Tactical Combat Casualty Care · MARCH Protocol
| Drug | Dose | Route | Notes |
|---|---|---|---|
| TXA | 1 g | IV/IO over 10 min | Within 3 hr of injury. Repeat 1 g over 8 hr if signs of shock or amputation. |
| Ketamine | 50 mg IM/IN 20 mg slow IV/IO |
IM / IN / IV / IO | Analgesia + dissociation. Repeat q30 min IM or q20 min IV until effect. Maintains BP and airway. |
| Fentanyl OTFC | 800 µg | Transmucosal lozenge | Mild–moderate pain, casualty still able to fight. Tape to finger. Monitor for resp depression. |
| Morphine | 5 mg | IV/IO, repeat q10 min | Severe pain. Naloxone reversal available. Avoid in head injury or hypotension. |
| Moxifloxacin | 400 mg PO | PO daily | Combat wound prophylaxis if casualty can take PO. Penetrating trauma, open fractures. |
| Ertapenem | 1 g | IV/IM | Wound prophylaxis if PO not tolerated (abdominal wound, shock, AMS). |
| Hextend / Plasma | 500 mL bolus | IV/IO | Hemorrhagic shock. Whole blood preferred when available. Reassess after each bolus. |
| Naloxone | 0.4–2 mg | IV/IM/IN | Reverse opioid resp depression. Repeat q2–3 min. |