Medical Handbook

---

The FM outlines our core skills, policies and guides to ensure every member stands ready for the mission ahead.

When giving first aid to a patient, follow the following steps:

• Minimize long term blood loss in 30 seconds or less (time it takes to apply 4 tourniquets or 3 bandages)
  • if unsure, tourniquet wounded limbs
• Manage the airway
• Perform further treatment as needed

Wherever practically possible using the correct bandage is essential for efficient wound management.

• Elastic Bandage: Quick closure for many wounds; use when speed is key and durability isn't crucial.
• Packing Bandage: Ideal in combat; designed for immediate bleeding control.
• QuickClot Bandage: For non-combat situations; speeds up clotting when stitching isn't an option soon.
• Field Dressing (Basic) Bandage: A versatile option when others aren’t available; useful for initial wound care.

Considerations

• Situation: Combat status and resource availability.

Chooses based on the situation, wound type, and available resources for best outcomes.

Use tourniquets to temporarily prevent bleeding from all the wounds on a limb, when individually bandaging the wounds would result in unacceptable blood loss.

• Prioritise the treatment of wounds by evaluating the severity and rate of blood loss. 
• Address the most severe wounds first to reduce overall blood loss, and then proceed to less critical wounds, employing appropriate bandaging techniques.

Use splints to temporarily treat broken limbs, until a personal aid kit can be used to restore full usage of the limb later.

Assess the airway with “check airways” and categorize as one of the following states:

• Clear
• Occluded
• Obstructed

Above: The location of the "Check Airway" action and the result as seen in the activity log

Turn the patient's head to clear the occluded airway of the patient if an Accuvac is not available.

Above: Action as seen in the medical menu

Hyperextend the patient's head to clear the obstructed airway of the patient, and stay within 2m of the patient during the process.

Above: Action as seen in the medical menu

Place the patient into a recovery position to keep the airway clear, if they:

• are stable
• do not need to be moved

• Administer or take combat wound medication pills to decrease pain by about 20%
• Limit frequency of consumption to no more than 6 pills every 6 minutes to avoid overdosing
• Be aware of side effects:
  • a slight increase in heart rate
  • a decrease in blood pressure

After identifying a patient with no heart rate

1. Perform CPR for at least 30 seconds
2. Check pulse
3. If no heart rate, repeat

Checking a patient's pulse whilst someone else is performing CPR or checking pulse on a limb with a tourniquet placed will provide an erroneous reading. 

• Categorize a patient as CAT-1 IMMEDIATE if they:
  • are bleeding
  • lost a large or a fatal amount of blood
  • have blocked airways
  • are in cardiac arrest
• Categorize a patient as CAT-2 DELAYED if they:
  • are unconscious
  • are not actively bleeding
  • have lost some or a lot of blood
  • have clear airways
  • are not in cardiac arrest
• Categorize a patient as CAT-3 MINIMAL if they:
  • are conscious
  • require medical attention
• Categorize a patient as CAT-4 DECEASED if they:
  • are dead
  • are wounded beyond recoverability

• Prioritize patients in order of triage:
  • CAT-1 IMMEDIATE
  • CAT-2 DELAYED
  • CAT-3 MINIMAL
• Within the same triage category prioritize patients in the following order:
  • People close to waking up
  • Medical personnel
  • Leadership
  • Force multipliers
  • Others

Use a stitching kit on a body part to permanently close all currently closed wounds on that body part.

• Administer TXA to automatically apply a packing bandage every 6 seconds
• Limit frequency of consumption to no more than 3 times every 2 minutes to avoid overdosing
• TXA can only be administered through IV or Fast IO

• Administer EACA to automatically stitch a wound every 6 seconds
• Limit frequency of consumption to no more than 10 times every 10 minutes to avoid overdosing
• EACA can only be administered through IV or Fast IO

A personal aid kit removes all injuries, to use a PAK the patient must be stable, the requirements of being stable are:

• is not actively bleeding
• has a heart rate
• is responsive 
• can still have tourniquets on
• has not lost more than some blood

Assess the airway with “check airways” and categorize as one of the following states:

• Clear
• Occluded
• Obstructed

Above: The location of the "Check Airway" action and the result as seen in the activity log

Turn the patient's head to clear the occluded airway of the patient if an Accuvac is not available.

Above: Action as seen in the medical menu

Use the Accuvac to clear the occluded airway of a patient.

Hyperextend the patient's head to clear the obstructed airway of the patient, and stay within 2m of the patient during the process.

Above: Action as seen in the medical menu

Place the patient into a recovery position to keep the airway clear, if they:

• are stable
• do not need to be moved

Use a guedeltube to prevent obstruction of the airway after the airway has been cleared, if a King LT is not available.

Use a King LT to keep the airway clear after it has been cleared.

Use pulse oximeter to monitor a patients blood oxygen levels, with low levels indicating the patient is not breathing normally.

• Administer or take combat wound medication pills to decrease pain by about 20%
• Limit frequency of consumption to no more than 6 pills every 6 minutes to avoid overdosing
• Be aware of side effects:
  • a slight increase in heart rate
  • a decrease in blood pressure

• Administer or take morphine to decrease pain by about 80%
• Limit frequency of consumption to no more than 4 times every 30 minutes to avoid overdosing
• Be aware of side effects:
  • a decrease in heart rate
  • a decrease in blood pressure

• Administer or take fentanyl to decrease pain by about 100%
• Limit frequency of consumption to no more than once every 15 minutes to avoid overdosing
• Be aware of side effects:
  • a slight increase in heart rate
  • a decrease in blood pressure
  • blurry vision (chromatic abberation)

• Attach an IV bag to one of the patients limbs or an IO needle to give them blood.
• Do not attach the bag to a limb with a tourniquet applied
• Do not give more blood than needed, to prevent the blood pressure from becoming too high

• Use IO needles to enable fluid and medication administration through a patients chest 
• When IV needles are not an option.
• Keep in mind IO needles cause pain to the patient

• Use a field blood transfusion kit to take 250ml of blood from a donor
• The donor has not lost a large or fatal amount of blood
• Only transfuse blood when no other source of blood is available
• You need space in your inventory

• Administer norepinephrine to
  • slow down bleeding
  • slow down transfusion speed
• Limit frequency of consumption to no more than 12 times every 6 minutes to avoid overdosing
• Be aware of side effects:
  • an increase in heart rate
  • an increase in blood pressure

• Administer phenylephrine to:
  • slow down bleeding more than norepinephrine FM/BS-363 - Use norepinephrine to slow down bleeding
  • slow down transfusion speed more than norepinephrine
• Limit frequency of consumption to no more than 6 times every 6 minutes to avoid overdosing
• Be aware of side effects:
  • a decrease in heart rate
  • an increase in blood pressure

• Administer nitroglycerin to speed up transfusions
• Limit frequency of consumption to no more than 6 times every 6 minutes to avoid overdosing
• Be aware of side effects:
  • faster bleeding
  • an increase in heart rate
  • a decrease in blood pressure

After identifying a patient with no heart rate

1. Perform CPR for at least 30 seconds
2. Check pulse
3. If no heart rate, repeat

Checking a patient's pulse whilst someone else is performing CPR or checking pulse on a limb with a tourniquet placed will provide an erroneous reading. 

• Attach the AED(-X) pads to the patient and press “analyze rythm”
• Administer appropriate medication ( FM/BG-201 - Recommended process for treating cardiac arrest with an AED(-X)) and:
  • Shock the patient when shock is advised
  • Perform regular CPR when no shock is advised FM/BS-224 - Use CPR to restore a normal heart rate when a patient has no heart rate

• Administer epinephrine to:
  • Increase heart rate
  • Increase blood pressure
  • Support CPR-based resuscitation
  • Support AED-based resuscitation (see FM/BG-201 - Recommended process for treating cardiac arrest with an AED(-X) for more information)
• Limit frequency of consumption to no more than 6 times every 2 minutes to avoid overdosing

• Administer amiodarone to:
  • Support CPR-based resuscitation
  • Support AED-based resuscitation (see FM/BG-201 - Recommended process for treating cardiac arrest with an AED(-X) for more information)
• Limit frequency of consumption to no more than 4 times every 2 minutes to avoid overdosing
• Be aware of side effects:
  • a decrease in heart rate

• Administer lidocaine to:
  • Support AED-based resuscitation (see FM/BG-201 - Recommended process for treating cardiac arrest with an AED(-X) for more information)
• Limit frequency of consumption to no more than 2 times every 2 minutes to avoid overdosing

• Administer ammonium carbonate to increase wake-up chance
• Limit frequency of consumption to no more than once every 30 seconds to avoid overdosing
• Be aware of side effects:
  • an increase in heart rate

• Administer epinephrine to increase a stable patient's wake-up chance
• Limit frequency of consumption to no more than 6 times every 2 minutes to avoid overdosing
• Be aware of side effects:
  • an increase in heart rate
  • an increase in blood pressure

See FM/BS-220 - Use epinephrine to manage the cardiac rhythm for usage of this medication for resuscitation purposes.

Use a pulse oximeter to monitor a patients pulse rate

• Administer atropine to counter chemical intoxication
• Limit frequency of consumption to no more than 4 times every 2 minutes to avoid overdosing
• Be aware of side effects:
  • an increase in heart rate

Recognize a mass casualty incident (MCI) as any situation where the element is overwhelmed by the amount and severity of casualties, to the point that the organically attached medical personel are unable to effectively deal with it.

As a medic working at a mass casualty incident (MCI) or casualty collection point (CCP):

•  follow this hierarchy:
  • MERT Officer or CMT Leader
  • Platoon Medic
  • SF Medic
  • MERT or CMT Technician
  • Squad Medic
  • Combat Medic
  • Combat Life Saver
• execute the tasks given by those above in the hierarchy
• give tasks to those below in the hierarchy

Communicate the following information to your leadership at regular intervals:

• Casualty count, by triage
• Estimated time to recovery
• A need for more help, if required

Choose a location with the best combination of the following factors:

• distance to casualties to be brought over
• protected from enemy fire
• enough room to walk around
• easily accessible, especially for people carrying patients
• no internal choke points

As a medic working at a mass casualty incident (MCI) or casualty collection point (CCP):

•  follow this hierarchy:
  • MERT Officer or CMT Leader
  • Platoon Medic
  • SF Medic
  • MERT or CMT Technician
  • Squad Medic
  • Combat Medic
  • Combat Life Saver
• execute the tasks given by those above in the hierarchy
• give tasks to those below in the hierarchy

Communicate the following information to your leadership at regular intervals:

• Casualty count, by triage
• Estimated time to recovery
• A need for more help, if required