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The Good Medic's Etiquette

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Cooper

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The Good Medic's Etiquette

 

As a medic, your philosophy should be to preserve the greater good; and the greater good involves every single member of your platoon.

You must be assertive even more than you should be knowledgeable, as you will often find a crowd around a body that will do everything in their power to be unhelpful. You are the one who will get a casualty up and running with maximum efficiency, so make sure everyone knows the boss is on station.

To be assertive, you must know to communicate effectively. Keep those around you informed of your actions, talk to whomever you're attending about your treatment. Whenever you arrive at a location, give everyone a quick shout asking if they need you. You're a gift from the gods when mortars land just as much as after a prolonged firefight with many small nicks and scrapes. This also means that you are indispensable normally and should keep your head down during engagements. Travel light to remain mobile, focus on your supporting equipment more than on your rifle. Smokes are your best friend when traversing gaps in cover, so if in doubt, bring more of those rather than extra magazines.

 

Triage, Casualty States and Priorities

When sorting through casualties and patients, it's often helpful to call out what is called a triage. This is where your voice is expected to be heard above all the noise and disorganization that usually ensues when it's come to the point of needing one.

Casualty states are assigned based on trauma level - there are a number of different, but overall similar routines from all over the world. For this purpose, we're using the UK triage system for short-hand, while ACE uses the US military equivalent. Let us agree on using the Priority (Px) short-hand, seen below, as convention for talking about it.

  • P1: severe injuries, likely already unconscious with blood loss and open wounds requiring immediate attention where any delay can prove fatal (ACE triage card equivalent: Immediate)
  • P2: severe injuries, but stabilized to the point of no longer requiring undivided attention, though should be kept in mind for later (ACE triage card equivalent: Delayed)
  • P3: light injuries that only just require the attention of a medic after P1s and P2s are dealt with; patients can still walk and be useful if necessary (ACE triage card equivalent: Minimal)
  • Deceased: patients beyond help, effectively or actually dead (ACE triage card: Deceased)

 

You may not always have time to update everyone's triage card, but make mental notes about everyone who comes to see you. A mortar victim with six large avulsions will be dead within a minute, whereas somebody emerging from a crashed HMMWV can usually walk it off and talk to you later down the line.

To decide which types of injuries dictate what type of reaction, let us move on to...

 

Injuries and Bandages

A good craftsman knows his tools.

There are 8 types of injuries with 7 types of open, bleeding wounds.

  • Abrasion: A scrape. Slow bleeding, though large ones cause a moderate amount of pain, these are low priority.
  • Avulsion: Tissue forcefully torn away from where it belongs. The most severe type of wound with extreme pain and the highest rate of bleeding -- very high priority.
  • Contusion: A bruise. You cannot fix these with bandages, but they also don't lead to blood loss. They might cause some minor pain and aim shake if on arms.
  • Crush: About as descriptive as it gets, this is tissue that's been crushed under heavy weights. Some bleeding and light pain, low to medium priority.
  • Cut: Occurs from shrapnel or other sharp objects cutting skin and muscle. Light pain, light to medium blood loss depending on size. Low to medium priority.
  • Laceration: Another sort of tear that separates tissue without shearing it off and away. Light pain, slow to medium blood loss. Low priority.
  • Puncture: Caused by shrapnel or long and thin, slow-moving sharp objects. Light pain, slow bleeding. Low priority.
  • Velocity: Deep penetrating wounds often caused by bullets. Extreme pain, medium to fast bleeding. High priority.

 

To treat these, you have four types of bandages at your disposal (*note: ST11 does not use the advanced wound system at this time so, wounds do not have a chance to reopen):

  • Basic: A medium-effect, medium-sealing bandage for your every-day needs. It's the averagest of averages.
  • Packing: Identical effect to basics, high chance to reopen, but excellent delay until a wound bothers you again. Every rifleman's best friend.
  • Elastic: Highest effect, highest chance to reopen, lowest delay. Riflemen stay away! These are for medics to use on severe injuries to prepare for surgery only.
  • QuikClot: Lowest effect, lowest chance to reopen, decent delay. Their low effectiveness means they require high volumes for large wounds, but they are excellent for small ones.

 

Vital Signs

To treat someone effectively, you must know which symptoms to treat in the first place.

  • There are three types of vital signs.
    • Heart rate, HR: The fundamental indicator of life.Is affected by drugs as well as physical activity and pain.
      • High: >120
      • Normal: ~80
      • Low: <45
  • Blood pressure, BP: A complicated measure to factor in, so we'll get back to this one later. These are basic numbers for a quick assessment.
    • Is affected by blood loss, inversely then by IVs and to a very minor extent by pulse
      • High: above 150/90
      • Normal: around 120/80
      • Low: below 90/60
    • Pronounced: "120 over 80"
  • Patient response: If you get a response from this action, you might as well have asked the patient directly if he's conscious.

 

Cardiac arrest is the technical term for a heart that has stopped beating. Several things can cause this:

  • Low heart rate (HR below 20)
  • High heart rate (HR above 200)
  • Blood pressure above 260/anything
  • HR above 190, BP x/190+
  • HR above 150, BP 150+/y

Cardiac arrest will kill you if you remain in that state for 2 to 5 minutes, unless CPR is applied periodically. So you see, these aren't just indicators for you to know what's lacking: if they're too much out of whack they will kill your patient. Ideally, you will want all these values to end up around their normal levels once you've finished your treatment.

To do so, we're now going to look at...

 

Injections and IV Bags

Fluids go out, fluids go back in. You can explain that. Soon.

You can directly influence heart rate and blood pressure using your injections. Drugs are applied in their own tab, while IVs are used from Advanced Treatments.

  • Heart rate is influenced by all four autoinjectors: Morphine, Epinephrine, Adenosine and Atropine
    • Morphine drastically lowers pain temporarily but, reduces the HR by an average of 20 per application while also thinning the blood.
      • Thinner blood means increased bleeding, so try to apply morphine at or near the end of your assessment!
      • You can effectively terminate a patient's pulse using this drug, use with caution!
      • Lingers in the system for 15 minutes
        •  Within that time frame, 4 applications are usually fatal either due to cardiac arrest (low HR) or respiratory depression (leads to suffocation, not handled in ACE so it's just an "overdose")
  • Epinephrine increases the heart rate depending on the starting value
    • Low HR: Increase by about 15
    • Normal HR: Increase by about 35
    • High HR: Increase by about 30
      • Lingers for 2 minutes and takes 10 applications for an overdose
  • Adenosine lowers the HR and thus reverses the effect of epinephrine
    • Average decrease is 20, higher effect at higher heart rates
    • 6 doses to an overdose
  • Atropine is meant for NBC scenarios which are not currently modelled -- incorrectly lowers HR instead, is redundant
    • About 40% less effective than adenosine
    • 6 maximum doses, but... don't carry these, really

Many patients will go out of their way to point out that they can hear their heart beating after you (or themselves) have given them morphine, meaning their heart rate has just dipped below nominal. If all else is optimal, they can literally walk it off and it returns to normal within a minute or two. There is no need to waste an epi on them.

Moving on to IV fluids, these are surprisingly easy to summarize as they all (incorrectly) do the same thing:

  • Blood, Plasma and Saline increase blood volume by the amount it says on the label

Blood volume, in turn, directly affects blood pressure. The lower your BP, the more blood you will have lost. It's hard to recommend doses with an absolute change in BP. If you find a patient unconscious due to low blood pressure, chances are they'll need more than 1000 ml of fluid. If a patient has just now got the remark "Lost a lot of blood", a single 250 ml or 500 ml bag can fix that issue without a problem. Experiment on your own and do report your findings.

Try not to administer more than 1500 ml of fluid at a time. Rather observe the changes, then come back to IVs later if necessary. Avoid wasted resources.

 

Sources and Reference Material

https://forums.ahoyworld.net/topic/8319-guide-ace-advanced-medical/

 

 

 

 

 

 

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