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+====== ACE Medical for Medics - Introduction ======
+This page contains considerations for individuals taking the Medic role (Squad, Platoon, or any other variation).
+It is **strongly recommended** that you are familiar with **both** the [[:medical:equipment|Equipment]] and [[:medical:selfaid|Self and Buddy Aid]] pages. To avoid duplicate information, neither equipment nor basic mod/interface functionality will be covered here. Rather, this page focuses more on the macro-level for Medic as a role. It's a bit more dense and a little less picture book, but it covers the more "upper level" ideas that will help you perform the Medic role better.
+Finally, we will once again assume the [[:medical:selfaid#appendix_aace_medical_menu_video|ACE Medical Menu]] is the "standard" way of performing medical treatment because, simply put, **it's just generally better**. Don't worry, though! If you're still an ACE Interaction loyalist, that's still fine, and you'll still need to do some self-study in order to make sure you can do everything you need to do in your preferred form of interaction.
+====== Overview ======
+   * Basic In-game Medical Process
+   * Triage
+   * Proactive Treatment
+   * Managing Supplies
+   * Managing Time
+===== Basic In-game Medical Process =====
+This will be short and sweet, unlike the rest of this page, because you should already be acquainted with the UI and all the tools at your disposal. As a result, telling you the order to use them in doesn't take a whole lot of real estate.
+**Step 1: Assess the casualty.** Unconscious or not? If unconscious, do they have a heart rate? If they don't have a heart rate, they're in cardiac arrest, and you need to get someone doing CPR on them straight away. What types of wounds do they have? How will you treat them? Is the casualty's heart rate or blood pressure substantially different from the nominal?
+**Step 2: Stabilize the casualty.** Implement your plan. Use the resources at your disposal to tourniquet and/or bandage all wounds. Make sure to call out what you're treating if you're working in tandem with a helper.
+**Step 3: Finalize the casualty.** Use your surgical kit to stitch wounds so they won't reopen. Use fluids, if necessary, to restore fluid volume. Use medications to affect the casualty's vitals (more on vitals later) or treat pain as needed.
+Now move on to the next casualty and repeat the process.
+Make sure to bark at the peasants (riflemen) nearby to make them hold security while you move and work.
+===== Triage =====
+Triage is the process of **categorizing individuals** based on their **need for medical treatment** at the current time. Real-world triage systems (of which there are many) broadly contain the "minimal treatment," "delayed treatment," "critical treatment," and "expectant" categories, which are usually associated with the colors green, yellow, red, and black, respectively. While we do not necessarily assign individual casualties to groups, it is still a useful way to conceptualize and understand who to treat and in what order.
+In-game, triage is **three parts**: 1) **assess number of wounded**, 2) **assess degree of "woundedness" on each casualty**, 3) **communicate and perform treatment**. It's important to understand whether there are three or ten wounded and whether they are all walking wounded (minor wounds, not necessarily time-critical) or critical (some will likely die before all can be treated). Furthermore, it is important to **communicate this information** to leaders, other medics, and potential helpers / security in the local area.
+Generally it is best to **start with the most critically-wounded** and work from most wounded to least wounded. Utilize nearby helpers to perform CPR on any casualties who are in cardiac arrest, and **be sure that extra hands are used to hold security** and not sit on top of you while you work. Encourage less-wounded individuals to alternate self aid and security within their buddy teams.
+Finally, keep in mind that some casualties **may not be worth the resources to save**. If a really messed up casualty is going to cause two or three others' condition to worsen (or maybe they outright die), then you may have to make the hard call to abandon that casualty in favor of **treating others who have a better chance at survival**. Some people might dispute your decision but that's fine. As long as you have a valid reason for feeling that you need to skip over treating someone (e.g. "If I treat this guy, these other two guys are going to die instead") then you have your justification and people are just going to have to live with it for a few minutes of "several people are typing..." in the AAR channel.
+===== Proactive Treatment =====
+You don't have to wait for people to come to you. In fact, people **shouldn't have to come to you**. Although you generally don't want to be going in to dangerous areas if you don't have to, it's perfectly safe to treat people on a short halt or while they're holding security on the far side of an objective. Make sure they're **actually holding security**, and **go around to each of the members** of the team or squad to check them out.
+Proactive treatment also extends to how you use your supplies. If you have an individual who is in severe pain and incapable of fighting effectively (aim sway), but their heart rate is too low to safely treat the pain with morphine, you can use epinephrine, morphine, and saline (or other fluids) to address all the issues at once rather than just not treating the pain or allowing the individual to pass out randomly in the next few minutes.
+===== Managing Supplies =====
+Any time you can acquire supplies from a vehicle, crate, dead friendly medic, or other source, **you should do so**. You don't need to go out of your way, but if you're walking by and the supplies are there, work it out with your squad leader to go acquire some of those supplies for yourself. **Fluids are the most common thing to run out of**, so you need to be careful when you use them, but don't save them forever, either. Use them when you need to and don't use them when you don't need to. Get more when you can.
+Another aspect of managing supplies is **resupplying the individuals in your squad**. When treating someone, you can ask if they still have enough bandages. If a rifleman doesn't have five or six bandages, you should resupply them with some of your own bandages. It is best to give field dressing, QuikClot, or packing bandages rather than elastic bandages. **Elastic bandages can fall off in a surprisingly short amount of time** and that's not something you want your riflemen having to worry about when they may not see you for 10 minutes at a time.
+Finally, don't forget to **cross-load with the other medics in the platoon**. If you're a platoon medic, you can push your supplies down to the squad medics the same way they push their bandages down to their squad members. If you're a squad medic, you can pick up some extra supplies from another squad's medic or offload some of your spare on to them. Work with your leader to organize rapid supply swaps when the HQ elements will be located nearby. This way you can reorganize the platoon's medical supplies and nobody will even notice the delay since it won't be out of the way and it won't take more than 30 seconds.
+===== Managing Time =====
+This is probably the **most important aspect** of the Medic role. You must be efficient with your time. Mission delays can happen based on the decisions you make, so always try to **be as efficient as possible**. Some things take time, but you want them to **take the minimum required amount of time** while still providing the **highest level of service** possible to the individuals you're responsible for treating (and probably some you aren't, if they lose their medic early).
+"Level of service" means both the **degree to which you're treating casualties** (quality; making the right decisions) and the **number of casualties you're covering** (quantity; as a percentage of total casualties available for you to treat). Inevitably as the peasant:medic ratio rises, you'll be forced to compromise one or both aspects and that's fine. Just as leadership disintegrates during a protracted and/or bloody mission, so does the medical role. Just be aware of it and try to manage it as best you can.
+So, how do you save time?
+For one, **don't let your squad leader halt the entire squad to treat one casualty**. Keep the squad moving and carry an unconscious casualty while they recover, if you have to. Even better, **arrange for the platoon medic to babysit your casualty** while you run off after your squad. If you can push some of your load off on to the next-higher medic, that's great for you, since it means you can now treat someone else without having to juggle the extra dead (hopefully not literally dead) weight.
+Another option is pushing an IV on a casualty who's going to need an IV before you even stitch their wounds. As long as you're confident the wounds **won't start reopening** before you finish the IV and perform the stitch, go for it. Doing this compresses the total amount of time the casualty is occupied by receiving treatment and they should, on average, **wake up sooner** if you push the IV sooner.
+Use tourniquets to **control multiple wounds** on a single limb. If a casualty is "stable" with a tourniquet on their arm, move on to someone else who needs treatment right away. Loop back to the casualty with the tourniquet after you address one or two others. Make sure not to forget about an unconscious not-technically-done-being-treated-stable-casualty.
+You'll find these types of optimizations as you play the role more. You'll also figure out when and when not to use them.
+====== Appendix A: Unconscious Casualties - How do? ======
+This is really not that complicated. In ACE Medical, people //remain// unconscious because something is wrong with them. It's possible to be knocked out temporarily by taking substantial damage in a short period of time, or taking a non-lethal round to the head, or being blown up, and so on. These alone don't always keep you unconscious. Something needs to be wrong to remain unconscious. Ultimately, **there are only three things that can be wrong with someone**, and they are all interrelated, so really, there is only one thing that can be wrong with them. The three interrelated things are: heart rate, blood pressure, and blood volume.
+You **lose blood volume by bleeding**, and you most commonly begin bleeding by being shot. When blood volume begins to drop significantly, blood pressure will drop significantly as well. There will be a period of time during this process that the heart rate spikes to try and compensate for the lack of blood in the system (i.e. trying to keep pressure nominal by pumping faster), but eventually the heart rate will also drop.
+So, what does this mean? It means that **people who have bled a bunch are going to pass out**. How do you fix it? Stop them from bleeding more and give them fluids, just like normal. How do you wake them up? You can't, not directly. ACE makes checks on a **fixed cycle** with a percent chance for the unconscious casualty to wake up at the end of each cycle. You can **boost that chance by a fixed value using epinephrine**. However, they will **only wake up on a successful check if everything is "good" with them**, meaning that something isn't wrong with them. It's kind of the "the missile knows where it is by knowing where it isn't" thing, right?
+What about cardiac arrest?
+It's basically the same process, except now they have no heart rate (hence the term cardiac arrest). One of the vitals' values has gone in to a "critical" range and it's very bad and the casualty's heart has stopped because it's very bad. Someone performing **CPR has a fixed percentage chance to be "successful"** and boost the casualty's heart rate somewhat while also adding time on to the casualty's "death timer."
+While someone is extending this timer for you, you need to be **treating whatever is causing the casualty to be in cardiac arrest**. In 99% of cases (barring player negligence or mischief) it's because they've been drained of blood by being **repeatedly perforated by little metal objects**. When you correct whatever the issue is to an acceptable degree, the casualty will come out of cardiac arrest (but still be unconscious) with a heart rate probably in the triple digits but definitely not ~30. **If you're still seeing 30 BPM the casualty is still in cardiac arrest**.
+For the record: if it's **routinely** taking you in the range of **five to ten minutes** to bring a //single// casualty (with no one else taking your attention for treatment etc) out of unconsciousness or cardiac arrest, then you're //probably// doing something wrong. It is entirely possible to bring up //at least// two or three casualties in that amount of time. As with anything, it //could// be the game, but don't be too quick to blame the mod or the game. **Double-check what you're doing and make sure your process is good** and then start to investigate if something is jacked up on the game's end.
+====== Appendix B: Vitals - what do? ======
+For reference, the **nominal values** are: 80 BPM heart rate, 120/80 mmHg blood pressure, and 6 liters blood volume.
+Recall that heart rate, blood pressure, and blood volume are **all interrelated**, and look back at the nominal values. Now consider that you check a casualty's vitals (heart rate and blood pressure) and see **140 BPM** and **110/75**. What does this mean? Without looking anywhere else, you can **safely assume the casualty has lost an appreciable amount of blood**. If you look at just the blood pressure and think, "Hey, this blood pressure is pretty close to nominal. No problem!" you're **missing the other half of the story**: that the heart is working overtime to address the lack of fluid in the system.
+There's not really any definite in-game way to see the "exact" amount of blood lost, and that's fine. T**he game tells you in the info panel to the right of the paper doll**: "lost some blood," "lost a lot of blood," "lost a large amount of blood," "lost a fatal amount of blood," and so on.
+Typically you want to be considering using fluids on someone who has "lost a lot of blood" or worse. Beneath that, you **don't really need to treat it**. If there's half-liter bags available, and you have nothing else to do, maybe you do that. But otherwise, **save the fluids for when you need to keep people standing** through 75 minutes of being shot at.
+What if someone's heart rate somehow spikes to 250 BPM? Or blood pressure goes up to 200/X? That's basically never going to happen, but there are outcomes for all of those types of things in the mod's code. They can cause cardiac arrest, but again, not necessarily something to worry about because they won't occur under usual gameplay circumstances.
+====== Appendix C: How to Practice ======
+Simple. **Turn on AI unconsciousness** in your local ACE Medical settings and **shoot some poor AI**, then treat them. You turned on AI unconsciousness so that they can **pass out** rather than just outright die. You can treat them (and save them, or fail saving them) the same way you would treat players, although AI are (in our default settings) a little more fragile than human-controlled units.
+If you want to practice the more macro-level concepts, you can **devise scenarios for yourself to solve**. What if you have three wounded: one who is conscious, one who is conscious but bleeding heavily, and one who is in cardiac arrest. You have no one else to help you. Who do you treat first? What do you prioritize working on? Who do you communicate with to get extra help if you think you need it?
+It might sound goofy but the first time you take the role and can't figure out what to do during a particular situation, you might see the value in having ran through a couple examples in your head before. You could also **get some other players together** and **create these scenarios in-game to practice "for real."** Like many things, the more saddle time you have, the better-prepared you are.