It is a simple acronym for remembering the necessary steps in priority for saving lives in combat.
M- Massive Hemorrhage
A- Airway
R- Respiratory
C- Circulation
H- Hypothermia
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Massive Hemorrhage
Massive hemorrhage is strictly about massive hemorrhage. The treatments include tourniquet application, which should be the FIRST treatment applied in true massive hemorrhage. Just remember. High and Tight!
Airway Control
There are three types of patients that may present, the unconscious casualty that would require a simple jaw-thrust. The conscious casualty with an airway obstruction or impending airway obstruction, may need basic airway maneuvers or insertion of an NPA. If these do not work, then a cricothyroidotomy (cric) is required. Other than the two mentioned criteria, AMS and weak or absent radial pulse are other signs.
Respiratory Support
The primary goal of the respiratory assessment is ID any penetrating chest trauma and a possible sucking chest wound. If a casualty has a penetrating trauma to the chest, putting in a Needle for chest decompression could potentially help restore the radial pulse due to decompression a tension pneumothorax.
Circulation
Shock assessment and treatment is addressed here, but it is not the only thing. Attempt to ID other non-life threatening bleeding and evaluate pulse and blood pressures. This is also where we talk about TQ conversion.
Hypothermia
Hypothermia is a critical factor in trauma care that is not often discussed in the EMS. Overall, the coagulopathy associated with hemorrhagic shock is probably more about the disruption of the coagulation cascade. Chances are, acute traumatic coagulopathy (ATC) is the bigger issue in trauma induced coagulopathy (TIC) (Figure 3). In TIC, both ATC and the lethal triad could be address with the use of whole blood and aggressive warming methods.
