Medical

Introduction
As a medic (combat life saver in ARMA3) you will be expected to be able to address, examine and treat many different types of physical conditions such as large wounds, dehydration, broken bones etc. With that comes extensive training ESPECIALLY because of the use of the Combat Space Enhancement (CSE).

We have put together an advanced medical training guide for use in the 9th Air Cavalry, 1st Squadron to help ease the burden of the CSE medical system. It will take practice, hard work and some research to master CSE but you will find that this is a crucial part of keeping the unit battle effective.

Medical Equipment
Quick clot dressing - Applied initially to Small, Medium, or large wounds to clot the blood and stop bleeding. Changes an open wound to a partial wound. carried by all.

Basic Dressing - A basic bandage, applied to small, medium or large wounds after quick clot / packing dressing has been applied. carried by all.

Elastic dressing - An additional dressing, applied to medium or large wounds, if required, after quick clot and basic dressings have been applied. Carried by all.

Packing dressing - Used instead of the Quick clot dressing, on more serious wounds, such as medium or large torso wounds. Carried by Medic.

Tourniquet - Use on limb wounds to initially stop bleeding. This allows extra time to apply bandages and begin treatments. '''Caution: Not to be used on head or torso wounds. Causes pain to patient if not removed after 5 mins.''' Carried by Medic.

Nasopharyngeal tube (NPG) - Used to open a patients airway, only when there is no breathing. DANGER: This equipment will de-stabilize the patients condition if applied unnecessarily. Carried by Medic.

Morphine - Opiate based drug. Alters heart rate and blood pressure. Used to relieve pain '''CAUTION: Do not use more than 2 doses in 30 mins. High overdose risk''' Carried by Medic.

Epinephrine - Adrenaline substitute. Increases heart rate. Used when pulse is <30 bpm. Caution: High overdose risk. Carried by Medic.

Atropine - Anticholinergic drug. Has an antispasmodic effect, which relaxes muscles. Is also an anti-arrhythmic drug. Used to restore heart beat during heart block and cardiac arrest Caution: High overdose risk. Carried by Medic.

Saline - A sterile solution of Sodium choloride (salty water). Administered intravenously (IV) during and after blood loss. Carried by Medic.***See Blood loss page for further info***

Chest seal - A sticky patch used to seal a sucking wound in a patients thoracic cavity. Apply over wound when patient exhales, sealing at least 2" wider than the wound, leaving a small area on one side to allow fluids and gases to escape but not to enter the thoracic cavity. Once applied will ease difficult breathing. Carried by medic.

Splint - Details to follow

Liquid skin - Details to follow

Body bag - Bag for carrying the deceased. Carried by medic

Triage Status
Triage status is basically, how critical a casualty's condition is. A casualty's condition will fall into one of four category's. Correct categorization allows for effective and efficient allocation of a medics time and resources. The category's and what conditions define them are as follows:


 * Minor - Small wounds to limbs, in pain. The casualty should still be almost fully combat effective, able to walk, run, fire weapons, and observe their surroundings.


 * Delayed - In pain, Medium / large partial wound, bleeding, difficulty breathing. The casualty is still able to move, fire their weapon, and observe their surroundings with only slight visual impairment.


 * Immediate - Unconscious, heavy blood loss, no breathing, large open wound to torso. The casualty is about to, or has lost consciousness, is unable to move, unable to respond, and is being given CPR.


 * Deceased - No heart rate, no blood pressure, no response, no breathing. The casualty is dead. This status should only be set by a suitably qualified medic, or a squad leader.

Note: An unconscious soldier wont be able to set their own triage status, in this instance, and only if its safe to, a squad mate would set the status for them, then begin CPR.

Wound Treatment
Open wounds require dressing, and the dressings have to be applied in the correct way to be effective. Smaller wounds require less dressings, while larger wounds require extra dressings. Applying the dressings using the wrong procedure, or applying extra dressings when not required will be a waste of time, and a waste of resources. Below is a list of common wounds and the procedure for treating and dressing them effectively:


 * Small open wound to limb - Apply Quick clot, apply basic dressing.


 * Medium Open wound to limb - Apply quick clot, apply basic dressing.


 * Large open wound to limb - Apply quick clot, apply basic dressing, apply elastic.


 * Small open wound to torso - Apply quick clot, apply basic dressing.


 * Medium open wound to torso - Apply packing bandage, apply basic dressing.


 * Large open wound to torso - Apply packing bandage, apply basic dressing, apply elastic.


 * Wounds to head - Apply quick clot, apply basic dressing, apply elastic (large wounds).

Note: Large and medium wounds to torso will always require a medic, in due time.

Tip: Use your own personal supply of bandages if the unit medic is unavailable. If your personal supply has been used, ask the medic for an additional supply.

If a casualty's condition deteriorates enough, they will pass out and become unconscious. Unconscious casualty's should be given Cardio-Pulmonary Resuscitation (CPR) immediately. CPR can stabilize a casualty's condition, and slow down further deterioration. CPR is available through the advanced treatments option on the Medical screen. Once CPR has been started it will continue for 90 seconds automatically, or until "Stop CPR" is clicked. CPR should only be stopped once the medic says it can be stopped, or until the casualty regains consciousness.

A casualty will fall unconscious during any of the following conditions:


 * Knocked unconscious by an explosion or a blow to the head.
 * Heart rate below 20 bpm
 * Blood loss greater than 65%
 * In pain greater than 48%

If the casualty has not regained consciousness and all the above conditions are stable. Consider blood composition symptoms (see blood loss).

Blood Loss
When a casualty has an open wound, they will bleed. The larger the wound the more they will bleed and the quicker the bleeding will happen. If the bleeding is not stopped in a reasonable time, the casualty will loose enough blood to loose consciousness, pass out, and eventually die. Treatment of blood loss is advanced and cannot be done during combat. It is possible however to keep a casualty in a stable condition until a safer and more suitable time and location, where a blood transfusion can take place.

Bleeding from an open wound on any limb can be temporarily stemmed using a tourniquet. Apply one tourniquet to each bleeding limb. Once tourniquet has been applied, bleeding will stop and bandages and dressings can be applied. Tourniquets must be removed once all the limb's open wounds have been bandaged and dressed.

Saline is carried by medics and can be used during bleeding, to temporarily maintain the blood pressure of the casualty. Saline, however isn't a direct replacement for blood. Blood and Plasma must be kept refrigerated. If blood and plasma are left out of a refrigeration unit for longer than 30 minutes the blood and plasma becomes useless. For this reason medics only carry saline solution, but will have to call for blood and plasma supplies to be brought in by Medevac or carried in a suitable container in a suitable vehicle.

It takes time to perform any IV transfusion, and once the transfusion has been completed it takes time see the effects. During any transfusion process', the casualty's blood pressure (BP) should be taken every 3 minutes, and if multiple transfusions are required, BP should be taken in between each transfusion. Normal blood in our bodies is 55% plasma, 40% red cells, and 5 % white cells. This must be taken into consideration when performing a transfusion.

Transfusion kits come in 3 sizes, 250ml, 500ml, and 1000ml. As a rough guideline, for using SALINE:


 * 250ml For each limb with a large wound or a large wound to torso.


 * 500ml For conscious heavy blood loss.


 * 1000ml For unconscious heavy blood loss.

It takes from one to three minutes to transfuse. The time depends on the IV's volume. To define the volume of IV injection you need to draw attention to the blood pressure. Each of 250ml makes systolic pressure rise on 4 mm of mercury during one minute. The 500 and 1000ml IV injections, in turn, lifts it on 8 and 15 mms in next three minutes. BTW, if the casualty passed out, you would need up to 15% more of volume to revive him.

An average healthy, male, adult body, contains approximately 5000ml of blood. If a casualty has passed out, due to blood loss, then they will require at least 2000ml of blood mixture (1000ml blood + 1000ml plasma) combined with Saline (already administered), to usually revive them.

If a casualty has been administered solutions, and their blood pressure has been stabilized, yet the casualty is still unresponsive, then there may be a blood composition problem. Too much plasma/saline will cause the blood pressure to rise and appear to be stable, yet with not enough oxygen carrying red cells in the blood composition, oxygen will be at a minimum and the casualty wont regain consciousness. In this instance, call for a blood drop, do not administer any more saline or plasma, whilst continuing CPR. Once the blood has been delivered, start transfusing the blood, continue to monitor vitals. If the blood pressure is too high before/during the blood transfusion, consider using Atropine to lower the blood pressure. This situation can be extremely frustrating for the medic, the casualty, and the rest of the squad. However, if dealt with calmly and collectively the casualty should regain consciousness.

How and when to call for a Medic
A units medic is an important role, and can literally be the defining factor of a life or death situation. A medic can be called using the short range radio, and calling for a "MEDIC". If no medics are in range, the squad leader will have to relay the transmission via long range radio. Key information should be included in all transmissions, these are:


 * Name of the casualty.
 * Location of the casualty.
 * Triage status of the casualty.

Note: Calm and clear transmissions have more chance of being understood first time.