What is the initial action in the circulation phase of the MARCH-PAWS sequence?

In the MARCH-PAWS sequence, the initial action in the circulation phase is to ensure there are no untreated sources of massive bleeding. This is crucial because massive hemorrhage is the leading cause of preventable death in trauma situations. Identifying and controlling bleeding takes priority to stabilize the casualty's condition before proceeding with other assessments or interventions.

If significant bleeding is present, it must be addressed immediately, often through direct pressure, the use of tourniquets, or hemostatic dressings. By prioritizing this step, medical personnel can effectively manage the casualty’s hemodynamic status, which is critical for survival.

While establishing IV access, assessing the airway, and checking for signs of shock are important actions in the overall management of trauma, they come after the immediate need to control bleeding in the MARCH-PAWS framework.