Overview of mechanics and treatments.
Contents
Majority of injuries will create wounds that bleed, if bleeding is not stopped the blood loss may deteriorate to the point of loss of consciousness, shock, cardiac arrest and death.
Pressure Bandage
Standard issue bandage meant for most wounds.
Emergency Trauma Dressing
Large surface bandage meant for covering many wounds at once, due to its size it takes longer to apply and cannot be used to self-bandage.
Elastic Wrap
Elastic Wraps are used to wrap already bandaged or clotted wounds to lower the chance of them falling off/wounds reopening, they cannot bandage bleeding wounds on their own.
Wraps can also be used to treat bruises, and to stabilize SAM Splints.
Also see: Coagulation Mild bleeding wounds have a possibility of clotting on their own. Clots can be made more durable with TXA, most clots are unstable and are likely to reopen and should be wrapped or stitched when possible.
See: Internal Bleeding
After going unconscious the airway will be partially or completely blocked due to the tongue falling back, preventing effective breathing.
Use of manual maneuvers or airway adjuncts is required to keep the airway open.
After being unconscious for a prolonged time the patient will lose reflexes to their upper airway, causing it to collapse and ultimately prevent any breathing.
Airway collapse can be mitigated by manual maneuvers, or managed with an i-gel.
After being unconscious for a prolonged time, the patient will lose reflexes to the muscles keeping the stomach contents from the esophagus, which can cause regurgitation and aspiration.
Additionally any open wounds close to the airway may seep blood into the airway, blocking it.
Airway obstruction is caused by vomit (regurgitation) and blood seeping into the airway.
Airway obstructions can be cleared via manual maneuvers if not severe, otherwise medical suction must be performed.
After staying unconscious for a while the patient may vomit, obstructing the airway.
Each patient will vomit a set amount of times, depending on stomach contents.
After going unconscious the airway will almost immediately become susceptible to blood seeping into the airway.
Make sure all wounds on the head are not bleeding to prevent any complications.
Also see: CBRN When exposed to corrosive chemicals the airway may become inflamed, narrowing the opening and impacting breathing ability.
Severe inflammation may block the airway entirely causing respiratory arrest and preventing insertion of certain airway adjuncts.
Significant airway inflammation requires a surgical airway to allow breathing.
Also see: CBRN When exposed to nerve agents that cause seizure activity the airway may also be impacted.
An active airway spasm will cause respiratory arrest, potentially making mechanical ventilation ineffective.
Airway spasm managment includes administration of nerve agent antidote and anticonvulsant medication, a surgical airway may also be necessary.
Head Turning
Head-Tilt Chin-Lift
Recovery Position
Guedel Tube (OPA)
Emergency Disposable Suction Bag
Every unit has an oxygen saturation value, it will drop if the person is not breathing or if they have other airway/breathing issues, if the saturation drops too low they will die.
<80 - unconsciousness
<67 - cardiac arrest
<55 - death
Oxygen deprivation can be visibly identified in patients as cyanosis, it is visible on the head and arms.
Oxygen saturation can be measured by a pulse oximeter, either standalone or as part of the AED.
Pulse Oximeters display a SpO2 reading, which is affected by blood volume, and will become less reliable the lower it is.
Diagnose action usable on unconscious patients to determine breathing state.
Active diagnose action used to listen to patient lung and heart sounds.
May be used to identify developing pneumothorax, tension pneumothorax and hemothorax, or to listen and measure respiratory rate or heart rate.
Pneumothorax may be identified by muffled breathing on one side of the chest, more severe chest injuries will be more noticable
Severe penetrating injuries to the chest may allow air to rush into the pleural space, over time as more air gets in it makes breathing difficult.
An untreated pneumothorax will deteriorate into a tension pneumothorax and will require further treatment.
Pneumothorax will deteriorate over time as long as the person is breathing.
An untreated pneumothorax will eventually deteriorate into a tension pneumothorax, where the tension built from the outside air is preventing the lung(s) from inflating at all.
Some penetrating injuries may also damage large blood vessels which can bleed into the pleural space. If not treated the Hemothorax will deteriorate into a Tension Hemothorax and prevent the lung(s) from inflating. A severe Hemothorax may be visible as bruising on the skin.
Pneumothorax can be caused by Velocity wounds, Puncture wounds, and Avulsions, depending on the severity of the injury a pneumothorax is more likely.
Finger Thoracostomy is a surgical procedure in which an incision is made, expanded, and then a gloved finger is poked through the incision to feel for abnormalities in the pleural space (collapsed lung/blood).
The Inspect Chest action is done by laying the patient flat on their back and looking past their chest from the level of the patient’s head, allowing chest rise and fall, and the even-ness of the chest to be noticeable.
It allows pneumothorax to be visibly identified as long as the airways are clear.
Medications come in ready-use autoinjectors or single-use vials.
Vial medication must be drawn into a syringe before administration.
Medication effect is affected by patient weight, certain patients may require a higher dose than others, doses outside of the dose range may not increase the therapeutic effect but will have worse side effects.
Patient weight is consistent in multiplayer per player and random on AI.
Syringes
Medication | Use | Access | Contents | Concentration | Dose Range | Onset | Peak | Duration | HR | BP | RR | Pain Relief |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Epinephrine | Cardiac Arrest | IV/IM | 1mg/1ml | 1mg/ml | 1mg | <5s/<30s | ~4m | ~6m/~7m | ++ | ++ | ++ | |
Morphine | Managing severe pain | IV/IM | 10mg/2ml | 5mg/ml | (IV) 0.05-0.1mg/kg or 3.75-10mg (IM) 0.07-0.1mg/kg or 4.25-10mg |
<25s/<2m | ~15m/~20m | ~21m/~30m | -- | -- | -- | STRONG |
Fentanyl | Managing severe pain | IV/IM | 100mcg/2ml | 50mcg/ml | (IV) 0.5-1mcg/kg or 38-100mcg (IM) 0.7-1mcg/kg or 52-100mcg |
<10s/<30s | ~14m/~15m | ~16m/~20m | -- | -- | -- | VERY STRONG |
Ketamine | Managing severe pain with compromised breathing ability | IV/IM | 500mg/10ml | 50mg/ml | (IV) 0.1-0.2mg/kg or 7.5-21mg (IM) 0.4-0.8mg/kg or 30-84mg |
<5s/<20s | ~9m/~10m | ~11m/~15m | STRONG | |||
Amiodarone | Treatment of shockable cardiac arrest (VT/VF) | IV | 150mg/3ml | 50mg/ml | 300mg, up to 2200mg | <10s | ~8m | ~12m | -- | -- | ||
Lidocaine | (IV) Treatment of shockable cardiac arrest (VT/VF) (IM) In advance of painful procedures |
IV/IM | 100mg/5ml | 20mg/ml | (IV) 1mg/kg, up to 3mg/kg (IM) 50-100mg |
<5s/<10s | ~6m/~4m | ~10m/~10m | (IV) -- | (IV) -- | ||
TXA | Managing severe internal or external bleeding | IV | 1g/10ml | 100mg/ml | 1-2g | <15s | ~10m | ~15m | - | |||
Ondansetron | Managing nausea from medications, vomiting | IV/IM | 4mg/2ml | 2mg/ml | 4mg, up to 8mg | <15s/<45s | ~10m/~12m | ~12m/~15m | - | |||
Calcium Chloride | Managing low calcium after blood transfusion | IV | 1g/10ml | 100mg/ml | 1g after first unit, then 1g after every 4 units of blood | <15s | ~5m | ~10m | ||||
Esmolol | Lowering heart rate for a short time | IV | 100mg/10ml | 10mg/ml | 0.25-0.5mg/kg | <20s | ~4m | ~5m | -- | |||
Ertapenem | Managing wound infection, requirement for evacuation | IV/IM | 1g/3.2ml | 312.5mg/ml | 1g | <5s/<30s | ~10m/~15m | ~15m/~20m | ||||
Adenosine | IV | 12mg/4ml | 3mg/ml | 6mg | <1m | ~25s | <2m | -- | ||||
Atropine | Treating nerve agent exposure, increasing heart rate | IV/IM | 1mg/1ml | 1mg/ml | (Nerve Agent Exposure) 2-4mg initial, more if required (Bradycardia) >1mg |
<5s/<15s | ~10m | ~15m | ++ | + |
Medication | Use | Access | Uses | Recommended Dose | Onset | Peak | Duration | HR | BP | RR | Pain Relief |
---|---|---|---|---|---|---|---|---|---|---|---|
Morphine Autoinjector | Managing moderate to severe pain | IM | 1x | 1 injection (5mg IM equivalent) | <2m | ~20m | ~30m | -- | -- | -- | STRONG |
Fentanyl Lozenge (OTFC) | Managing severe pain | BUC | 1x | 1 lozenge | <2m | ~10m | ~15m | - | - | -- | VERY STRONG |
Penthrox Inhaler | Managing moderate to severe pain for a short time | INH | 8x | 1-5 uses | <3s | <90s | ~4m | - | MODERATE | ||
Paracetamol | Managing mild to moderate pain | PO | 10x | 1-2 pills | <4m | ~15m | ~50m | WEAK | |||
Naloxone Spray | Reversing opioid overdose | IN | 1x | 1-2 uses | <3s | ~2m | ~6m | ||||
Ammonia Inhalant | Waking up patients | IN | 8x | <3s | <6s | <40s | + | ++ | |||
Epinephrine Autoinjector (EpiPen) | IM | 1x | <30s | ~4m | ~7m | + | + | + | |||
ATNA Autoinjector | Treating nerve agent exposure | IM | 1x | 2-3 injections initial | <15s | ~10m | ~15m | ++ | + | ||
Midazolam Autoinjector | Managing seizure activity caused by nerve agent exposure | IM | 1x | 1 injection | <30s | ~15m | ~20m | - | - |
Lost blood volume can be replaced with fluids.
Effective Blood Volume = Blood volume capable of carrying oxygen
Fresh Whole Blood
Whole Blood
Plasma
Saline
The Transfusion Menu allows connecting new fluid bags and managing pre-existing ones.
Available Fluid Bag List
Active Fluid Bag List
Whole Blood and Fresh Whole Blood bags are an invaluable resource for severe trauma patients.
Fresh Whole Blood is whole blood freshly donated from another unit, FWB will flow faster and more effectively replenish oxygen in the recipient’s blood compared to Whole Blood.
Fresh whole blood bags will lose their benefits the longer they are kept out, so it is advisable to use them soon after transfusing, if kept out for a prolonged time they will be as effective as Whole Blood bags.
To perform a field blood transfusion a Field Blood Transfusion Kit should be connected to the donor like a regular fluid bag, it must be connected to an IV.
When connected the Field Blood Transfusion Kit will fill up to its designated volume.
Once the Field Blood Transfusion Kit is full it can be disconnected and used as a Fresh Whole Blood Bag.
Incompatible blood type transfusions will cause an immune system response, potentially killing the recipient.
The blood type can be checked on the patient’s dog tag.
Recipient | Donor | |||||||
---|---|---|---|---|---|---|---|---|
O- | O+ | A- | A+ | B- | B+ | AB- | AB+ | |
O- | ||||||||
O+ | ||||||||
A- | ||||||||
A+ | ||||||||
B- | ||||||||
B+ | ||||||||
AB- | ||||||||
AB+ |
All blood transfusions can cause low calcium levels in the blood, eventually causing coagulopathy.
This is managed with Calcium Chloride administration, 1 gram of Calcium Chloride should be given after the first unit (500ml) of blood, then 1 gram after every 4 units.
Penetrating injuries not only cause damage on the “outside” but also damage the inside of the body, after external bleeding is managed internal blood vessels may still be bleeding.
Internal bleeding can be managed with fluid administration and TXA.
Severe Internal bleeding will present as bruises on the skin, additionally the patient’s blood pressure will drop.
As a person bleeds the body tries to stem the bleeding by clotting, using platelets.
Small and medium wounds have a chance to clot on their own, large wounds will require bandaging.
Platelets are used up as long as the person is bleeding and will slow the loss of blood.
When out of platelets coagulation will fail, bleeding rate will increase and wounds will no longer clot.
Coagulation will also stem and clot internal bleeds.
Platelet count is replenished on its own and by fluid administration.
Coagulation is enhanced with administration of TXA, for both internal and external wounds.
IV access allows administration of IV medication and fluids.
IV lines are affected by tourniquets and limb damage.
IVs are preferable due to the fast flow rate, but in case of severe injury and no immediately available IV locations IOs should be used instead.
16g IV
14g IV
FAST1 IO
EZ-IO
IVs inserted into damaged body parts have a chance to cause complications, chance depends on IV size and body part damage.
IV catheters can be inspected for complications or to see if the IV is busy.
Cardiac Arrest means the heart isn’t actively pumping blood, stopping oxygen from traveling from the lungs to the brain, causing brain damage and eventual death.
Cardiac Arrest should be confirmed by a manual pulse check, when confirmed an AED should be connected or CPR should begin immediately until an AED is available.
The AED allows displaying of cardiac rhythms when the pads are connected, the electrical signals from the heart will be interpreted and the Electrocardiogram (EKG) will be displayed on the monitor as a waveform.
Shockable
Non-Shockable
Shockable rhythms are disorganized rhythms that should be stopped (defibrillated) to get the heart to a sinus rhythm again.
Non-shockable rhythms will not react to defibrillation and should not be shocked.
PEA is an unique non-shockable rhythm that looks like a sinus rhythm when viewed on the EKG.
PEA signifies that the electrical signals are in order but another cause is preventing the heart from beating normally.
Reversible causes:
The cause should be reversed first if possible, and CPR started immediately after.
An AED is preferable as it can quickly diagnose the rhythm and increase chances of Return Of Spontaneous Circulation.
If no AED is available CPR should be performed as soon as possible.
The AED can be used in AED mode in which it will automatically analyze and shock as required, with audio prompts to signal when to start CPR.
ROSC chance is based on CPR consistency, medication, recent shocks, patient blood volume and the medic’s traits.
Fractures are caused by velocity and crush wounds on the limbs, fractured legs will cause limping and fractured arms will increase weapon sway.
Diagnose action usable on injured limbs of patients to determine injury severity and if it is fractured.
Fracture realignment can be performed on damaged limbs that are suspected to be fractured, consider IM lidocaine to prevent pain.
Depending on fracture severity the fracture may deteriorate from further damage or over time, complex fractures cannot be managed in field and will require evacuation to fully treat.
(Chemical, Biological, Radiological, and Nuclear)
Chemical Weapon Agents (CWA) are chemicals with toxic properties designed to incapacitate, injure and kill.
CS Gas is a tear agent, it is deployed as a faint grey gas from CS Grenades, 40mm CS Grenade Shells or mortar rounds.
It is absorbed by inhalation, and eyes.
All effects can be prevented with the use of a gas mask.
Chlorine Gas is a pulmonary agent, it is deployed as a bright yellow gas from mortar rounds, it may also be released from chemical IEDs.
It is absorbed by inhalation and the skin.
Inhalation can be prevented with the use of a gas mask.
Skin exposure can be prevented with the use of a CBRN suit.
Sarin Gas is a nerve agent, it is deployed as a colorless gas from mortar rounds, it may also be released from chemical IEDs.
It is absorbed by inhalation and the skin.
Inhalation can be prevented with the use of a gas mask.
Skin exposure can be prevented with the use of a CBRN suit.
Lewisite is a blister agent, it is deployed as a colorless gas from mortar rounds, it may also be released from chemical IEDs.
Inhalation can be prevented with the use of a gas mask.
Skin exposure can be prevented with the use of a CBRN suit.
Personal Protective Equipment (PPE) includes gas masks and CBRN suits.
By default all vanilla arma gas masks and CBRN suits are defined as such, custom ones will need to be added in the settings.
Gas masks come with filters, the filters get used up if exposed to a hazard agent, they may be replaced at will.
Additionally vehicles may be defined as sealed or overpressured in the settings.
The Evacuation addon allows reinforcement of player casualties, lowering the time infantry players spend unconscious without impacting medical gameplay.
This system requires some setup on the mission side as well as settings.
During a mission players (with appropriate medic traits) are able to convert player casualties into AI ones, teleporting the casualty player back to the set reinforcement area, from there those players should seek transport to be fully reinserted.
The casualty is still left to be treated in-field and eventually evacuated, if this casualty dies they will count towards player deaths and use a respawn ticket.
To be able to convert a player casualty these requirements need to be met:
If met, the medic can perform the conversion, after completion this action will use a casualty ticket.
Carried casualties can be evacuated on the defined interaction object, this will return the claimed casualty ticket.
Check Airway:
Collapse:
Inspect Chest:
Chest Auscultation: Listen for diminished or lack of breathing sounds on one side of the chest
Analyze rhythm manually or use AED Mode
Signs:
Pre-dosed
Liquid Medication (See Medication Administration)