Paramedic and CFA

This page is about the operational procedures for PJs and CFAs. Refer to ACE ADVANCED MEDICAL for information on the injury/medical system run by ASOR and equipment.

On this page:

  1. Introduction
  2. Role descriptions
  3. Communication
  4. Triage
  5. Treating patients
  6. Escalating care

Introduction

There are two medical positions in ASOR’s structure to provide medic aid.

The first are Combat First Aiders (CFA), players attached to individual squads and who are responsible for the section’s health. Usually, they should follow the squad leader unless given specific tasks. The primary focus of the CFA is to keep the squad operational until higher care is available. CFAs have access to a wider range of bandages and medications than regular soldiers, as well as intravenous fluids.

The second are the PJs (callsign GUARDIAN 1 and 2), a Command element that may be tasked with supporting CFAs or facilitating medevacs, in addition to providing medical aid to Command. The PJ also has access to the full range of bandages, medications and intravenous fluids. In addition, they may also use surgical kits to suture wounds and personal aid kits to treat “gimping” and other conditions.

The general principles of ASOR’s medical procedures are outlined below:

  • CFAs should be the primary caregiver within squads. Self-aid or buddy aid should be limited to the application of tourniquets, unless the CFA is incapacitated and bandaging is urgently needed, or otherwise directed by the CFA.
  • CFAs and PJs may require soldiers to assist in patient care. This may include the application of tourniquets, bandaging under direction, moving to a different location if they need treatment, or directing them to retrieve a wounded teammate.
  • Generally, the role of non-medical personnel is to engage the enemy and provide security for CFAs and PJs.
  • Medical providers are allowed to be firm with their patients and instruct them to remain still to allow treatment. Be sure to give some indication once you’re finished so the patient knows they’re free to go.

Role Descriptions

Combat First Aiders

The responsibility of the Combat First Aider (CFA) is to maintain the health of their squad. In addition to directly treating wounds, you should actively monitor your squadmates for wounds they are unaware of, as well as reopened wounds that require bandaging and closure. It is important to be thorough as players are often unaware of reopened wounds and blood loss which can increase the risk of even relatively minor wounds leading to serious complications. It is also important to ensure your squadmates are adequately stocked with their own tourniquets and bandages throughout operations. Remember that within your squad, you have authority over medical situations. It is appropriate for you to be firm with patients and give them directions during treatment. 

You should be continuously aware of the status of wounded players and the seriousness of their condition. You should keep your squad leader informed and advise them when a PJ is necessary. Although it can be considered the “entry level” medical role in ASOR, the CFA requires a high degree of proficiency in resource and time management, multitasking and communication skills.

PJ/Guardian

The responsibilities of the PJs are to facilitate and provide advanced medical treatment to wounded players, to support CFAs and provide medic aid to the command team. The most common task for a PJ is to travel to a squad and provide low acuity wound closure at the request of the squad’s CFA. In some cases, this task continues to include the evacuation of gimped players unable to be treated in the field. In mass casualty incidents, you may also be responsible for coordinating the scene and providing treatment.

Communication

Medical Channel

CFAs and PJs may organise an additional radio channel during mission preparation for communication. CFAs must still request PJs through their squad leader and not directly through the additional channel. Once tasked to assist a squad, Guardian will radio for the particular CFA to request further details.

CFAs should be prepared to brief the PJ on the number of patients, their condition and priority, and the services required from the PJ. It may also be advisable to provide directions to the PJ and inform them of any threats.

The standard frequency is 107.9.

Medevacs

Triage

Patients can be grouped into three categories, Category One, Two and Three. These correspond to the triage card within the medical menu, where One equals Immediate, Two Equals delayed and Three equals Minor.

Category Three patients are those who have been attended to by the CFA, are no longer actively bleeding but require treatment by a PJ in order to close wounds or resolve gimping.

Category Two patients are the “walking wounded.” They are injured, they are actively bleeding, but are still conscious. If necessary, they can be directed to apply self-aid.

Category One patients are those who are unconscious. They are severely wounded and unable to perform self-aid. They require the most urgent assistance.

Triage categories are useful when prioritising care in mass-casualty incidents and when determining if treatment should delay squad movement. They are also relevant when updating a Guardian coming to assist a CFA.

Treating Patients

General procedures

Generally, wounds are sustained during a firefight. The first priority is to prevent further casualties. Return fire, seek cover and assess wound severity. Where possible, apply tourniquets to wound extremities.  To assist in assessing severity, consider that wounds to the head and torso are of most concern. Extremities can have a tourniquet applied and treatment can be reasonably delayed until threats are neutralised. Head and torso wounds will continue to bleed until bandaged, and so usually take priority following tourniquet application. Further, consider the number of wounds sustained sustained and their size.

Further notes:

  • The unconscious state persists for quite some time and unconscious players do not attract enemy fire. It is not the medic’s responsibility to retrieve patients from open areas and you are discouraged from doing so. Generally another member of the squad should be directed to retrieve the patient, when possible, and bring them to the medic for treatment.
  • Unconscious patients can be differentiated from outright dead patients in a few ways. Unconscious patients lie prone in identical poses, with rifle in hand and with slight head movement. Under certain rare conditions (i.e. morphine overdose), they may have no pulse. Outright dead patients are ragdolled and no longer hold their rifle in their hand.
  • Generally, a player with no pulse is completely dead and unable to be resuscitated.

Bandaging

For most wounds, field dressings are ideal as they only require one bandage to close and have a balanced reopening chance. For some of the larger wounds, a single bandage may only partially close the wound, meaning a second bandage will be required. In these cases, applying Quikclot as the second bandage should accomplish complete wound closure with the added advantage of a decreased reopening chance (compared to two field dressings).

Regardless of wound type or size, elastic bandages will always completely close the wound. The disadvantage is they will likely reopening shortly after. Their use as the primary wound bandage is discouraged. They’re best utilised in urgent situations, such as mass casualty incidents, when wound bandaging is a time critical task. They may also be useful when a PJ is suturing nearby, as wound reopening will not be a concern.

Quikclot is also discouraged as the primary wound bandage, except for most minor wounds. They are useful in some cases as an adjunct to field dressings, as described above. They are also good as a follow up bandage after wounds have reopened, particularly if a PJ is delayed.

Fluid Therapy

Patients that have been bleeding heavily or for a prolonged period of time may experience a significant loss of blood. This will be reflected in a decreased blood pressure. Lost should be restored through the administration of intravenous fluids, otherwise there is an increased risk of the patient falling unconscious in the next engagement. Fluids should be administered until the patient’s blood pressure stabilises.

As a rough guide, 500 ml of saline appears to restore 10 points of systolic blood pressure.

Resuscitation

An unconscious player can be resuscitated by correcting their vital signs and pain status.

The first step is to control any active bleeding, as with any other patient. Wounded limbs should be have tourniquets applied as necessary and all wounds should be properly bandaged. The CFA/PJ may direct teammates to assist with this task.

Once bleeding is controlled, or is being controlled by teammates, the CFA/PJ should assess the patient’s vital signs. Fluid replacement therapy should be initiated as required to restore the patient’s blood pressure. Fluids flow overtime, so replacement is not immediate. Adrenaline (epinephrine) may be necessary to correct shock unresponsive to adequate fluid therapy. However, fluid therapy alone is generally sufficient.

After the player’s wounds have been managed and their blood pressure has been restored, the final step is usually to manage their pain. An injection of morphine should restore the patient’s consciousness. Be careful to ensure the morphine does not drop the patient’s pulse rate or blood pressure enough to cause them to lose consciousness again.

Remember to instruct the patient to remove any tourniquets that have been applied.

Escalating Care

CFAs are capable of handling the majority of injuries sustained during operations. However, they are unable to permanently close wounds. It will be necessary for the CFA to request through their squad leader a PJ to attend to the squad and suture wounds. Some wounds may cause players to walk with a limp, even after wound management and suturing. Such players are “gimped” and require medevac to restore limb function. Again, this is organised through your squad leader and the PJs, who will be required to facilitate the medevac.

Multicasualty incidents are also an appropriate time to request additional medical support, as a single CFA can easily be overwhelmed with multiple urgent patients. There is also a high likelihood that some victims will require a subsequent medevac, too.

FINAL WORDS

As long as you know the medical system well, and have skilled people working with you, your patients should never die. That not to say people won’t die, if someone was instantly killed there’s nothing you can do, don’t feel bad about it. But if your patient is in a safe position and you know what you’re doing, they wont die. It’s okay to shoot the enemy when in a medical role, just don’t prioritize it over helping the wounded.  

 

 

 

 

 

 

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