Advanced Combat Triage and You
Lifesaving first aid
Order of treatment
When in a hostile environment or a combat situation, it is of upmost importance that everyone is aware how to perform combat triage and lifesaving first aid.
If you are two men, scouring for firewood, and one is injured, you cannot rely on a medic to be around. If you are in a combat situation with several casualties, you cannot expect the mender to treat everyone at the same time.
Thus, lifesaving first aid is in a situation, with one casualty, where your focus will be to preserve one life.
Combat triage is the act of prioritizing, and aiding the medic in gaining the knowledge needed to save as many lives as possible, out of the casualties.
You might see lesser-experienced medics jump to the most severely injured person around. However, if said person is a lost cause, with no chance of surviving, the medic might have lost valuable time, which could have been used to save others.
It is your job, to aid the medic, to gain the knowledge needed about every single casualty on the field. This does not mean, the medic should know about every little scratch, but they should know who needs treatment.
Good luck on the battle field
Private of the 55th regiment
In combat triage, the casualties should be divided into the following groups:
– Those who are likely to live, regardless of what care they receive;
– Those who are likely to die, regardless of what care they receive;
– Those for whom immediate care might make a positive difference in outcome.
Group one and three should immediately be brought out of the combat zone, and to safety. Do not attempt to aid them while in the combat zone. You may end up with two casualties instead.
If a casualty may die, regardless of treatment, the job will be to relieve them from pain in the best way possible.
When considering the casualties, you need to prioritize the casualties after the following injuries:
Critical: Arterial lesions, internal hemorrhage, major amputations. These needs immediate treatment.
Severe: Minor amputations, flesh wounds, fractures and dislocations. These should have constant observation and rapid treatment.
Less severe: Minor lacerations, sprains and abrasions. These needs treatment when practical and possible.
Likely to die: Severe injuries, uncompensated blood loss, negative neurological assessment. Observe them, and if possible, offer pain relief.
Deceased: Once the situation has cleared, collect and identify the bodies. Casualties are considered deceased in the absence of breathing after clearing of airways.
The medic will consider the usage of Light or elements to their knowledge. The medic will normally have the last say in the situation. You can aid the medic, by organizing the casualties in the different groups, or by aiding with information regarding the status of the casualties.
If the medic is still overburdened by critical patients, consider lifesaving first aid, such as tourniquets or CPR. Do not attempt such unless it is a matter of life or dead, as a wrongly placed tourniquet can cause the loss of a limb.
Other means of first aid can be to apply pressure to an open critical wound, or to help clear airways, blowing air into the chest of someone not breathing, in case of heart failure, heart massage and similar.
This kind of first aid, is life prolonging, rather than life saving. It is your job to keep people alive, until the medic has time to focus on the patient at hand.
Without a medic at hand, these people will most likely die eventually. Do not be afraid to attempt anything, such as heart massage, if you lack training. If you do nothing to aid them, they are dead. Nothing you can do can make that situation worse.
Lifesaving first aid
If anyone is injured near you, it is important that you know how to react, and what to do. Especially if you are without a medic, or the medic is overburdened on the battle field.
– The most important thing here is to secure the situation. Make certain no one is further injured, including yourself.
– Inspect the casualty. Are there massive bleeding? Check Airways, are they clear? Check Breathing, is the patient breathing on his own? Finally Circulation; is the heart pumping? Is there a bleeding injury, which causes the person to lose blood?
Order of treatment
First off, you need to make a physical and visual control of the casualty’s body. Run your hands down across limbs, around the neck, up around the groin, checking for arterial bleedings. Remember, a massive bleeding will always cool the patient down to a degree, why covering the patient in a blanket is adviced, even if the location is warm.
Aid the person to gain clear airways by the usage of backslaps and abdominal thrusts. Move the head backwards, and lift the chin to gain clear airways, unless spinal injury is suspected.
If the person is not breathing, place them on the back, tilt their head slightly backwards to open the airways, and blow air down through the person’s nose and mouth. If you cannot cover both mouth and nose, close one, and blow through the other.
Blow air only now and then, your main concern here will be to perform massage of the heart. Remove plate and armor, place your hands with the lower of your palms on top of the heart, and press down.
You need to compress the heart thirty times within just as many seconds, before you blow air into their chest twice, and then repeat. If you are more than one person present at the scene, take turns to compress and breathe air in. Remember to consider your patient. Compressing the heart of a dwarf requires more force than an elf. Remember to check the pulse and respiration in between.
Once the person breathes, place him in a recovery position, and move on to circulation.
If the circulation of blood is disrupted by an open wound, apply pressure, and if possible a tight bandage. Your medics usually have a stock of bandages, in case you do not have any, yourself. Do not attempt a tourniquet, unless it is a matter of life or death, as it can cause a loss of limb. Be careful if the wound is to the gut or brain, as applying pressure here, could cause internal damage.
Check the capillary response, by squeezing a nail on the patient for five seconds. Let go, and measure the time it takes to regain colour. A slow reaction indicates bad circulation or a chilled patient.
At this stage, you check upon the consciousness level of your patient. Your patient can have one of the following consciousness levels:
Alert – The patient is fully awake (although not necessarily oriented). This patient will have spontaneously open eyes, will respond to voice (although may be confused) and will have bodily motor function. The patient is responding, but might have slurred speech, confusion, dizziness, lightheadedness or unable to respond coherently. Questions to ask your patient, could be, but not limited to: How old are you? Can you tell me what month it is? What day is it? Do you know where you are? Do you know what happened? What are your name?
Verbal – The patient makes some kind of response when you talk to them, which could be in any of the three component measures of eyes, voice or motor – e.g. patient’s eyes open on being asked “Are you OK?”. The response could be as little as a grunt, moan, or slight move of a limb when prompted by the voice of the rescuer.
Pain – the patient does not react to voice or gentle shaking, but reacts to pain, for instance by being rubbed with knuckles across the breastbone, or squeezing a finger.
Unresponsive – if the patient does not react to pain, he must be considered unconscious.
Drugs: If the patient is alert and awake, without signs of brain trauma, you may administer herbs or a potion. Do not sedate a patient if the patient shows sign of head trauma, as you will struggle to determine the level of consciousness. Imagine a concussed patient. You will wake him up each two hours, but if administered sedatives, he can possibly not be woken up, or appear dizzy, blurry or confused. Would this be due to the injury, or the sedative?
The final step, is preparing the person for evacuation, back to a more secure location. Consider the means of transportation to make it as comfortable for the patient as possible, especially be cautious if back injury is to be suspected. Do not move or twist the spine, before a mender has checked upon the patient.
Acidic injury on skin: Wear gloves yourself. Removes clothes if covered with acid. Apply plenty of water, until the pain wears off. Call for a medic.
Bleeding, internally: Calm the patient. Remove tight clothes. Place the patient on the back, to ease pressure on the stomach. Protect patient from heatloss. Inform the mender of the state.
Bleeding, minor: Stop the bleeding, clean the wound, apply bandage. Inform the medic whether or not, the patient needs sutures. (Unless you are skilled yourself, and there’s not other casualties needing your attention.)
Bleeding, nose: Make the patient sit up, and bend the head forward – never backwards as it could clog the airways or make the patient swallow blood, which could in turn cause vomiting.
Bleeding, severe: Apply pressure with fingers or hand. Get the person lying down, raise the legs. Apply bandage if possible. Lift location of injury as much as possible. Calm the patient. If need be, protect patient from heatloss.
Broken bones: Calm the patient. Attempt to stabilize fractured bones. If the fracture is open and bleeding, cover the injury with a piece of cloth. Call for a mender.
Burns: Apply water or ice. Remove tight clothes. Be cautious not to cause hypothermia. Call for a mender if severe. In case you apply ice, do not place it directly on the skin, and remove it after twenty minutes.
Chilled patient: Calm the patient. Get the patient sheltered. Remove wet clothes. Use blankets to heat person, and provide hot drinks if available.
Cramps: Stay calm. Person is not in pain, and are not in danger of dying. Place person down, and remove tight clothes. Protect the patients head from hurting itself. Do NOT apply anything between the person’s teeth; this might harm the person. Wait for the cramps to fade.
Concussion: Stop any visible bleeding. Do not apply pressure to a severe bleed though, as it could cause internal bleeding. Calm the patient. Remove tight clothes. Place patient down on back, but keep head elevated, if patient is awake.
Drowning: Perform mouth to mouth/nose and heart massage. Do not waste time, trying to empty lungs of water by squeezing, but attempt to roll the patient to the side, so water can run out on its own.
Frostbites: See Hypothermia. Place person in water warmed to thirty-seven degrees celsius if possible.
Heatstroke: Calm the patient, get the patient out of the sun. Remove as much clothes as you can. Apply water to cool down the person, use wet cloths or a tub of water. Make certain the person drinks as much as possible.
Hypothermia: strip down the casualty from wet clothes, strip down yourself, and cover your both by blankets, as you use your body heat to warm the casualty. Armpits are great for heating up feet and hands. Consider applying a rough massage to the patient’s hands and feet, to ensure circulation and lessen the risk of losing a limb.
Poison digested, conscious patient: Gather information regarding what the patient consumed. Secure yourself if need be. Keep the poisoned patient calm.
Acidic poisons should not be forced up again, instead head to your nearest tavern and acquire milk. If you are in the wilderness, acquire water, and make the person drink as much as possible.
Non-acidic poisons can sometimes be forced up again, by inserting a couple fingers into the throat of the casualty. Often your medic will have knowledge of certain herbs, which can counter the poisons, so get to your medic if possible.
Poison digested, unconscious patient: Place the patient in recovery position, avoid provoking vomiting, call for a medic or a mender. Often your medic will have knowledge of certain herbs, which can counter the poisons, so get to your medic if possible.
Poisonous air (e.g. plague): Secure yourself first! If inside, open doors and windows. Move the person out, if possible. Make certain respiration is existing, otherwise perform CPR. Fetch a mender.
Spinal injury: Keep the person in the original position. Place hands on both sides of the patient’s head. Keep the head locked in said position, call for a mender. If no mender is available (in the wilderness), bring the person home on a stretcher, after stabilizing neck and back.
Sprains and swollen joints: Treat with rest, elevation, compression and ice.
Torniquet: Choose a bandana, leather belt, straps from knapsack, cotton shirt or long socking. To minimize cutting into the skin, ensure that the improvised tourniquet is at least an inch wide and preferable two to three inches in width, and place cloth in between the torniquet and the skin. Place the torniquet two to four inches away from the edge of the wound. Tie a halfknot, then place a stick or rod above, and tie a full knot over it. Twist the rod until the torniquet is tight around the limb, and the bleeding stops. Keep it on, for a maximum of two hours to avoid tissue death. If need be, cool the limb down with ice while elevated to delay tissue death. Cover the open wound with a cloth. Keep patient warm and hydrated.
Be aware, that herbal knowledge may differentiate if the patient is pregnant. Always mention if that is the case.