Airway & Respiratory: Their Role in the SMARCH-E Algorithm

Airway & Respiratory: Their Role in the SMARCH-E Algorithm

When responding to a medical emergency, prioritization is critical. The MARCH-E algorithm—a tactical and trauma-based approach to emergency care—provides a structured way to assess and treat life-threatening conditions in order of importance.

The second step in MARCH-E is Airway & Respiratory, which addresses the ability of a casualty to breathe effectively. Without a clear airway, oxygen cannot reach the lungs, and without proper respiratory function, oxygen cannot be exchanged in the bloodstream. Recognizing and managing airway and respiratory issues quickly can mean the difference between life and death.

Understanding Airway & Respiratory in MARCH-E

The MARCH-E framework stands for:

  • Massive Hemorrhage
  • Airway
  • Respiration
  • Circulation
  • Head Injury/Hypothermia
  • Everything Else

After controlling massive bleeding, the next priority is ensuring a patent airway and supporting respiration. If the casualty cannot maintain their own airway, immediate intervention is required.

Common Causes of Airway and Respiratory Compromise

  • Unconsciousness leading to airway obstruction
  • Trauma to the face, throat, or chest
  • Foreign object obstruction (choking)
  • Swelling due to an allergic reaction or burns
  • Pneumothorax (collapsed lung) from penetrating chest trauma


Essential Tools & Techniques for Airway & Respiratory Management

To effectively address airway and respiratory issues, we recommend having the following life-saving medical knowledge/ tools on hand:

1. Recovery Position

For unconscious casualties who are breathing, placing them in the recovery position helps keep the airway open and prevents aspiration. This simple technique is an essential part of first aid for airway management and should be widely practiced.

2. Nasopharyngeal Airway (NPA)

An NPA (Nasopharyngeal Airway) is a flexible tube inserted through the nose to maintain an open airway. It is particularly useful when a casualty has a decreased level of consciousness but still has an intact gag reflex. Proper sizing and lubrication are essential for effective use.

3. Bag Valve Mask (BVM)

A BVM (Bag Valve Mask) is a critical tool for providing positive pressure ventilation to a casualty who is not breathing adequately. This device allows rescuers to manually deliver oxygen to the lungs and is especially important in respiratory arrest situations.

4. Chest Seals

For casualties with penetrating chest wounds, vented chest seals help prevent tension pneumothorax by allowing air to escape while preventing it from re-entering. This is a must-have trauma kit item for prepared civilians, first responders, and emergency medical providers.

5. Decompression Needle (For Trained Personnel)

In cases of tension pneumothorax, a decompression needle can relieve pressure built up in the chest cavity, allowing the lung to re-expand. This is an advanced procedure that should only be performed by trained medical professionals. *Remember, the Good Samaritan Laws in each state vary.

Be Prepared, Save Lives

Understanding and effectively addressing airway and respiratory issues within the MARCH-E algorithm can significantly increase a casualty’s chances of survival. Having the right first aid equipment—and knowing how to use it—ensures you’re prepared to provide life-saving intervention when seconds matter.

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