plan and handoff ready

Examples

Bike crash: Massive elbow bleed—direct pressure → tourniquet; airway clear; breathing rapid but effective; wrap in jacket, lay flat; call EMS with location and number injured; monitor and document times.
Fall on trail: Unresponsive but breathing; jaw thrust to open airway; obvious femur bleed packed and held; insulate; send two to trailhead with precise coordinates while one stays and monitors.

Common Mistakes

Skipping scene safety and entering traffic, fire, or unstable structures; becoming a second casualty.
Treating minor wounds before life‑threats; not following MARCH‑E.
Leaving patients on cold ground; rapid hypothermia worsens outcomes.
Unnecessary movement of suspected spinal injuries without clear benefit.
Delaying the call for help; failing to give exact location and patient count early.
Poor documentation: No times for TQ/application or changes in status.

Key Takeaways

Safety first; your first patient is you. Control hazards or retreat.
Use MARCH‑E to find and fix life‑threats before anything else.
Prevent hypothermia early; reassess vitals and interventions regularly.
Communicate clearly and document times, treatments, and changes.

Scenario

🧭 Scenario (Bike crash): Rider down, bleeding, breathing fast, shivering in drizzle.
🔍 Decisions: Bleeding vs airway first; hypothermia now or later; who calls.
✅ Outcome: You control bleeding with pressure/TQ, open airway, seal chest abrasion, insulate from ground, assign a caller with exact location, and monitor.
🧠 Lessons: MARCH‑E sequence + insulation early
🏋️ Drill: Say MARCH‑E out loud while laying out your kit.