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  • Advanced Wounds Guide


    Gditz

    "Help! I've been shot!" -  Advanced Wounds 101

    MedicalSymbol.png.bec5826b5be8cdfa0dd8e68dadd2610a.png

    The goal of this guide is to replace the outdated medical guides we have and act as a complement to the CSAR guide we currently have. One thing I noticed from my many missions and talks with people is that the Advanced Medical system with wound reopening and what bandages are "best" often vary from person to person. While most of the things I've heard are true to most extents, they often ignore other aspects of the system leading to flawed treatment strategies. The most common one being that Elastic bandages are the best thing for non-medical personnel. Once you've reached the end of this post and read all of the points I hope you will have learned something new.

    Table of Contents

    • Enabling the Medical Menu
    • Using the Medical Menu
    • Wound Types
    • Bandage properties
      • Efficiency
      • Reopening Chance
      • Time Until Wound Reopens
    • Bandage Examples
    • Playable Roles
      • Non-Medical Personnel
        • Medical Gear
        • Treatment strategy
      • Medic
        • Medical Gear
        • Treatment strategy
      • Battlefield Triage Personnel
        • Medical Gear
        • Treatment strategy
      • Combat Search And Rescue Doctor
        • Medical Gear
        • Treatment Stratergy
    • Concluding Remarks
    • Sources and Reference Material

    Enabling The Medical Menu

    Using The Medical Menu

     

    Wound Types

    Before we begin talking about bandages or applying medical treatment in general, we need to mention why they are used. In Arma, all units can receive injuries. Depending on the source of injury a unit takes, they will receive different types of wounds [1]. Wounds will also have a different size depending on their severity. Minor, Medium and Large are the three sizes. Each type of bandage will react differently to each type of wound and also the size of the wound [2]. Some wounds are however not as common as others which means that ones goal should be to have the best treatment available for them. The two most common are Avulsions and Velocity wounds, responsible for around 66% of all combat injuries [3]. The full table of different wounds, their sources and effects can be seen below:

    WoundTypes.thumb.PNG.ba622fa72fafe943c25c01db7fe4b37e.PNG

    Bandage Properties

    The best way to treat a wound is to apply a bandage. When choosing bandages there are 3 main attributes to take into consideration. We will go through all of these and rank all the different bandages in regards to each attribute. The exact properties of each bandage when used on different wounds can be seen below. Reopening chance is given as a value from 0 to 1, where 0 is 0% and 1 is 100% chance of the wound reopening. The MinDelay and MaxDelay values are given in seconds.

    BandageMatrix.thumb.PNG.7f9f92036d1a83c6bfeeb3ae096c5b60.PNG

    Efficiency

    Pretty straightforward, the higher efficiency value a bandage has the more it can cover and treat a wound. A large wound might need 2 or 3 bandages that have low efficiency or it can be closed with a single bandage with high efficiency. For treating Avulsions and Velocity wounds the best you can use is an Elastic bandage, Field dressing and Packing bandage are tied for 2nd place and QuikClot is the least effective.

    Reopening Chance

    Once a wound has been closed, it will have a chance to reopen. How big this chance is depends on the different bandages and what wounds they have been applied to. For keeping Avulsions and Velocity wounds closed, the best you can use is a QuikClot, Field dressing is 2nd and Packing bandage and Elastic bandage are equally awful. In fact, Packing and Elastic have a 100% chance of the wound reopening when it comes to treating any type of Velocity wound.

    Time Until Wound Reopens

    The least known factor is the time each bandage has before it opens. Each treated wound has a minimum time for which the wound will remain closed. If a wound will reopen, it will happen somewhere after the minimum time has passed but before the maximum time. The exact point is randomized but on average it will happen in between the minimum and maximum value. This is not affected by how much player is moving about.

     

    Bandage Examples

    The best way to understand how each bandage works is to read and full comprehend the above tables. This can take a lot of time and still not make that much sense unless you have some example to connect the theory with practice. Below we provide an injury situation for 4 different soldiers in the form of a story. The times are averaged and the chances for wound reopening are also averaged. This is only an example.

    Gditz and his 4 squad mates, Abraham, Ben, Caroline and Diane are out on patrol when they all get shot from an enemy MMG. All of Gditz's friends now have one Large Velocity wound each. They don't have a medic with them but luckily they all have their own bandages with them. 

    1. Abraham patches up his leg using only Elastic bandages. While he only needs a single bandage to treat the wound, every 80 to 200 seconds his wound reopens and he has to use another bandage. After around 7 minutes Abraham is out of bandages and after 2 more minutes his wound is now open and bleeding.
    2. Ben proceeds to use one of his Packing bandages on his bleeding limb. Ben only needs a single bandage to cover his wound but he knows the wound will reopen. The benefit of the packing bandage is that it will take a long time for the wound to reopen. After 1 hour and 10 minutes Ben applies his last packing bandage and will start bleeding in around 23 more minutes.
    3. Caroline looks over her wound and pulls out her Field dressing. She only needs to apply a single bandage to close the wound and hope that the wound doesn't reopen. Unfortunately the first two field dressings open up and after 10 minutes she applies the 3rd bandage. This time the wound stays closed and she has one Field dressing left.
    4. Diane quickly withdraws her QuikClot bandages and begins to dress the wound. The injury is a bit too large and she ends up using 2 bandages in order to close it. After 23 minutes the wound had a chance to reopen but luckily it stayed closed. Diane has 2 QuikClots left and continues on her mission.

    Since we all have different roles and mission types it is difficult to make a guide that will give you the best loadouts and strategies for all situations but I will describe a few roles and provide a detailed list of what medical gear you should bring. These roles, their gear and treatment strategies are listed below.

     

    Playable Roles

    Non-Medical Personnel

    The medical gear you are allowed to bring is limited and thus a lot easier to remember and manage. The only thing that you can adjust is the overall bandage mix you bring with you. Since most people are in a squad that features a medic, they rarely actually need to use their bandages. If they do use them they can often get a re-fill from their medic later or scavenge more from fallen EI or friendlies. What is most important in my mind is for all members of a squad to have good medical equipment that means they can extend their combat effectiveness long enough for another squad's medic to arrive or for a CSAR team to make contact.

    Medical Gear

    NMP.png.7b840bc390f914c698d22fea49174ec9.png

    Total weight - 0.32 kgs

    Treatment strategy

    Before you treat any of your wounds or those of your comrades, you need to make sure that the AO is safe. This does not mean safe in the sense that all EI are dead and objectives cleared but instead means that your treatment doesn't put anyone else at a higher risk. Just imagine how frustrating it would be if an enemy creeps up from a flank you thought a teammate was covering. So while your friend patches their wound you get lit up by a 7.62mm burst and you get killed. A small wound has now indirectly resulted in a causality because someone panicked and failed to provide cover.

    So always keep a cool head and don't immediately go for your bandages. A quick check of your wounds through the medical menu is always a good idea. This means you know how many wounds you have and how much you are bleeding. A few seconds of light bleeding is not gonna kill you but if all of your bodyparts are pouring blood you need to inform your medic before you pass out. If a friend is down and injured you call it out, clear the AO and then proceed to help them, not before.

    Once you are treating yourself or someone else, always cut of the bleeding from any limbs by toruniqeting the wounded bodypart first.

    • If the wound is an Avulsion, use your QuikClots bandages. For this wound type they are really good because once the wound has been closed, it only has a 20% chance to reopen. If the wound does reopen, it will do so between 16m40s to a maximum of 26m40s.
    • If the wound is a Velocity wound, use your Packing bandages. Although the wound has a 100% chance to reopen, it will not reopen until at least 13m20s has passed and may stay closed for a maximum of 33m20s.

    Both of these bandages types ensure you have plenty of time to get it stitched up before then. If you are treating other types of wounds you are to first use your packing bandages and then use the QuikClots if you run out before the wound is closed.

    Once the wounds are closed, remove the tourniquet and use the morphine followed up by an epinephrine if the patient is in a fair amount pain. The morphine will remove the pain and lower the heart rate. This produce a loud thumping noise in your ears which the epinephrine counteracts by raising your heart rate. Small amounts of pain are not a good enough reason to apply a morphine.

     

    Medic

    As a medic, you have no limits on the amount of medical equipment you may bring beyond your physical carry capacity. You are expected to bring enough stuff to be able to treat all of your patients and also to be able to resupply your squad while still having enough gear to be combat effective. This means you will need equipment that fit your treatment strategies but also items that fulfill the needs of your squadmates (Non-medical personnel) and enough magazines and smokes to fight the enemy. Do note that this gear list is more flexible and should be adjusted for the size of your squad, how far away friendly backup is going to be and how you will be traveling. Bigger squads means more potential patients and you should increase the amounts of bandages and autoinjector drugs. If you will be hoofing it on foot for longer distance you should consider bringing less bandages and blood in order to reduce your overall weight. You will also need to bring a Surgical Kit to stitch up wounds and a Personal Aid Kit to fix broken limbs.

    Medical Gear

    Medic.png.2ddcdad47c2016cbccbe6c6b39c8505b.png

    Total weight - 7.26 kgs

    Treatment strategy

    With great gear comes great responsibility. Similar to how all non-medical personnel operates when it comes to securing the immediate area, a medic has to make sure that leaving their position to tend to a patient does not bring any other squadmates at higher risk of injury. It's extremely bad and inefficient if a medic through his or her actions manages to indirectly cause more harm than they seek to prevent. This means you don't automatically sprint towards any friends that get downed the second it happens. Instead your job is to stay safe and once the current battle is over, proceed to treat the wounded. Many people fail at this and simply rush into fire in an attempt to save a downed comrade just to be met with a shiny bullet to the head. Congratulations, you died and now your squad has no medically competent personnel. So, always keep yourself and your squad safe by fending of enemies first and treating the wounded second. Remember, you are first and foremost a riflemen, a medic second.

    Once the smoke clears and most enemies have been dealt with, assess the current health situation of your squad. Usually your squad will keep you updated with their injuries or who has fallen but sometimes in the confusion of battle someone might be forgotten. A radio check is always a good idea after heavy engagements to make sure everyone is still up or if anyone needs immediate attention. Once you have a good understanding of the current status of your squad, it is time to triage. In general, people who are still unconscious should be prioritized ahead of those who are conscious. If any conscious person is really badly injured they should have informed you and then you still want to make sure no unconscious person is worse off.

    So you've got several patients, some really bad and some with only a few scratches. You need to work quickly to make sure no one dies. 

    1. Tourniquet all bleeding limbs.
    2. If the patient is low on blood, select a limb and apply a blood IV.
    3. Next, start patching up the head or torso, starting with the one body part that is most severely injured. Use Elastic Bandages to close the wounds.
    4. Once the head and torso are no longer bleeding, start working on any injured limbs. Use Elastic Bandages to close the wounds.
    5. Once all wounds are closed, use a surgical kit to permanently close all the wounds.
    6. Remove all tourniquets.
    7. Apply Morphine and Epinephrine if the patient is in great pain.
    8. Use a Personal Aid Kit to fix any broken limbs. This would also restore any blood loss on a player but it is really slow. Should only be used to fix broken limbs.
    9. If the patient dies while treating or is found dead, take their dog tag and then place them in a bodybag. This is only to be done if all other living patients have been tended to first.

    The reason why a medic should only use Elastic Bandages is that they are the most effective at closing wounds. They will not stay closed for long in most cases but you should be able to patch the wounds and then stitch them before they have time to reopen. Another thing to take note of is that some situations will require you to treat multiple patients at the same time to make sure no one dies. This usually means you do step 1 and 2 on all patients in order to slow their bleeding and buy yourself time to patch up one of them at a time starting with the patient who is in the most critical condition. You cannot afford to get tunnel vision and solely focus on a single patient, this is how people end up dying out of neglect.

    Another item of note is that while your SL has command over you, they should not interfere with the order in which you treat patients. They technically have the authority to make you leave a dying patient to go patch up their paper-cut but any SL worth their salt will not do this. Instead, keep good communication with your SL and tell them how much time you need to treat your patients. This makes both your lives easier.

     

    Battlefield Triage Personnel

    As Battlefield Triage Personnel, or BTP for short, you have one of the most intensive and demanding jobs one can have when it comes to medical roles. Your main function, when you are not engaging enemies, is to keep all your squadmembers alive by applying the correct bandages for specific wounds and to keep a constant check on the amount of injuries your squad has sustained on an individual basis. The overall combat effectiveness of your squad needs to be structured according to the Medevac SOPs [4] and then communicated to your SL so they can call in for a CSAR team when they deem it necessary. As if this wasn't troubling enough you also have huge limitations on what gear you can bring. You are not allowed to bring Surgical kits, Personal Aid Kits or Blood IV bags. This is the role for those who want to push their skills to the limits in order to stand out from the crowd of average medical personnel.

    Medical Gear

    BTP.png.588edc55da473c29eb9b5ca3a1820330.png

    Total weight - 7.03 kgs

    Treatment strategy

    Similar to how paramedics are the vital connector from site of injury to the hospital ER, BTP act as a life extension for their squad. In general, the longer a squad is deployed the more wounds the squad will have in total. Each of these wounds will bleed if left untreated and worse yet, they will reopen if treated improperly. Every single wound reopening will require at least an additional round of bandages and more treatment time. This time in turn decreases the overall combat effectiveness of the whole squad. To minimize this a BTP should aim to stabilize patients first and secondly to treat wounds with a focus on keeping wounds closed for long enough that a CSAR team can make contact.

    While you are equipped to tend to injured people, you are a rifleman first. This means you apply force to neuteralize enemy threats before tending to the wounded. Patching up a friendly is of no use if you get overrun and killed in the process. While it's no fun losing a teammate, it is preferable to your squad getting wiped. Priority should be to keep your friends from getting wounds in the first place.

    Unfortunately, shit happens and once the dust settles it's time to bring out your gear. The same process that medics follow is used here with the exclusion of step 5 and 7 since a BTP does not have a Surgical Kit nor a Personal Aid Kit. Step 2 is different in the sense that Saline IV is used instead of Blood IV. Another difference is that each wound needs to be treated in regards of wound type and overall patient status. If a patient has lost a lot of blood and have several wounds on their limbs, torso and head they need to be stabilized quickly. Once all tourniquets are applied and a Saline IV have been given, the wounds on the torso and head need to be closed as soon possible. This means using the most efficient bandage type, Elastic bandages.

    If the patient is no longer bleeding or has not lost a large amount of blood, you should instead focus on making sure you use bandages that minimize the chance of reopening and maximize the delay for the wound to reopen. This means that each wound type has an optimal bandage you should use. Below I have listed each wound type and what bandage you should apply to keep the patient combat effective for as long as possible.

    • Abrasion -> QuikClot Bandage
    • Avulsion -> QuikClot Bandage
    • Velocity wound -> QuikClot Bandage
    • Cut -> QuikClot Bandage
    • Laceration -> QuikClot Bandage
    • Contusion -> Elastic Bandage
    • Crush Wound -> Field Dressing
    • Puncture wound -> Field Dressing

    It should be noted that this strategy will use more bandages during initial treatment but that it will use less in the long run given that wounds are less likely to reopen and need another round of treatment. Another thing to note is that the BTP should not use packing bandages but still carries a few of them in order to resupply his teammates.

    So you've patched up your friends and now have to summarize the total health status of your squad and report it to your SL or 2iC. If you have 1 person with broken limbs and 2 patients who need stitching of their wounds, you tell them you have "One times Cat 2, Two times Cat 3." and let them call it in to the CSAR. If the request is granted, your SL is in charge of keeping the perimeter safe while you have authority to send people to or away from the CSAR vehicle. You stay close to the vehicle and communicate with the CSAR Doctor and tell them how many patients you have and make sure they get treated in order of priority. Should the CSAR only have time to treat a single patient they have to focus on the most critical one. A common problem is that people bunch up and want to stay close to the vehicle when they do not need to. This is dangerous for everyone and you have to tell people to back off. Only patients currently being treated and the BTP should be close to the chopper at any given time.

     

    Combat Search And Rescue Doctor

    The purpose of a Combat Search And Rescue Doctor, or CSAR Doctor for short, is to take care of patients handed to them by the squad BTPs and get them back to full combat effectiveness in a fast manner. CSAR Doctors are backed up by either a helicopter or an armored vehicle to make their movement fast and keep them relatively protected. This means that they are not really encumbered by a having their bags filled with lots of medical gear. They are also expected to treat more patients than a BTP and are recommended to load up their vehicle with extra supplies for themselves and any BTP who need to resupply their medical gear. Note that only the gear carried by the CSAR Doctor is listed so be sure to pack a few medical bags with the BTP gear and load them into the CSAR vehicle.

    Medical Gear

    CSARDoctor.png.bf0e7bc70bd4de594d89590d23ac41fe.png

    Total weight - 10.11 kgs

    Treatment strategy

    Treat patients similar to how a Medic would treat them. Follow the same steps and prioritize the most serious patients first. If the CSAR is without tasking and a queue of Cat 4 patients are waiting, head towards them and pick them up. If they have not been body-bagged do so prior to loading them into the vehicle.
     

    Concluding Remarks

    Some times are given in the XXmYYs format. For example, 10m20s means 10 minutes and 20 seconds. The information in this guide has been partially sourced from practical tests in Arma 3 but also a few other direct sources. Most of the conclusions and data has been compared with the ACE Medical code found on the GitHub [5] to verify that it is correct. If you do find inaccuracies I sincerely encourage you to point them out, link relevant sources and help us all get a better understanding of the medical system. This guide is a living document and will be updated regularly.

    Disclaimer: Note is that these loadouts are my own personnel recommendations for the playstyle I tend to use. I suggest you use them as reference and then build upon them with experience to make loadouts that fit you and your needs for specific roles and missions. 

    Sources and Reference Material

    [1] https://ace3mod.com/wiki/feature/medical-system.html#221-wounds-bandages-and-medications
    [2] https://ace3mod.com/img/wiki/feature/medical1.jpg
    [3] https://docs.google.com/spreadsheets/d/1tUvdGi5WCd5GZ3iesZK1-54xzC50iPg7mPy0hw9yEl4/edit?usp=sharing
    [4] https://www.fuckknows.eu/forums/topic/489-critical-casualty-clearance-a-guide-to-implementing-medevacs-in-arma/
    [5] https://github.com/acemod/ACE3

    Edited by Sarissa




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