Rifleman Medical Basics

RIFLEMAN'S BASIC MEDICAL GUIDE

INTRODUCTION

This guide is aiming to teach you basics of medical care in Arma 3 with ACE3 Advanced Medical for a non-medical personnel (for ACE version 3.13.1 and above).
You will find recommended medical loadouts, how to use the medical menu, medical procedure and some tips.
Credit: ThePointForward (base layout), johnb43 (rewriting), griffin68965 (advice), FloofyFloof (updates)

DEFINITIONS

• "Pull Security”: Keeping your gun up, and looking outward away from triage. Constantly scanning the area for anything that may pose a threat to friendly forces.
• “Stable”: If the person can be left alone and not die, he is stable. Specifically, he is not bleeding and his medication will not kill him. (Consciousness is only secondary)
• “Unstable”: If the person can't be left alone due to uncontrolled bleeding or medication.
• “Category”: Category of patient’s injuries:
  • CAT1: The patient is at an immediate risk of death (heavy bleeding, cardiac arrest, unconscious + unknown medical status).
  • CAT2: The patient is combat ineffective (bleeding controlled or minimum, broken limbs, severe weapon sway, unconscious + stable).
  • CAT3: The patient is combat effective (small bruises, scrapes, pain, controlled bleeding).
    • If you are still combat effective and have a task at hand, avoid running to the medic immediately. Deal with your task first, then ask your team leader if you can move to the medic or wait for the medic to catch up to you.
  • CAT4: The patient is dead. KIA.

IMPORTANT

• This guide will be gradually updated with new knowledge.
• Always listen to the medic when you are in the triage or getting treatment from him. His word overrules the squad lead's, but only in those situations.
• If the medic has not asked for your help, don't. It is extremely annoying to have people who think they are a medic and start doing stuff without the medic's consent. All you need to do is hold security around the medic and only when he asks you to help, you follow his instructions.
• Whoever does medical treatment will have their supplies used first, then the patient's. This is regardless of medic status or not. So, remember to reclaim your tourniquets now!

BUSTING MYTHS

• CPR does not wake up unconscious people - never true: It only brings them out of cardiac arrest. If the patient has a heart rate, CPR isn't going to help.
• Helmets are effective - previously not the case: Now helmets can make the difference between life and death. However, a helmet will not stop a bullet that hits you directly in the face.
• Splints do not affect PAK time - previously not the case: Previously it could help, now it does not help. Fractures are caused by damage, but don't count as damage, therefore not contributing to the PAK time.
• Blood loss does not affect stamina usage.
• Running doesn’t increase bandage falloff chance.
• High heart rate and High blood pressure doesn't affect one's ability to wake up.

EQUIPMENT

General Overview

As a non-medic (from riflemen to asset crews) you're limited by the framework (except for IVs) to following supplies at spawn:

• 6x Bandages - take Bandages (Packing)
• 1x Epinephrine Autoinjector - boost heart rate and blood pressure; also boosts the chance of waking up when given to unconscious people
• 1x Morphine Autoinjector - reduces pain, but also blood pressure and heart rate
• 1x Tourniquet (CAT) - stops the bleeding of a limb, regardless of the number of wounds on that limb
• 1x Splint: Heals one fracture (doesn't affect PAK time; can be applied if still bleeding!)
• 2x 500ml of Plasma or Saline (optional, but the medic will like you more if you take those)

You should bring IV bags (Saline, Plasma) if you can, however you will not be able to use them yourself. 1L total is recommended as a minimum.
We recommend medics to take blood and riflemen take Saline or Plasma, so that the medic can distinguish between whose supplies he is using first.
Surgical Kit and Personal Aid Kit are medic only items and therefore are useless to you. Don't ever take them from a live medic!

That said, this limit only applies for spawn, respawn and whenever you leave an arsenal. In the mission you can take medical supplies from fallen enemies and friendlies.

Morphine

Before going any further in this guide, we need to address morphine: Morphine has changed significantly from ACE 3.12.6. It can be powerful and dangerous if you don't know what you are doing.

• Do NOT give a morphine to an unconscious person, it will NOT wake them up.
• Do NOT give a morphine to somebody who has had a morphine given to already.
• You can overdose yourself with 2 morphine if you are not careful. Giving yourself a morphine and reinjecting one after a minute will get you into cardiac arrest.
• Morphine stays in your system for a very long time, effecting your vitals (blood pressure and heart rate) measurably until wearing off fully (it takes 30 mins).
• Morphine reduces your heart rate and blood pressure significantly.
• Morphine still gives you the heart beating sound, although it is a lot quieter now (HR < 60).

If you give yourself a morphine, wait minimum 16s and maximum 30s, then give yourself an epinephrine. If you wait not long enough or too long, the epinephrine will lose its effectiveness completely, so timing is crucial.
However because drugs have a certain randomness to them, this procedure might not have any effects. But overall it is better to give yourself the epinephrine to try to mitigate the effects then not giving an epinephrine at all.

Bandage Selection

There are 4 types of bandages:

• Bandage (Basic)
• Bandage (Elastic)
• Bandage (Packing)
• Bandage (QuikClot)

As a non-medic the two most interesting types are QuikClot and Packing Bandages. The reason is that they have the lowest chances of falling off (for the most common wounds, those being avulsions and velocity wounds; bruises (especially minor ones) are also very common, but do no need to be bandaged).

You can learn more about bandages and wounds in Medical guides.

MEDICAL MENU

Enabling Medical Menu

To enable the Medical Menu, press Escape, and go into "Configure" > "Configure Addons", then select the "Client" tab on the top, then select the drop down menu "ACE Medical".
Then, scroll down until you see "Enable Medical Menu" on the left panel, then on the right side select the drop down and click "Enabled". Select "Reopen Medical Menu" if it is unchecked.

The default button for opening the Medical Menu is 'H', but you can re-bind this to whatever key is memorable (ESC > "Controls" > "Configure Addons" > "ACE Common", very bottom).
N.B: 'H' also opens the "last help" menu from vanilla - to disable that, go into "ESC -> "Controls" -> "Common" -> "Last Help"; if you scroll to the very bottom, it will be the 3rd option from the top.

Using Medical Menu
When you open medical menu you'll be greeted by name of the patient (1), a bunch of buttons (2), a click-able figurine (3) and an overview of the patient (4).

The name of the patient in top left corner is fairly self explanatory, but nonetheless it's important. Sometimes the menu opens for yourself when you want to treat others, other times you are just too close to others but can't move.
How to switch will be described later too.

The figurine is click-able and you can switch between different body parts that way: Head, Torso, Left/Right Arms and Left/Right Legs. The overview on the right side provides information of the body part you have selected:

• "Bleeding" if the patient as a whole is still bleeding
• "In mild pain", "In pain", "In severe pain" means the patient is in pain.
• "Fractured" if that limb is fractured (you can also see it on the figurine, the bone of that limb is red)
• Types, sizes and number of wounds

Further, the colour of the limb depends on it's state:

• White: No wounds present or stitched wounds are present
• Blue: Wounds are bandaged or bruises are present. Some stitched wound still appears as blue.
  • "B" means the wounds have only been bandaged and can reopen
  • "S" means that the wounds have been stitched and can't reopen
• Red: Wounds are open

The colour also changes intensity based on the intensity and the number of wounds. More serious wounds will produce deeper red, while minor scratches will barely change the hue at all.

Now about the buttons in the left side:

• (1) Triage card - history of treatment
• (2) Diagnose - checking pulse, blood pressure, responsiveness
• (3) Bandages and Fractures - treating wounds
• (4) Medication - morphine, epinephrine
• (5) Advanced treatment - mostly for medics, but also for CPR, which anyone can do
• (6) Drag/Carry - dragging and carrying
• (7) Toggle Self - switching between you and others

Triage Card

The triage card just shows history of treatment. It's mostly useful for medics to see what you had done before they took over, so that they don't OD you with drugs for example.
On the image below I applied a tourniquet 2 minutes ago, then a morphine followed by an epinephrine. It only shows the duration in minutes.

Diagnose

The diagnose tab allows you to check pulse and blood pressure.
Keep in mind that for the first two it matters where on the figurine you are!

• Always check pulse on the head or torso to avoid any chance of checking on tourniqueted limb. Limbs with tourniquet on will produce no heart rate, which is where inexperienced people pronounce unconscious people as dead.
• Blood pressure can't be measured on the head or torso, you'll need to check it on a limb.
• If a patient does not have a blood pressure or a heart rate, but is in the unconscious animation, he is in cardiac arrest. CPR is needed at this point, but if a medic is around, let him handle the situation.
• Responsiveness can be only measured on the head (checks if the patient is responsive(conscious), unresponsive(unconscious), taking shallow gasps(cardiac arrest) or cold and unmoving(dead)) but it is always accurate.

When you use "Check Pulse" or "Check Blood Pressure" the measurements will appear on your screen and in bottom right in quick view part of the medical menu. Same goes for responsiveness:
 

Blood Pressure and Heart Rate

When you check for Heart Rate and Blood Pressure you only see a vague indication on their vitals. This indication can give you a good approximation on how the patient is doing.

Heart Rate:

• Weak: Between 20 and 60
• Normal: Between 61 and 100
• Strong: Between 101 and 220

Blood Pressure:

• Low: Between 20 and 100 systolic
• Normal: Between 101 and 160 systolic
• High: Between 161 and 285 systolic

Bandages and Fractures

The Bandages and Fractures part of the menu allow you to treat wounds. It will show mix of your and your patient's medical supplies and it will first take them from you, so keep that in mind.
 

You commence treatment by selecting the injured part of the body you want to treat and then selecting desired treatment. For example: Apply tourniquet to a wounded leg and see how the symbol for tourniquet appears on the figurine.
You can also notice the wound is still red, however the "bleeding" in overview has disappeared. You can then apply a splint to regain the ability to run and sprint.

After having applied a splint, the "red bone" icon has disappeared, along with the "Fractured" in the overview. From here, the medic would take over, so do not waste a bandage on a already tourniqueted limb.
The medic would, when necessary, bandage that wound so they can PAK or stitch you.

When you apply enough bandages to bandage all the wounds on given body part the Red will turn Blue. Notice the "B" next to the "1x Small Velocity Wound". This is relevant for Rifleman on the torso and head mostly, but also for limbs when you have run out of tourniquets.

Here the wound has been stitched by a medic. The "B" next to the wound has become an "S" and the limb has changed colour back to white. Which means there no longer any "damage" on this limb.
At this point, you can remove the tourniquet, provided the medic tells you to. This is mainly to stop from gaining pain out of the tourniquet.

You do not need to remove tourniquet while being PAK'd, the tourniquet will automatically go back in your inventory when it is complete.

Medication

To apply drugs you will need to go to the Medication part of the menu and select a limb where to inject them. Keep in mind that Tourniquets will block spread of the drugs until removed and then they enter the body. Again it will show mix of yours and the patient's injectors available.

Drag/Carry

Drag and carry allow you to trigger dragging and carrying on people who have either broken legs and/or are unconscious. You cannot drag or carry if you have broken legs yourself.
Dragging is fast to start - you just grab the person and start dragging them backwards.
However dragging itself is fairly slow, therefore ideal for very short distances like around a corner out of harm's way. You have the ability to use your weapon to shoot while dragging if you need it.
Carrying is slow to start - it triggers a long animation (although faster than previously) that puts the carried person on your back into a fireman's carry. However once finished you will be able to move fairly fast. It ignores stamina therefore it is ideal to do in relatively safe environment where longer distances are needed - like 300 meters to evac.

Do not drag a person that is ragdolling. Let them go into the unconscious animation first, otherwise it breaks stuff.

Toggle Self/Others

Finally the switch works fairly simply, you click on it and it will toggle between you and whoever you're looking at while in range of medical menu.

PROCEDURES

Treating Injuries

If you get hit and stay conscious or wake up after being unconscious, the procedure of treatment is as follows:

1. Finish the engagement and find cover. If you immediately start bandaging yourself you're likely to get shot again.
2. Check your wounds. Might be a minor wound, might be a broken leg. Know what you're dealing with.
3. Notify people around you on your status. Somebody has to cover your sector while you treat yourself.
4. Call in your injury to medic over the radio (if he is around, otherwise skip this step; if he is within earshot, just tell him)
   • Who?: Announce yourself in 3rd person. ("Medic, PointForward")
   • Where?: Announce where you are. ("I'm 10 meters east of actual")
   • What?: Announce severity of your wound. ("stable")
   • Announce extra conditions like broken legs (can be important for SL too).
   • The announcement can sound like this: "Medic, PointForward is hit, I'm 10 meters east of actual, stable, broken leg".
   • The "where" and the "what" can be switched - but always put your name first ("Medic, PointForward is hit, stable, broken leg, I'm 10 meters east of actual").
   • The worst thing you can announce on radio is "I'm hit." Who? Where? How bad?
5. Start treatment (if medic can't get to you within 10s). Blood is extremely important, so don't let yourself bleed for no reason!
   • If you got hit in Torso or Head start bandaging.
   • If you got hit in Leg or Arm tourniquet that limb.
   • If you can get to a Medic within ~5 minutes you can just keep tourniquet on without bandaging. More than that it might be better to bandage yourself to prevent extra pain.
   • If you have broken limbs, use a splint (does not have to be bandaged or tourniqueted). Do not use them on your legs if you are very close to the medic (20m away at max). If you are further out, use them, it is better to splint your leg so that you can get to the medic quicker or seek cover quicker if you get engaged rather than limping around.
   • Keep an eye out on wounds reopening, especially if you're inside a vehicle like a tank.
6. Get treatment from the medic, especially if you can't stabilize by yourself.
   • You don't need to seek the medic immediately if you have minor wounds that you have bandaged, it's better if you continue your task if you are combat effective.

Same procedure applies when you see other people being unconscious and injured, except you call their name out ("Medic, johnb43, unconscious, bleeding from his leg, on actual") .

When to give someone epinephrine and when not to wake them up

Essentially this boils down to how much blood the patient has lost:

• If the patient has only "Lost some blood", you are good to give the patient an epinephrine.
• If the patient has "Lost a lot of blood" or more, do not give epinephrine. It will not help.

Checking a body to see if a person is dead or alive

There are several ways to tell without going into a person's medical menu.
Dead:

• If the person falls and stays ragdolled they are dead (apart from being hit by a vehicle, see below).
• If the person ragdolls and drops their weapon out of their hand they are dead.
• If you can't drag them they are dead.
• If you are both in a vehicle, you can ACE interact with them using the passenger menu. If you can see "Radios" they are dead.

Alive:

• If you can drag the person they are alive.
• If they ragdoll but while doing so they are still holding their weapon in their hand, they are likely alive.
• If the person has ragdolled, but goes into the unconscious animations, they are alive.
• If the person has been hit by a vehicle, they will ragdoll, however they are probably not dead so double check. It takes a while for said person to get up.
• If you are both in a vehicle, you can ACE interact with them using the passenger menu. If you can't see "Radios" they are alive.

Another way is to check their heart rate or blood pressure. Always make sure you're checking heart rate or blood pressure on the torso or the head as they cannot be tourniqueted. Tourniquets stop blood flow and therefore their pulse and blood pressure would be 0 on a limb.

• If they have a heart rate and a blood pressure, they are alive.
• However, if they do not, it doesn't mean they are dead: They could be in cardiac arrest. In this case try to access their inventory or to try to drag them to see if they are dead or not.

What to do if your squad-mate is unconscious

Follow the procedures under "Treating injuries", then try to find out why he is unconscious.
There are 5 reasons why person can be unconscious:

• Pain due to taking damage
• Low fluid volume (blood loss)
• Low heart rate
• Low blood pressure
• Cardiac arrest

Pain due to taking damage:

There is a set threshold to how much pain/damage you can take before going unconscious. However, this pain will not keep you unconscious, so morphine will not help. If you see someone go unconscious stabilize that person when it is safe. Once stabilized:

• If a medic is in the vicinity, call him in to take care of the patient.
• If a medic isn't around, give him an epinephrine if he has only "Lost some blood" and hasn't woken up after a minute.

When people are in pain, it will affect weapon sway heavily, depending on the intensity of the pain. Do not apply morphine when heart rate or blood pressure is low!
Typical signs: "In pain", "In mild pain", "In severe pain"
Typical cause: Any sort of damage

Low fluid volume (blood loss):
When people suffer excessive blood loss, they can only be helped by a medic with an IV solution (blood, saline, plasma). The only thing you can do is stabilize them and call the medic.
Typical signs: "Lost a lot of blood", "Lost a large amount of blood", "Lost a fatal amount of blood", low blood pressure, high heart rate when close to bleeding out
Typical cause: Bleeding out for a while

Low heart rate:
When people have low heart rate, they can stay unconscious. If the patient had taken a morphine previously and has only "Lost some blood", you can give him an epinephrine, provided the medic isn't in the area.
If they fall unconscious due to low heart rate this will lead to cardiac arrest.
Typical signs: Low heart rate.
Typical cause: Usually morphine or adenosine

Low blood pressure:
If the patient had taken a morphine previously and has only "Lost some blood", you can give him an epinephrine, provided the medic isn't in the area.
Typical signs: Low blood pressure.
Typical cause: Morphine or adenosine; Bleeding out for a while (more than"Lost some blood"; refer "Low fluid volume" above)

Cardiac arrest:
If you encounter a patient who is in cardiac arrest in the field, call in a medic. Until the medic gets there, you stabilize the patient, get him into cover and then do CPR until the medic arrives. The CPR will not necessarily get his heart going again, but it will slow down the cardiac arrest timer.
Typical signs: No heart rate and/or blood pressure. Response state "patient is not responsive, taking shallow gasps and convulsing"
Typical causes: Overdosing on drugs, bleeding out

What NOT to do

Some things are common waste of time or resources:

• Applying morphine for minor pain. (waste of resources, can be dangerous if you don't know what you are doing)
• Applying drugs into a tourniqueted limb. (drugs just stay in your limb, not having the desired effect)
• Checking Heart Rate on a Tourniqueted limb. (waste of time, danger of leaving somebody behind)
• Relying solely on heart rate to check if someone is dead. (danger of leaving somebody behind)
• Announcing your injury over radio as "I'm hit!". (waste of time)