Phase 3

Table of Contents


Combat Life Saver

The role of the CLS is stabilization and mobility. They are equipped to get the riflemen going and to keep them going until a medic can provide definitive care. CLS’s are a useful role in a team composition, but they are not a replacement for a medic.

The CLS Role in Operations

To lighten the load of an FTL and ensure members of a fire team stay combat ready, one member of every fire team is assigned CLS duty in the event that there are not enough medics to assign one to each team. When a player in a team is assigned the duty of CLS it does not make them any less combat viable within the team, nor does it mean they will have to haul in a great deal of extra medical equipment. All members of a fire team can handle basic self-care, however, when a teammate gets knocked out by a massive injury, the CLS needs to step up and take medical action while the rest of the team continues to engage and maintain security. After a combat engagement, it is their job to double check with members of the team to make sure everyone is alive and there are no major injuries that need tended to. In all, a CLS helps prevent major injuries from going unnoticed and untreated, ensures better combat effectiveness of the fire team and allows the FTL to focus on more pressing leadership tasks.

This section gives an overview of the CLS role, but if you wish to learn more about the ACE medical system and our unit's procedures, check out the 3rd JCG Medical Handbook.

Scene Safety

While a CLS isn't absolved of the duty of engaging the enemy, they should still be aware of their own well-being. Scene safety can be difficult to ensure, depending on the complexity of the situation, but it is easily summarized as: "using common sense in a dangerous environment". Even when there are wounded teammates that need help, rushing into the same line of fire will just lead to more casualties. To prevent yourself from becoming a casualty, try to enlist help from other teammates to cover you while you go to retrieve a wounded comrade. Even if the worst should happen, and the CLS gets injured by a hidden enemy, the friendly covering for them can engage that target and call for additional help.

Most combat deaths are a result of players bleeding out when separated from the rest of their team. For this reason, the "buddy system" is absolutely paramount to preventing combat deaths. If a player goes unconscious without another team member nearby to spot and help them, they can bleed out, go into cardiac arrest, or be shot by the enemy while down; any of these things can result in either an immediate or eventual death and respawn.

Vital Signs

Combat Life Savers must understand the difference between a stable and unstable casualty in order to determine the next step in the treatment process. This includes, among other things, the reading of a patient's Heart Rate.

The baseline reading for a Heart Rate is 80 beats per minute. If this is too high (~160 or above) or too low (~40 or below), the casualty will be at risk of falling into cardiac arrest and will then need CPR. To easily remember these values simply take note that half of 80 is 40 and double of 80 is 160. So as long as you remember that the baseline of the Heart Rate is 80, you will never forget those readings.

  • Vital signs will fluctuate when the player is in pain.
  • Vital signs will destabilize if the patient is losing blood.

The baseline reading for Blood Pressure is 120/80. It is good to know this for purposes of identifying a patient at full health, but use of blood pressure is otherwise beyond the scope of CLS training.

Blood Loss

In addition to understanding basic vital reading, a CLS needs to understand what to deduce from the Blood Loss Indicator.

There are 4 stages of the BLI:

  • "Lost some blood" [~500mL] This will appear if the patient has suffered from any bleeding, no matter how small.
  • "Lost a lot of blood" [~1000mL] Appears after a significant injury or short period of bleeding.
  • "Lost a large amount of blood" [~2000mL] Severe injuries or extended bleeding without care.
  • "Lost a fatal amount of blood" [~3000-5000mL] Nearly or already bled out completely.

The BLI is not very accurate, but it is very difficult to know the true extent of a casualty's blood loss. Using blood pressure to determine this can complicate the process for a CLS and is only recommended if they are already trained as Combat Medics. Using the BLI, while less accurate, is the quickest solution for the level or care expected from the CLS.

Using the BLI to understand patient severity and determine treatment is actually quite simple:

  • If the blood loss is worse than "Lost some blood", administer a Saline IV. In the event that logistical support or medical resupply is available it is also advisable to administer Saline until the BLI goes away entirely.
  • It is highly unlikely a patient will return to consciousness while the BLI still says "Lost a lot of blood" or worse. A Personal Aid Kit cannot be administered to a patient with a lot of blood loss or worse.
  • Call for a medic if a BLI reads "Lost a large amount of blood", as a rather large amount of Saline will be needed to get them back to full health.
  • A "fatal amount of blood" loss often spells the end for a casualty, but if you can stop the bleeding soon enough you may have a chance to keep them alive until the medic arrives. However, in the event that you have other critical casualties, those with "fatal" blood loss are effectively your lowest priority.

Drugs

Epinephrine:

Used to wake up the patient and to keep them from falling asleep due to the application of morphine. Lasts 90 seconds per dose.

  • Will increase heart rate
  • Drastically increases the chance for a stable patient to wake up for 90 seconds
  • Will not wake up unstable patients

Morphine:

Used to treat pain if the patient cannot function in the combat environment. Lasts 10 minutes per dose.

  • Gets rid of pain gradually
  • Drastically reduces heart rate, always administer a dose of Epinephrine with Morphine
  • Lasts a very long time and can increase risk of falling unconscious and cardiac arrest

Drugs can also be quite simple, so long as you only use them for their directed purposes. Otherwise, they will complicate the treatment process and yield less consistent results in treatment.

If you have a patient stabilized, with a Heart Rate within safe margins and BLI reading "Lost some blood" or better, you may administer Epinephrine to greatly improve the chance of the patient waking up. A patient that wakes up from unconsciousness will immediately go into pain from the injuries they sustained, altering their vital readings. You may apply morphine if they are in too much pain to function within the fire team, but they must understand the risks of using the drug. In many cases, pain will gradually go away on its own, so consider abstaining from morphine and letting the pain go away naturally.

The Treatment Process

Lets take the information we just covered and apply it to how we deal with a critical patient. It's important to lay out our priorities and determine in what order we will treat each problem. Keep in mind: this example of treatment is provided with the understanding that the patient is unconscious and cannot take care of their own self. CLS intervention is not necessarily required if the patient is conscious and has otherwise not sustained any significant injuries.

  • Step 1: Stop Bleeding

In this first step, preventing further blood loss will stop the destabilization process and the complete decay of the patient's state.

  • Step 2: Stabilize

This step involves a combination of CPR and Saline, and requires you to understand the information in the "Vital Signs" and "Blood Loss" sections. Simply put: give them CPR to get their heart rate back and prevent final death; give them Saline to restore blood and improve vitals.

  • Step 3: Wake Up

Once the patient is finally stable with a heart rate within the safe range of 40-160 and a BLI that reads "lost some blood" at worst, they will likely wake up shortly after the administering of Epinephrine.

  • Step 4: Follow Through

Everything else in treatment may very well be dependent on the situation, the extent of injuries, or any complications that arise in the meantime. A medic should be called if your team needs extra Saline, stitches or medical personnel. Splints should be applied to broken limbs, morphine may be needed to stop pain and supplies may need to be restocked. This part is all about common sense and keeping an eye on any casualties who have just recovered from terrible injuries.

Casualty Collection Point

When taking a CLS slot, you will have access the ability to establish a CCP via ACE Interaction. The CCP is used for mass casualty situations, or in the event that Personal Aid Kits are needed to reduce supply attrition. Usage of this resource is often a tactical decision to be made by an FTL or SL, but a CLS or Medic has the ability to deploy it once it is determined that it will be useful for the situation.

Functions of the CCP:

  • Increases training level of all personnel standing on the CCP tarp
  • Allows the usage of Personal Aid Kits (similar to a medical vehicle)
  • The CCP will be added to your ACE Self-Interaction Menu upon leaving base while in a CLS or Combat Medic slot.
  • You only get one CCP per mission, but you may use the same one multiple times by deploying and deconstructing it.

How to use:

  • Self-Interact on yourself and select "Unpack CCP", this will deploy a bag in the ground about 3-5 meters in the direction you are looking. Avoid doing this inside buildings as the bag will deploy on the ground, not on the floor of buildings, and as such they may morph into the geometry and become lost.
  • Interact on the red bag and select "Establish CCP", you can also pick it up with "Pack Up" if you didn't like the placement.
  • Once you're ready to move out, interact on the center of the tarp and select the "Deconstruct" option. This will completely pack up the tarp and restore the ACE "Unpack CCP" option.

Simple Triage

A dedicated CLS is not required to know everything about dealing with mass casualty situations, but for individual casualties a CLS should always be able to keep the patient stable until the arrival of a Combat Medic at the very least. In the event that a CLS has to assist with mass casualty incidents, it will be important for them to understand the basic system of triage to ensure that the most possible wounded can be saved:

  • Blue: Bandaged, stable and waiting for stitches. They can wait until it’s convenient. Lowest priority.
  • Green: Stable vital signs. Minor or few wounds that the rifleman can deal with himself. Low priority.
  • Yellow: Multiple or moderate wounds, head/chest wounds, vitals outside normal range. Needs attention, but not necessarily immediately. Priority if nothing past yellow.
  • Red: Major or many wounds, vitals unstable, unconscious, cannot be handled by a non-medic or non-CLS. Highest priority in mass casualty.
  • Black: They’re not dead yet, but they’re going to be. If it will consume most of your supplies and it is unlikely that you will get them back these are a complete waste of your time. Do not prioritize them unless the casualty is a mission critical VIP.

Battle Drills

      • Security - one of the more important aspects of a fire team is keeping up security. When you stop for any reason (medical, navigation, ect) that doesn’t mean your safe. Enemies will still continue to attack your position and attempt to flank you. Being distracted could end with the whole team getting wiped.


      • Reacting to Contact - when the rounds start to fly it’s important to keep things by the book. Call out targets (direction, distance, composition, and strength) and make sure not everyone in the unit is firing at a single target; security is still a priority.


      • Engaging - before you engage a target it’s best to get a full assessment of the situation. There very well could be an MBT around the corner from the fire team you are about to shoot.


      • Breaking Contact - ramming your head into a brick wall isn’t always the best strategy. It’s best to step back and weigh if the constant casualties is worth it or not. Sometimes the best thing you can do as a leader is retreat and approach the situation from a different angle.

Leadership

ACE reports - Your fireteam leader might request an ACE report, which in turn might have been requested from the Squad Leader or the Platoon Commander. ACE stands for:

  • (A) Ammo
  • (C) Casualties
  • (E) Equipment

The general intent of an ACE report is to maintain individual and team awareness in regards to logistical considerations. A fire team leader needs to know about deficiencies within the team in order to make corrections or call for support from other elements. For this reason, ACE reports should be quickly conducted by individuals and communicated to leadership after any significant event within the mission such as: taking enemy contact, completing an objective, or halting for resupply. Any time high leadership calls for a SITREP or any status update, the ACE report should be one of the first things that come to mind.


MET-TEC - A mnemonic similar to one used primarily by the U.S. Army as a framework to aid its warriors in analyzing a situation, prioritizing key aspects and planning accordingly to achieve success. For 3rd JCG, MET-TEC is worded slightly differently to reflect elements that are more prominent in-game, or will simply be more cohesive with the online group. Mission Dossiers will follow this format, and players are encouraged to remember this mnemonic so they may recall important details of their mission.

  • (M) Mission - your goals and objectives for the operation
  • (E) Equipment - what gear and supplies the players will have access to
  • (T) Terrain - the map, surroundings and weather players will have to operate in
  • (T) Time - mission length, time-frame and in-game environment time
  • (E) Enemy - hostile forces players will have to engage
  • (C) Civilians - non-combatants within the area of operations, and player force ROE