Summary for Soldiers

• Step 1: Secure the area, win the fight, and triage casualties.

• Step 2: Stop all bleeding using tourniquets and bandages.

• CPR: Learn and use CPR if a teammate has no pulse.

• Communication: Always notify your team and TL of your actions.

Key Rules for Non-Medics

1- No Drugs (Except Morphine for Self-Use):

• Only use Morphine if you are conscious and experiencing flashing vision.

• Notify the TL immediately after use.

2- Communication Is Critical:

• Inform your team when performing first aid.

• Report all actions to the TL or Squad Medic, including Morphine use.

3- Learn CPR:

• CPR is essential if a teammate has no pulse. Continue compressions until a medic arrives.

1- CPR: For Patients with No Pulse

1. Check for a Pulse:

   • After bandaging all wounds and stopping bleeding, check the patient’s pulse.

2. If No Pulse, Begin CPR:

   • Perform 30 chest compressions at a rate of 100–120 compressions per minute.

   • Recheck the pulse after each CPR cycle (every 30 seconds).

3. Continue CPR Until a Medic Arrives:

   • Maintain compressions to keep blood circulating until professional care can take over.

2- Self-Aid: For Soldiers Who Are Hit but Conscious

1. Secure the Area:

   • Win your fight first—do not begin treatment while under fire.

2. Communicate:

   • Inform your team:

     • “I’m hit, performing first aid on myself.”

3. Perform First Aid:

   • Bandage all bleeding wounds.

   • If you experience flashing vision, use Morphine from your kit to stabilize yourself.

4. Notify the Team Leader (TL):

   • Immediately report Morphine use:

     • “Used Morphine at [time].”

   • This ensures the medic knows Morphine has been administered, preventing overdose risks or complications.

3- Caring for an Unconscious Teammate

1. Win the Fight First:

   • Ensure the area is secure before approaching the casualty.

2. Stabilize the Patient:

   • Stop all bleeding by following Step 2: Hemorrhage Control.

   • Apply tourniquets and bandage all wounds as needed.

3. Call for Help:

   • Notify the TL or Squad Lead:

     • “Soldier down, stabilized, requesting medic at [location].”

4. Move the Patient (if Safe):

   • Carry the unconscious soldier to the Casualty Collection Point (CCP) or a safe area.

   • If moving is unsafe, provide security until the medic arrives.

5. Do Not Use Morphine on Unconscious Soldiers:

   • Leave drug administration to medics.

Key Drug Colors and Usage

• Yellow (Epinephrine): Restores circulation and revives patients.

• White (Metoprolol): Lowers high heart rate (HR).

• Blue (Naloxone): Reverses drug overdoses.

• Red (Morphine): Pain relief (use only on conscious patients).

• Green (Phenylephrine): Increases blood pressure and stimulates cardiac function.

• Ammonium Carbonate (Smelling Salts): Revives unconscious patients.

Step 1: Secure the Area and Assess the Situation

1. Prioritize Your Safety:

   • Ensure the area is secure.

   • Neutralize any immediate threats—you cannot provide care if you are under fire.

2. Triage Casualties:

   • Use the following priority system:

     1. Unconscious patients with critical bleeding.

     2. Conscious but immobile patients with severe injuries.

     3. Ambulatory patients with minor injuries.

Step 2: Stop Bleeding (Hemorrhage Control)

1. Assess Bleeding Severity:

   • Critical Zones First:

     • Check and treat in this order: Head, Neck, Chest, Abdomen.

   • Then address limbs if there’s arterial bleeding.

2. Apply Tourniquets (Limbs Only):

   • Use tourniquets immediately on limbs with heavy bleeding.

   • Leave them in place until the critical zones are stabilized.

   • Remove the tourniquet and bandage after stabilizing other injuries.

3. Bandage All Bleeding Wounds:

   • Move systematically across the body.

   • Ensure all bleeding is stopped before proceeding.

Step 3: Restore Circulation

1. Administer Saline:

   • After stopping all bleeding, give saline to restore blood volume.

2. Check Pulse:

   • If Pulse is Present:

     • Administer Yellow (Epinephrine) to restore proper circulation.

     • Use Ammonium Carbonate (Smelling Salts) to revive unconscious patients.

   • If Pulse is Absent:

     • Proceed to Step 4: Cardiac Arrest Protocol.

Step 4: Cardiac Arrest Protocol

1. Administer Green (Phenylephrine):

   • Inject Green to stimulate cardiac function if the patient is in cardiac arrest (Pulse = 0).

2. Perform CPR:

   • 30 compressions at a rate of 100-120 per minute.

   • Check the pulse after every compression cycle (30 seconds).

3. Repeat Cycles:

   • Alternate between CPR and checking vitals.

   • Administer additional Green (Phenylephrine) as needed (allow 30 seconds for drug effects before repeating).

Step 5: Stabilize Vital Signs

1. Monitor Heart Rate (HR) and Blood Pressure (BP):

   • Use ACE Medical equipment to measure the patient’s vitals.

   • Compare them to the following baselines:

     • Resting HR: 40–100 BPM

     • Stable BP: 120/80

2. Administer White (Metoprolol) or Green (Phenylephrine) as Needed:

   • If HR is too high (tachycardia): Administer White (Metoprolol) to lower HR.

   • If BP is too low (hypotension): Administer Green (Phenylephrine) to stabilize BP.

3. Check Every 30 Seconds:

   • Reassess vital signs and administer additional medications if needed.

Step 6: Address Drug Overdose

1. Identify Signs of Overdose:

   • Symptoms may include:

     • Respiratory depression.

     • Loss of consciousness.

     • HR = 0 or abnormal vital signs.

2. Administer Blue (Naloxone):

   • Use Blue to counteract overdose symptoms (e.g., from excessive Morphine or other drugs).

3. Reassess After 30 Seconds:

   • Observe the patient for signs of recovery or return to normal function.

Step 7: Pain Management

1. Use Red (Morphine):

   • Only administer Red to conscious patients experiencing pain.

   • Morphine lowers HR, so do not use on unconscious patients.

2. Monitor for Side Effects:

   • Watch for respiratory depression or significant drops in HR/BP.

   • Be prepared to use Blue (Naloxone) in the event of an overdose.

Setting Up a Casualty Collection Point (CCP) and Signaling a Medevac

This guide provides a detailed explanation of how to set up a Casualty Collection Point (CCP) and effectively signal a medevac helicopter. The focus is on maintaining organization, ensuring patient safety, and using clear methods to communicate with the medevac.

Part 1: Setting Up a CCP

1. Location Selection:

   • Choose a secure and defendable area close to the field of engagement but out of direct enemy fire.

   • Ensure there is space for triaging, treating, and moving casualties.

2. CCP Layout:

   • Divide the CCP into a triangular grid, with three primary zones:

     1. Zone 1: Incoming Casualties (Triage Area):

        • Patients are brought here for an initial assessment and stabilization.

        • Immediate action is taken to stop bleeding, restore circulation, and stabilize critical injuries.

     2. Zone 2: Recovery/Observation Area:

        • Patients who are stable but waiting for drug effects (e.g., morphine, saline) to take full effect are placed here.

        • These patients are rechecked to determine if they are fit to return to duty or need evacuation.

     3. Zone 3: Evacuation Area:

        • Patients who are combat ineffective (e.g., severe injuries) and require MEDEVAC are placed here.

        • This area also serves as the staging point for loading patients onto medevac transport.

3. Positioning Notes:

   • Place ambulatory patients (green status) at the entrance or perimeter to defend the CCP if needed.

   • Maintain an organized flow between zones to avoid congestion and confusion.

4. KIA Morgue:

   • Designate a separate location near the CCP for deceased personnel.

   • Document all KIA details for mission reporting (e.g., time, location, identification).

5. Platoon Medic Role:

   • The Platoon Medic or HQ Medic is in charge of the CCP.

   • They are the only ones equipped with the Med Box to ensure centralized care and supplies.

Part 2: Signaling a Medevac

1. Daytime Signaling:

   • Use colored smoke to mark the CCP for the incoming helicopter.

   • Do not announce the smoke color over the radio until the helicopter is in the area. This prevents the enemy from mimicking your signal.

2. Nighttime Signaling:

   • Use a chem light or similar light source to signal the helicopter.

   • Green chem lights are often used but can be adjusted based on your team’s SOP.

   • Avoid using helmet strobe lights to prevent confusion with other signals.

3. Alternative Methods:

   • Flares:

     • Can be used if chem lights are unavailable. Use triangulated flare setups if visibility is low.

   • Flash Chem Lights:

     • For forested areas or dense environments, flash the chem light to confirm your location to the pilot.

4. Marking the Landing Zone:

   • Select a clear area with minimal obstructions.

   • If necessary, mark the perimeter of the landing zone with triangle-shaped flares or chem lights for added visibility.

5. Final Steps:

   • Confirm the landing zone is secure before signaling the helicopter.

   • Communicate clearly with the medevac crew to avoid misidentification.

Instructor Notes for Training

• CCP Setup:

  • Teach soldiers how to divide the CCP into three zones and the importance of keeping it organized.

  • Emphasize the role of the Platoon Medic in managing the CCP.

  • Demonstrate how to document KIA details.

• Medevac Signaling:

  • Practice using colored smoke, chem lights, and flares for both day and night operations.

  • Highlight the importance of confirming the medevac's location before deploying signals.

  • Stress the need for secure communication to prevent enemy interference.

Summary for Soldiers

1. CCP Setup:

   • Divide the CCP into three zones:

     1. Incoming Casualties (Triage).

     2. Recovery/Observation.

     3. Evacuation Area.

   • Place ambulatory patients in a defensive position if needed.

2. Signaling Medevac:

   • Use colored smoke (day) or chem lights/flares (night).

   • Announce smoke color only when the helicopter is nearby.

   • Confirm the landing zone is secure before signaling.

3. Key Reminders:

   • The CCP should be controlled and supplied by the Platoon Medic.

   • Always keep the area secure and organized.

   • Use reusable tools like chem lights where possible to reduce the load.

Detailed Explanation of the Reports in the Provided File

The attached Medic Kneeboard includes several critical frameworks for managing and reporting casualties during in-game operations. Below is an elaboration on each section, providing further clarity for practical use.

1 - Status Codes (9-Line MEDEVAC)

This is the 9-Line MEDEVAC Request format, which ensures effective communication for casualty evacuation. Each line corresponds to specific information:

1. Frequency and Standby:

   • Provide the radio frequency for the MEDEVAC request. Include the appropriate callsign and suffix.

2. Grid Location:

   • Clearly specify the exact grid coordinates for the pickup site to ensure accurate MEDEVAC dispatch.

3. Number of Patients by Precedence:

   • A - Urgent (Within 90 minutes).

   • B - Priority (Within 4 hours).

   • C - Routine (Within 24 hours).

4. Special Equipment Required:

   • Indicate any special requirements:

     • A - None.

     • B - Hoist.

     • C - Extraction equipment (e.g., "Chemical").

5. Number of Patients by Type:

   • L - Litter (patients requiring a stretcher).

   • A - Ambulatory (patients able to walk).

   • E - Escorts for children or dependents.

6. Security of Pickup Site:

   • Indicate security conditions:

     • N - No Enemy.

     • P - Possible Enemy.

     • E - Enemy in the Area.

     • X - Hot Pickup Site.

7. Marking the Pickup Site:

   • How the site will be identified:

     • A - Panels.

     • B - Pyrotechnics.

     • C - Smoke.

     • D - None.

     • E - Other (must specify).

8. Patient Nationality and Status:

   • Clarify patient affiliation:

     • A - U.S. Military.

     • B - U.S. Civilian.

     • C - Non-U.S. Military.

     • D - Non-U.S. Civilian.

     • E - Enemy Prisoner of War (EPW).

9. Pickup Site Description:

   • Include hazards and ingress recommendations.

Important Notes:

• MEDEVACs will confirm smoke color only when they see it; do not preemptively provide this detail.

2 - MIST Report

Used for relaying detailed casualty information:

1. M (Mechanism of Injury):

   • Examples: Gunshot wounds, blast injuries, vehicle crashes.

2. I (Injury or Illness Sustained):

   • Describe the specific injuries (e.g., hemorrhage, fractures).

3. S (Signs, Symptoms, and Vitals):

   • Provide critical health information:

     • Heart Rate (HR).

     • Blood Pressure (BP).

     • Consciousness status.

4. T (Treatment Given):

   • Outline all medical interventions provided:

     • Tourniquets, bandages, drugs administered.

3 - ACE Report

Summarizes the team’s combat readiness:

1. A (Ammo):

   • Total ammunition remaining.

2. C (Casualties):

   • Specify the number and severity of injuries.

   • Identify any KIA (killed in action).

3. E (Equipment):

   • Status of critical mission equipment.

4 - TCC (Tactical Combat Casualty Care) Phases

Breakdown of medical priorities into three key phases:

1. Phase 1: Care Under Fire:

   • Priority: Security and suppression of threats.

   • Apply tourniquets for life-threatening limb hemorrhages.

2. Phase 2: Tactical Field Care:

   • Conduct detailed medical assessments.

   • Treat injuries and stabilize patients.

3. Phase 3: Tactical Evacuation Care:

   • Prepare patients for evacuation.

   • Monitor and adjust treatments as needed during transport.

5 - MARCH-PAWS Protocol

A systematic approach to casualty care:

1. Massive Bleeding:

   • Control life-threatening hemorrhages with tourniquets or hemostatic dressings.

2. Airway:

   • Ensure a patent airway (use NPAs or intubation if required).

3. Respiration:

   • Treat sucking chest wounds with chest seals; manage tension pneumothorax.

4. Circulation:

   • Restore blood flow with IV/IO fluids or blood products.

5. Hypothermia/Head Injuries:

   • Prevent hypothermia; manage intracranial pressure for head injuries.

6. Pain Management:

   • Administer Red (Morphine) or alternative analgesics.

7. Antibiotics:

   • Prevent infections for open wounds.

8. Wounds:

   • Close non-life-threatening injuries.

9. Splinting:

   • Stabilize fractures and immobilize injured limbs.

6 - Patient Status Codes

• Green: Minor injuries, no immediate medical intervention needed.

• Yellow: Major injuries requiring medical supervision (e.g., hemorrhage Class 1).

• Red: Severe injuries needing constant care (e.g., hemorrhage Class 2, unstable vitals).

• Black: Cardiac arrest or deceased.

7 - Key Reminders for Medics

• Always prioritize security.

• Follow the 9-Line MEDEVAC structure for clear evacuation requests.

• Use the MIST report for in-depth casualty updates.

• Apply the MARCH-PAWS protocol systematically.

• Know your drug colors:

  • Yellow (Epinephrine): Boost circulation.

  • White (Metoprolol): Reduce heart rate.

  • Blue (Naloxone): Reverse overdoses.

  • Red (Morphine): Pain management.

  • Green (Phenylephrine): Stabilize blood pressure.

  • Ammonium Carbonate (Smelling Salts): Revive unconscious patients.