Emergency medical care on the battlefield means the difference between getting back in the fight, and dying unnecessarily. Combat medicine begins as soon as a friendly is wounded, and ends when they are 100% back in the fight.
“Eins, zwei, dr- ugh, I do not think ve bought enough body-bags.” —The Medic, Team Fortress 2
The purpose of combat medicine is to ensure that as many casualties as possible stay in the fight rather than ending up in a body bag. In one life missions, saving lives on the battlefield helps maintain combat power by keeping as many people alive as possible. In respawn missions, medical care keeps the mission moving by limiting the time spent waiting for reinfil.
The first stage of combat medicine is care under fire. This phase begins when a friendly is shot, and ends when all immediate threats have been eliminated. When providing care under fire, following the following steps:
Tactical care begins when the immediate threat has been eliminated. There may still be enemies in the area, but nobody is shooting at you anymore. At this stage it is safe to begin treating wounds beyond just tourniqueting limbs. If the patient is conscious, coordinate with them to perform these steps. Follow these steps in order:
Combat life savers have a greater ability to provide combat medicine than anyone else in the squad. However, you are a rifleman first, and a combat life saver second, recognize that your first priority is still to stay alive. If you die trying to be a hero, there are now two dead soldiers, and more coming when people go down without a CLS to keep them in the fight. You have the authority to order other people to assist you with medical care. Use it. As a CLS, you will still follow the steps in Care Under Fire and Tactical Care, but ultimately, you should concentrate on stabilizing wounded.
Medics have the greatest ability to provide care than anyone else in the platoon. Working closely with the platoon leader, you are the main medical care provider, and you have the authority to order other people, CLS's and non CLS's alike, to assist you with medical care. Use it. You will still follow the steps in Care Under Fire and Tactical Care, but do not do CPR yourself. Get someone else to so that you can continue treating patients. Once a patient has been fully bandaged, follow these advanced steps:
-Stabilize blood pressure. If your patient has lost blood, begin administering an IV of blood, plasma, or saline to stabilize their blood pressure.
-Stabilize heart rate. Check your patient’s heart rate. If your patient’s heart rate is below 46 apply epinephrine to increase their heart rate. If it is close to 46, consider giving them epinephrine anyways, since morphine is going to lower it.
-Manage pain. Once the patient’s blood pressure and heart rate are stable, it is safe to give them morphine. Morphine is going to lower their heart rate and blood pressure, and can only be safely given once every ten minutes.
Mass Casualty Incidents
A mass casualty incident, or MASSCAL, is when multiple people are wounded so rapidly that it requires a special coordinated response. Any medic or leader may declare a MASSCAL. Generally a MASSCAL should be declared when enough people are wounded that your squad will be unable to continue mission without rapid medical intervention. As soon as a MASSCAL is declared, the squad medic should take charge and begin coordinate the response. If the medic is one of the casualties, the senior most leader onsite should take charge and request medical assistance from other squads or the command squad. The command squad should immediately shift focus towards assisting with the MASSCAL, with the platoon medic taking charge when they arrive at the site of the MASSCAL. Follow the steps below to respond to a MASSCAL.
- Immediate or red casualties are those with severe injuries who will die without immediate intervention. They are your first priority.
- Delayed or yellow casualties are those who are unconscious or too wounded to fight, but will likely not die immediately, even without care from a medic. After you have stabilized all of your immediate casualties, delayed are next.
- Minor or green casualties are those who have minor wounds that likely need only stitches. These casualties are your lowest concern, and should help with treatment and security.
- Expectant or black casualties are those for whom you can do nothing. If a patient has extreme wounds to all of their limbs and torso and has already lost too much blood, treat them only after you have ensured the survival of your red and yellow casualties first.
- Helicopter exfiltration is the preferred method to exfil. They can get large numbers of troops away from the battlefield quickly, and bring minguns to help cover the extraction. The downside is that they need a relatively large area to land, and are vulnerable during the take-off and landing. - Find an LZ before you request extraction. Anyone with a squad leader radio should be able to get onto the air support net to request a medevac bird. If the JTAC is still alive, have them handle the request.
- Ground vehicle extraction is another viable option to get troops out of harm’s way. The main advantages that ground vehicles provide over helicopters is that they can fit in much tighter spaces to provide evac under fire, and they are likely already nearby. The downside is that they cannot get away as quickly, and are easier to target even while moving at full speed. Once again, anyone with a squad leader radio should be able to contact any ground vehicles nearby.
- On foot. Exfilling on foot is typically the last resort for extraction. If you are extracting on foot, odds are “shit’s fucked yo”. The only pro of extracting on foot is that it is very straightforward. The cons are that you are very slow and very exposed while you are combat ineffective. If you have to exfil on foot, try to get somewhere safe ASAP and holdout for someone to pick you up via truck or helicopter. Be sure someone in your group is monitoring command frequency to help coordinate your rescue. To coordinate an extraction on foot, the first step is to establish some sort organization within your group. If you are extracting on foot, then you probably don’t have a leader and you aren’t in contact with any other groups. First, get somewhere safe. Next, designate a leader and make sure they get on command frequency. Finally, try to follow your planned exfil route. Note: The exfil route is only to get you somewhere safe enough to get picked up by air or truck and taken to an actually safe location.
ACE Medical adds a lot of different medical supplies to the game. This is an overview of what they are, and when to use them. When in doubt, elastic bandages followed by quikclot are your friends.
- Field dressings. Old school cotton pads with ties on either side. Effective bandages with standard reopening rates, but with a long application animation.
- Packing bandages. Rolls of bandages meant to be shoved into wounds. Higher than normal reopening rate, but longer delay between reopening "checks".
- Elastic bandages. Similar to field dressings, but with an elastic band allowing you to cinch it tight quickly. Short animation, with excellent effectiveness against all wounds, but high reopening rates.
- Quikclot. Bandages soaked in a coagulant to help stop bleeding. Not very effective, but they have the lowest reopening rates of any bandages.
- Morphine. Helps manage pain, but also lowers blood pressure and heart rate. Can cause a patient to OD if given too much too quickly.
- Epinephrine. Raises heart rate, and also eliminates the annoying heartbeat sound you get when you take morphine.
Atropine & Adenosine. Lower heart rate. Generally not used since most people are going to need morphine anyways.
Fluids. Blood, saline, and plasma. All three do the same thing: raise blood pressure.
Surgical kit. Allows a medic to suture cuts, ensuring that they will not reopen.
PAK. Personal Aid Kit; allows a medic to completely “reset” a player’s vitals. Currently not used by TCS.