DRABC vs. MARCH vs. CABC vs. PAWS – Choosing the Right Emergency Response Model for Maritime & Expedition Medicine

Introduction

In a medical emergency at sea, there’s no second-guessing. Whether you're on a superyacht, expedition vessel, or remote island, the protocol you follow can determine survival.

Recently, a discussion about a kitesurfing accident led to an important question:

• Should airway or massive hemorrhage be the priority?

• Which emergency system works best for maritime medicine?

• How do we apply the evidence behind each model?

Maritime and expedition medicine presents unique challenges—drowning, inhalation injuries, anaphylaxis, trauma, and delayed evacuation times. This means that different environments require different approaches.

Let’s break down four major emergency response protocols: DRABC, MARCH, CABC, and PAWS.

DRABC – Prehospital & Maritime Medicine

Application

• Used in marine, remote, and general prehospital settings

• Focuses on airway, circulation, and stabilization before evacuation

Sequence

1. Danger – Ensure the environment is safe

2. Response – Check the casualty’s level of consciousness

3. Airway & Arterial Bleeding – Clear the airway and control arterial bleeding

4. Breathing – Assess and support breathing

5. Circulation – Control bleeding, manage shock

Why It Works

• Airway compromise (drowning, anaphylaxis, airway obstruction) is a leading cause of preventable death at sea

• Casualties often need prolonged stabilization before evacuation

• Recognizes that both airway and catastrophic bleeding must be addressed early

Key Debate

Some argue that massive hemorrhage should always be prioritized over airway. While this is true in combat settings, in maritime medicine, airway obstruction can kill just as quickly as bleeding.

MARCH – Tactical & Combat Medicine

Application

• Designed for combat and high-threat environments

• Used where uncontrolled bleeding is the leading preventable cause of death

Sequence

1. Massive Bleeding – Stop hemorrhage immediately (tourniquets, hemostatic dressings)

2. Airway – Open and secure the airway

3. Respiration – Manage breathing injuries (pneumothorax, chest wounds)

4. Circulation – Prevent and manage shock

5. Hypothermia/Head Injury – Keep the casualty warm, protect the brain

Why It Works

• In combat settings, massive bleeding is the #1 preventable cause of death

• If a casualty bleeds out within minutes, airway management becomes irrelevant

• Proven to improve survival in battlefield trauma cases

Key Difference from DRABC

MARCH does not prioritize airway first—it stops catastrophic hemorrhage before anything else.

CABC – Trauma & Bleeding Priority Model

Application

• A hybrid approach between MARCH and DRABC

• Used in trauma-heavy environments where bleeding is the most immediate threat

Sequence

1. Catastrophic Bleeding – Immediate hemorrhage control

2. Airway – Secure the airway

3. Breathing – Assess and support breathing

4. Circulation – Manage shock and circulation

Why It Works

• Ensures catastrophic bleeding is addressed first while still securing the airway

• Balances trauma response between MARCH and DRABC

• Used in prehospital trauma care settings outside of combat

Key Difference from MARCH

CABC prioritizes bleeding first, but it’s not as strictly combat-focused as MARCH.

PAWS – Secondary Trauma Care

Application

• Used after MARCH for secondary casualty management

• Focuses on long-term stabilization and extended field care

Sequence

1. Pain – Manage pain for casualty comfort

2. Antibiotics – Prevent infection in open wounds

3. Wounds – Conduct full assessment and treat injuries

4. Splinting – Stabilize fractures and prevent further damage

Why It Works

• Prepares casualties for long-term care and evacuation

• Helps prevent secondary complications after initial interventions

• Commonly used in combat medicine as a follow-up to MARCH

Key Difference from Other Protocols

PAWS is not a primary response model—it’s used after initial life-saving actions.

Which Emergency Model Should You Use?

DRABC Maritime, expedition & prehospital medicine

MARCH Combat & tactical medicine

CABC Severe trauma & major hemorrhage control

PAWS Secondary trauma stabilization

Final Thoughts

In maritime medicine, airway often takes priority. But if there’s an arterial bleed, it MUST be stopped immediately.

There is no one-size-fits-all protocol. The best responders assess the situation, adapt to their environment, and apply the right model based on the injury, evacuation time, and available resources.