Basic Medical Handbook
A comprehensive guide for the ION's operatives on medical procedures and protocols.
This handbook is designed to provide operators with the necessary knowledge and skills to render aid in the field. It covers essential medical procedures, equipment, and protocols to ensure effective casualty management.
The handbook linked below is a comprehensive guide for Medic operatives, detailing advanced medical procedures and protocols. It is intended for use by trained medics only and should not be used by non-medical personnel.
Standard Issue Equipment
The following is the minimal kit that is recommended for every Operator to take.
- 2x 16g IV - Main use for this is by a medic. This allows fluids and medications to be administered intravenously.
- 20x Pressure bandage - Basic bandage. As a non-medic this will be your main bandage, used for closing wounds. Whilst it is an option to wrap bandaged wounds to prolong reopening time, not doing so should already give you enough time to get stitches from your medic.
- 1x Calcium chloride vial - See Common Medications.
- 2x Chest seal - Used to seal the chest when a (possible) pneumothorax/lung puncture is present. See Clearing and securing an airway.
- 5x Elastic wrap - Used to stabilize SAM splints and wrap bandaged wounds. You can wrap bruises to lessen pain, but not recommended. Take paracetamol instead.
- 1x Emergency disposable suction bag (suction bag) - See Clearing and securing an airway.
- 2x Emergency Trauma Dressing (ETD) - Great for closing many wounds at once (about 3 elastic bandages worth), but you can’t use it on yourself. As a medic this will be your main bandage.
- 1x Epinephrine autoinjector - See Common Medications.
- 2x NPA - See Clearing and securing an airway.
- 1x Pulse oximeter - Used to measure HR and SpO2. See Vitals.
- 2x SAM splint - Used to treat fractures (broken bones). Requires an elastic wrap to stabilize the fracture.
- 4x Tourniquet (CAT) - Completely blocks blood flow to the applied limb. NOTE: when a tourniquet is applied on a limb the HR and BP will show 0, with possible cyanosis as well, even if the patient is fine.
- 2x TXA - See Common Medications.
- 2x Paracetamol - See Common Medications.
- 2x Penthrox inhaler - See Common Medications.
- 2x O- Blood bag (500ml) - See Common Medications.
How To Render Aid (AEET drill)
Focus on winning the firefight and use the Alert, Eliminate, Evacuate and Treat (AEET) mnemonic.
Alert
Call out “man down, man down. [Name of casualty] is down”.
Eliminate
Kill or suppress the enemy, create concealment (e.g. smoke grenades) or disengage from the firefight.
Evacuate
Get the casualty to a safe location and in cover (e.g. rocks, big trees, cleared buildings, CCP’s, vehicles).
Treat
When in a safe location begin stabilisation/treatment, following the MARC(H) mnemonic.
Upon arrival tell the medic the urgency and what you have done.
The medic has overall command of the scene. A Operator is expected to provide security, unless told otherwise by the medic.
Before putting yourself in danger to save another, take a second to review your surroundings. Make sure it is safe (enough) to collect the casualty before putting yourself in a dangerous position and becoming another casualty yourself.
Vitals
Vital signs can give an indication on how severe the injuries are and in what state the patient is. Every Operator carries a pulse oximeter on them, so is able to measure their heart rate indicated in Beats Per Minute (BPM) and oxygen level (%).
| Vital | Low | Normal | High |
|---|---|---|---|
| BPM | <65 | 65-130 | >130 |
| SpO2 | <80% = Unconscious <67% = Cardiac arrest <55% = Lethal/Death | ≥95% | N/A |
The pulse oximeter SpO2 reading is affected by blood volume. The more blood someone loses, the less reliable the reading becomes. For those medically trained in real life as well, some vital signs deviate from what is considered normal/abnormal.
Common Medications
Supplement calcium lost from bleeding and blood transfusions. Slightly increases HR. Mainly used by medic.
Recommended dose is 1gr after the first unit (500ml), repeat after every 4 units. Too low calcium can cause clotting problems, thus it needs to be administered after receiving fluids.
Clearing & Securing An Airway
Checking the airway (action on head) shows the status of the patient’s airway and will tell you whether it’s clear, obstructed or collapsed. If your patient’s airway is obstructed or collapsed they will be unable to breathe, thus their SpO2 levels will slowly decrease. The SpO2 will also decrease with an active pneumothorax. Every penetrating chest wound (IE bullets/shrapnel) can cause a pneumothorax.
You can prevent worsening or treat these conditions by following the steps below.
| Airway state | Treatment | Notes |
|---|---|---|
| Clear | N/A | Insert NPA to prevent collapse |
| Collapsed | Mild -> NPA/OPA, Head tilt-Chin lift, Recovery position. Mild-Severe -> I-Gel, Head tilt-Chin lift, Recovery position. | Head tilt-Chin lift is an active action, thus preventing other actions.Only medics can insert I-Gels |
| Obstructed | Mild -> Head turning, Recovery position. Severe -> Suction required. | Perform until successful. |
| Pneumothorax | Chest Seal | This is only to prevent worsening of the condition. A medic still needs to treat this. |
Putting an unconscious casualty into the recovery position clears the airway and prevents it from collapsing/obstructing. However this is only recommended if you have no tools to otherwise secure the airway. This is because it prevents the following actions:
| NPA/OPA | I-Gel | Surgical Airway | Chest Seal | ACCUVAC |
|---|---|---|---|---|
| AED | CPR | Fast IO | Thoracostomy | Auscultate |
MARC(H)
If you forget what to do, or don’t know what’s next, this is a good general rule of thumb in what order you should treat a casualty:
Massive Hemorrhage
Tourniquet all injured limbs, bandage head and/or torso.
If only “some blood” is lost, slap casualty 1-2 times to try and wake them up before proceeding.
Airway
Check the airway. For mild obstructions perform head turning, for severe obstructions suction airway. For mild collapse insert NPA, for severe collapse use suction bag. When clear insert NPA. If no breathing start CPR and call for medic.
Respiration
If it’s possible to apply a chest seal, do it.
Circulation
Check for pulse on head. If normal or weak, move to next step. If no pulse, inject EpiPen and start CPR.
Help Arrives
Around this time your medic should have arrived. Update them on what steps in the MARCH you have done and give an estimation as to what their triage urgency is. After this you’re expected to provide security for your medic and casualty, unless told to help with treating the casualty (e.g. doing CPR, giving rescue breaths, bandaging, etc).
Triage
Triaging is a simple, yet effective way for an Operator and a Medic to know in which order to help casualties. It varies from T1 to T5. T1 casualties have the highest urgency, with T5 casualties having the lowest, and are described as follows:
T1 - Immediate
- Is unconscious AND has major injuries
- Is not breathing OR needs airway management
- Has a pulse OR is in cardiac arrest OR has lost a fatal amount of blood
- Is likely saveable with current resources
- (A stabilised and treated T1 becomes a T2)
T2 - Delayed
- Is unconscious OR has major injuries
- Has a pulse AND is breathing
T3 - Minimal
- Is conscious AND is able to walk
- Has only minor injuries
T4 - Expectant (expected to die)
- Is unconscious
- Is not breathing OR needs airway management
- Has a pulse OR is in cardiac arrest OR has lost a fatal amount of blood
- Is likely dead with current resources
T0 - Deceased
- Casualty has no signs of life AND has no possibility of revival (respawn needed).
MASCAS
A Mass Casualty incident (shortened to MASCAS) is defined as a scenario where a callsign (such as a section) is combat ineffective. Most of the time this is due to most people on said callsign being injured to the degree where medical attention is the number 1 priority.
As an Operator there are a couple things you need to do:
- Go to frequency
30 (0 Coy’s frequency)on your radio - Figure out in which grid you are (6-digits)
- Remember your (section’s) callsign
- Say the following:
“Hello Zero, this is [callsign]. MASS CAS, MASS CAS, grid [coordinates]. Advice, over”.
- Follow up on the given orders.
Triage is also different in the case of a MASCAS.
The number 1 priority should be to try and get your medic up and running again if they are down. Doing so allows for quicker, and more advanced care to be given.
The second person to try to get up and running again is your IC (Commander). The IC can better coordinate and communicate to get the best help where it is needed.
The third person to try to get up and running again is your gunner. This gives the necessary firepower to defend yourself until further help has arrived.
When all these people are up you can continue your triage as usual over the rest of the casualties.
Chemical Warfare
Protection against chemical threats is provided by respirators (gas masks) and CBRN suits. Respirators need filters in order to work properly. You can check the filter durability via the ACE menu action. You can also change the filter in this menu if you have spare filters in your inventory. The durability of these filters is measured in green stripes, each representing 10% durability (so the more green, the better). Respirators will lose durability while used in a contaminated area.
Respirators can be put on an unconscious person’s head via the ACE menu, performed on its head. If any facewear is present it will be stored in either their or your inventory, or will be dropped on the ground if there is no inventory space. CBRN suits do not degrade over time and do not need any extra items in order to prevent skin exposure. Keep in mind the items in your uniform do not transfer automatically when putting a suit on.
Currently there are 4 CBRN threats implemented in Arma 3: CS gas (also known as tear gas), chlorine gas, sarin gas and lewisite.
Symptoms and treatment vary depending on what you’re exposed to:
| Threat | Symptoms | Treatment |
|---|---|---|
| CS gas (grey gas) | Immediate: coughing, pain Moderate: blindness Prolonged: difficulty breathing | Most painkillers will manage the pain. Rinsing eyes with water will reverse blindness. |
| Chlorine gas (yellow gas) | Immediate: coughing, pain, choking Moderate: blindness Prolonged: respiratory arrest -> death | Most painkillers will manage the pain. Rinsing eyes with water will reverse blindness. When exposed treatment by a medic may be necessary depending on the length of exposure |
| Sarin gas (colorless gas) | Immediate: coughing, pain Moderate: muscle spasms Prolonged: respiratory arrest -> death | Most painkillers will manage the pain. Exposure can be mitigated with atropine/ATNA. Midazolam will stop the muscle spasms. Ask your medic for this if exposed. |
| Lewisite (colorless gas) | Immediate: coughing, pain, chemical burns Moderate: blindness Prolonged: respiratory arrest/shock -> death | Most painkillers will manage the pain. If the chemical burns are too severe fluids are needed to prevent shock. Ask your medic for this if exposed. Chemical burns CANNOT be bandaged/wrapped/stitches. |