Medical Handbook

---

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

A Skill Card compiles relevant information for specific combat areas from the UNITAF Force Manual and plays a crucial role in the peer-to-peer training system. It facilitates evaluations among members, highlighting individual strengths and weaknesses. This feedback enables members to see exactly where they currently excel and where they may need improvement providing a clear focus for training development. The card includes essential Guide, Policy, and Skill information and assigns skills to a starting Tier level, indicating the stage at which these skills should be mastered and integrating them seamlessly into the Tier Progression system.

To enhance your Skill Card ratings in UNITAF you should actively seek evaluations from more experienced members.

1. Identify: Refer to the training team of the skill card you are looking for ratings on
2. Request: Politely ask these members to monitor your performance during operations and practices, or even ask them to give you 1-1 observation privately, specifying the skills you'd like to be evaluated on.
3. Participate: Engage in exercises and operations as frequently as possible. The more you're involved, the more opportunities experienced members will have to evaluate your abilities.

This proactive strategy ensures that your evaluations are based on comprehensive observations across multiple scenarios, providing a clearer and more accurate reflection of your skill levels. Over time, this approach to gathering feedback will help you pinpoint areas for improvement, aiding in your overall development and progression in UNITAF.

Rating other's Skill Cards in UNITAF is an integral part of the peer-to-peer training system, fostering a culture of continuous feedback and development, you can only rate skill cards if you have been appointed to the Training Team of the skill cards combat area.

1. Understand: Familiarise yourself with the skill definitions and proficiency level criteria outlined in the Skill Cards. This ensures your evaluations are grounded in the established framework.
2. Observe: When evaluating peers, consider their performance over a range of recent operations and practices. Look for consistency and adaptability in their skills across different scenarios. Ensure your ratings are objective, based on observed performance rather than personal relationships. Fair evaluations help maintain the integrity of the training system.
3. Feedback: Aim to offer feedback where you can that is constructive and actionable. Highlight strengths while also suggesting areas for improvement, helping your peers understand how they can develop their skills further.

After making an assessment, update the Skill Card in a timely manner. This keeps records up-to-date and allows for immediate reflection and action on the feedback. By actively participating in the rating process, you contribute to the growth of your peers and the overall effectiveness of UNITAF's training ecosystem.

The 'Training Team' is a specialised group within the unit responsible for overseeing and managing the evaluation and improvement of a specific combat area. Comprising appointed individuals including Chief Instructors, Staff Instructors, Training Instructors, and Observers, the team operates under the guidance of Training Command. Each member has distinct roles and responsibilities, ranging from providing subject matter expertise to facilitating training sessions and assessing skill levels. Together, they ensure that training standards are met, skills are effectively taught and practiced, and feedback is provided to enhance individual and unit proficiency in specific combat areas.

• Designated member of the unit serving as a subject matter expert in a specific combat area
• Minimum of 1 and maximum of 2 may be assigned to any combat area
• Acts as a senior advisor to unit command, providing guidance on potential changes and advising on ongoing discussions
• Active participant in training, application, and observation of combat area skills
• Holds the highest weighted opinion among all other roles
• Accountable to both the Staff Instructor and Training Command
• Appointment made at the discretion of Training Command

• Member of J7 Staff responsible for overseeing a specific combat area, its training and training team
• Minimum of 1 and maximum of 2 per skill card; each staff member can oversee up to 4 skill cards in total
• Serves as the primary point of contact in the combat area for Training Command, Chief Instructors, Instructors, Observers, and the wider unit
• Ensures adequate training and practices are conducted through the training team
• Appoints and removes Training Instructors and Observers as needed, based on advice from Chief Instructors and in collaboration with Training Command
• Collaborates with Policy staff to implement changes and distribute them upon publication by Unit Command
• Holds the second highest weighted opinion among the roles involved
• Actively participates in training, application, and observation of combat area skills
• Accountable to Training Command and appointed at their discretion

• Unit member appointed as a Training Instructor in a specific combat area, having transitioned from the role of Observer
• Recognized by the training team as a well-rounded individual capable of effectively teaching relevant combat area skills in group settings
• Possesses a solid understanding of the combat area skills
• Holds the third highest weighted opinion among the roles involved
• Limited to a maximum of 6 Training Instructors per combat area
• Actively engages in training, application, and observation of combat area skills
• Accountable to both the Staff Instructor and Chief Instructors

• A member of the unit who is appointed as an Observer in a specific combat area, who in the eyes of the training team is trusted to assess others in a non-teaching capacity in the combat areas skills.
• Typically a starting role on route to Training Instructor.
• Holds the lowest weighted opinion.
• Maximum of 8 per combat area
• Active in the training, application and observation of combat area skills.
• Accountable to the Training Instructors and Chief Instructors.

UNITAF uses medical in a unique way to achieve our aims. This approach is what influences most decisions in relation to changes in medical procedures. 

UNITAF uses at its core the advanced configured ACE Medical system for Arma 3 with an additional KAT Medical expansion, although we have modified these to suit our needs. The system introduces a more realistic and immersive model for injuries and treatments, this results in a more prominent role for combat medics and gives players a bigger incentive to play as a team.

Advanced medical introduces the following:

• A detailed wound system, including fractures
• Accurate blood loss based upon sustained injuries
• Vitals simulation, including heart rate and blood pressure
• Cardiac arrest events
• Various modular treatment methods such as;
  • CPR,
  • IVs
  • drugs
  • tourniquet
  • bandages
  • splints

Although our system mimics real military operations, it's essential to recognize the game mechanics underlying death and serious injuries. The objective is to maintain a balance between realism, gaming and specifically discouraging carelessness in actions.

The most important element of a medical system is to provide consequence to actions, catching a shot in the arm should provide a small inconvenience for the player, and being hit 5 times in the chest should provide a much greater one. We have never used respawns or reinsertions as a primary method of player consequence primarily because they are no consequence to the player.

All persons in a team, squad, platoon and company should have to deal with casualties as they mount, whilst still focusing on their objectives at large. They should have to make quick decisions on how to deal with any situation as it arises. Medical consequences should extend beyond individual players. All unit members, irrespective of their roles, are impacted by increasing casualties, emphasising prompt decision-making and adherence to objectives.

Both individual players and the wider unit need to be acutely aware of and impacted by consequences. This necessitates the creation of deterrents and considerations for player actions.

At the heart of UNITAF's operations is the emphasis on large-scale teamwork. This mandates the need for collaborative efforts in medical procedures, ensuring shared responsibilities and a unified approach to challenges.

ACE medical

• Wound Reopening / Advanced Bandages: Enabled
• PAK Usage: Medics only, not CLS
  • In smaller operations, PAK may be permitted "in the field"
  • In larger operations, PAK is only permitted “off the field” requiring medical vehicles or facilities
• Primary Weapon must be slinged or holstered before you can tend to any casualties
• Morphine Usage: CLS and above
• Epinephrine Usage: CLS and above
• Fracture Chance: 0.4
• PAK Consumed: Yes
• Stitching Kit Consumed: No
• Stitching Location: Anywhere

KAT - ADV medical: airway

• KingLT usage: Squad medic and above
• Geudeltube usage: CLS
• Accuvas usage: Platoon medic and above

KAT - ADV medical: breathing

• Lethal SPO2 value: Enabled
• Pulse oximeter: Squad medic and above

KAT - ADV medical: circulation

• AED usage: Platoon medic
• AED-X Usage: MERT,MT and SF medics
• AED location: Anywhere

KAT - ADV medical: pharmacy

• Coagulation: Disabled
• Amiodarone: MERT. MT and SF medic
• Atropine: Combat Medic and above (only when required by mission)
• Fluids and medication: Require IV/IO inserted
• IV/IO drop time: 6 minutes
• Carbonate: CLS
• TXA: Platoon medic and above
• EACA: Platoon medic and above
• Fentanyl: Platoon medic and above
• IO: MERT , MT and SF medic
• IV: Combat medic and above
• Lidocaine: MERT, MT and SF medic
• Norepinephrine: Squad medic and above
• Phenylephirne: Squad medic and above

All personnel are equipped with bandages to provide initial treatment for wounds until they can receive more advanced medical care. There are four distinct types of bandages, each varying in the time required for application and the duration of effectiveness. 

• Elastic bandages are recommended for situations where quick application is crucial, despite their lower durability. 
• QuikClot bandages are best for long-lasting wound protection, offering the highest endurance. 
• Packing bandages present a balanced option, optimising for application speed, wound coverage, and durability.

Field dressings also known as Bandage (Basic) are the most fundamental type of bandages available to us, primarily used for managing low-priority wounds quickly, as well as for treating crush and puncture wounds effectively.

Above: A Field Dressing as seen in the inventory

Elastic bandages are valued for their rapid application and effectiveness in temporarily closing wounds. They are often the preferred choice in scenarios involving severely injured individuals or mass casualty incidents because of their speed of use. However, their low durability means they must be replaced frequently. Since they do not promote blood coagulation, once they come off, bleeding is likely to restart.

Above: A Elastic Bandage as seen in the inventory

Packing bandages, although not quite as efficient as elastic bandages in closing wounds, offer significantly greater durability. This feature makes them ideal for situations where a medic is unable to suture wounds promptly. Like elastic bandages, packing bandages also do not promote blood coagulation.

Above: A Packing Bandage as seen in the inventory

QuikClot bandages are notably less efficient at closing wounds compared to elastic bandages, requiring more time and patience for application. This makes them a slower option than both elastic and packing bandages. However, QuikClot bandages offer significant advantages: they are durable and facilitate blood coagulation, allowing for a "set and forget" approach to wound care. This characteristic is especially valuable in scenarios with fewer wounds or when Combat Life Savers (CLS) or medical personnel are not immediately available. It's important to note, however, that QuikClot bandages are slightly less effective on crush and laceration wounds.

Above: A QuickClot Bandage as seen in the inventory

Combat Life Saver

A CCL including the following additional items:

Combat Medic

A CCL including the following additional items:

Squad Medic

As per Combat Medic, with the following changes:

• Norepinephrine: +4 units minimal, +8 units optimal.
• Phenylephrine: +4 units minimal, +6 units optimal.
• Pulse Oximeter: +1

Platoon Medic

A CCL including the following additional items:

SF Medic

A CCL including the following additional items:

Technicians from a Medical Emergency Response Team (MERT) and Combat Medical Team (CMT)

All roles must contain a CCL in addition to:

• MERT roles may in addition include Flight Crew uniforms/helmets

MERT/CMT Leader/Officer

• Long Range Radio
• CCL
• The same medical equipment as the technicians above.

Tourniquets are used to restrict blood flow to an injured limb, effectively halting bleeding as a temporary measure. This is particularly useful in situations where a casualty has multiple wounds, allowing you to prioritise which injuries to address first. 

However, tourniquets also have drawbacks: they make it impossible to check the pulse or blood pressure in the affected limb. Moreover, if left in place for an extended period, they can cause significant pain. Additionally, tourniquets inhibit the administration of medications and the performance of blood transfusions to the injured limb.

Above: A Tourniquet as seen in the inventory

Splints are designed to support broken limbs, enabling a partial restoration of the limb's mobility and function as a temporary solution until more comprehensive treatment can be administered.

Above: A Splint as seen in the inventory

Personal Aid Kits (PAK) represent a significant advancement in medical technology, providing medics with the capability to fully restore a patient's vital signs and bodily functions. In practice, this means healing all wounds and mending broken limbs. However, the use of PAKs necessitates medical expertise and typically requires support from medical vehicles or facilities to ensure proper application.

Above: A Personal Aid Kit (PAK) as seen in the inventory

• As soon as a person is wounded, you should immediately inform your Chain of Command about the incident and the casualty.
• Provide a brief report that includes the number of casualties and the location, which will help in planning an immediate medical response.
• Use clear and concise communication to ensure the message is understood.

• Prioritise safety by first winning the firefight to reduce further risk to yourself and the casualty.
• If the situation is too dangerous to administer first aid on the spot, use the ace interaction to drag or carry the casualty to a safer location, such as behind cover or a concealed area away from immediate threat.

Bleeding

• Quickly apply tourniquets to bleeding limbs or bandages if no other areas are wounded. 
• Aim for this to take no longer than 30 seconds. 
• If there's significant blood loss, call for advanced medical help.

Airway: Check the airway in the medical menu. 

• If occluded, turn the head until it's clear. 
• If obstructed, hyperextend the head within 2 meters to maintain clearance.

Beating Heart:

• Check pulse
• If there's no heart rate
  • Perform CPR for two minutes by selecting it when the chest is highlighted. 
  • Re-check the pulse afterward.

Evacuation: 

• Move the casualty to a Casualty Collection Point (CCP) for medical personnel to take over.

Above: An infographic summarizing first aid procedures for bleeding control, airway management, resuscitation, and casualty evacuation, with specific instructions for severe blood loss and shock treatment.

After addressing life-threatening bleeding and airway issues, assess the casualty for other injuries.

• Start with untreated wounds on the head and chest. 
  • Bandage these areas thoroughly because you can't use tourniquets here, and injuries to these regions can be critical.
• Move on to limbs with the least severe wounds. 
  • This helps to stabilise the casualty but also streamlines the process for incoming medical personnel.
• After bandaging, if you identify any broken limbs, apply splints.

Continue to monitor the casualty's condition by regularly checking their breathing, bleeding, and consciousness.

• Repeat the treatments from Steps 3 and 4 as necessary this includes;
  • checking and reapplying bandages
  • ensuring airways remain clear
  • monitoring for signs of circulation.
• Stay with the casualty until they regain consciousness or until medical personnel arrive. 
• Provide updates to medical personnel upon their arrival and assist as directed.

If you are instructed by medical personnel or your duties require you to rejoin your unit, ensure that the casualty is left in capable hands before departing.

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

Abrasions (or scrapes)

• They occur when the skin is rubbed away by friction against another rough surface.
• Sources: falling, vehicle crashes.
• Effects: pain - extremely light, bleeding - extremely slowly.

Avulsions

• Occur when an entire structure or part of it is forcibly pulled away, such as the loss of a permanent tooth or an ear lobe.
• Sources: explosions, vehicle crashes, grenades, artillery shells, bullets, backblast.
• Effects: pain - extremely high, bleeding - extremely fast (depends on wound size).

Contusions (Bruises)

• Also called bruises, these are the result of a forceful trauma that injures an internal structure without breaking the skin.
• Sources: bullets, backblast, vehicle crashes, falling.
• Effects: pain - light, no bleeding.

Crush wounds (crushed tissue)

• Occur when a heavy object falls onto a person, splitting the skin and shattering or tearing underlying structures.
• Sources: falling, vehicle crashes.
• Effects: pain - light, bleeding - extremely slowly.

Cut wound

• Slicing wounds made with a sharp instrument, leaving even edges.
• Sources: vehicle crashes, grenades, explosions, artillery shells, backblast.
• Effects: pain - light, bleeding - speed depends on length and size of the wound.

Lacerations (tears)

• These are separating wounds that produce ragged edges.
• Sources: vehicle crashes.
• Effects: pain - light, bleeding - slow to medium speed (depends on wound size).

Velocity wounds

• They are caused by an object entering the body at a high speed, typically a bullet or small pieces of shrapnel.
• Sources: bullets, grenades, explosions, artillery shells.
• Effects: pain - extremely high, bleeding - medium speed (depends on wound size).

Puncture wounds

• Deep, narrow wounds produced by sharp objects such as nails, knives, and broken glass.
• Sources: shrapnel, grenades.
• Effects: pain - light, bleeding - slowly.

Fractures

• Fractures cause pain, increased weapon sway (when arms) or inability to jog or run forcing the player into a limp (when legs). 
• Fractures in ACE3 are not fatal. So are far lower on the priority list in regards to treatment. 
• Focus on stabilising the patient first, then once stable, apply a splint to their fractured limb/s.

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.

Airways can become blocked when a casualty is unconscious, when rendering first aid the airway should be checked to see if it is blocked or occluded if this is not treated, then it will result in death of the casualty.

Airways can be cleared by turning or hyperextending the head or by using other advanced medical equipment. Once clear, a patient can be placed in the recovery position.

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

Pain is typically caused by wounds and the prolonged use of tourniquets. Increased pain can effect weapon sway, stamina, vision and cause audible moaning. Combat wound medication pills can be used to suppress pain for first aid, however more advanced suppression is possible using morphine or fentanyl.

• 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

You can check the pulse of any non-tourniqueted bodypart and the result returned will be descriptive for non-medical personnel or an accurate value for medical personnel, the possible results are:

• No heart rate (0)
• Low heart rate (1-60)
• Normal heart rate (60-100)
• High heart rate (100+)

Some drugs will influence heart rate.

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

Airways can become blocked when a casualty is unconscious, when rendering first aid the airway should be checked to see if it is blocked or occluded if this is not treated, then it will result in death of the casualty.

Airways can be cleared by turning or hyperextending the head or by using other advanced medical equipment. Once clear, a patient can be placed in the recovery position.

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.

Pain is typically caused by wounds and the prolonged use of tourniquets. Increased pain can effect weapon sway, stamina, vision and cause audible moaning. Combat wound medication pills can be used to suppress pain for first aid, however more advanced suppression is possible using morphine or fentanyl.

• 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)

Our system assumes that an individual with full blood volume intact has 6 litres of blood, the current amount of blood loss is shown on the medical menu at all times, if relevant.

• Lost some blood
  • the patient has lost up to 0.9 litres of blood
  • the patient does not suffer significantly from the blood loss itself
• Lost a lot of blood
  • the patient has lost between 1.0 and 1.8 litres of blood
  • should the patient bleed and/or fall unconscious
  • the blood loss might prevent reawakening
• Lost a large amount of blood
  • the patient has lost between 1.9 and 2.4 litres of blood 
  • it is unlikely that the patient is conscious
  • the patient will not reawaken until blood volume is restored
  • in case of cardiac arrest, resuscitation is possible but difficult
• Lost a fatal amount of blood
  • the patient has lost more than 2.4 litres of blood
  • likely to suffer cardiac arrest due to blood loss
  • resuscitation is impossible until blood volume is at least partially restored

• 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

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 pads to the patient
• Shock the patient after hearing “Shock advised” and the AED(-X) is charged, indicated by a “beep” sound
• If first shock is ineffective, use appropriate medication to support resuscitation FM/BG-201 - Recommended process for treating cardiac arrest with an AED(-X)

When utilising an AED or AED-X for resuscitation purposes, it is advised to follow the following procedure: 

1. Place AED(-X) pads on the patient's chest
2. Connect Vitals Monitor to one of the patient's hands
3. Shock using the AED
4. If patient's heart rate is not returning, administer epinephrine FM/BS-220 - Use epinephrine to manage the cardiac rhythm
5. Shock using the AED
6. If patient's heart rate is not returning, administer amiodarone FM/BS-221 - Use amiodarone to manage the cardiac rhythm
7. Shock using the AED
8. If patient's heart rate is not returning, administer lidocaine FM/BS-222 - Use lidocaine to manage the cardiac rhythm
9. Shock using the AED

If by step 9 the patient's heart rate has not returned, do not administer any further heart rate medicines at this point. 

This process is stopped as soon as a continuous heart rate is detected.  

• 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

Chemical warfare simulation involves using gas masks for protection against chemical threats, with their effectiveness depending on settings that determine how long you can go without a mask before experiencing negative effects. Gas masks require filters, which degrade over time and can be monitored and replaced via the ACE menu, using green stripes to indicate filter durability (each stripe represents 10% durability). Durability decreases in contaminated areas and can be adjusted in addon settings.

To detect contaminated areas, use a chemical detector, which emits a sound when entering a hazardous zone, even without active monitoring. The threat level, viewable by pressing “O” (pressing “O” twice toggles visibility), ranges from 0.0 to 1.0, with 1.0 indicating maximum danger.

Gas masks can also be fitted onto unconscious individuals through an ACE action targeting the head, automatically managing any existing face-wear by storing it in the inventory or dropping it if space is unavailable.

• 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

A mass casualty incident is any medical situation which renders an element combat ineffective and where it's unable to sustain itself. When dealing with MCIs as a medic a structured approach is required. For example a senior medic may instruct the following:

• Combat Life Savers: tourniqueting all limbs, checking airways, bandaging head and torso, stitching or CPR.
• Squad or Combat Medics: ensuring airways are clear and all casualties are receiving blood.
• Platoon Medics and above: triaging incoming wounded and tasking other helpers to ensure all casualties are being treated.

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

A Casualty Collection Point (CCP) serves as a centralised and secure location for the treatment of casualties. The primary aim is to coordinate care efficiently, making use of all available resources to ensure that casualties are ready to return to action as quickly as possible. This involves crucial processes such as triage, coordination, and prioritisation, with the goal of enabling a unit to move without delays caused by waiting for individuals to recover. 

Situations that might require immediate attention include scenarios where:

• medics are incapacitated
• leadership is compromised
• the CCP location lacks sufficient security

CCPs are categorised into two types: improvised and planned. While the preference is always for a CCP to be planned, circumstances may necessitate the use of an improvised CCP, especially if a unit is rendered combat ineffective or unable to reach a pre-established CCP. Improvised CCPs are set up in defensible locations close to the site of the incident, focusing on the stabilisation of casualties and organised based on the available space to separate different triage states.

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

An improvised CCP is a contingency measure, utilised when it's impractical to transport casualties to a planned CCP. It's established by the most senior medic present, prioritising the collection and stabilisation of casualties away from direct conflict. The selection of a defensible location near the incident site is crucial, with organisation tailored to the specific environment to effectively manage different triage categories.

A planned CCP is ideally situated behind the frontlines, balancing accessibility for casualty evacuation with safety from immediate dangers such as indirect fire (IDF). These CCPs are equipped with advanced medical supplies and are set up in anticipation of need, especially when a Medical Emergency Response Team (MERT) or Combat Medical Team (CMT) is involved. Coordination and supply logistics are managed to ensure readiness for treating a high volume of severe injuries, under the guidance of a designated senior medic who oversees the optimisation of resources rather than directly administering treatment.

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