MEDICAL SOP

4th Canadian Mechanized

Brigade Group
MEDICAL SOP
For Ace and KAT
Created By; S. Banerjee
Approved By: Col. A. Bloggins
Updated: 09-10-2021

Table of Contents
Medical levels_____________________________________________ 4

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 MEDICAL SOP

Introduction_______________________________________________ 5
BBB 3b’s 5
THE BASICS 5

Qualification Levels______________________________________ 6
TACTICAL COMBAT CASUALTY CARE | Medic (TCCC/CLS) 6
Pararescuemen(PJ) 6

ADVANCE EQUIPMENT___________________________________ 6
ACCUVAC 6
Advanced Airway Treatment Kit (AAT Kit) 6
AED 6
AED X-SERIES 6
AID PACK 6
Medic Kit 7
CASUALTY COLLECTION POINT 7
CHEST SEAL 7
GUEDEL TUBE 7
KING LT 7
PERSONAL AID KITS 7
PULSE OXIMETER 7
SALINE PLASMA AND BLOOD 7
STETHOSCOPE 7

DRUGS______________________________________________________ 8
Autoinjector 8
Morphine 8
Epinephrine (Epi) 8
Adenosine 8
ATNAA (Antidote Treatment Nerve Agent Autoinjector) 8
Medications 8
Naloxone(NARCAN) 8
Amiodarone 8
Lidocaine 9
Atropine 9
TXA(Tranexamic Acid) 9
Ondansetron(Zofran) 9
Norepinephrine 9
Phenylephrine 9
Nitroglycerin(Nitro) 10
OTHER 10
Painkillers 10
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Ammonium Carbonate 10

REVIVE SYSTEM___________________________________________ 10
Death And Unconscious 10
Death happens if one of the following happens. 10

BLEEDING__________________________________________________ 11
INJURY TYPE 11
ABRASIONS 11
AVULSIONS 11
CONTUSIONS 11
LACERATIONS 11
VELOCITY WOUND 11
PUNCTURE WOUNDS 11
BANDAGES 11
TOURNIQUETS 12
SURGICAL KITS 12
SPLINTS 12

BREATHING________________________________________________ 12
CHECK AIRWAYS 12
AIRWAY MANAGEMENT 13
HEAD TURNING 13
HYPEREXTENDING HEAD 13
BLOOD OXYGEN SATURATION 13
XYZ-Thorax 13
PNEUMOTHORAX 13
TENSION PNEUMOTHORAX 14
Hemothorax 14

BEATING____________________________________________________ 14
VITALS 14
BLOOD PRESSURE 14
HEART RATE 14
CARDIAC ARREST 14
TREATMENTS 15
IVS 15
IV Transfusions 15
BLOOD TYPES 15
PROVIDING AID TO A PATIENT 16
CARE UNDER FIRE 16
TRIAGE 16

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TIMERS 16
PRIORITY 16
IMMEDIATE 17
DELAYED 17
MINIMAL 17
EXPECTANT 17
Cardiac Arrest System 18

PROCESS____________________________________________________ 19
STEP 1: IS THE PATIENT RESPONSIVE? 19
STEP 2: IS THE PATIENT BLEEDING? 19
STEP 3: IS THE PATIENT BREATHING? 19
STEP 4: IS THE BLOOD OXYGEN SATURATION GOOD? 19
STEP 5: DOES THE PATIENT HAVE A PULSE? 19
STEP 6: DID THE PATIENT LOSE A LOT OF BLOOD? 19
STEP 7: IS THE PATIENT IN PAIN? 19
STEP 8: IS THE PATIENT AWAKE NOW? 19

MEDIVAC___________________________________________________ 20

FAQ__________________________________________________________ 21
What do SpO2 change values mean? 21
What is the difference between Guedel Tube and KingLT? 21
How do I use painkillers? 21
What are the differences between pneumothorax, tension pneumothorax and
hemothorax, and how do they happen and treat them? 21
Pulse-oximeter, AED and AED-X - what are the differences and how do they
work? 22
How blood groups work in KAT and how do I use an IV stand? 22

Medical levels_____________________________________________
1. Infanteer (RIFLEMAN)
a. IFAK
i. 2x Packing bandage
ii. 2x Elastic Bandage
iii. 2x QuikClot
iv. 2x TQ
v. 1x Splint
vi. 2x Chest Seal

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vii. Painkillers
2. CFA (MEDIC)
a. IFAK
i. 2x Packing bandage
ii. 2x Elastic Bandage
iii. 2x QuikClot
iv. 2x TQ
v. 1x Splint
vi. 2x Chest Seal
vii. Painkillers
b. 2x Pulse Oximeter
c. 500/250ml Saline (4/8 max)
3. Med Tech (DOCTOR)
a. IFAK
i. 20x Packing bandage
ii. 20x Elastic Bandage
iii. 10x QuikClot
iv. 8x TQ
v. 4x Splint
vi. 4x Chest Seal
vii. Painkillers
b. 4x 1000ml Saline
c. 12x 16g IV
d. 4x FAST IO
e. 6x King LT
f. 4x Pulse Oximeters
g. 1x AAT Kits
h. Surgical kits
i. Stethoscope
j. Drugs
i. 6x Morphine [pain suppression/lowers BP & HR]
ii. 10x Epinephrine [treat cardiac arrest/increase HR]
iii. 5x ATNAA [counter nerve agents/lower HR 5 MAX]
iv. 5x TXA [temporarily treat severe trauma/pre casevac 5 MAX]
v. 5x Ondansetron (Zofran) [prevents vomiting 5 MAX]
vi. 5x Adenosine [stabilize/lower HR 5 MAX]
vii. Naloxone (NARCAN) [combat overdose]

Introduction_______________________________________________
BBB 3b’s
March can be simplified in to the Following for ARMA purposes Bleeding, Breathing,
Beating,

Bleeding
Simplified is the Patient Bleeding.

Breathing

Include breathing and Oxygen saturation

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Beating

Includes pulse and blood volume

THE BASICS
In ACE the human body is represented as 6 distinct areas that can receive damage. Some of
these areas have special abilities such as applying a tourniquet or using a variety of IV
solutions.

Each living person in the battlespace has Four key metrics which define their state of
health. Every action you take will be to maintain or restore one of these metrics:
● Blood Volume
● Pulse
● Oxygen saturation
● Responsive State (Are they conscious?)

Besides the 4 elements introduced by basic medical, advanced (w/KAT) introduces the
following:
● More detailed wound system.
● Accurate blood loss based upon sustained injuries.
● Vitals, including heart rate and blood pressure.
● Cardiac Arrest.
● Airway Management
● Breathing
● Circulation
● Various treatment methods such as CPR, different kinds of IVs and a working
tourniquet.

ADVANCE EQUIPMENT___________________________________
ACCUVAC
The Accuvac is a mobile medical suction device which can be used in order to clear airways.
If the patient is not unconscious, then the device does not need to be used. Select the head
in the medical menu to use the item.

Advanced Airway Treatment Kit (AAT Kit)

Simulates a pre-prepared sterilized kit designed for the treatment of various airway related
medical conditions

AED
An AED is a lightweight, battery-operated, portable device that checks the heart's rhythm
and sends a shock to the heart to restore a normal rhythm. The device is used to help
people having sudden cardiac arrest.

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AED X-SERIES
The AED X-Series is a monitor and an Automated External Defibrillator all in one. It
monitors heart rate, blood pressure and oxygen saturation all in one. Once the patient's
vitals are being monitored it appears in the “quick view” section of the medical menu.

To monitor the vitals, select the chest in the preferred method either ace interaction or the
medical menu (H) then press “monitor vitals”.

The beeps when the patient is being monitored is the heart rate, obviously the faster the
beat the faster the larger the beats per minute. Normal vitals can be anywhere around HR:
80, RR: 120/80 mmHg, Sp02: 100%. The defibrillator can be accessed like the normal AED.

AID PACK
A packed kit containing all the medical supplies an operator will need, use ace self interact
to unpack and add items to your inventory.

Medic Kit
One full Medic Loadout, in a single package, use ace self-interact to unpack and add items to
your inventory.

CASUALTY COLLECTION POINT

A deployable, that sets up a medical facility in the field, including an IED, and supplies

CHEST SEAL
Chest Seal is used to treat pneumothorax, it is engineered to treat, seal and reseal open
chest wounds under certain circumstances.

GUEDEL TUBE
The Guedel Tube is an airway securing tube, this tube lifts the tongue up so that the route
of the airway is not blocked unless there are other problems like vomit and blood. It has no
suction capabilities.

KING LT
The King LT is a multipurpose airway aspiration protection and securing tube. It stops
vomit going into the airways. It has no suction capabilities.

PERSONAL AID KITS

The Personal Aid Kit is a one hit Jesus level wonder of modern medicine that instantly
restores the user to full health in every way. This glorious and remarkable achievement can
only be performed in a medical facility or Medical Vehicle and on a stable Patient.

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PULSE OXIMETER
The Pulse Oximeter is similar to the AED X-Series, however it does not have a defibrillator
function and does not monitor blood pressure. To use it you must select either arm then
press “use pulse oximeter”.

SALINE PLASMA AND BLOOD

All three restore the volume of liquid in the bloodstream. As a result blood pressure is
raised for all of them.

Only Saline can be carried in the field, Plasma and Blood need refrigeration.

STETHOSCOPE
Facilitates the diagnosis of patient (speeds it up)

DRUGS______________________________________________________
Autoinjector
Morphine
● relieves pain, but also lowers Blood Pressure and Heart Rate. If you use more than
one stick every 10 minutes, you may overdose yourself and pass out. Please be
weary of this. Typically Medical personnel will be the only ones administering
morphine.

Epinephrine (Epi)
● Epinephrine has low risk of application and while it only increases the success
chance of a patient by 5 points, it offers other benefits as it stacks over time,
increasing its effectiveness as the cardiac cycle goes on. Epinephrine is also the only
drug that can be used to increase the success chance of a patient in non-shockable
cardiac arrest.

Adenosine
● lowers the heart rate, this is used to counter the effects of too much Epi. You will
rarely use this, so we advise you to take three sticks at most.

ATNAA (Antidote Treatment Nerve Agent Autoinjector)

● It’s Atropine in an autoinjector, to be used in the event of contact with a nerve agent.

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Medications
Naloxone(NARCAN)
● Naloxone is primarily used to combat morphine overdoses through the simple
elimination of morphine from a player’s medication array. This is done one at a time
so if someone has two morphines in their array, it would take two Naloxone nasal
sprays to fully eliminate morphine from the player’s system. Note that any pain that
is being suppressed by the morphines will return once said morphines are removed.

Amiodarone
● Amiodarone’s primary function is to increase the success chance of a patient under
shockable cardiac arrest. When compared to the other antiarrhythmics in Pharmacy,
it is the most effective and can give a 20 point increase to a patient’s wakeup chance,
however there is a downside to this as Amiodarone has a 1-in-3 chance of giving the
patient bradycardia, which can decrease the standing heart rate by 15-20 points.
Considering this, it is not recommended to give more than a single Amiodarone dose
to a patient.

Lidocaine
● Lidocaine increases the success chance of a patient in shockable cardiac arrest with
less risk of bradycardia when compared to Amiodarone and in turn gives less of a
boost to said success chance, standing at around 10-12 point increase. When
Amiodarone fails to resuscitate a patient on the first try, Lidocaine should be the
second drug a medic reaches for.

Atropine
● Atropine may not be able to treat nerve agents (yet) but it is able to treat
bradycardia created by Amiodarone and Lidocaine. Currently this medication acts
like Naloxone where it simply locates the bradycardia effect in the player’s medical
array and removes it, however this will become more involved over time.

TXA(Tranexamic Acid)
● Used primarily for patients who have experienced severe hemorrhaging and
trauma, it is recommended by the TCCC to be used on individuals who will need
significant blood transfusions in the near future. TXA should be administered as
quickly as possible as it will clot open wounds and assist medics in the bandaging
process. Currently this medication has no contraindications and is recommended for
all unconscious patients regardless of status.

Ondansetron(Zofran)
● It is recommended by the TCCC to be used to counter the vomiting that can come
with the administration of certain pain management medications. Ondansetron will
prevent a patient from vomiting and should be used if an airway cannot be properly
established. Be advised that it will not clear any vomit currently present in the
patient, just prevent additional vomit from being generated.

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Norepinephrine
● The first-line drug used in cases of septic shock, Norepinephrine is a vasopressor
which acts on both the Alpha-1 and Beta-1/2 receptors to help with
vasoconstriction and increasing cardiac output and in turn, increasing overall blood
pressure. Norepinephrine will quickly increase blood pressure by 15% in a patient
and will stay in a patient’s system for two minutes before clearing.

Phenylephrine
● While Norepinephrine acts on both Alpha and Beta receptors, Phenylephrine is pure
Alpha, focusing specifically on vasoconstriction which means its more effective at
actually increasing blood pressure compared to Norepinephrine and will do so by
30%. However, the downside with this drug is that the pure alpha focus causes
reflexive bradycardia in a patient meaning that while blood pressure may increase,
pulse will simultaneously fall by 5-15 points while Phenylephrine is in the patient’s
system.

Nitroglycerin(Nitro)
● While Phenylephrine and Norepinephrine are focused on vasoconstriction,
Nitroglycerin is instead focused on vasodilation which dilate a patient’s blood
vessels and decrease their blood pressure by 15%

OTHER
Painkillers
● Painkillers can be found within the "Magazines" section of the arsenal, they have ten
uses each and can be used to treat mild pain without the undesired effects of
Morphine.

Ammonium Carbonate
● ACE Medical has a nasty tendency of knocking people out for remarkably minor
wounds. Rather than rely on the wakeup chance with Epinephrine, Ammonium
Carbonate goes right to the wakeup script and will wake players up as long as they
are within the stable vital threshold. It is found within the “Magazines” section.

REVIVE SYSTEM___________________________________________
The revive system lets you bring downed units back up. Upon receiving a deadly amount of
damage a unit will fall unconscious. In that time a medic will need to treat them to bring
them back up.

Death And Unconscious

Unconsciousness happens when one of the following is met :
● Pain threshold is reached

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● Low Blood pressure

● Cardiac Arrest.
● Oxygen saturation below 70%

Someone can not recover from unconsciousness till the underlying factor has been resolved

Death happens if one of the following happens.

● Nonexistent: 0 - 20 systolic.
● Oxygen saturation below 5%
● The Cardiac Arrest timer runs out, the base timer is 300 seconds (5 minutes) , this
can be extended to a max of 3600 seconds (60 minutes) with CPR each usage will
extend the timer by 120 seconds.

BLEEDING__________________________________________________
The priority in combat medicine is always to keep the blood inside the body. Bleeding control and
management is more important than anything else because without it all other efforts will be
wasted.

INJURY TYPE
Each limb on the body can receive different types of injury. Each injury has a different level of pain
and bleeding that it will inflict. Each injury type also has a set of treatment procedures that are best
suited for it - these will be laid out in the subsequent chapter about rendering aid.

ABRASIONS
An Abrasion is a wound caused by friction. Examples include Vehicle Crashes and Rope Burn.
This wound type has a low pain effect and an extremely slow bleed rate.

AVULSIONS
An Avulsion is when an entire structure is separated from the body. Examples include lost teeth or
an ear lobe. These are caused by explosions, shrapnel and any other situation which could sever a
body part.
Avulsions have an extremely high pain effect with an extremely fast bleed
rate.

CONTUSIONS
Contusions, commonly known as Bruises are caused by trauma that injures an internal structure
without breaking the skin. Blunt blows to areas such as the chest or head can cause contusions.

LACERATIONS
Lacerations are wounds with ragged edges. They are produced by large forces exerted on the body.
Lacerations have a slight pain effect with a slow bleed rate.

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VELOCITY WOUND
A Velocity wound is caused by objects entering the body at speed, such as shrapnel or bullets.
Velocity wounds have an extremely high pain effect with a medium bleed rate.

PUNCTURE WOUNDS
A puncture wound is a narrow wound produced by a sharp object such as a knife.
Puncture wounds have a slight pain effect with a slow
bleed rate.

BANDAGES
ACE provides four different types of bandages - each with a different level of effectiveness on a
given wound type.

Efficiency: Bandage efficiency, higher is better.

Reopening chance: Reopening chance when advanced wounds are enabled, lower is better.

TOURNIQUETS
Tourniquets are pressure devices used to prevent blood flowing into a limb. Due to the
nature of the device, they are highly effective at bleeding reduction in the limbs stopping
bleeding entirely.
The downside of tourniquets is that they put the patient in a lot of pain if they are left on
too long - sometimes to the point of rendering the patient unconscious. In addition any
drugs or or fluids put into a tourniqueted limb will not work as they will not flow into the
body.

SURGICAL KITS
Surgical Kits allow the bearer to sew wounds closed to prevent them from reopening.

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SPLINTS
Are used to fix damaged (broken) arms and legs.

BREATHING________________________________________________
Breathing is the second most important thing, if the blood is not carrying oxygen this service has no
purpose.

CHECK AIRWAYS
To check the patient’s airways you must open the medical menu and select the head, here we get an
option to “check airways” in the section of “examine patient” .

In this case the patient needs no airway management so the normal treatment procedures can be
followed. In the case where airway management is needed it will say “airway management needed”.

AIRWAY MANAGEMENT
is the process of ensuring that:
● there is an open pathway between a patient’s lungs and the outside world, and
● the lungs are able to aspirate

HEAD TURNING
In the case of an occluded airway (symptoms of puking) you must either use an Accuvac or use the
Head Turning treatment. The Head Turning has a smaller chance of success (35%) compared to the
Accuvacs 100%.

HYPEREXTENDING HEAD
In the case of a collapsed airway/lung you should use a NPA (King LT or Guedel Tube) however if
you are lacking any of the tubes you should overstretch the head. This treatment, if successful, will
increase the blood oxygen saturation (SPO2)

BLOOD OXYGEN SATURATION

Blood Oxygen Saturation is measured in SP02 values, they signify from a 100 to 0 from the patients’
values.
If the airway is secured either by overstretching the head or insertion of a NPA the value of the
blood oxygen saturation should increase.

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If the saturation is lower than 90% then the patient will be unconscious.
The moment the saturation hits 10% the patient will die.

XYZ-Thorax

PNEUMOTHORAX
Pneumothorax is a medical event where the lung is damaged and leaks air into the chest
cavity damaging lungs over a prolonged time.

In order to treat Pneumothorax medics will have an option to use a chest seal under the
chest section in the ace medical menu. It can be spotted by seeing the blood oxygen
saturation levels dropping quickly, it is also worth noting that using an NPA on a patient
will not work if Pneumothorax is diagnosed (this is how you can tell if a patient has it).

TENSION PNEUMOTHORAX
A tension pneumothorax is a life-threatening condition that develops when air is trapped in
the pleural cavity under positive pressure, displacing mediastinal structures and
compromising cardiopulmonary function.

In order to treat tension pneumothorax medics will have an option to use an AAT Kit under
the chest section in the ace medical menu.

Hemothorax
The accumulation of blood in the pleural cavity (the space between the lungs and the walls
of the chest)

In order to treat a Hemothorax medics will have an option to use an AAT Kit under the
chest section in the ace medical menu.

BEATING___________________________________________________
_

VITALS
BLOOD PRESSURE
Your blood pressure is recorded as two numbers:
Systolic blood pressure (the first number)
Diastolic blood pressure (the second number)

Blood pressure is affected by the amount of blood lost as well as IVs and medication.
● Nonexistent: 0 - 20 systolic.
● Low: 20 - 100 systolic.

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● Normal: 100 - 160 systolic.

● High: 160 and above systolic.

HEART RATE
The heart rate (pulse) is affected by the amount of blood lost and medications.
● Low: 45 and below
● Normal: between 46 and 119
● High: 120 and above

CARDIAC ARREST
A patient will enter cardiac arrest when:
● The heart rate is below 20.
● The heart rate is above 200.
● The systolic blood pressure is above 260.
● The diastolic blood pressure is below 40 and the heart rate is above 190.
● The systolic blood pressure is above 145 and the heart rate is above 150.

TREATMENTS
IVS
ACE provides two types of intravenous bags that can be administered to patients. All IVs
are used to help restore blood volume.

The first type is Saline which is used to rapidly provide blood volume to a patient. Saline is
a double-edged sword as it reduces blood clotting meaning that bleeding can be intensified
by overuse of saline IVs. It is useful for restoring patients who have lost a little blood or
stabilizing patients who are suffering from cardiac failure due to low blood pressure until
MEDEVAC arrives.

The second type of IV is a blood/plasma transfusion. Blood/ plasma transfusions restore

blood volume and are used in cases of heavy blood loss.

Medics should not carry blood or plasma in the field.

Blood and plasma require special storage conditions
which limit them to only being kept in medical vehicles or facilities.

IV Transfusions
The movement of fluids such as saline, blood, and plasma into the body are now
determined by a flow rate variable. This variable changes based on the size of established
IVs and IOs, which smallest to largest are 20g IV, 16g IV, and 45mm IO. This variable also
changes based on the heart rate of a patient as lower heart rates will mean a slower intake
of fluids and in cardiac arrest, will stop entirely. Be aware establishing an IV or IO into a
conscious patient will inflict pain the 16g IV causes medium pain while the Fast IO will
cause severe pain, if the patient is already in pain but still conscious a Fast IO will push
them past the pain thresholds and they will pass out.

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However, this only applies to the 20g and 16g IV, meaning that the flow rate of the 45mm
IO is not dependent on heart rate and can be used to still push fluids into a body while in
cardiac arrest. (This decision is based on gameplay considerations as to give players a
reason to pick different sized IVs and IOs. Very subject to change in the near future).

BLOOD TYPES
Blood types are determined by the presence or absence of certain antigens – substances
that can trigger an immune response if they are foreign to the body. Since some antigens
can trigger a patient's immune system to attack the transfused blood, safe blood
transfusions depend on careful blood typing and cross-matching.

O AB B A

B
Patient
Blood Type
AB

PROVIDING AID TO A PATIENT

There is no Medicine in a firefight.
You should not attempt to render aid to a casualty until the friendly force has obtained fire
superiority.
Failure to ensure that the friendly force hold fire superiority can lead to a multiplication of
casualties as first responders become injured.

CARE UNDER FIRE

Care under Fire is the actions undertaken by the squadmates of the injured personnel when
a casualty is first injured. This phase revolves solely around bleeding control.

TRIAGE
Triage will be performed at all levels. Traditional categories of triage are immediate,
delayed, minimal, and expectant. To easily remember the order of the categories, use the

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acronym IDME. No significant treatment should occur in the triage area. Casualties should
be rapidly sent to the appropriate treatment area for care.

TIMERS
Revive Timer:600 seconds
Breathing timer: 300 seconds

PRIORITY
In general, the treatment priority is as follows (from most-urgent to least-urgent):

IMMEDIATE
● Bleeding and unconscious. These soldiers may bleed to death if not treated. The
soldier administering the treatment may even often call for help in bandaging the
patient, to make sure that the bleeding stops before the patient bleeds out.
● Life-threatening Bleeding. A conscious but bleeding soldier could pass out or die if
not treated. Therefore, anyone bleeding severely is a high priority for treatment.
● Not breathing. A soldier has 300 seconds before death if not breathing,

DELAYED
● Unconscious but not bleeding. Unconsciousness is somewhat dangerous in and of
itself and needs to be treated with some haste. Death from unconsciousness,
however, is rarer. Furthermore, once the unconscious soldier is revived, he may be
able to provide cover for the medic during the rest of the treatment.
● Severe Pain. A soldier in severe pain may pass out, requiring more treatment.
Therefore, it may be necessary to administer Morphine to them before that can
happen.

MINIMAL
● Minor Bleeding. Minor bleeding can worsen over time and even lead to
unconsciousness and death, but it is not immediately life-threatening. Soldiers with
minor bleeding may even be able to treat themselves.
● Crippled Legs. Soldiers with crippled legs have a bare minimum of mobility.
Leaving them in this state could cause them to fall behind if the unit needs to leave
the area, and should be treated sooner rather than later.
● Crippled Arms. Soldiers with crippled arms are not very combat effective.
Treatment of this injury will restore one soldier - and his gun - back to effectiveness.
● Mild Pain. Mild pain in itself is not life-threatening and reduces a soldier's
effectiveness only mildly. Furthermore, Morphine is in short supply, and medics

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may choose not to treat Mild Pain at all in order to conserve it for more serious
cases.

EXPECTANT
● Multiple bleeding wounds, not breathing, cardiac arrest

If there are more than one wounded, treating the Expectant may cause the death of other
wounded, a decision to not treat may be necessary.

Cardiac Arrest System

The cardiac arrest system now has two classifications of arrest rhythms, shockable
(VF/PVT) and non-shockable (Asystole). As the names suggest, shockable rhythms can be
treated with either the AED or AED-X while the non-shockable rhythms can only be treated
through manual CPR. Shockable rhythms can also be treated with Epinephrine, Lidocaine,
and Amiodarone while non-shockable rhythms can only be treated with Epinephrine.

The determination for which rhythm a patient will fall into is made on the first CPR or
Analyze Rhythm action performed on a patient. If at the time a patient has lost a fatal
amount of blood, then they are almost guaranteed to fall into asystole and if they have
more than that, then they will fall into VF/PVT. While this may seem gamey, it is done with
the intention to emphasize quick recognition and response to cardiac arrest. Patients who
are put into the cardiac arrest algorithm the quickest will be the easiest for medics to treat
and the first ones to get back in the fight.

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 MEDICAL SOP

Once cardiac arrest has been entered, the first priority is attaching a defibrillator to
determine if the patient’s rhythm is shockable or not. Depending on what you are told, it
breaks down into two patterns, the VF/PVT and Asystole patterns. VF/PVT is based on the
use of AEDs to deliver shocks to the patient and administer our three main
antiarrhythmics. If at any time a return of spontaneous circulation is achieved, the pattern
stops and we move into post-arrest care. Note that currently VF/PVT cannot devolve into
Asystole so if a patient is in VF/PVF, they are staying there until they are out of cardiac
arrest.
Also be advised even if CPR succeeds, failure to get a patient into the “Lost a Large Amount
of Blood” category will trigger another asystole check and will push the patient back into
asystole.
Medics should also remember that if no defibrillation equipment is available, they should
treat all cardiac arrest cases as if they are in Asystole as while the VF/PVT pattern and the
medications Lidocaine and Amiodarone only work for shockable rhythms, the Asystole
pattern works for all rhythms.

PROCESS___________________________________________________
_
STEP 1: IS THE PATIENT RESPONSIVE?
Yes: Ask him if he has wounds / he is in pain. | No: Go to step 2.

STEP 2: IS THE PATIENT BLEEDING?

Yes: Treat the wounds and go to step 3. | No: Skip this step.

STEP 3: IS THE PATIENT BREATHING?

Yes: Go to step 4. | No: Clear the airway

STEP 4: IS THE BLOOD OXYGEN SATURATION GOOD?

Yes: Go to step 5. | No: check for a Pneumothorax and treat if needed

STEP 5: DOES THE PATIENT HAVE A PULSE?

Yes: Go to step 6. | No: Perform CPR, or use an AED (do not touch the Patient when using
the AED)

STEP 6: DID THE PATIENT LOSE A LOT OF BLOOD?

Yes: Give fluids. | No: Go to step 7.

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STEP 7: IS THE PATIENT IN PAIN?

Yes and stable pulse: Give him morphine. | No: Go to step 8.
Yes and unstable heart rate: Stabilize the heart rate before administering morphine.

STEP 8: IS THE PATIENT AWAKE NOW?

Yes: You’re done. | No: Go to Step 1.

MEDIVAC___________________________________________________
The important steps to make sure this procedure is handled correctly are:

Important: no matter what the situation on the ground the radio operator should
remain calm and collected at all costs. Personnel calling in a MEDEVAC while in a
state of panic may relay incorrect information or speak in a manner that is
incomprehensible over the radio. Remember, responding units will not come any
faster if the RTO is calling the 5Liner in an excitable manner.

LINE USAGE NOTES

Line One Location of the pick-up point. Grid/marker of pick up point

Line Two Radio Frequency, Call sign

Line Three Number of Patients:

A Urgent

B Priority

C Routine

Line Four Security at pickup point:

N No enemy troops in area

P Approach with caution

X Armed escort required

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 MEDICAL SOP

Line Five Marking of PUP/LZ A - IR/Thermal/Strobe

B - Coloured Smoke
C - None
D - VS Panel

FAQ__________________________________________________________
What do SpO2 change values mean?
There are two SpO2 change values - Small and Big. SpO2 value can decrease from multiple
reasons (0 HR, Obstruction/Occlusion, XYZthoraxes and their combinations). There is also
time included, so before 100 seconds, SpO2 change will be "Small" unless you combine
multiple complications(2 and more) - that will become "Big". If nothing combines, after
some time, it will change to "Big". Current default values are 30 for "small "value and 66 for
"big" value - it can be changed in add-on settings.

What is the difference between obstruction and occlusion, and how do they happen?
Obstruction happens due to a loss of airway reflexes. A real world example is the tongue
falling back and blocking the airway. Occlusion is a foreign body (such as emesis, blood, a
crayon etc.).
In this mod, obstruction can happen only when the unit goes unconscious. However
occlusion can happen when the unit is unconscious and chance for that is calculated every
60 seconds. They both decrease SpO2 value. In order to remove obstruction, you either
need to use Guedel tube/KingLT/Accuvac or if you don't have such tools, you can resort to
hyper-extending head of the patient which will mitigate the effect of obstruction, but you
need to stay close to the patient until he awakes(Awakening will result to removing the
obstruction). Occlusion can be removed by using KingLT/Accuvac or you can try head
turning and according to the chance set in add-on options, it will successfully remove
occlusion or it won't. Chances for both obstruction and occlusion can be changed in add-on
settings.

What is the difference between Guedel Tube and KingLT?

A6: Guedel tube after insertion will only prevent obstructions from happening. Patients
with Guedel tubes still can get occlusions. KingLT will prevent both obstructions and
occlusions from happening thus "permanently" securing the airway.

How do I use painkillers?

Because of the ArmA limitations, painkillers that you should use are located in the
magazine category. From there, you can grab them and use them both via ace interaction
on your head, or medical menu. You can use each package 10x.

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 MEDICAL SOP

What are the differences between pneumothorax, tension pneumothorax and

hemothorax, and how do they happen and treat them?
Pneumothorax can happen from extended damage to the character. Once the damage
threshold is crossed, chance for pneumothorax is calculated(You can adjust the chance and
threshold in add-on settings). Currently if a unit has pneumothorax and is unconscious, his
SpO2 value will drop pretty fast. Hemothorax is the state in which the chest cavity is filled
with fluid(mostly blood and so on). Tension pneumothorax is like hemothorax, but the
chest cavity is filled with gas, rather than fluid. In order to treat pneumothorax, you only
have to apply a Chest seal to the torso. In order to treat hemothorax, you will need to apply
Chest seal first and then use AAT Kit and then use that will drain fluids. To treat tension
pneumothorax, you only need AAT Kit to perform needle decompression.

Pulse-oximeter, AED and AED-X - what are the differences and how do they work?
Pulse oximeter is a very simple device that you can put on patient arms(IRL fingers) and it
can monitor HR(Heart Rate) and SpO2. That is all that it does. AED (Automated External
Defibrillator) can be used on a patient's torso and give him a "shock" in order to give him
HR. We know that this is not a realistic approach, but rather "gameplay mechanics” so stay
calm and enjoy the game. Other than giving a "shock", AED cannot do anything else. AED-X
is a better version of AED and it does what AED does + it can monitor HR, SpO2 and
BP(Blood pressure). You can connect it to the patient and it will make a beeping
sound(which you can turn off via ace interaction). It will be connected to that patient, so if
he moves away too far from the medic, it will get disconnected. For both AED and AED-X,
there are success chances which can be set in addon settings.

How blood groups work in KAT and how do I use an IV stand?

Each unit can choose its own blood group in add-on settings if it is not forced from mission
or server. If it is not forced by mission or server setting and the player did not choose his
blood group, blood groups will be assigned randomly. You can check the blood group by
checking the dog-tag. In KAT, there are no Rh factors for blood groups, but apart from that,
it will work fairly the same as in real life. There is also a blood group cheat-sheet if you are
unsure which blood group is compatible. If you give someone the wrong blood group, you
can kill him. In order to counter it, you will have to use painkillers(Tylenol). Currently
blood cannot be hung to IV stands - only the saline bags can.

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