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Verox

Advanced Medical System

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So with the switch to ACE and our exclusive use of the advanced medical system there's been quite a lot of confusion regarding how exactly to fix someone up, i'm going to try and clear up some of this confusion and hopefully outline some new methods of thinking we all need to use to be effective. This is assuming a single-patient scenario.

 

There's one golden rule to follow: Blood is a vital resource, if you've got no blood in you it doesn't matter how many wounds you bandage or how much epinephrine you give you're never going to wake up.

 

While in ACE2 it was simple a matter of bandaging someone up so they weren't bleeding anymore and sticking some morphine in them this will no longer work, in fact if you blindly follow this procedure with the advanced medical system you're very likely (read: will) end up killing your patient.

 

This is common to everyone treating a casualty, medic or not.

The ABSOLUTE FIRST thing you need to do is check if your patient is alive. Check their responsiveness and check if they have a pulse (i,e, heartbeat). If they're dead then there's nothing you can do for them (In ACE, if that ever changes i'll update the guide.)

Assuming the patient is alive then check for any wounds, prioritize these wounds based on their severity. Head, torso, legs and arms. You can apply a tourniquet to limbs to halt bleeding giving you time to treat wounds on the head and torso. (don't start bandaging the large bruise on their arm when there's a bullet hole in their head)

Once you have stopped the bleeding your job is done, take your patient to your nearest medic.  While responsive patients may be able to continue fighting I don't recommend it unless in the direst of circumstances, you will already have low blood pressure from your initial wound, another one will likely end up with you dead. Everything else past this point should be done by a medic (except one thing. pay extremely close attention to the bit in bold)

If the patient is responsive (i.e. awake) and in pain (REALLY in pain, not a bruise) then you can administer ONE SHOT of morphine to the patient ON AN UNAFFECTED LIMB (this will prevent the morphine from literally bleeding out of the patient.)

IF THE PATIENT IS NON-RESPONSIVE DO NOT UNDER ANY CIRCUMSTANCES ADMINISTER MORPHINE. Unconsciousness can be caused by low blood pressure. Morphine lowers blood pressure. A casualty who has just lost a lot of blood may have already dangerously low blood pressure. If you administer morphine to an unconscious patient you WILL cause them to have a heart attack which WILL kill them.

DO NOT UNDER ANY CIRCUMSTANCES ADMINISTER MORE THAN ONE SHOT OF MORPHINE, EVER. (per 30 minutes.) This can cause an overdose and will likely kill the patient. Even if you're in pain AFTER the morphine, deal with it. Extra sticks will not do anything.

 

Everything else can only be effectively carried out by a medic.

The following is a rough guide of the motions, knowing what you can do and the effects of it will help you greatly in determining what to do here.

The first thing you should do is check your patient again for responsiveness, pulse and any un-bandaged or re-opened wounds. If found redress them and continue.

Next, check their triage card, note any drugs given (i.e. morphine) as this will affect your assessment and consequent actions. An incorrect action by you at this stage could end up with a perfectly heal-able patient, dead.

Now take their blood pressure. Adjust the blood pressure based on any drugs given (morphine decreases, epinephrine increases).

If the patient has a normal blood pressure then stitch their wounds (if you can) and either send them on for a full heal or send the back into battle.

If the patient has a low blood pressure then stitch their wounds and send them on, if they HAVE to be back in battle then give them saline (should prevent death if they get shot again) and send them back. This is obviously not recommended. If you happen to have a blood bag on you then this is preferred and should be almost as good a full heal. This should wake the patient up if they were unconscious, if it fails to do so (give it 5 minutes!) then give them epinephrine.

If the patient has a high blood pressure this is normal, blood pressure naturally increases with excercise. Do not  under any circumstance give them saline or blood or epinephrine. This can cause a heart attack. If the patient has extremely high blood pressure (dunno anything in ACE that could cause this other than overdose) then monitor them, if after 5 minutes the pressure isn't going down give them morphine and continue to monitor (be prepared to perform CPR...)

If the patient has EXTREMELY low blood pressure immediately give them epi and saline, epi first. Send them up as fast as possible. Monitor their pulse and be prepared to perform CPR.

If the patient has been overdosed on drugs by somone and their heartrate or bloodpressure is critically high or low then use Atrophine to even it out. Just enough to bring it out of critical, don't overdose the patient on Atrophine. If the patient has been overdosed on morphine DO NOT GIVE THEM SALINE. When the morphine finally dissapates they'll have a high blood pressure which could lead to heart attack. IRL you could use a small amount of saline to flush or dilute the morphine but I don't thnk that's impemented in ACE.

 

Don't forget, drugs and IVs take time to take effect. Constantly monitor your patient.

 

Special situation: If your patient has low blood pressure and you have no IVs then you can try one stick of epi to wake them up. In the event this doesn't work (very low bp) then they are shit out of luck. You need to get them to some blood bags asap or they'll die.

 

+ = High / - = Low / None = Normal

HR/BP = Normal.

-HR/-BP = Morphine

+HR/BP = Blood loss

+HR/-BP = Extreme blood loss

+HR/+BP = Epinephrine

-HR/+BP = Too much IV.

0HR (or --HR)/+-BP = Heart attack. CPR.

 

NR = Non-Responsie / R = Responsive

NR/0HR/0BP = Dead due to blood loss.

NR/HR/BP = Unconcious due to being KO'd? Dunno if this happens in ACE, monitor and wait for them to wake up. If they don't give one stick of epi.

NR/+HR/+BP = Unconcious due to being KO'd? Don't give epi, monitor and wait for either BP/HR to go down or or wake up by themselves.

NR/+HR/-BP = Unconcious due to blood loss. Give saline/blood and monitor, should wake up. Give epi if that fails.

 

I'm going to carry this on tomorow, it's 4AM right now I just wanted to get it out before the friday prime time. 

The main thing to take away from this is blood is vital, simply bandaging yourself is not enough to get you back into the fight anymore, a medic is absolutely required.

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Excellent and very accurate guide so far, I really hope that everyone would read this.

 

One noteworthy thing I've noticed with how pain functions though. I've had a mild pain effect for a while (only near the screen edges) which then suddenly changed into very intense pain, after which within seconds I passed out. Often if that's the case you'll see someone going in and out of consciousness in a few to 10 seconds interval, only being conscious for 1-2 seconds. In that scenario the only way of waking up the casualty is with morphine (of course don't forget to check vitals first so you don't kill him). Also in the list of symptoms there is no difference between light and heavy pain, so this requires careful assessment.

 

Would very much welcome some elaboration on how exactly atropine can be used together with other drugs.

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+ = High / - = Low / None = Normal

HR/BP = Normal.

-HR/-BP = Morphine

+HR/BP = Blood loss

+HR/-BP = Extreme blood loss

+HR/+BP = Epinephrine

-HR/+BP = Too much IV.

0HR (or --HR)/+-BP = Heart attack. CPR.

I think you switched these both?:

-HR/-BP = Morphine and +HR/+BP = Epinephrine

Or am I misunderstanding that table?

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Superb, Verox!

 

Small tip might help fellow medics/players. Since the amount of information from the new medical system is overwhelming (in a good way). I'm using Evernote to note down stuff like Briland and Best2nd bandage charts. Load Evernote with Steam in-game browser as my cheat sheet.

 

Of course you can always load the forum pages directly but something like Evernote also allows you to take notes without pen and paper. Pretty handy.

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One noteworthy thing I've noticed with how pain functions though. I've had a mild pain effect for a while (only near the screen edges) which then suddenly changed into very intense pain, after which within seconds I passed out. Often if that's the case you'll see someone going in and out of consciousness in a few to 10 seconds interval, only being conscious for 1-2 seconds. In that scenario the only way of waking up the casualty is with morphine (of course don't forget to check vitals first so you don't kill him). Also in the list of symptoms there is no difference between light and heavy pain, so this requires careful assessment.Excellent and very accurate guide so far, I really hope that everyone would read this.

I had this happen to me before. The reason this happened to me is probally due to the fact that I had a tourniquet on both my arms and legs. Make sure you remove your tourniquet within five minutes or else you're going to be in a lot of pain which gets amplified by the amount of tourniquet you have.

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Unsure if this is a bug or not, but I have required to give an unconscious patient morphine to wake them up. [i know it makes no sense :( ]    

 

The casualty had heavy blood loss, was in pain, low BP and pulse, and non responsive.  After bandaging all wounds, he was given saline and Epinephrine. After a few minutes his BP and pulse had returned to normal. He remained unconscious for another 5 mins, lacking any other options we decided to try sticking him with morphine to remove the "in pain" status effect. He then immediately woke up. 

I'm assuming this is a bug/unintended, has anyone else had a similar experience?

 

 

Additionally should morphine not have a preventive effect on pain?

 

For example, I sustained a minor gunshot wound and was in pain, took some morphine. 10 minutes later I was shot again, and received "in pain" again. Shouldn't the morphine I took 10 mins ago prevent this pain effect?

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I assume this is because of the passing out  due to pain feature. If a patient passes out because of pain or their pain progresses to a point where it would make them pass out if they were awake then you won't be able to wake them up (probably because of some if check somewhere if (pain > 60) { dont wake up }) It's a bit shit but the original statement is still valid, you will need to fully check their bp/hr and replace any lost blood before giving morphine to wake them up or you could well cause them to pass right out again or die because of low blood pressure.

 

As far as morphine affecting subsequent pain, yeah it should. Although it only works to a point, I can tell you from recent experience morphine won't completely remove lots of pain.

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I think you switched these both?:

-HR/-BP = Morphine and +HR/+BP = Epinephrine

Or am I misunderstanding that table?

 

Morphine lowers heart rate which in turn results in lower blood pressure. Epi does the opposite.

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Morphine lowers heart rate which in turn results in lower blood pressure. Epi does the opposite.

yeah I misunderstood the table, all good :D

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Although kinda hard to read at times, very well done on this guide. Is there any way to sum it up into an easily digestible piece? I've always went by TCCC guidelines which are very clear on the CUF, TFC and Extraction Care phases with pneumonics like MARCH/H-PAWS to help you out.

Edited by Rye

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Although kinda hard to read at times, very well done on this guide. Is there any way to sum it up into an easily digestible piece? I've always went by TCCC guidelines which are very clear on the CUF, TFC and Extraction Care phases with pneumonics like MARCH/H-PAWS to help you out.

 

Stop bleeding, scream for a medic.

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Happened to me yesterday:
 

A guy had multiple gunshots.

Bandaged them.

 

He was not responsive and had no pulse but a 60/20~ blood pressure.

Applied CPR

 

CPR Success, his vitals were ok to be awake, around 55 Pulse, Blood Pressure 100/60~.

No pain (gave him morphine).

<insert name here> is not responsive.
Applied 1x epinephrine, his blood pressure went up 120/70~.

 

<insert name here> is not responsive.

Guy had lost a lot of blood, replenishing with a 250ml saline (although, ACE is bugged since it showed giving him 1000ml, so basically 250ml acts as 1L saline)

Guy wakes up after a couple of minutes.

 

The goddamn blood.

Edited by Vinicius

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@Vinicius; This actually is normal. If the amount of blood is too low, he wont wake up.

 

To me it seemd that not only the visibility of the saline is bugged.

Last time I had to administer 250ml of Saline the blood pressure increased through out the process and reached dangerous levels where an heart attack could have appeared.

luckily it didn't. 250ml seems to not only show 1000ml it must also administer a higher volume than he actual 250ml.

This did not happen with 250ml of blood (which administered about 10mins later to another patient - currently I try to abstain from saline due to this bug(??))

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Although kinda hard to read at times, very well done on this guide. Is there any way to sum it up into an easily digestible piece? I've always went by TCCC guidelines which are very clear on the CUF, TFC and Extraction Care phases with pneumonics like MARCH/H-PAWS to help you out.

 

I wrote this guide at 4 in the morning after a long string of days without much sleep, I had planned to re-write it clearer but my router blew up so I'm left without internet. I'll do it as soon as a replacement router arrives

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Oh and, final word on the pain situation is: as it stands Morphine takes a straight 40% off the pain value which is 0% to 100%. The chance to pass out is at 60% so if your patient is in 100% pain giving them morphine without first removing the cause of the pain will cause them to immediately pass out again and you won't be able to administer any morphine for 10 minutes. This has been changed for the next version of ACE to make morphine numb your pain (makes it seem as if you have 0% pain for 10 minutes), but lets the actual value naturally decrease. Once the 10 minutes are up you will start to feel the pain again which, if it's over 60%, you may pass out again. Assuming you don't take any additional wounds or have tourniquets (seriously, take these things off once you're done with them) on your pain will decrease ~15% in those 10 minutes. It takes about an hour to go from full pain to 0 pain.

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I wrote this guide at 4 in the morning after a long string of days without much sleep, I had planned to re-write it clearer but my router blew up so I'm left without internet. I'll do it as soon as a replacement router arrives

 

Good to hear, I'll keep an eye on it.

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@Vinicius; This actually is normal. If the amount of blood is too low, he wont wake up.

 

To me it seemd that not only the visibility of the saline is bugged.

Last time I had to administer 250ml of Saline the blood pressure increased through out the process and reached dangerous levels where an heart attack could have appeared.

luckily it didn't. 250ml seems to not only show 1000ml it must also administer a higher volume than he actual 250ml.

This did not happen with 250ml of blood (which administered about 10mins later to another patient - currently I try to abstain from saline due to this bug(??))

Hey Pax, do you feel like giving an unofficial CLS course? I've got few doubts regarding these changes from CSE into Ace (mainly about basic X advanced medical system) and about correcting my procedures of first aid, last time I had a course was in arma 2 about Field Medic and Combat Life Saver, I like playing as a support role in the field.

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Hey Pax, do you feel like giving an unofficial CLS course? I've got few doubts regarding these changes from CSE into Ace (mainly about basic X advanced medical system) and about correcting my procedures of first aid, last time I had a course was in arma 2 about Field Medic and Combat Life Saver, I like playing as a support role in the field.

I am currently occupied with searching a new job.

How to handle medical situations and how to react to the way medical personal is used/treated on SRV1 at this time, needs much experience.

It is not optimal done, that should be obvious. Can't tell you much more than the ACE3 documentation does.

http://ace3mod.com/wiki/feature/medical-system.html#

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Hello,

 

You might not be aware of the new medial menu from ACE (same menu from CSE). It provides a much cleaner interface when you are dealing with patients.

 

To enable it:

  1. Go to Ace Option (hit ESC then the top left corner)
  2. Enable "Use medical menu"
  3. Hit 'h' key in game to bring up the menu (hit 'h' in the middle of the treatment will cancel the action, very handy)

Beware if you are facing another player while hitting the 'h' key, you will be examining him/her instead of yourself. You can switch between yourself and player view using the right most icon from the medical menu. Another 'feature' is that now you can bring up player medical menu from a distance, it kills the immersion.

 

The ACE team did a great job on the wiki, it is updated with a lot more in depth about the medical system e.g. with bandage types, vitals. Definitely worth revisit it.

 

Tuff

Edited by TuffShitSki

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It's useful to remember that different bandages have different min and max wound reopen delays, if you want you can look those up in the medical/ACE_Medical_Treatments.hpp file.

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Hi guys, I found too charts which, from my POV, are somewhat useful when printed next to your gaming setup.

For Medics:

l4qMwB3.png6eHsgjJ.png

 

The entire post can be found here.

KR
Pax

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Posted (edited)

Now that this thread's been bumped, I wish people stopped using morphine so much. I used to say that you should only use it if you're in pain serious enough to put you at a risk of passing out, but I don't remember the last time I've passed out or seen anyone pass out from pain, so I don't know if that can even practically happen anymore. The pain from even pretty serious wounds (a large avulsion in the head or something) seems to go away on its own in a few minutes without morphine, so personally I basically never use my autoinjector.

Then again I don't remember the last time I've seen someone go into cardiac arrest either, and epinephrine is very rarely useful too, so I'm suspecting that either changes to ACE or the server settings have caused a lot of these features to become basically obsolete...

Edited by Pekka

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