Medic's Guide

MEDIC'S GUIDE

INTRODUCTION

In this guide we will be covering your role as a medic outside of triage, the triage process, and what equipment a medic should take.
However before reading on please make sure that you are familiar with "Rifleman Medical Basics" guide. This guide bases itself off of the Rifleman one:

Credit: griffin68965 (layout, content), johnb43 (advice), FloofyFloof (updates)

IMPORTANT

• This guide will be gradually updated with new knowledge.
• If you need help, you can easily tell someone around you to help. However, if you don't need help and someone starts helping, tell them to stop. This behaviour should not be encouraged.
• The carrying animation is faster now (twice as fast).
• Only torso and headshots count towards death. Limb damage does not, however it does affect PAK time just as much as the torso and head damage.
• If the patient moves too far away from you, your interaction will be interrupted.
• As a medic you can stitch yourself and give yourself IVs too.
• Medics can now stitch without all bleeding stopped. However, if you want to stitch a body part, it needs to be fully bandaged. This allows a medic to stitch in several steps, making sure that the other bandaged parts don't reopen.
• Sometimes, ACE needs some time before the PAK interaction appears when all requirements are met.
• PAKing over tourniquets that have a reasonable amount of open wounds is not allowed.
• PAKing over tourniquets will give the tourniquets to the patient.
• Stitching can impact PAK time due to stitching healing hitpoints.

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 false: 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 true: 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.

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).
  • CAT4: The patient is dead. KIA.

PART 1 : MEDIC OUTSIDE OF TRIAGE
There is only one medic per squad, your safety directly affects the ability of your group. If you die their job becomes infinitely more difficult, maybe even impossible. Therefore as a medic YOUR health is more important than anyone else's. The following is how you can keep yourself safe in a mission:

IF YOUR SQUAD IS STATIONARY the best way to keep yourself safe is to keep away from the front lines, finding a suitable triage is also extremely important and as buildings tick both of these boxes they should be your first choice. However buildings will not always be available, in this situation try and find natural cover, a large rock or ditch will suffice in a pinch, and if all else fails you have your entrenching tool with which to build your own cover. In all cases remember to mark your position as triage on map, and to clearly announce it over the radio. It is worth noting that although a medic should under no circumstance seek out the enemy, if engaged you SHOULD seek to protect yourself, your triage, and the people within.             

IF YOUR SQUAD IS MOVING staying in one place is not an option, the ways in which a squad can move vary, and your actions will have to adapt depending on the situation. 

IF YOUR SQUAD IS MOVING BY VEHICLE get into the central vehicle (or rear vehicle if only 2 are available), and ask any injured troops to get in with you, you can treat them on route. Once you have arrived at your destination set up in the nearest safe location and complete the triage process, (please note that the nearest safe place may be the vehicle.) It is worth remembering that people might not hear your call asking about medical, so it is important to check people's medical menus when in transit. 

IF YOUR SQUAD IS MOVING ON FOOT your behavior will have to change depending on the situation, these situations can be boiled down to two unique environments. The first being when you are traveling on foot from one objective to another, and the second being when your squad is town clearing.

WHEN TRAVELING, try and stay as close to the middle of the squad as you can, as it is by far the safest spot available. If possible also try and stay close to your SL, when moving a triage point isn't exactly convenient and the next best thing is their "actual marker". If someone is injured you can rendezvous there, or at least use it as a point of reference, once you have met up with the injured party you can then treat them accordingly.        

WHEN TOWN CLEARING your actions will have to vary. If the town is a small one a triage is feasible, however due to the risk of severe injury going up drastically when in CQC, be prepared to venture out of your triage at all times.
In medium to large sized towns a triage is out of the question. In this situation it is best to stick with your SL, people with injuries can come straight to you, or if that isn't possible you can ask for their position in regards to the "actual marker" and (if it is safe to do so) head to them. This advice only works if your SL does not engage in CQC, if they do then you cannot follow. In this situation your best strategy is to move from cleared building to cleared building, preferably keeping a one building gap between you and the rest of the squad. If someone is injured they can simply hold position until it is clear for you to advance.

Additional Notes

• As a general rule medics DO NOT DRIVE . (A few exceptions would be if you are Platoon Medic, or if you are driving a short distance through a cleared town to pick up the squad, however the latter is at your discretion.) 
• The medic should always take the safest seat available in a vehicle, this is normally a seat inside the vehicle towards the back. 
  It is NOT a GUNNER SEAT or a COMMANDER SEAT.
• In any environment if your squad is splitting up for a prolonged period of time, it is advised that you go with the group who is likely to need you the most.
  Remember to take your own safety into consideration when making this decision, and once you have decided remember to alert your SL.
  It is also incredibly important that you choose carefully, as moving from one group to another later on may prove to be extremely dangerous.
• You are a rifleman first in any situations, keep that in mind.

PART 2 : THE TRIAGE PROCESS

This section will have two themes, the first being general triage procedure, the second being identification and treatment of cardiac arrest.

First and foremost, if you get engaged, you return fire and deal with the immediate threat before you move into a situation. Have a rifleman with you to try to cover you while you do initial treatment. Do not rush in trying to save your squadmate only for you to die/go unconscious because you were careless. From there:

Triage - sorting who needs you first

1. Any unstable patients (including yourself)
2. Patients in cardiac arrest
3. Unconscious patients
4. Conscious but closed wounds (needing a stitch)
5. Conscious but broken limbs (needing a splint)
6. Final treatments (PAK)

Triage Procedure 

• 0. If you have to leave the triage to save an unconscious squad mate, perform stages 2,3 and 3.5 as soon as possible.
      once complete continue to stage 1.
• 1. Position yourself and the patient in the safest part of the triage.
• 2. Open the patients medical menu and check the wounds. Identify which body part is losing the most blood. 
• 3. Stabilize the patient with elastic bandages (if there are multiple patients packing bandages can be wise), going from most injured body parts to least.
  • 3.5 If a limb has more than 2 large wounds, 3 medium wounds or 5 small wounds, tourniquet the limb. The tourniquet will stop the bleeding, you can bandage it later.
• 4. Check if the patient is in cardiac arrest (check heart rate or blood pressure or use response); If so, follow procedures listed below in the “Cardiac Arrest” section.
  • 4.5 If you see them with "Lost a Large amount of blood" they might be in Cardiac Arrest. If you see "Lost a Fatal amount of blood" they are automatically in Cardiac Arrest.
• 5. If the patient has lost blood, apply an IV until it reads "lost some blood". For how much blood you should give, refer to the picture below
     
      If the patient has severe wounds that are bandaged on arrival, perform part 6. first.
• 6. Stitching : It is advised that you stitch the chest and head of the patient at this point. A patient with minor injuries can be PAK’d straight away. You need a limb to be fully bandaged to be able to stitch it.
  • 6.1 If the patient has tourniqueted limbs with unbandaged wounds, now is a good time to bandage then stitch them if the situation permits it
  • 6.2 In combat situation, quickly stitching minor injuries and letting them continue fighting can be the best choice.
• 7. PAKing: this will completely heal the patient and make them ready to return to combat. (This can be delayed when "in the field" as stitching heals hitpoints.)
      The PAK has several requirements before it can be used, they are as follows. (The last four are also requirements for consciousness.)
  • Not bleeding (tourniquets count as not bleeding)
  • Conscious
  • Less than 15% blood volume lost ("lost some blood")
  • BP 60+ Systolic, 50+ Diastolic (60/50 minimum)
  • HR 40+
  • Not in cardiac arrest (otherwise BP and HR would be 0)

You boost HR and BP with epinephrine. You increase blood volume with IVs.

Triage in the field

• 0. If you have to treat someone in an unsafe location, check their medical menu immediately. You must now decide if they can reach a safe location in their current condition.
  • IF THEY CAN, splint their leg if required, pop smoke and head for the nearest suitable triage location.
  • IF THEY CAN'T, get them to the nearest cover and stabilize them, once you are satisfied with their condition, move them to the nearest suitable triage location.
  • Once at the triage location refer to "TRIAGE PROCEDURE 1."

Communication

Communicating is very helpful in any situation. We expect you to be able to talk to your patients, whenever you are treating them or gathering information on their medical status while treating another.
Talking about what you are doing can help the patient's, and others around you, ability to know their own status. Don't be scared to do the same to someone unconscious, having someone talking to them can help chase off some boredom of being unconscious.

Just let the players around you know who you are treating and what you are doing.
Examples: "Name, bandaging right leg.", "Name, giving 500 blood.", "Name, PAKing.", "Name, PAK, 50%.", "Name, You're good/green."

You can refrain from saying the name of the patient if you only have one patient to take care of and that they are aware of it, just make sure to say the patient's name when you start having more patients.

Cardiac Arrest

A patient in cardiac arrest should be your top priority, unless there are other CAT1 patients in need of stabilizing and you have nobody to help you with stabilizing.
There are two types of cardiac arrest, one is caused by blood loss, the other by medication overdose (OD).

The conditions for entering cardiac arrest are as follows:

• If your heart rate is below 30 or above 220.
  • It means that a patient in "Lost a Large amount of blood" has a chance of going back into cardiac depending on how close they are to fatal.
• You lose a fatal amount of blood but don't die (usually caused by HR going over 220).
• You overdose on medication. A fully healed person can go into cardiac arrest from 2 morphine, 5 epinephrine or 3 adenosine. Look at the triage card to get more information.

Cardiac arrest can be identified by the patient having no blood pressure and/or no heart rate.
Checking responsiveness on the patients head can also identify Cardiac Arrest if the response you get is "patient is not responsive, taking shallow gasps and convulsing"

Cardiac Arrest treatment

Treating a patient in cardiac arrest is time consuming and should only be done in a safe location, although you can stabilize the patient in the field if necessary.
Once the patient is safe you can begin proper treatment. Treatment will vary depending on the reason for entering cardiac arrest, as seen bellow.

• If it happened due to blood loss: Administer 1l of blood first, then perform CPR. If not successful, try until you see a HR and a BP.
• If it happens due to a morphine overdose: Stitch the patient fully and top him off with blood if he needs it. Give the patient as many epinephrines as he has had morphines (look at triage card), add an extra epinephrine, then perform CPR. If they do not have a HR and a BP, do the same procedure again. Once they have a HR and a BP, give them the same amount of epinephrines again until they wake up, then PAK them as soon as possible.
• If it happens due to an adenosine overdose: Give the patient as many epinephrines as he has had adenosines +1(look at triage card), then perform CPR. If they do not have a HR and a BP, do it again. PAK as soon as possible.
  If you are low on epinephrine or do not want to use them, you can do CPR for 2 minutes. By then the effect of the adenosine will have worn off for certain, so they should wake up.
• If it happens due to an epinephrine overdose: Perform CPR. If that doesn't work, give them an adenosine first, then perform CPR. They wake up on their own, so PAK as soon as possible.

PART 3 : EQUIPMENT

In this section we will be covering what equipment does what, and what should be in your medical loadout.

Equipment descriptions

• Personal aid kit: Completely heals the patient (if interrupted, you have to start from the beginning again)
• Surgical kit: Prevents wounds from reopening (if interrupted, you can continue where you left off later on)
• Adenosine: Reduces HR and BP (don't take)
• Epinephrine: Increases HR and BP; increases the chance of waking up
• Morphine: Reduces HR, BP and pain; remains in the system 15x longer than Adenosine
• Blood: Provides fluid to a patient
• Saline: Same as blood (don't take as medic)
• Plasma: Same as blood (don't take as medic)
• Basic bandage: Awful (don't take)
• Elastic bandage: Very effective, high chance of falling off
• Packing bandage: Moderately effective, medium chance of falling off
• Quickclot bandage: Low effectiveness, low chance off falling off (don't take)
• Tourniquet: Stops bleeding when placed on a limb (stop drugs and IVs entering the system if drugs or IVs are injected in a tourniqueted limb)
• Splint: Heals one fracture (doesn't affect PAK time; can be applied if still bleeding!)

Medical loadout

A medic's loadout is incredibly important, forgetting something is not an option, so make sure you have everything you need before heading through the pole.

The following is the recommended loadout for medics (stick to the 35kg mark if possible). Where ever it says "placed in vest/uniform" it is to ensure that nobody else can take those items out. If you are in the middle of a PAK and someone were to mistakenly take out the PAK, it wouldn't be good.

• 14l of BLOOD (not saline or plasma; 7x 1l & 14x 500ml recommended)

• 1x Personal Aid Kit (PAK; placed in vest/uniform)

• 1x Surgical kit (placed in vest/uniform)

• 8-10x Tourniquets

• 2-4x Morphine Autoinjectors

• 10x Epinephrine Autoinjectors

• 60-65x Elastic Bandages

• 35-40x Packing Bandages

• 10x Splints

• 1x Mag light equivalent (placed in vest/uniform)

• 1x Entrenching tool (placed in vest/uniform)

• 1-2x White smokes

• 1-2x Blue/Green smokes 

Weapon selection

Try to take the lightest weapon with lightest ammo possible. If no restrictions are in place, the HK G36KV with Mk262/Mk318 ammo from ace and SIG SG55x series with SOST can be good choices, but they aren't STANAG compatible.
If you want STANAG compatible weapons, take the Jack Carbine, the RHS M4A1 or the NIArms Colt M4A1 (or many others), all with Mk262/Mk318 ammo from ACE. Attachments will add up, so consider what you really need carefully.
You can also take SMGs, however be mindful that you are still a rifleman.