Advanced Medical Guide

TMTM’s Advanced medical system is confusing to the uninitiated, but this will help you through the process of stabilizing and reviving downed friendlies. To fully understand reading will be required. Use the table of contents below to navigate through this document. If you are playing Standard Medical Operations use this guide instead.

Abbreviations

BP = Blood Pressure
PSB = Plasma, Saline, Blood
EPI = Epinephrine
HR= Heart Rate<be>

General Info

Here are some general tips and pieces of advice that you should know whether or not you are a medic.

1. When a person's pulse is below 20 or above 200, they enter cardiac arrest and have 3 minutes (TMTM default) to be CPR’d again before they die
2. Performing CPR has a 40% chance to restore heart rate
3. If someone is unconscious, DO NOT give them morphine
4. If you have self-medicated yourself and you start to hear your heartbeat (it is tied to your effects volume), consult the closest medic. This can be caused by too much epi or morphine
5. Pain increases blood pressure
6. Never take more than one morphine at a time
7. If you have lost enough blood, taking morphine can knock you unconscious.
8. You can not give someone too much blood
9. Tourniquets will stop medication and blood from going into your system
10. Medics perform medical actions faster than any regular infantry, so it's better to have a medic bandaging/giving blood instead of doing cpr
11. If someone is providing medical to someone downed do not crowd around them, they will ask for help if needed
12. Remember to get stitched after bandaging wounds since they will eventually reopen

TMTM Specific Settings (Compared to ACE default)

1. Players bleed out 50% as fast
2. IV transfusions are 4x faster

Useful Information

Types of Injuries

Type of Injury	Description	Effect
Avulsion	Tissue torn away from where it belongs	Extreme pain & high rate of bleeding can cause limping on legs w/o fracture
Velocity	Deep penetrating wound	Can cause fractures. Very high pain & fastest bleeding
Crush	Tissue crushed under heavyweights	Can cause fractures & limping. Slow bleeding & high pain.
Laceration	Tear that separates tissue without carrying it away	Moderate pain & medium blood loss
Fracture1	Broken bone	Cause extreme aim shake on arm injuries, cause limps on leg injuries. Extremely painful & no blood loss
Puncture	Caused by shrapnel or slow-moving sharp objects	Light pain & slow bleeding
Cut	Caused from shrapnel or sharp objects	Light pain & light blood loss
Abrasion	A scrape	Slow bleeding, though large ones can cause moderate amounts of pain.
Contusion2	A bruise	Cause moderate amount of pain

1. Fractures can only be healed by splints
2. Contusions cannot be healed by bandages, only PAKs or time
3. All other wounds can be healed by bandages

Injuries can be either Minor, Medium, or Large. The larger the wound the more bandages it will take to staunch the bleeding.

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Bandages

Bandage	Effect (↑=Better)	Reopen Chance (↓=Better)	Delay to reopen (↑=Better)
Basic	Medium	Medium	Medium
Packing	Medium	High	High
Elastic	Highest	Highest	Low
Quikclot	Lowest	Lowest	Medium

Other Items

Splint	Instantly fixes one fracture
Tourniquet	Stops bleeding from limb, causes pain after 2 minutes, blocks injections, vitals, and PSB to affected limb

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Resource Effects on Pulse and Blood Pressure

Resource Effects on Pulse and Blood Pressure

Resource	Pulse	Blood Pressure	Notes
PSB	None	Increases based on administered amount	Patients will have no pulse if blood is too low
Morphine	Decreases Drastically	Decreases Drastically	Will suppress an individual's pain levels. Takes 60 seconds for full effect and lasts ~30 mins.
Epi	Increases	Increases	Will increase the chance of individual waking up when stable. Lasts ~2 mins
Adenosine	Decreases	Decreases	Can be used to counteract epinephrine. Lasts ~2 mins

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Blood Loss Tables

There are two ways to find BP, one is through the ACE interactions (CTRL + Windows Key) another is through the medical menu (CTRL + H).

Medical Menu

Medical Menu Message	Lower Bound	Upper Bound
No Message	6.0 liters	6.0 liters
Lost some blood	5.1 liters	6.0 liters
Lost a lot of blood	4.2 liters	5.1 liters
Lost a large amount of blood	3.6 liters	4.2 liters
Lost a fatal amount of blood	3.0 liters	3.6 liters
Dead	0.0 liters	3.0 liters

There is no way to check the exact amount other than the prompts in the Medical Menu

• If you go below 3.6 Liters you will instantly fall unconscious.
• You can only wake up if you have 5.1 or more liters
• If you fall below 3.0 Liters you will die

ACE Interactions

Message	Corresponding BP (Systolic)
Can't find BP	0-50*
Low BP	50-90*
Normal BP	90-160*
High BP	>160*

*These numbers are unconfirmed

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Defintion of "Stable"

1. Not bleeding
2. Must have at least 5.1 liters of PSB
3. Not be in cardiac arrest
4. HR above 40
5. BR above 50/60

Non-Medic Roles

This section will go over what supplies you should have and what to do if you find a downed friendly. Info learned here can be applied to yourself if you are hurt.

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Inventory

While you aren’t a medic you still require medical supplies to keep yourself or others in the fight, these are the items you should check for before you set out.

• Bandages (Basic or QuikClot) - 10-12
• Morphine - 2
• Epi - 2-4
• Adenosine (Optional) - 2-4
• Tourniquets - 4
• Splint - 1-2

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Fixing a Downed Friendly

Step 1

• Report downed friendly over Short-Range radio
  • Report over SR so the medic is notified and the Squad leader or Team leader knows who is down
• Secure the area
  • Do this by popping smoke for cover or killing the enemies that downed the friendly
  • Do not grab them immediately or you might be the next one down

Step 2

• Confirm they are alive
  • If you can check their inventory, walk over their body, or not be able to drag them they are dead, if not they are alive
• Drag to cover
  • Incase a new enemy pops out you won't be shot while healing

Step 3

• Check Vitals
  • Check Pulse, it will be one of these four
    • No HR
    • Weak
    • Normal
    • Strong
  • Check Blood Pressure if there is a HR, it will be one of these 4
    • Can’t find BP
    • Low
    • Normal
    • High

Step 4

• CPR once if no HR
  • Do this to possibly reset their countdown (3 minute timer to death once HR hits 0)
  • Don’t check pulse while CPR is being performed since it will give weak HR

Step 5

• Tourniquet
  • If more than 3 parts of their body is heavily damaged tourniquet the respective limbs to stop the blood loss
  • Do not pump PSB, morphine, epi, or adenosine into tourniqueted limbs since they do not take effect until the tourniquet is removed
• Bandage
  • Focus on chest and head first since limbs can be tourniqueted if needed
• If multiple people are working on the same person call out which part you are bandaging as to not waste time double bandaging the same part
• CPR Again
  • If bandaging it taking too long (over 1.5 minutes) perform CPR again to possibly reset their timer
    • Check Pulse after every round of CPR to see if heart has started

Step 6

• Recheck Vitals & Call over Medic again
  • Check Pulse
    • If no pulse continue to perform CPR
  • Check Blood Pressure
    • If it is any other than “Lost some blood”, Low or Can’t find BP, call medic or pump in blood if you have it

Step 7

• They are “stable” they can be moved to medic if
  • They have a strong HR (don’t check while CPR is being performed since it will give weak HR)
  • If blood pressure is “Lost a Large amount of blood” or higher
  • Isn’t bleeding out

Medic

This section is a step-by-step for the medic role in operations. Remember that you are meant to heal others, do not put yourself in risky scenarios.

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Medic Specific Tools

Personal Aid Kit (PAK)	Will fully heal someone if they are stable (use on chest)
Surgical Kit	Will stitch wounds close to stop reopening (takes 5 seconds per wound)

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Inventory

Double-check your inventory before setting out, not having the right medical supplies could cost someone their life.

• PAK - 1
• Surgical kit - 1
• Bandages (Basic, Elastic, Packing, or a mix) - 45-60
• Morphine - 10-15
• Epi - 20-25
• Adenosine (Optional) - 8-10
• Tourniquet - 4-6
• Splint - 8-10
• 1000ml PSB - 4-6^a
• 500ml PSB - 4-5^a
• 250ml PSB - 2-3^a

^aThis is up to personal preference, some people prefer to take more 1000ml than 500ml.

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Fixing a Downed Friendly

This section is a step-by-step for the medic’s role in operations. Remember that you are meant to heal others, do not put yourself in risky scenarios.

Step 1

• Report downed friendly over Short-Range radio
  • Report over SR so Squadleader or Teamleader knows who is down
• Secure the area
  • Do this by popping smoke for cover or killing the enemies that downed the friendly
  • Do not grab them immediately or you might be the next one down

Step 2

• Confirm they are alive
  • If you can check their inventory, walk over their body, or not be able to drag them they are dead, if not they are alive
• Drag to cover
  • Incase a new enemy pops out you won't be shot while healing

Step 3

• Check Vitals
  • Check Pulse, you will see numbers, it will fall into one of these categories
    • No HR: 0
    • Weak: <55
    • Normal: between 60 - 110
    • Strong: >115
  • Check Blood Pressure if there is a HR, you will see numbers, the numbers below apply to the left side (systolic), it will fall into one of these categories
    • Can’t find BP: 0-50
    • Low: 50-90
    • Normal: 90-160
    • High: 160 and above
  • If they are under “Lost a lot of blood” or 90 BP or they will need blood to wake up

Step 4

• CPR once if no HR
  • Do this to possibly reset their countdown (3 minute timer to death once HR hits 0)

Step 5

• Tourniquet
  • If more than 3 parts of their body is heavily damaged tourniquet the respective limbs to stop the blood loss
  • Do not pump PSB, morphine, epi, or adenosine into tourniqueted limbs since they do not take effect until tourniquet is removed
• Bandage
  • Focus on chest and head first since limbs can be tourniqueted if needed
  • If multiple people are working on the same person call out which part you are bandaging as to not waste time
• CPR Again
  • If bandaging it taking too long (over 1.5 minutes) perform CPR again to possibly reset their timer
    • If possible call someone over to take over CPR so you can focus on bandaging
    • Check Pulse after every round of CPR to see if heart has started

Step 6

• Recheck Vitals once bleeding has been staunched
  • Check Pulse
    • If no pulse continue to perform CPR or get someone else to help
  • Check Blood Pressure
    • If it is any other than “Lost some blood” or under 90 BP pump in blood if you have it

Step 7

• Raising BP
  • Start with 1000 ml of PSB (Plasma, Blood, or Saline they are all the same)
    • If BP is under “Lost a lot of Blood” or 50 BP give at least 2000 ml
  • Wait for BP to raise & check Pulse
    • If no HR continue to CPR

Step 8

• Stable?
  • Is the pulse between 60 and 120?
    • Yes = stable
    • No = Medicine
      • Epi = Raises Pulse
      • Adenosine = Lowers Pulse
      • Morphine = Lowers Pulse
  • Is the BP between 90 - 160?
    • Yes = Stable
    • No = Medicine
      • More PSB = Raises BP
      • Epi = Raises BP
      • Morphine = Drastically Lowers BP
      • Adenosine = Lowers BP

Step 9

• Not waking up?
  • Push Epi if vitals allow
  • Recheck Pulse and BP

Step 10

• Once friendly awakens (or waiting for them to wake up due to lack of blood while stable)
  • Stitch wounds
    • If possible stitch wounds before sending friendly back into the fight since depending on the bandage used it could reopen quickly
  • PAK (once stable & if time allows)
    • PAK friendlies to set their stats to default if time allows