Arma Reforger

Arma Reforger

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Ace Medical Prototype - Standard Procedure
By Nevan Nedall
An in-depth guide to how to stabilize and resuscitate your comrades using the Ace Medical Prototype Mod
   
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Introduction and Basic Summary
So, you wanna save lives. But you don't understand how this new-fangled modded medical system works.
What the hell is Metoprolol, and when should I use it?
Why isn't Epi waking people up like in base game?
All these questions and more will be answered in detail in this guide.

Before we break things down in detail, here are my recommendations for what to bring with you into the field, in order of their importance, in my opinion, and what they do at the most basic level:

Bandages - Stops bleeding. These should be considered these mandatory for all players to carry.
Saline - Replaces lost blood volume.
Ammonium Carbonate - Wakes stable patients up.
Morphine - Relieves Pain, decreases vitals. Avoid giving to unconscious patients.
Epinephrine - Assists in CPR, increases vitals.
Tourniquet - Stops severe bleeding in the limbs.

The above are things I would consider bringing no matter who you are or what your role is. Below are more specialized medication that Medics should carry, but other people may not often need.

Medical Kit - Heals other people's injuries when you have access to supplies, same as base game, and can replenish medications, bandages, and saline. Requires a field hospital or ambulance to heal minor injuries.
Phenylephrine - Slows bleeding.
Metoprolol - Decreases vitals.
Naloxone - Treats morphine overdose.

And here is a quick summary of the steps that should be taken to help somebody:


Now, onto the more detailed explanation.
Triage
Triage is a preliminary assessment of a patient to determine how urgently they require treatment and what treatments are necessary. You use this to prioritize multiple patients, or simply to figure out what is necessary for the one you're handling.

In this mod, triage is relatively simple.
First, before starting, make sure both you and the patient are secure. You're no use to the patient if you get shot in the head in the middle of treating them. You're equally useless as a medic if you pass out from blood loss in the middle of treatment, so deal with your own life threatening injuries before you work on others.

Example of a patient with light bleeding and a Class 1 Hemorrhage.Once you're in relative safety, make note of is the patient's state of consciousness, and if they are unconscious, check for a pulse at their neck or one of their limbs. You can then gather additional information about their current status using Check Injuries to get a summary of what's wrong with them.

Make note of if the patient is bleeding and to what extent, if they have a hemorrhage and of what class, and if they have a pulse. We'll concern ourselves with high or low heart rate and blood pressure later.

Patients with the most severe vitals should be handled first, and you should re-assess the status of your patients as you work.
However, there may be situations in which a patient's injuries are so numerous and/or severe that treatment may not be possible under the circumstances you're in, such as lack of resources or assistance, enemy presence, time and difficulty in stabilizing patient before they die of their injuries, and other such complications. In such cases, other patients may need to be prioritized, and/or the patient in question may need to be considered too far gone to help. It's a judgement call, but generally speaking you should handle the worse off people that you're capable of assisting first, and if circumstances allow.
Vitals
Heart Rate (HR), Blood Pressure (BP), and Hemorrhage class are your patient's vitals. These three values will determine your patient's current status, be it stable, unstable, critical, cardiac arrest, or dead. A patient for whom any of their vitals have entered the critical state will fall unconscious. A patient who remains in cardiac arrest too long or who's hemorrhage becomes too excessive will die.

Heart Rate is measured in beats per minute (BPM)
  • The stable range for heart rate is between 40 and 220 BPM
  • A heart rate above 220 will lead to cardiac arrest.
  • A heartrate below 40 is considered unstable.
  • Below 30 is critical.
  • Below 20 will lead to cardiac arrest.
A HR outside of stable can be addressed with medications, which will be covered later, or CPR. For now, just worry about it not being 0.

Blood Pressure is measured in two values put together.
  • The stable range for BP is between 69/46 and 284/189
  • A BP higher than 284/189 will lead to cardiac arrest.
  • < 69/46 is unstable
  • < 51/34 is critical.
If your patients HR and BP both enter critical ranges, it will lead to cardiac arrest.
A BP outside of stable can be addressed with medications.

Hemorrhage classes summarize the amount of blood your patient has lost.
  • Hemorrhage Class I means your patient has lost < 30% of their blood volume, and is considered stable, as is no blood loss at all, of course.
  • Class II is >30% lost, and is considered unstable.
  • Class III is > 60% lost, and is considered critical
  • Class IV is >80% lost, and will lead to cardiac arrest.
  • Your patient will exsanguinate, which is fatal, at 100% blood loss.
Bleeding and CPR
The most important step in medical treatment is ensuring the patient stops getting worse.

Your first priority is to stop any and all bleeding as soon as possible using bandages, and in severe cases, tourniquets.
Note: if using a tourniquet, it's good practice to then apply bandages to the effected limb, and once wounds have been sufficiently bandaged, to remove the tourniquet.
If, while attending to heavy bleeding, you suspect or confirm a severe hemorrhage, provide saline to prevent the patient exsanguinating.

Once bleeding has been stopped, confirm that the patient is unconscious, and if they have no pulse.

Patients without a pulse are in Cardiac Arrest, immediately perform CPR.

If you're alone, you will have to do your best to take other life saving measures in-between sets of chest compressions. Approximately every 30 seconds, pause chest compressions and check the patient's pulse. If it returns to 0, immediately restart CPR.

If you have help, direct someone to do CPR while you take other life saving measures. Have them stop approximately every 30 seconds and check the patient's pulse. If it returns to 0, immediately restart chest compressions. If you check a patient's pulse while CPR is underway, they will show as having a pulse, you must stop CPR to confirm if the patient's heart is beating.

In addition to CPR, you may need to address a patient's hemorrhage. If the patient has a class II hemorrhage or greater, this will decrease your chances of successfully restoring a pulse while performing CPR. If it's Class IV, the patient's heart will not restart. Provide saline and continue CPR, and continue providing saline if necessary.

Finally, epinephrine improves your chances of successfully restoring a pulse. Administer it whilst continuing CPR, however, wait at least 60 seconds between doses.

Continue CPR until patient's pulse is restored.
Medication
Now that the patient's heart is beating, lets get them stable and wake them back up.
We discussed the various vitals and where we want them to have the patient be considered stable, so lets look at how we manipulate them: Medications.
There are a variety of medications that all do different things, which I will summarize here.

Glossary:
  • T Max: Time to maximum effect
  • T 1/2: Time to half effect
  • LD-50: How many doses will cause cardiac arrest in 50% of patients.
  • TD 50: How many doses will render 50% of patients unconscious.

Ammonium Carbonate ("Smelling Salts")
Used to wakes up stable, unconscious patients. Will have no effect if the patient is not stable.
  • T Max: 2.3 seconds
  • T 1/2: 3-4 seconds

Epinephrine ("Epi")
Used to increase HR and BP, and assists when performing CPR.
  • Increases Revive Chance
  • Increases HR
  • Increases BP
  • T Max: 23 s
  • T 1/2: 1 minute 3 seconds
  • LD 50: 4.4

Metoprolol
Used to decreases excessive HR and BP.
  • Decreases HR
  • Decreases BP
  • T Max: 25 s
  • T 1/2: 1 min 9 s
  • TD 50: 3.1
  • LD 50: 3.8

Morphine
  • Suppresses pain
  • Generally should not be administered to unconscious patients.
  • Decreases HR
  • Decreases BP
  • T Max: 1 min 57 s
  • T 1/2: 15 min 20 s
  • TD 50: 3.1
  • LD 50: 3.8

Naloxone ("NARCAN")
Used to counteract over-usage of narcotics.
  • Treats morphine overdose.
  • T Max: 1 min 35 s
  • T 1/2: 7 min 26 s

Phenylephrine
  • Slows down bleeding and transfusion
  • Increases BP
  • T Max: 29 s
  • T 1/2: 1 min 18 s
  • LD 50: 2.9

Use the above medications to adjust the patient's vitals until they are stable.
You can see the history of a patient's recent medications by using Check Injuries.
Wrapping Up and Recap
Now that you're patient is awake, confirm by using Check Injuries if they have anything else that needs attending to, such as a minor hemorrhage, or limb injuries that need to be treated with a medical kit, same as in base game. You can also apply morphine if they are in pain and it's been greater than 15 minutes since the last time it was administered.

Congratulations, you've saved a life!

To recap, in brief:
  1. Stop any bleeding the patient has.
  2. Restore the patient's pulse if they do not have one via CPR, Epi, and saline as required.
  3. Stabilize the patient's vitals with medications.
  4. Administer Ammonium Carbonate to wake up a stable patient.
  5. Administer any additional medications or saline as needed.
Credit and Sources
Most of the information provided is obtained or derived from the Ace GitHub[github.com], including the flow chart, medication stats and details, and other detailed information.

Please note that some of the exact values can be modified by your server's admins. If something seems off about something in this guide, that may be the reason.

That said, please let me know if you have found any errors or additional details in the comments.
2 Comments
Chonkems 31 Jul @ 9:34am 
we can never escape ace medical.
Esir 30 Jul @ 11:33pm 
Very useful, thank you!❤