Medic (ACE3)

BB 2b’s (2b's for Ace only 3b's for kat)

March can be simplified in to the Following for ARMA purposes Bleeding & Beating,

Bleeding

Simplified is the Patient Bleeding.

Beating

Includes pulse and blood volume 

The advanced medical system provides a more complex and detailed medical simulation and is based off the CSE CMS. It focuses on a more realistic model for injuries and treatments, thus resulting in a more important and prominent role for combat medics, and a bigger incentive to avoid getting shot.

The system behind advanced medical is designed to attempt to mimic important parts of the human body, as well as react to any injuries sustained and treatments applied in a realistic manner. 

THE BASICS

In ACE the human body is represented as 6 distinct areas that can receive damage. Some of these areas have special abilities such as applying a tourniquet or using a variety of IV solutions.

Each living person in the battlespace has Four key metrics which define their state of health. Every action you take will be to maintain or restore one of these metrics:

• Blood Volume

• Pulse

• Oxygen saturation

• Responsive State (Are they conscious? )

Besides the 4 elements introduced by basic medical, advanced introduces the following:

• More detailed wound system.

• Accurate blood loss based upon sustained injuries.

• Vitals, including heart rate and blood pressure.

• Cardiac Arrest.

• Various treatment methods such as CPR, different kinds of IVs and a working tourniquet.

Unconscious Wake Up Chance

Every 15 seconds during unconscious, a check is performed for stable vitals. By default this setting is set to 5% meaning that every 15 seconds there is a 5% chance a stable person will wake up from unconsciousness. Additionally Epinephrine can boost the chances of waking up by increasing the amount of checks the wake up chance does while Epinephrine is in the patients system.

Death And Unconscious

Unconsciousness happens when one of the following is met:

• Pain threshold is reached

• Low Blood pressure

• Cardiac Arrest.

Someone cannot recover from unconsciousness till the underlying factor has been resolved  

Death happens if one of the following happens.

• The Cardiac Arrest timer runs out, the base timer is 300seconds (5 minutes), this can be extended to a max of 3600 seconds (60 minutes) with CPR each usage will extend the timer by 120 seconds. 

AI

The AI can if enabled go unconscious, and can be revived

ACE 3 is a matrix of complicated 3D menus and contrived custom keys. 

Changing the Medical Menu to a 2D interface:

1. Go to the ACE OPTIONS menu in the top left-hand corner of your in-game options menu.

2. Navigate to the “Medical Menu” option

3. Enable the Medical Menu

After enabling the medical menu, you should be able to ACE interact and find the “Medical Menu” under interactions - this is in contrast to the usual 3D “Medical” setting that would be there. This allows you to access the 2D medical menu and access time critical information faster.

 Overview Window

Red - Open wounds, severe bleeding

Orange -Open wounds, intermediate bleeding

Yellow -Open wounds, minor bleeding

Light blue -Bruised

Dark blue -Fully bandaged

Blue belt -The limb is tourniquet'ed

Red bone -The limb is fractured

Blue bone -The limb is splinted

TOURNIQUETS

Tourniquets are pressure devices used to prevent blood flowing into a limb. Due to the nature of the device, they are highly effective at bleeding reduction in the limbs stopping bleeding entirely.

The downside of tourniquets is that they put the patient in a lot of pain if they are left on too long - sometimes to the point of rendering the patient unconscious.

SURGICAL KITS

Surgical Kits allow the bearer to sew wounds closed to prevent them from reopening.

SPLINTS 

Are used to fix damaged (broken) arms and legs.

SALINE PLASMA AND BLOOD

All three restore the volume of liquid in the bloodstream. as a result, blood pressure is raised for all of them.

Only Saline should be carried in the field, Plasma and Blood should require refrigeration.  

Suture 

Surgical Suture for stitching injuries.

Tourniquets:

A tourniquet is a device that is used to apply pressure to a limb or extremity in order to stop the flow of blood it will cause pain, so should be removed as quickly as possible.

Surgical Kit

Used when advanced wounds (reopening) is enabled to permanently close wounds. It does NOT heal or restore hit-points).

PERSONAL AID KITS

The Personal Aid Kit is a one hit Jesus level wonder of modern medicine that instantly restores the user to full health in every way. This glorious and remarkable achievement can only be performed in a medical facility or Medical Vehicle and on a stable Patient.

There are four types of Auto Injector for injecting drugs. Drugs are used to manipulate the pulse and to reduce pain levels.

The first and most common autoinjector is Morphine which reduces the pain experienced by the patient. It also has side effects of reducing the patient’s blood pressure and heart rate, reducing it by around 20 BPM. There is a potential of overdosing, (3+ with in 10 minutes)

The second autoinjector is Epinephrine - more commonly known as Adrenaline. This drug solely affects the patient’s pulse raising it by around 20 BPM.

The third autoinjector is Atropine - a muscle relaxant - which lowers the heart rate of the patient by approximately 20 BPM. 

The fourth is Adenosine, it lowers the heart rate. (some mode use Adenosine as an NBC/CBRN miracle cure)

Morphine (time to max effect: 30 seconds)

• • • Drastically lowers pain

    • Reduces heart rate

    • Do NOT give a morphine to an unconscious person, or a patient that is not stable

    • Do NOT give more than two morphine to somebody who has had a morphine given in the past 10 minutes. 

    • You can overdose yourself or a patient with two morphine. Two with in one minute will put the patient in to  cardiac arrest.

    • Morphine stays in the patients system for up to 10 minutes, , effecting the vitals, death or a zeus heal will reset this

Epinephrine (time to max effect: 10 seconds)

• Increases heart rate

• Hastens wake-up checks when unconscious

• 10 injections to overdose

• Peaks after 10 seconds, lingers 2 minutes

Adenosine (time to max effect: 15 seconds)

• Decreases heart rate

• 6 injections to overdose

• Lingers 2 minutes

INJURY TYPE

Each limb on the body can receive different types of injury. Each injury has a different level of pain and bleeding that it will inflict. Each injury type also has a set of treatment procedures that are best suited for it - these will be laid out in the subsequent chapter about rendering aid.

ABRASIONS

An Abrasion is a wound caused by friction. Examples include Vehicle Crashes and Rope Burn. This wound type has a low pain effect and an extremely slow bleed rate.

AVULSIONS

An Avulsion is when an entire structure is separated from the body. Examples include lost teeth or an ear lobe. These are caused by explosions, shrapnel and any other situation which could sever a body part.

Avulsions have an extremely high pain effect with an extremely fast bleed rate.

CONTUSIONS

Contusions, commonly known as Bruises are caused by trauma that injures an internal structure without breaking the skin. Blunt blows to areas such as the chest or head can cause contusions.

LACERATIONS

Lacerations are wounds with ragged edges. They are produced by large forces exerted on the body.

Lacerations have a slight pain effect with a slow bleed rate.

VELOCITY WOUND

A Velocity wound is caused by objects entering the body at speed, such as shrapnel or bullets.

Velocity wounds have an extremely high pain effect with a medium bleed rate.

PUNCTURE WOUNDS

A puncture wound is a narrow wound produced by a sharp object such as a knife.

Puncture wounds have a slight pain effect with a slow bleed rate.

Treatment Order 

1. Avulsion 

2. Velocity Wound

3. Laceration

4. Cut Wound

5. Puncture

6. Crush Wound

And tied for 7th Abrasion & Contusion

• Efficiency: Bandage efficiency, higher is better.

• Reopening chance: Reopening chance when advanced wounds are enabled, lower is better.

Bandages are used to pack ounds to reduce bleeding and provide a surface for blood to clot against. Bandages are temporary solutions and wounds will require stitching to repair permanently.

VITALS

BLOOD PRESSURE

Your blood pressure is recorded as two numbers:

Systolic blood pressure (the first number) – indicates how much pressure your blood is exerting against your artery walls when the heart beats.

Diastolic blood pressure (the second number) – indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

Blood pressure is affected by the amount of blood lost as well as IVs and medication.

• Nonexistent: 0 - 20 systolic.

• Low: 20 - 100 systolic.

• Normal: 100 - 160 systolic.

• High: 160 and above systolic.

HEART RATE

The heart rate (pulse) is affected by the amount of blood lost and medications.

• Low: 45 and below

• Normal: between 46 and 119

• High: 120 and above

• Minimal HR to get someone up: 40

Bradycardia is a heart rate that's too slow

Ventricular tachycardia (VT or V-tach) is a type of abnormal heart rhythm, or arrhythmia.

CARDIAC ARREST

A patient will enter cardiac arrest when:

• The heart rate is below 20.

• The heart rate is above 200.

• The systolic blood pressure is above 260.

• The diastolic blood pressure is below 40 and the heart rate is above 190.

• The systolic blood pressure is above 145 and the heart rate is above 150.

TREATMENTS 

IVS

ACE provides two types of intravenous bag that can be administered to patients. All IVs are used to help restore blood volume.

The first type is Saline which is used to rapidly provide blood volume to a patient. Saline is a double-edged sword as it reduces blood clotting meaning that bleeding can be intensified by overuse of saline IVs. It is useful for restoring patients who have lost a little blood or stabilizing patients who are suffering from cardiac failure due to low blood pressure until MEDEVAC arrives.

The second type of IV is a blood/plasma transfusion. Blood/ plasma transfusions restore blood volume and are used in cases of heavy blood loss.

Cardiac Arrest Treatment

• VF/ PVT – Shockable cardiac arrest, using AED allowed (using Epinephrine, Lidocaine and Amiodarone advised) 

• Asystole – Non-Shockable cardiac arrest, using AED not allowed (using Epinephrine advised)

Blood Loss (know its not beating per say but fix it in the beating stage)

The normal ArmA body has 6 liters

• 15% =.9

• 30% 1.8

• 40% = 2.4

• 50% = 3

Minimal amount of blood to get someone up: 5,1l (“lost some blood” status)

Lost Some Blood 

 Lost less than 15% blood, Class I Hemorrhage

Lost a Lot of Blood

Lost more than 15% blood, Class II Hemorrhage

 Lost a Large Amount of Blood

Lost more than 30% blood, Class III Hemorrhage

Lost a Fatal Amount of Blood

Lost more than 40% blood, Class IV Hemorrhage

Lost more than 50% blood, Unrecoverable

You should not attempt to render aid to a casualty until the friendly force has obtained fire superiority.

Failure to ensure that the friendly force holds fire superiority can lead to a multiplication of casualties as first responders become injured.

CARE UNDER FIRE

Care under Fire is the actions undertaken by the squamates of the injured personnel when a casualty is first injured. This phase revolves solely around bleeding control.

TRIAGE

Triage will be performed at all levels. Traditional categories of triage are immediate, delayed, minimal, and expectant. To easily remember the order of the categories, use the acronym IDME. No significant treatment should occur in the triage area. Casualties should be rapidly sent to the appropriate treatment area for care. 

TIMERS

• Revive Timer: Ask your server admin

PRIORITY

In general, the treatment priority is as follows (from most-urgent to least-urgent):

IMMEDIATE

• Bleeding and unconscious. These soldiers may bleed to death if not treated. The soldier administering the treatment may even often call for help in bandaging the patient, to make sure that the bleeding stops before the patient bleeds out.

• Life-threatening Bleeding. A conscious but bleeding soldier could pass out or die if not treated. Therefore, anyone bleeding severely is a high priority for treatment.

• Not breathing. A soldier has 300 seconds before death if not breathing,

DELAYED

• Unconscious but not bleeding. Unconsciousness is somewhat dangerous in and of itself and needs to be treated with some haste. Death from unconsciousness, however, is rarer. Furthermore, once the unconscious soldier is revived, he may be able to provide cover for the medic during the rest of the treatment.

• Severe Pain. A soldier in severe pain may pass out, requiring more treatment. Therefore, it may be necessary to administer Morphine to them before that can happen.

MINIMAL

• Minor Bleeding. Minor bleeding can worsen over time and even lead to unconsciousness and death, but it is not immediately life-threatening. Soldiers with minor bleeding may even be able to treat themselves.

• Crippled Legs. Soldiers with crippled legs have a bare minimum of mobility. Leaving them in this state could cause them to fall behind if the unit needs to leave the area, and should be treated sooner rather than later.

• Crippled Arms. Soldiers with crippled arms are not very combat effective. Treatment of this injury will restore one soldier - and his gun - back to effectiveness.

• Mild Pain. Mild pain in itself is not life-threatening and reduces a soldier's effectiveness only mildly. Furthermore, Morphine is in short supply, and medics may choose not to treat Mild Pain at all in order to conserve it for more serious cases.

EXPECTANT

• Multiple bleeding wounds, not breathing, cardiac arrest 

If there are more than one wounded, treating the Expectant may cause the death of other wounded, a decision to not treat may be necessary.

 Do Not Resuscitate Guidelines

Do NOT resuscitate (DNR) casualties under the following circumstances:

1. Combat (direct fire) situations:

   • Patient with no pulse, regardless of cause.

   • Patient with a pulse but no respirations, who cannot be resuscitated without endangering the lives of caregivers and/or rescuers.

NOTE: The decision not to initiate resuscitation IS NOT a legal declaration of death, unless a qualified physician declares the patient dead.

2. In a combat situation, body recovery should be attempted unless the attempt exposes the rescue team to undue danger. If the body cannot be safely recovered, the location should be noted as accurately as possible (GPS coordinates preferred) for later recovery efforts.   If the body has a set of ID tags that can be safely recovered, one should be left with the body, and one should be secured.

3. In non-combat situations, attempt body recovery only if it can be accomplished with a minimum of risk to   the rescue team. If there is any suspicion of CBRN the body and the area around it should be undisturbed, until personnel with proper equipment are present.

STEP 1: IS THE PATIENT RESPONSIVE?

Yes: Ask him if he has wounds / he is in pain.

No: Go to step 2.

STEP 2: IS THE PATIENT BLEEDING?

Yes: Apply tourniquet to the limbs  Bandage the rest, and go to step 3.

No: Skip this step.

STEP 3: DOES THE PATIENT HAVE A PULSE?

Yes: Go to step 4.

No: Perform CPR,

STEP 4: DID THE PATIENT LOSE A LOT OF BLOOD?

Yes: Give fluids.

No: Go to step 5.

STEP 5: IS THE PATIENT IN PAIN?

Yes, and a stable pulse: Give him morphine.

Yes, and unstable heart rate: Stabilize the heart rate before administering morphine.

No: Go to step 6.

STEP 6: IS THE PATIENT AWAKE NOW?

Yes: You’re done.

No: Go to Step 1, 

(If you have completed the process two times already, evac the patient)