The SAFE-MARCHE-RYAN protocol is an effective tactical first aid method designed for use during serious emergencies, particularly in military or crisis situations. It provides a structured framework for the rapid treatment of an injured casualty, prioritizing the control of severe bleeding using tools such as tourniquets or compression bandages, while ensuring safe evacuation. This protocol is based on three key steps: SAFE to secure the area and eliminate threats, MARCHE to treat life-threatening conditions such as bleeding and respiratory problems, and RYAN for continuous reassessment, including the prevention of shock and hypothermia. Adopted by recognized institutions such as the Desgenettes Military Hospital and CITERA Lyon, this protocol is essential for any professional or volunteer working in a hostile environment. Mastering these steps ensures rapid intervention and reduces errors in extreme conditions.

Understanding the Safe March Ryan Protocol

Origin and Necessity of the Protocol

The Safe March Ryan protocol was originally designed in a military context to meet the specific needs of tactical first aid on the battlefield. Derived from Tactical Combat Casualty Care (TCCC), which was developed in the 1990s, it aims to structure the care of casualties in hostile environments where the safety of the first responder may be compromised. Its main objective is to reduce preventable deaths by providing responders with a clear, hierarchical, and mnemonic guide for essential emergency procedures. This protocol was subsequently adapted for civilian use as Tactical Emergency Casualty Care (TECC). This demonstrates its relevance in all crisis situations, particularly during the evacuation of a seriously injured victim.

Composition and Steps of the Protocol

The Safe March Ryan protocol is divided into three complementary phases, each represented by an acronym that outlines the steps to be taken:

SAFE is the first step. It focuses on securing the area and conducting an initial assessment in order to neutralize any immediate threat that could compromise patient care.

MARCHE defines the priorities for treating the injured person. This phase focuses on critical aspects such as controlling severe bleeding, managing breathing, and preventing shock. Each action is designed to maximize the chances of survival in an emergency situation.

This systematic approach optimizes the use of resources and equipment, such as tourniquets or bandages, while increasing the chances of survival.

The "SAFE" component: Security and initial assessment

Stop the burning process / Eliminate the threat

The first step of the SAFE protocol, "Stop the burning process," involves eliminating or neutralizing any immediate threat at the scene of the incident. This includes stopping anything that directly endangers the victim, as well as the rescuer. This phase may involve responding to an attack or quickly sheltering the injured and responders to prevent the situation from worsening.

Without first securing the scene, it is impossible to provide effective care to the injured.

Assess the scene / Assess the situation

Once the area has been secured, it is essential to assess the scene. This includes determining the number of injured individuals, identifying any remaining hazards, and assessing the nature of the injuries sustained. This assessment allows for prioritizing actions, organizing the necessary equipment, and preparing for a possible evacuation using the "pick and run" method, which involves quickly removing the victim from danger and moving them to a safer location.

No danger to you / You are out of danger

To ensure optimal care, the first responder must make sure they are personally out of danger. This involves assessing their own surroundings and taking all necessary precautions to avoid injury. By staying safe, the first responder can respond calmly and effectively, without jeopardizing the rescue mission.

Assess the casualties / Assess the injured

The final phase of the SAFE component is the assessment of the injured. This rapid assessment allows for the identification of the most serious cases and the performance of an initial triage. It includes:

• Checking the level of consciousness.
• Checking for any visible or heavy bleeding.
• Recognizing signs of airway obstruction.

This step is essential for determining priorities for medical intervention before moving on to the MARCH phase.

The "MARCH" phase: Urgent action

Massive Bleeding

The top priority in the MARCH protocol is controlling massive bleeding. Rapid blood loss is the leading cause of preventable death in the field. To stop the bleeding, a tourniquet or a suitable pressure bandage should be applied immediately. These steps must be performed thoroughly and effectively, as any delay or inadequate treatment can lead to irreversible hemorrhagic shock.

Airways

Once the bleeding has been controlled, it is essential to check the victim’s airway. The rescuer must ensure that the airway is clear and take action using simple techniques, such as clearing the airway or placing the victim in the recovery position. Any delay at this stage can seriously compromise breathing and lead to rapid hypoxia.

Breathing and Circulation

After securing the airway, it is essential to assess breathing and blood circulation. Any respiratory distress or circulatory insufficiency must be detected and treated quickly. The protocol emphasizes the importance of preventing shock by maintaining the victim's perfusion and respiratory function. This helps limit complications and facilitates stabilization. Shock: Checking for Radial Pulse. To detect the risk of shock, the rescuer must check for the presence of a radial pulse. The absence or weakness of this pulse indicates inadequate blood perfusion, requiring urgent care and appropriate treatment. This check is a key indicator for assessing the severity of the injured person’s hemodynamic status. Head Injury / Traumatic Brain Injury and Hypothermia: It is essential to check for the presence of a head injury or signs of hypothermia, as both of these complications are common and potentially fatal. Management of head injury relies on rigorous neurological monitoring and appropriate stabilization. As for preventing hypothermia, it requires appropriate thermal protection to avoid further compromising the victim’s prognosis. Everything else / Evacuation and everything else: Once life-threatening priorities have been addressed, the rescuer must organize the evacuation of the injured person, ensuring that any secondary injuries are secured and stabilized, even if they are not immediately life-threatening. This step is essential to optimize subsequent medical care during transfer to a specialized center, such as the Desgenettes Military Hospital in Lyon or the CITERA in Lyon. Each additional action taken aims to maintain the injured person’s stability while awaiting the arrival of advanced care. The "RYAN" component: Reassessment and advanced care src="https://cdn.prod.website-files.com/61f1c5bbc327ec3679e7457c/68c7dc0e6e294a9c548b131c_66459227240.webp" width="auto" height="auto" loading="auto">

Re-evaluate the patient

The RYAN component represents a critical reassessment step following the initial interventions carried out under the MARCHE protocol. This phase involves systematically examining each treated area to ensure the effectiveness of the procedures performed, such as maintaining or adjusting tourniquets and bandages. It also allows for the detection of any potential worsening of injuries and the adjustment of care accordingly, while preparing the victim for safe evacuation.

Eyes and Specific Treatments

During this stage, a thorough examination of the eyes and the nervous system is recommended to identify any injuries that may have gone unnoticed during initial care, particularly in cases of head trauma. This rapid neurological assessment includes evaluating pupillary response and level of consciousness, allowing for referral to specific treatments or enhanced medical monitoring if necessary.

Analgesics and Pain Management

Pain management is an integral part of advanced care. Administering analgesics, when possible and appropriate, is essential to improve the injured person’s comfort while reducing their stress level. Particular attention is paid to avoiding any worsening of the patient’s condition, favoring methods compatible with existing injuries. Wound cleaning and infection prevention: Wound cleaning is an essential step to prevent any risk of infection. Although tactical first aid takes into account sometimes difficult conditions, it emphasizes the importance of rigorous antisepsis and the use of sterile dressings. This approach helps reduce post-traumatic complications and preserve the victim’s functional prognosis until transfer to a specialized hospital. Conclusion: The Safe March Ryan protocol is an essential tool for effective emergency response. It combines tactical first aid, the SAFE protocol for securing the victim, the MARCHE protocol for managing life-threatening emergencies, and the RYAN protocol for advanced care and reassessment. Mastering these steps is essential for saving lives, while also optimizing the use of equipment and techniques, such as tourniquets and the management of massive bleeding. We strongly encourage you to train today so you are ready to respond quickly and effectively in critical situations.

FAQ

How does Safe Marche Ryan help save lives, and what first aid steps and techniques are taught?

Safe Marche Ryan helps save lives by focusing on priority first aid techniques, particularly in military or extreme situations. Here are the main steps:

• SAFE: Secure the area to prevent any immediate danger.
• MARCHE: Treat critical injuries based on their severity, including severe bleeding, respiratory problems, shock, and hypothermia.
• RYAN: Treat less urgent secondary injuries while preparing for evacuation.

These actions, carried out quickly and effectively, maximize the chances of survival in hostile situations or those involving multiple casualties.

Who is eligible to take the Safe March Ryan training, and what are the prerequisites?

Safe March Ryan training is primarily intended for military personnel, as it is an integral part of their initial combat casualty care training. It is designed to teach the necessary first aid techniques in extreme conditions, in order to protect and quickly care for a casualty in the field.

No specific prerequisites are listed, other than having been exposed to military situations that require these skills.

How long is the Safe March Ryan training, and does it lead to a recognized certification?

Safe March Ryan training is included in the initial training program for the Armed Forces Health Service. However, the exact duration is not specified in the available sources.

It certifies proficiency in the field of tactical first aid, particularly in a military setting. However, it does not lead to an official civilian certification.