ISD Medical Handbook

Knight, & Axiss

Contents
1 Introduction 1

2 Basic Medical Knowledge 2

3 Advanced Medical Knowledge 3

3.1 Drugs and Fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.2 Handling Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.3 Triaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3.4 Medical SOP/ Basic Treatment Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

4 Medical command structure 6

4.1 Medical Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
4.2 CCP Setup and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

5 Medical Loadouts for Mission Makers 8

1 Introduction
• Every soldier requires Basic Medical Knowledge (read section 2). Advanced medical actions are avail-
able for medics only.

• Advanced Medical Knowledge (read section 3) contains detailed information on drugs, fluids, tools,
handling fractures, and the medical SOP.

• Section 4 has the distribution of responsibilities between squad level and platoon medics and CCP setup.

• Finally, section 5 Provides medical loadout intem requirements for mission makers.

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2 Basic Medical Knowledge
Handling pain :: Painkillers
• A box of painkillers comes with 10 pills. Red box found in the ammo section, do not use the
yellow tube found in the medical menu.

• Can take one pill at a time by interacting on head and choosing the action.

• Fatal when 10 pills are consumed in ten minutes

→ in mild pain : Take 1 pill

→ in moderate pain : Take 3 pills

→ in severe pain : Take 6 pills

• Epinephrines and Morphines are no longer issued to infantry.

Heart rate and Blood Pressure

• Only medics can see actual numbers for HR & BP. Non-medics get a text response saying Strong,
Normal, Weak and None.

• CPR :: A successful CPR resets the cardiac arrest timer which is currently set to 6 mins after
which the casualty will die if CPR is not given.

Splints
• Splints help in reducing pain in case of delayed treatment of a fractures. Fractures reduce move-
ment (limping) and aim accuracy.

Heart rate Blood Pressure (Diastolic/Systolic)

Strong : 100 and above. Strong : 160/100 and over.
Normal : around 80. Normal : 120/80.
Weak : 60 and below. Weak : 100/60 and under.

Figure 1: Bandage cheat sheet. Efficiency is number of cuts,abrasions,avulsions,...etc handled per bandage.

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3 Advanced Medical Knowledge
3.1 Drugs and Fluids

Drug Description
Norepenephrine Increases HR, increases BP, slows down bleeding and transfusion.
Nitroglycerine Increases HR, decreases BP, speeds up bleeding and transfusion.
Phenylephrine Decreases HR, increases BP, slows down bleeding and transfusion (more than Norepinephrine)
Wound Handling
TXA For 120 seconds it applies a packing bandage to a body part every 6 seconds. (Bandages everything)
EACA Fully stitches any previously bandaged wounds. Lasts 10 mins and will also work with TXA.
Usage limits TXA – 2 per 10 minutes. EACA – 5 per 10 minutes.
Surgical Drugs
Lidocaine (Closed reductions) (Local to limb)
Lorazepam (Open reductions) sedates patient for 10 mins. Patient can wake up under severe pain.(Global)
Etomidate (Open reductions, after Lorazepam) Prevents patient from waking up for 45 secs. (Global)
Flumazenil After Open reductions. (Starter to wake up patient)
Miscellaneous
Naloxone Used to clear opioid overdoses caused by medications such as Morphine.
Morphine Opiod reduces pain, lowers blood viscosity. Fatal if 2 taken in a span 10 minutes.
Epinephrine Increases HR, used to kick start heart.
Adenosine Lowers HR, Increase BP.

Fluids/IVs
All IVs increase blood pressure as they increase blood volume.
Blood :: It is blood.
Plasma :: Same as blood but increases clotting.
Saline :: Used for flushing the system and surgical cleaning.
If more than 1500 ml is pushed through the system at once, it will cause kidney failure.

Tools to push fluids and drugs into the system

16g IV :: Inserted on a limb and is required to push fluids. Optional to remove after stable.
FastIO :: Make a hole in chest to push fluids faster and works with tourniquets.
Remove for sure as it causes severe pain with time (A hole in the chest, duh!).
Autoinjector :: Can push some drugs without an IV or IO through the limbs.

3.2 Handling Fractures

• Simple fractures can be handled at squad level. Complex fractures require an open surgery and are
done in a medical vehicle or building by the platoon medic.

• Morphine can be used for simple fracture in an emergency but Lidocaine is the preferred and safer
option.

• See flow chart for steps (Figure 2).

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Figure 2: Basic flow chart when handling a fracture with brackets specifying some requirements.

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3.3 Triaging
Casualty is unconscious
No Heart Rate
1 - Immediate No Blood Pressure
Blood loss is Lost a large amount of blood or worse
Active bleeding
Casualty is unconscious
Heart Rate close to 40+
2 - Delayed Blood Pressure close to 100/60
Blood loss is Lost a lot of blood or better
No longer actively bleeding
Casualty is Awake
3 - Minimal Blood loss is Lost some blood or better
Active bleeding
Casualty is unconscious and cannot be dragged or carried
4 - Deceased Note: Medics can declare an unrecoverable person a casualty, but this is exceedingly rare.

• Order of handling casualties:

1. Immediate

2. Delayed

3. Minimal

* Sequence priority for each case :: Medics > Leadership > Force multipliers (AR,AT,AA)> Closest
to waking up > and the rest.

3.4 Medical SOP/ Basic Treatment Protocol

The standard protocol order for treating a casualty is BHEC. While the order is defined, the casualty vitals
must be monitored regularly between steps or when in doubt.

• Bleeding

1. Casualty immediate :: Phenylephrine → Fast IO → push TXA & EACA.

2. Casualty delayed :: Fast IO → push TXA & EACA.

3. Casualty minimal :: Tourniquet Limbs → Bandage Torso & Head → stitch.

* TXA & EACA are suggestions only and should be used under medic discretion.

• Heart rate & Blood pressure

1. Casualty immediate :: Push fluids, CPR → AED shock (Platoon medic) → check pulse and
Repeat∗

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 2. Casualty delayed :: Push fluids, CPR → check pulse and Repeat∗

* Drugs can be used to kick start HR & BP.

• Evacuation

1. Casualty immediate :: Report on radio → Drag/Carry (3 min max) → Drop and CPR (at 3
min) → Resume moving∗

2. Casualty delayed :: Report on radio → Stitch all wounds → Move

* Immediate casualties are recommended to be stationary and must be monitored every 3 mins
while on move.

• Conciousness

1. Bring blood lost to lost some blood.

2. Bring HR close to 80.

3. Bring BP close to normal 120/80.

4. Re-orient patient once above conditions are met.

4 Medical command structure

4.1 Medical Elements
Differences between platoon level and squad level medical elements.

• Squad Medic:

→ Can carry basic medical items

→ Can carry IVs/IOs and fluids

→ Can carry most IV and injector drugs

→ Can use TXA and EACA

→ Can stitch wounds using a surgical kit

• Platoon Medic/MERT Officer:

→ Can carry basic medical items

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 → Can carry IVs/IOs and fluids

→ Can carry all IV and injector drugs

→ Can use TXA and EACA

→ Can stitch wounds using a surgical kit

→ Can operate on fractures in a medical vehicle or facility

→ Can Operate an AED/AED-X(Advanced External Defibrillator)

4.2 CCP Setup and Management

• In the event of a Mass Casualty Incident(MCI), the location must be marked on cTab. The Platoon
Medic will choose a suitable location to set up a CCP(Casualty Collection Point).

• The CCP is to be set up in a safe, defendable location not far from the MCI to take care of the
casualties present there.

• A medical vehicle must be on standby to transport casualties or to operate on a casualty.

• All medics must immediately report to the CCP to assist in treatment of the casualties.

• The Platoon medic is the commander of the CCP and delegates responsibility to all units in the CCP.
The Squad medics are next in line in the order of seniority.

• Triaging is a priority and must be done at the earliest.

• The medics must move in a cycle clockwise to work on all casualties. This is to prevent tunnel vision.

• The Platoon Medic delegates responsibilities like bleeding control, fluids, and heart rate to other medics
and themself.

• Most importantly, the medics must make sure that movement is unhindered and casualties are brought
in and arranged properly.

• The platoon medic is also responsible for the security of the region, and may ask people to assist in
the process for CPR as an example.

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5 Medical Loadouts for Mission Makers
• Rifleman now carry some medical items to reduce load on medics.

• A medical vehicle or a medical building (tent,room,...) should be available for surgeries.

• A medical vehicle inventory can just be the standard resupply as well.

Rifleman Squad Platoon Resupply

medic Medic

Painkillers 2 5 5 50
Field dressing 0 0 0 0
Elastic bandage 10 20 20 100
Packing bandage 10 20 20 100
Quick clot 10 20 20 100
Tourniquet 4 6 6 30
Splint 4 4 4 40
Drugs

Morphine Autoinjector 2 7 7 60
Epinephrine Autoinjector 2 15 15 60
Adenosine Autoinjector 2 10 10 30
Norephenephrine 5 5 30
Nitroglycerin 5 5 30
Phenylephrine 5 5 30
Phenylephrine Autoinjector 2 2 30
TXA 5 5 30
EACA 5 5 30
Naloxone 5 5 30
Lidocaine 5 5 30
Lorazepam 5 30
Etomidate 5 30
Flumazenil 5 30
IVs (total volume)

Blood (1 l & 0.5 l packs) 1000 ml 4000 ml 4000 ml 20000 ml

Plasma (1 l & 0.5 l packs) 2000 ml 2000 ml 20000 ml
Saline (250 ml packs only) 500 ml 1000 ml 2500 ml
Tools

16g IV 2 15 15 60
FAST IO 1 7 7 60
Scalpel 5 50
Retractor 1 3
Clamp 1 3
Bone plate 5 30
AED 1 1
Surgical kit 1 1 3