Combat Medic

Introduction


The medic role is the primary support asset that is needed in every operation. It is not a glamorous role and you will often be frustrated by the medical system and your patients. You will be responsible for the health and wellbeing of those around you in operations. There are high expectations for your conduct and practice when you are in the medic role.

Duties and Responsibilities


A Combat Medic is a medic that performs their duties in combat situations. They are a medic first and foremost, and their primary duty is to maintain the health and wellbeing of everyone on their team.

An essential responsibility of the medic is to stay alive. Naturally, a dead or injured medic is useless to the team. It’s generally a bad idea for a medic to spend time shooting at enemies instead of checking on their team, this is a fact anyone will have to accept when taking on the role of Combat Medic. You need to accept the fact that there will be operations in which you do not fire a single shot.

Medics are responsible for their team’s wellbeing. It is their responsibility to keep a team operational to the best of their ability. On certain occasions, medics may have to perform medical on enemies to preserve prisoners for capture and interrogation. If the team leader is wounded, the medic may even have to take command to keep the team functioning until the team leader is back up. Medics will have to make difficult decisions during firefights and in dire situations, but they are expected to remain calm and collected through it all.

Standard Medic Loadout


A.E.D. (Automatic External Defibrillator) – 1

Surgical Kit – 1

PAK - 1

Elastic Bandages – 20

Quick Clot – 12

Packing Bandages – 12

Epi Injectors – 10 +1/team member

(Example: A fireteam of 5 members means you bring 15 Epi Injectors)

Morphine Injectors – 10

Saline – 1000mL per team member

(Divide into 1000mL, 500mL, and 250mL. 500mL is the most useful size. Example: Team of 5: 1x1000mL, 6x500mL, 4x250mL for a total of 5000mL)

Tourniquets – 8

SAM Splints – 8

Ear Plugs – 1

Cable Ties – 2

E-tool – 1

This is in addition to the kit you load in with as a rifleman. The supplies in your uniform are for you. Everything else is for your team. It is advised to keep these supplies in a backpack that others would be able to access.

Standard CLS Loadout


Surgical Kit – 1

Elastic Bandages – 12

Quick Clot – 4

Epi Injectors – 5

Morphine Injectors – 3

Saline - 2 x 500mL

Tourniquets – 2

SAM Splints – 4

Ear Plugs – 1

Cable Ties – 2

E-tool – 1

This is in addition to the kit you load in with as a rifleman. The supplies in your uniform are for you. Everything else is for your team. It is advised to keep these supplies in a backpack that others would be able to access.

WOUND REOPENING

While you can always seal a wound with the appropriately bandage, many of them have the audacity to peel off… This is known as Wound Reopening. Movement, nearby explosions, time, and even the movement of your arm when tossing a grenade will eventually cause a wound to reopen. This will allow bleeding to resume, further draining the player’s blood.

Use a Surgical Kit to seal a wound permanently.

BANDAGE TYPES

Elastic

A medic’s best friend. Elastic bandages should only be carried by medics and CLS’s. One elastic bandage will cover multiple wounds, so you can stop the bleeding faster. The downside is that they fall off almost immediately. Elastics are there to hold someone together just long enough to stitch them.

Packing

A longer term fix. These are good for when there’s not enough time to stitch right now, but you need them to stop bleeding because saline is not infinite. These are good for lacerations, puncture wounds, and small velocity wounds.

Quikclot

This is a necessary staple of your kit. If someone has avulsions or medium/large velocity wounds, you will probably need to use Quikclot along with packing or elastic to get the bleeding to stop. If you don’t have time to stitch and they’re bleeding out, Quikclot is a good place to start.

Basic Bandages

These are, basically, bandages for those who have no idea what they’re doing (usually riflemen). The only place a medic should have basic bandages is in their uniform from the rifleman medical loadout. The way they function is very simple, 1 wound = 1 bandage. They will last for variable amounts of time depending on how severe the wound is, but they’re good enough for a quick fix, or getting someone going in a pinch. As a rule, medics should never use basic bandages on someone else. You’d probably be using up their personal supply.


KNOCKOUT

When a player is injured enough or hit hard enough (usually in the head), they will go unconscious until they are revived. Depending on the mechanism of injury, there is a miniscule chance they might wake up spontaneously for a very brief time. For the other 99% of cases, you’ll need to revive them yourself. Your options for revival vary depending on the situation.

No Heartbeat, but still has Blood Pressure

If they don’t have a heartbeat, but they do have blood pressure, you need to use the defibrillator to revive them. Make sure to call out and enforce “CLEAR!” because anyone touching someone getting defibrillated is going to get hurt. This will get their heart rate up to 40 BPM, which is notably short of the required minimum heart rate. You will need to use Epi injectors to bring their heart rate up. You cannot let them out of your sight until their heart rate is at least 60 BPM. If you’re under fire, defibrillate them and either carry them out or stay with them until you finish stabilizing them.

No Heartbeat with very low Blood Pressure

If there isn’t a heartbeat, you’ll need to use the defibrillator, but if their blood pressure is too low (under 80/##) there’s a chance the defibrillator won’t work. In that case, you will need to have someone perform CPR (any rifleman can be drafted to do this) and you’ll need to bring their blood pressure up with Saline and Epi. A rule of thumb, 500mL Saline will get you about a 10/## increase in blood pressure.

Defibrillated, has a stable heart beat and stable blood pressure, but still unconscious

This is a tricky situation to diagnose quickly, but you’ll get better with time and practice. If their vitals are stable and they are still unconscious, you’ll need to make sure all wounds are stitched, then you need to alternate Morphine and Epi until they wake up. Most of the time, you’ll just need one Morphine and they’ll snap to. The danger with that is that Morphine will lower their heart rate drastically, possibly below stable values. That is why you give an Epi for each Morphine you give.



If you’re under fire and can’t really troubleshoot an unconscious player use:

Epi – Epi – Morphine – Epi

This pattern is reasonably likely to get them going again. This is not a very resource conserving method, so resort to this standard only when you can’t deal with it procedurally.


They’ve been knocked out, and now they’re up again....

Every time someone goes unconscious, it becomes easier to knock them out again. Eventually, bumping into a rock in a vehicle or jumping off a rock will be enough to knock them out. If you’ve revived someone more than once, you’ll need to watch them carefully and check in frequently because they will quickly become narcoleptics with rifles.


Rules for medications

3 or more Epi/Morphine in a row can be lethal. If you need more than one or two of something, alternate one of them with the opposite medication. Epi increases the heart rate, Morphine decreases it. Ideally, you want the heart rate between about 80 BPM and 110BPM. As low as 60BPM and as high as 120BPM are only acceptable if it is a high risk situation and you do not have time to safely correct their vitals. Less than 60BPM and more than 120BPM are not acceptable to let someone loose with. You need to monitor them closely until you can fix it.

Nothing is working!? What the heck?!

An easy mistake to make is putting all the meds and/or saline into a limb with a tourniquet on it. We’ve had riflemen die or get knocked out because they or their medic were stacking meds into a tourniqueted limb, so when the tourniquet was removed, all of the meds hit at the same time.



Standard Values for Vital Signs

(must be memorized)

Heart rate:

<60BPM – must monitor closely if it can’t be corrected

60 to 80BPM – follow up regularly

80-100BPM – ideal range

100-110BPM – follow up regularly

>120BPM - must monitor closely if it can’t be corrected

(Adjust heart rate with meds. One Epi increases it by approximately 10BPM. One Morphine decreases it by approximately 10BPM)

Blood Pressure:

(all values given as systolic only. Y’all aren’t doctors so diastolic doesn’t matter)

(systolic/diastolic)

<40/## - Black tag unless you have nothing else to do or they are mission critical

<60/## - must monitor closely if it can’t be corrected

60/## to 100/## - follow up regularly

100/## to 120/## - ideal range

>120/## - what the actual fuck? How much saline did you give them?

(A rough guideline: 500mL Saline will get you around 10 to 15 increase in systolic pressure)



Triage Terms and Guidelines

Tagging system:

Blue: Bandaged, stable and waiting for stitches. They can wait until it’s convenient. If they’re blue and complaining, smack them. 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. Need 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 at all. 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 and materials unless you literally have nothing else to do and a resupply is available.

Triage is an art not a science.

There is no standard protocol for triage. This is where we are counting on your judgment and critical thinking skills. You need to be able to make these decisions quickly, and your team will literally live or die by your ability to do this well. You will learn your own methods in time. Until then, use the tag system as a guideline for getting into the swing of things. If you need help, ask an instructor. If you’re in an operation and you need help, call for the other medics or draft the riflemen into helping you.

There are no wrong answers here as long as you can justify your decisions.


Medic Tiers

First Aid/First Responder/Self Medical

- Different uses for different types of bandages

- Different Auto-Injector Meds and their uses

- Basic scene safety and expectations for medic-patient interactions

Combat Lifesaver

- Overview of Medic role in operations

- Details and best practices for scene safety

- Single patient, multiple injury triage

- Basics of the revive system

- Splinting and Stability

Combat Medic

- Revive system, complete understanding of unusual situations.

- Mass Casualty triage

- How to Un-Arma someone

- Direction of others in mass casualty situations