Difference between revisions of "Legacy Advanced Medical & TCCC (A3 KAT)"

Revision as of 02:10, 18 October 2021

Squad Medic Responsibilities;

Conduct rapid and efficient assessments of casualties and triage.
Address any emergent conditions in the field.
Manage the supply of medical equipment for your fireteams of responsibility

This document will address these responsibilities and ensure familiarity with the concepts of ACE advanced medical as it has been adapted to Coalition™ gameplay.

Patient Presentation & Assessment

General terminology

Hypotensive - Low blood pressure, defined as a systolic pressure less than 90mmHg and/or a diastolic pressure less than 60mmHg.
Normotensive - Normal blood pressure (around 120/80mmHg).
Hypertensive - High blood pressure, defined as a systolic pressure greater than 140mmHg and/or a diastolic pressure greater than 90mmHg.
Bradycardia - Low pulse, threshold is generally 60bpm but becomes symptomatic in arma in the 30-40bpm range.
Tachycardia - High pulse, threshold is generally 100bpm but becomes symptomatic in arma in the 150bpm range.
Vasodilation - The widening of blood vessels to decrease blood-pressure.
Vasoconstriction - The narrowing of blood vessels to increase blood-pressure

In its present condition the ACE medical system we have adapted provides for a singular "normal" patient presentation. This comprises a pulse of around 80bpm and a blood-pressure of 120/80mmHg. These metrics will fluctuate with increased activity and injury. While pulse fluctuation is straightforward there is reason to outline blood-pressure here.

Pulse & Blood Pressure

Blood Pressure is read as the top number (the numerator) over the bottom number (the denominator), that is around one-hundred and twenty over eighty normally. These are your systolic and diastolic pressures respectively. Systolic pressure, as the name implies, is the arterial pressure of blood in the body as it is circulated by the contraction of the heart. Diastolic refers to the pressure between contractions of the heart. Thus as "beats per minute" increase (again normal is 80bpm in Arma) the pressure will hover around 120/80 millimetres of mercury (mmHg). This is important in rectifying blood loss and in considering morphine administration. As the casualty's injury exsanguinates, or bleeds, the pressure will drop - although if the pulse is high enough it may fluctuate upwards, this features when considering the administration of epinephrine.

Essentially think of the heart as a pump, because it is, and the pressures measured as changing with the increased or decreased volume of fluid in the system as it relates to the contractility of the heart pump. So following the Frank-Starling Law as we increase volume with fluids administered in the field, we increase blood pressure, but as we decrease heart rate (pulse) we lose blood-pressure.

Symptoms

As is to be expected, wounds accelerate the loss of blood and fluctuation in those circulatory metrics can affect the player's health. In-game, as pulse rises into tachycardic ranges or blood-pressure enters hypertensive ranges the player will begin to hear a fast heartbeat in their ears. Likewise, as the pulse decreases to bradycardic ranges or the blood-pressure drops into hypotensive ranges the heart-rate sound in the player's ears will drop in intensity and tempo. In the former's case this is more of an annoyance, but in the latter case it can be the undoing of the player. In the event another wound is sustained by the bradycardic or hypotensive patient they are more likely to be knocked unconscious or to die outright. Further, in hypotensive ranges the screen will grey and colour will drain from the game-world for the player.

Broken limbs similarly hinder the player. Broken arms will affect recoil management and weapon manipulation. Broken legs will near incapacitate the player's movement requiring prompt splinting. Splinting is not reliant on the bandaging of the limb and may be delayed until the more acute injuries are addressed.

Lastly, pain is often a side-affect of injury. The pain effects of ACE medical are either a pulsing blur of cinematic aberration or a white flashing at the peripheries of the screen. This can be modulated in a player's settings.

Interventions

Tools of the Trade

15x elastic bandages best used for avulsions, lacerations and crushed tissues. See figure X
15x packing bandages best used for penetrating injuries. See figure X
10x splints for broken bones. See figure X
2x tourniquets for stemming the flow of blood. See figure X
12x epinephrine doses for increasing heart-rate and "coding" patients. See figure X
12x morphine doses for analgesia and in a pinch hypertension correction. See figure X
5x body-bags for the management of the deceased See figure X

In this section we'll assume an understanding of the applications of elastic and packing bandages covered in Basic Medical Information/TCCC. As such we cover primarily pharmacological interventions available in ACE medical starting with the things you're generally issued and terminating with the items found in Casualty Collection MASH tents and Field Hospitals.

||Note, Tourniquets will occlude the administration of any of the following. You must administer fluids or drugs peripherally (via limbs) that are not occluded.

Epinephrine is a vasoconstrictor. In-game epi should be employed if the pulse drops into or below the 70bpm range or systolic blood-pressure falls below 90mmHg and symptoms are present. In the same vein unconscious patients, covered in "Acute Care & Resuscitation" section below require epinephrine to increase the contractility of the heart.

Morphine in-game has rather exacerbated vasodilatory effects and is used primarily for analgesia. Though it is often requested by the general infantry one must be careful. There is no naloxone to reverse its affects. My rule of thumb is a systolic pressure greater than or equal to 100mmHg in an otherwise stable patient. Anything less than that and I tell them I'm not comfortable doing so. If the player's wounds have been addressed and their pain is compromising their ability to function, and they meet the systolic pressure threshold, morphine as indicated for pain may be administered without concern. Else they need their pressure increased. In a pinch you can give epi and morphine together although I'd still monitor them.

Atropine was likely added to the game for potential NBC activities because it really doesnt feature elsewhere in the game. In terms of ACLS it is indicated for bradycardia, although not everyone responds to it in real life. I am unsure as to how effective it is in Arma as that discrepancy is likely not modelled - so in cases of bradycardia epinephrine is preferable but atropine is an alternative.

Adenosine is indicated for narrow PSVT/SVT and wide QRS tachycardia, adenosine in-game appears to have been added for their stamina system. It is not used by Coalition, not least of all because we've no NS flushes and second because we're not converting irregular rhythms as we would with adenosine.

Fluids such as Plasma, Blood and Saline ("Normal Saline" or "NS", a 0.9% NaCl solution) are available for volume replacement. Lactated Ringers is, for some ungodly reason, not an available crystalloid. Unfortunately ACE medical doesnt really model the clotting cascade so all fluids are technically the same. They are provided in 250mL, 500mL (known as a "unit" of fluid), and 1000mL volumes. A good rule of thumb is to infuse 2L in anyone with a systolic pressure less than 70mmHg. There have been times, in acute care situations, I have hung a litre while another individual bandages so as to begin fluid resuscitation as soon as possible. Ultimately, you're replacing fluids lost with the goal of reaching a systolic over 100mmHg or as close to 120/80mmHg as possible.

Acute Care & Resuscitation

The most interesting moments you receive as a medic in Coalition Arma are critical casualties. These are essentially a "code blue" in civilian medicine. Someone on the field of battle has sustained injuries so extreme that they are unconscious. This could be due to incredible pain, it could be due to significant fluid loss, but it's your job to respond to and manage that situation.

First, secure the scene. If applicable snag an adjacent squad-mate to begin chest compressions (CPR). Else snag someone to pull security depending on where the casualty is being treated. You dont want enemy walking up on you mid treatment.
- When in cardiac arrest a timer will begin. When it runs down the patient will die. When one completes a round of CPR however it will reset the timer, buying the intervening medical personnel time.
Tourniquetting wounds is often faster than bandaging multiple injuries. This will buy time, although if it's merely a singular wound to be addressed it may be best to do that first. Remember tourniquets will impeded drug and fluid administration.
Bandage from chest and head wounds to the extremities.
Pulse check. These should be completed every 30-60seconds in-game as the time is rather accelerated compared to real life. Remember the vitals numbers you're seeking to return to (80bpm, 120/80mmHg blood-pressure).
- Note tourniquets will also render a "No Heart Rate Found" message, see figure XYZ
Begin epinephrine as you've most or all wounds bandaged. It will take time to take effect but will rapidly increase the rate of the patient's recovery.
Begin fluid replacement depending on the blood-pressure reading you got previously.
Lastly, consider shock and pain.
- ACE Medical will add a degree of shock for high levels of pain. It may be that the patient is unconscious because of this and morphine will thus be indicated, but as noted above this will affect pulse and blood-pressure. Epinephrine and fluids may be indicated to resist the side-affects of morphine.

@@ Line 1: / Line 1: @@
-== '''Pre-hospital Trauma Life Support & Tactical Combat Casualty Care''' ==
+[[File:Tccc.png|right]]
-This quick guide will work from least to most difficult wounds, and has been tailored to our most current, in-house, Coalition brand of ACE advanced medical.
-'''Duties of TCCC for Combat Medics:''' [[File:Tccc.png|right]]
-*Identify wounded personnel in your fireteams of responsibility
-*Conduct rapid and efficient assessments of casualties and triage
-*Stop Bleeding, distribute bandages, utilise CLS as support
-*And administer advanced treatments and meds only after taking vitals
-== Casualty Triage ==
+'''Squad Medic Responsibilities;'''
-In most cases you'll have more than one casualty - thus it's important to determine which needs treatment and which can treat themselves. Some green recruits may continue on mission despite bleeding, worsening their wounds, so dictating to them what needs to be done becomes important. In some cases ask the nearby CLS to act on this in support of your triage efforts.
+*Conduct rapid and efficient assessments of casualties and triage.
+*Address any emergent conditions in the field.
+*Manage the supply of medical equipment for your fireteams of responsibility
-'''Categories of Wounded:'''
+This document will address these responsibilities and ensure familiarity with the concepts of ACE advanced medical as it has been adapted to Coalition™ gameplay.
-Part of Triage is to categorise your wounded and relay this information via medical net or squad net to the appropriate parties. If you are to liaise with platoon medical officer, med net is 343-Chan 16, otherwise use the applicable 148 Squad Net. These sorts of categories are also used on line 3 of a conventional CASEVAC 9-Line, though we dont use that in Coalition because we arent that spergy. Proscribed categories of wounded allow personnel to prioritise worse wounded over those least likely to die on arrival at a Casualty Collection Point (''CCP'') or Field Hospital (''FH'').
-*Cat 1 (or Cat Alpha) - ''Urgent'' -> Likely still bleeding, several wounds and sub 50 systolic pressure, needs treatment immediately. Needs to be evacuated immediately after stabalisation.
-*Cat 2 (or Cat Bravo) - ''Urgent Surgical'' -> Was Cat 1 urgent but is now stable, several wounds and sub 80 systolic pressure, needs surgery soon or condition will deteriorate. Likely requires evacuation very soon.
-*Cat 3 (or Cat Charlie) - ''Priority'' -> perhaps two wounds, may be ambulatory, sub 100 systolic pressure, needs surgery but can be delayed during triage. Could be treated in the field without need for evacuation.
-*Cat 4 (or Cat Delta) - ''Routine'' -> walking wounded, one to two wounds, systolic pressure between 120 and 90, may need additional help but can hold. Almost always treated in the field.
-There is a Cat 5, (Cat Echo) "Conventional" but we wouldnt really use that.
-Once you've isolated the injured party, stop the bleeding.
+==Patient Presentation & Assessment==
-'''Different types of bandages:'''
+'''General terminology'''
-*Packing Bandages - For most small to medium velocity wounds - use a packing bandage, follow with elastic if its still light red.
-*Elastic Bandages - Use if the casualty suffered an avulsion (a chunk of flesh torn from them).
+*Hypotensive - Low blood pressure, defined as a systolic pressure less than 90mmHg and/or a diastolic pressure less than 60mmHg.
+*Normotensive - Normal blood pressure (around 120/80mmHg).
+*Hypertensive - High blood pressure, defined as a systolic pressure greater than 140mmHg and/or a diastolic pressure greater than 90mmHg.
+*Bradycardia - Low pulse, threshold is generally 60bpm but becomes symptomatic in arma in the 30-40bpm range.
+*Tachycardia - High pulse, threshold is generally 100bpm but becomes symptomatic in arma in the 150bpm range.
+*Vasodilation - The widening of blood vessels to decrease blood-pressure.
+*Vasoconstriction - The narrowing of blood vessels to increase blood-pressure
-*Quickclot - If the casualty is hemorrhaging from a large velocity wound, consider using quickclot for its hemostatic properties, followed by a packing bandage and/or an elastic bandage.
+In its present condition the ACE medical system we have adapted provides for a singular "normal" patient presentation. This comprises a pulse of around 80bpm and a blood-pressure of 120/80mmHg. These metrics will fluctuate with increased activity and injury. While pulse fluctuation is straightforward there is reason to outline blood-pressure here.
-*Tourniquets - Are present in all IFAKs (individual first aid kits) and may be used to decrease bleeding from an extremity. After 15min of continual use they begin to cause pain to the wearer.
+'''Pulse & Blood Pressure'''
-Note: it is advised you treat wounded in cover, or away from combat, yet in some cases this is not possible. If they have a significant wound to their leg, they may not be able to run, so treating such an injury is often the right call, even in an open area where the enemy may fire on you as they are otherwise not ambulatory.
+Blood Pressure is read as the top number (the numerator) over the bottom number (the denominator), that is around ''one-hundred and twenty over eighty'' normally. These are your ''systolic'' and ''diastolic'' pressures respectively. Systolic pressure, as the name implies, is the arterial pressure of blood in the body as it is circulated by the contraction of the heart. Diastolic refers to the pressure between contractions of the heart. Thus as "beats per minute" increase (again normal is 80bpm in Arma) the pressure will hover around 120/80 millimetres of mercury (mmHg). This is important in rectifying blood loss and in considering morphine administration. As the casualty's injury exsanguinates, or bleeds, the pressure will drop - although if the pulse is high enough it may fluctuate upwards, this features when considering the administration of epinephrine.
-== Patient Assessments ==
+Essentially think of the heart as a pump, because it is, and the pressures measured as changing with the increased or decreased volume of fluid in the system as it relates to the contractility of the heart pump. So following the Frank-Starling Law as we increase volume with fluids administered in the field, we increase blood pressure, ''but'' as we decrease heart rate (pulse) we lose blood-pressure.
-Note: once the bleeding has been dealt with and/or the casualty has been displaced to a safe area to treat them, we need to determine vitals. Be aware that some wounds may reopen in transport of the patient, or may re-open due to increased blood pressure, so advanced treatments determined after an assessment of vitals may require further bandaging.
-Normal BP, ''Blood Pressure'' is 120/80 (systolic / diastolic) pressure - and normal heart rate (or ''pulse'') is 80 bpm (''beats per minute''). These are the basic thresholds, ''vitals'', we want to restore the casualty to these thresholds and maintain them for the duration of the mission.
+'''Symptoms'''
-[[File:Vitals.PNG|300px|right]]
-||
-Common BP abnormalities include; ''Hypotension'' - generally BP 90/60 and lower and ''Hypertension'' - threshold of 140/90 - though this is extremely uncommon. Additionally, unless you over-administer epinephrine, tachycardia, forms of atrial fibrillation and/or superventricular tachycardia dont happen. Medications are issued to regulate these heart rate and BP abnormalities.
-=== '''Example:''' ===
+As is to be expected, wounds accelerate the loss of blood and fluctuation in those circulatory metrics can affect the player's health. In-game, as pulse rises into tachycardic ranges or blood-pressure enters hypertensive ranges the player will begin to hear a fast heartbeat in their ears. Likewise, as the pulse decreases to bradycardic ranges or the blood-pressure drops into hypotensive ranges the heart-rate sound in the player's ears will drop in intensity and tempo. In the former's case this is more of an annoyance, but in the latter case it can be the undoing of the player. In the event another wound is sustained by the bradycardic or hypotensive patient they are more likely to be knocked unconscious or to die outright. Further, in hypotensive ranges the screen will grey and colour will drain from the game-world for the player.
-For our example we'll treat an individual who suffered a gunshot wound to the chest, and an avulsion to the left arm from fragmentation.
-The patient presents with these above-mentioned injuries. They've already placed a tourniquet on their left arm. This is a Category 3 (Charlie) Priority casualty.
+Broken limbs similarly hinder the player. Broken arms will affect recoil management and weapon manipulation. Broken legs will near incapacitate the player's movement requiring prompt splinting. Splinting is not reliant on the bandaging of the limb and may be delayed until the more acute injuries are addressed.
-Concerns in order:
-*1. Working from centre mass to extremities, determine if the chest wound is an avulsion; large, medium, or small velocity wound and bandage accordingly.
-*2. We dont know how long the tourniquet was on, so pop that off.
-*3. Assess pain, often by asking the patient "how's the pain" - though in real life we'd ask on a scale of 1-10, 10 being the worst pain they've ever experienced - in arma it's easier to ask them if its noticeable.
-**If the wound is to one of their arms, its likely this will lead to a lot of weapon-sway and weapon accuracy difficulties, so treating that pain is an appropriate measure.
-*4. Take vitals, I like to start with BP but pulse is an appropriate place to start too. For this example we find 101/79, pulse reads 80. - Both are fine. If they suffer further injuries they may require a transfusion once systolic pressure drops below 100, however.
-*5. If they find the pain difficult, these vitals are appropriate to administer a shot of morphine if they find it necessary - though its not required.
-Note, if their vitals were lower, for example if their pulse was below 60, ''bradycardia'', administering morphine would cause them to hear their heart rate. If you choose to administer morphine for the pain and they hear their heart rate, or you assume they will, follow with one shot of epinephrine as well to counteract any CNS, ''central nervous system'', suppression associated with morphine and opioid agonists.
+Lastly, pain is often a side-affect of injury. The pain effects of ACE medical are either a pulsing blur of cinematic aberration or a white flashing at the peripheries of the screen. This can be modulated in a player's settings.
-||
+==Interventions==
-Tip: If you're treating the patient in tandem with other medics or CLS, announce what you're doing. Example: "bandaging left leg" or "getting vitals ... (and proceed to announce those vitals) ... BP 89/50", etc.
-'''Conclusion to example:''' The patient can be released, notify them their wounds may reopen, to treat the arm with an elastic and the chest with a packing bandage. Remind them if they hear their heart-rate to find a medic.
+'''Tools of the Trade'''
-== Advanced Treatments ==
+*15x elastic bandages best used for avulsions, lacerations and crushed tissues. '''See figure X'''
-Often a casualty will sustain more significant injuries, or go untreated if they dont notice or dont treat previous injuries. As a result, wounded may present with more complex wounds requiring advanced treatments.[[File:Med_gear.png|right]]
+*15x packing bandages best used for penetrating injuries. '''See figure X'''
-These may require:
+*10x splints for broken bones. '''See figure X'''
-*Medication
+*2x tourniquets for stemming the flow of blood. '''See figure X'''
-*Blood Transfusions
+*12x epinephrine doses for increasing heart-rate and "coding" patients. '''See figure X'''
-*Personal Aid Kits
+*12x morphine doses for analgesia and in a pinch hypertension correction. '''See figure X'''
-*And surgery
+*5x body-bags for the management of the deceased '''See figure X'''
-==== '''Medication:''' ====
+In this section we'll assume an understanding of the applications of elastic and packing bandages covered in Basic Medical Information/TCCC. As such we cover primarily pharmacological interventions available in ACE medical starting with the things you're generally issued and terminating with the items found in Casualty Collection MASH tents and Field Hospitals.
-Meds administered to patients should adhere to the rule of 3 - no more. If you have to administer more than 3 morphine, or more than 3 epinephrine, the patient will more than likely go into shock or die. This said, dont be afraid to utilise these meds, especially with extremely wounded individuals - just be able to justify your decision based on the vitals you determine after regular reassessments.
-There are several types of autoinjector medications available in ACE advanced medical:
+||Note, Tourniquets will occlude the administration of any of the following. You must administer fluids or drugs peripherally (via limbs) that are not occluded.
-*Epinephrine (''quantity 8 / medic'') - A sympathomimetic that increases heart rate and blood pressure.
-*Morphine (''quantity 10 / medic'') - Provides analgesia (relief of pain) as an opioid agonist at the cost of CNS suppression.
-*Adenosine (''not generally issued'') - A coronary vasodilator that increases bloodflow, decreasing heart rate without analgesic effect.
-*Atropine (''not generally issued'') - An anticholinergic substance that decreases heart rate, without analgesic effect.
-||
+'''Epinephrine'''
-Note, '''DO NOT''' administer medication to a limb that is constricted by a tourniquet, it will have no effect until the tourniquet is removed and thus release massive quantities of morphine or epinephrine into the patient, often resulting in death. A hapless medic is death's helping hand.
+is a vasoconstrictor. In-game epi should be employed if the pulse drops into or below the 70bpm range or systolic blood-pressure falls below 90mmHg and symptoms are present. In the same vein unconscious patients, covered in "Acute Care & Resuscitation" section below require epinephrine to increase the contractility of the heart.
-==== '''Introvenous Transfusions & Fluid Resuscitation:''' ====
+'''Morphine'''
-There are three fluids we administer via IV to increase blood volume, which when combined with astute epinephrine administration can increase blood pressure.
+in-game has rather exacerbated vasodilatory effects and is used primarily for analgesia. Though it is often requested by the general infantry one must be careful. There is no naloxone to reverse its affects. My rule of thumb is a systolic pressure greater than or equal to 100mmHg in an otherwise stable patient. Anything less than that and I tell them I'm not comfortable doing so. If the player's wounds have been addressed and their pain is compromising their ability to function, and they meet the systolic pressure threshold, morphine as indicated for pain may be administered without concern. Else they need their pressure increased. In a pinch you can give epi and morphine together although I'd still monitor them.
-*Saline (''quantity 4 bags 500mL each / medic'') - Lasts 15min before losing effect. Can be used in the field to manage minor blood loss. 1000mL bags can be found in the FH, but are less useful than other IV fluids.
-*Blood (''In CCP/FH 250mL, 500mL & 1000mL'') - Replenishes blood loss and should be used frequently.
-*Plasma (''In FH 250mL, 500mL & 1000mL'') - Replenishes blood loss and restores some clotting factor for coagulopathies like hemophilia.
+'''Atropine'''
+was likely added to the game for potential NBC activities because it really doesnt feature elsewhere in the game. In terms of ACLS it is indicated for bradycardia, although not everyone responds to it in real life. I am unsure as to how effective it is in Arma as that discrepancy is likely not modelled - so in cases of bradycardia epinephrine is preferable but atropine is an alternative.
-[[File:Med_status.png|600px|left]] '''Systolic Thresholds:'''
+'''Adenosine'''
-The human body has roughly 5-6 litres of blood, and what goes in may come gushing out elsewhere, so make sure all open wounds have been bandaged and are showing as blue on the patient treatment screen.
+is indicated for narrow PSVT/SVT and wide QRS tachycardia, adenosine in-game appears to have been added for their stamina system. It is not used by Coalition, not least of all because we've no NS flushes and second because we're not converting irregular rhythms as we would with adenosine.
-The medical menu may say "Lost a lot of blood" in the status field on the right - this isn't always true however, so it's best to use BP thresholds to determine the quantity of IV fluid that should be provided, as it's actually quite simple:
+'''Fluids'''
-Remember 120/80 (systolic/diastolic) is the objective.
+such as Plasma, Blood and Saline ("Normal Saline" or "NS", a 0.9% NaCl solution) are available for volume replacement. Lactated Ringers is, for some ungodly reason, not an available crystalloid. Unfortunately ACE medical doesnt really model the clotting cascade so all fluids are technically the same. They are provided in 250mL, 500mL (known as a "unit" of fluid), and 1000mL volumes. A good rule of thumb is to infuse 2L in anyone with a systolic pressure less than 70mmHg. There have been times, in acute care situations, I have hung a litre while another individual bandages so as to begin fluid resuscitation as soon as possible. Ultimately, you're replacing fluids lost with the goal of reaching a systolic over 100mmHg or as close to 120/80mmHg as possible.
-* >Below 120, above 100 - 500mL saline or blood.
+==Acute Care & Resuscitation==
-* >Below 100, above 80 - 1000mL saline or blood, preferably blood.
-* >Below 80, above 60 - 2000mL blood or plasma. Plasma especially if the patient has numerous wounds and has been hemorrhaging while bandages keep reopening.
-* >Below 50 - Open line 4 litres of blood and plasma, prefferably 2000mL blood, 2000mL plasma.
-Be aware that sub 50 systolic pressure generally means the patient is unconscious.
+The most interesting moments you receive as a medic in Coalition Arma are critical casualties. These are essentially a "code blue" in civilian medicine. Someone on the field of battle has sustained injuries so extreme that they are unconscious. This could be due to incredible pain, it could be due to significant fluid loss, but it's your job to respond to and manage that situation.
-==== Surgery & PAKs: ====
+*First, secure the scene. If applicable snag an adjacent squad-mate to begin chest compressions (CPR). Else snag someone to pull security depending on where the casualty is being treated. You dont want enemy walking up on you mid treatment.
-Once bleeding has stopped, medication has been properly administered, and all limbs which were wounded show blue on the medical menu, the use of a Surgical kit or PAK (Personal aid kit) are available.
+**When in cardiac arrest a timer will begin. When it runs down the patient will die. When one completes a round of CPR however it will reset the timer, buying the intervening medical personnel time.
+*Tourniquetting wounds is often faster than bandaging multiple injuries. This will buy time, although if it's merely a singular wound to be addressed it may be best to do that first. Remember tourniquets will impeded drug and fluid administration.
-All leadership carry a PAK, which can only be used on a stabalised patient in a CCP or field hospital. Once used, a PAK restores the patient to pristine health, without necessity of a blood transfusion, so it is often advised if you intend to use a PAK that the patient be stabalised and then administer the PAK without the blood transfusion, as it resets their medical status to no pain, no wounds, pulse 80, BP 120/80.
+*Bandage from chest and head wounds to the extremities.
+*Pulse check. These should be completed every 30-60seconds in-game as the time is rather accelerated compared to real life. Remember the vitals numbers you're seeking to return to (80bpm, 120/80mmHg blood-pressure).
-However, PAKs are finite, and once used they disappear. A surgical kit has unlimited uses, and can be used in a field hospital or CCP. The surgical kit still requires all wounds blue, however, it will not reset medical, only alleviate wounds. Pain and blood loss remain after a surgical kit is used and thus must be used in tandem with the administration of medication and IV transfusion.
+**Note tourniquets will also render a "No Heart Rate Found" message, '''see figure XYZ'''
+*Begin epinephrine as you've most or all wounds bandaged. It will take time to take effect but will rapidly increase the rate of the patient's recovery.
-=== '''Advanced Medical Example''' ===
+*Begin fluid replacement depending on the blood-pressure reading you got previously.
-This example is based on a casualty I treated recently during a MOUT operation in Helvantis.
+*Lastly, consider shock and pain.
+**ACE Medical will add a degree of shock for high levels of pain. It may be that the patient is unconscious because of this and morphine will thus be indicated, but as noted above this will affect pulse and blood-pressure. Epinephrine and fluids may be indicated to resist the side-affects of morphine.
-Patient presents unconscious at the CCP with a large velocity wound to the chest, avulsion to the left arm with a tourniquet, small velocity wound to the right leg without tourniquet, and an avulsion to the head he has been bandaging throughout the mission with elastic. BP is 49/30, heart rate is 39. This is a Category 1 (Alpha) Urgent Casualty.
-* 1. First stop the hemorrhaging chest wound with a quick-clot, if available, as its a large wound to the torso where bleeding will remain torrential.
-* 2. Tourniquet the right leg prior to applying a packing bandage to the small velocity wound on the right leg.
-* 3. Elastic bandage to the left arm where the avulsion is meagerly managed by the tourniquet. Removing and reapplying the tourniquet when the avulsion was bandaged to buy time.
-* 4. The chest reopened, so I followed with another packing bandage to the large velocity wound in the chest.
-* 5. Re-assessed patient's vitals finding a BP of 35/20 and a heart rate of 39.
-* 6. Began an open line of 2 litres, 2000mL of blood to the left leg, because it is one of the only un-injured extremities I can start the transfusion in.
-** Note if you begin a transfusion in a limb that has a tourniquet applied to it, the blood will not flow or will flow minimally, thus it is imperative this is applied to an open limb or the tourniquet is removed before transfusing.
-* 7. Pushed one epinephrine and one morphine autoinjector into the left leg.
-||
-Moved on to another wounded individual during triage, returning to reassess vitals less than 20 seconds later.
-* 8. Example patient showed BP of 50/30 and a heart rate of 40. Always reassess patients every 20-30 seconds, especially after administering medication and IV transfusion.
-* 9. Pushed an additional litre, 1000mL of blood and 500mL saline (all I had) into the left leg followed by epinepherine to increase circulation and morphine to decrease shock and pain.
-* 10. Reassessed over 60 seconds, BP rose to 80/50 and a heart rate of 60 - he woke up not long after.
-'''Conclusion to example:''' The casualty was in dire straights when he arrived, and though there were two other unconcious patients I was tending to at the time, if he'd been one of five I'd have considered him a lost cause. He was the most wounded we had in the CCP at that moment with more critical casualties en route. Once awake, the mission ended, however if it had not I would have tranferred him to the field hospital for surgery, solicited the medical officer bring a surgical kit to the CCP, or beg his fireteam leader or my Squad leader for their PAK to complete treatment. In his condition any significant movement would have reopened his injuries, leading to further bloodloss, shock, unconsciousness and death.
-== '''Conclusion of Pre-hospital Trauma Life Support & TCCC''' ==
-This should be just about everything. I attempted to stay away from the Revised Trauma Scoring and START pneumonics, though some detail really applied to the serious subjects, and boiled down to the key points of acting in TCCC as a medic with Coalition. If you have any questions please do not hesistate to contact me, Cpl. Koala on discord for further information.