Bourbon Warfare ACE Medic Guide

Author: Argus, Alablm, Mozaik

Last Updated: 4/29/21

The Medic Role and You:

A Guide to playing as a Medic in Bourbon Warfare

Quick Start Guide

Did you just get slotted as a medic and now you are frantically looking at this guide during safestart to figure out what to do? If yes, this is the section for you.

Emergency Treatment:

As a medic in a combat situation, your three main goals for any patient are the following:

1. Stop the bleeding

2. Stabilize pulse

3. Administer fluids

Regardless of if someone is in cardiac arrest, unconscious with a heart rate, or awake and injured, you are always performing these same three steps.

The first thing you should do is identify which scenario you are dealing with. If the person is unconscious, check their medical menu (H key) and do the following:

1. Check pulse. If their pulse is present, move to the section “Unconscious with a pulse”

2. Check their blood loss on the top right of the menu. If the target has no pulse or a “very faint” pulse AND they have “lost a fatal amount of blood”, then the target has been in Cardiac arrest at some point. If you have reason to believe that they have gone into this state within the last three minutes, they may still be revivable. Go to the section “Cardiac Arrest”.

Cardiac Arrest:

This is where things get murky. It can be difficult to tell if someone is in cardiac arrest. If they have bled out within the last 3 minutes, it is very likely they are in cardiac arrest. Have a soldier perform CPR if you can. Otherwise, perform CPR once and then:

1. Check pulse immediately after CPR is performed. The 3 minute timer resets each time their heart starts, as briefly as it may last. If you can confirm their heart has started at least once, their “death countdown” has reset, giving you three more minutes to stabilize them.

2. Bandage wounds, ensure all bleeding has stopped.

3. Continue to check pulse.

4. So long as the pulse is missing or not stable, continue performing CPR intermittently. Once their pulse has returned and stays for several minutes, CPR is no longer necessary.

5. Inject epinephrine to wake them up faster now that they are in a stable unconscious state. Continue this every two minutes while monitoring pulse.

Unconscious with a Pulse:

Your immediate goal here is to ensure the soldier doesn’t go into cardiac arrest. As always:

1. Bandage wounds to ensure they do not bleed any longer than they have to.

2. Check pulse. If it is exceedingly high, give them adenosine.

3. Administer fluids. If the soldier has lost “a lot of blood” or “a very large amount of blood” dose them with 1000ml. Otherwise, start with 500-750ml. Once fluids have been administered give the patient epinephrine. You should give another stick of epinephrine every two minutes until they wake up, just be sure their heart rate doesn’t go too high.

Awake and Injured:

If you have a soldier that has been wounded and needs help, but they can still move, work WITH them to ensure they are healed as rapidly as possible. As you approach, speak to them to identify how severe their wounds are. While performing medical, announce what you are doing and issue them commands as to how they should work on healing themselves to ensure minimal waste.

1. Bandage their wounds to ensure they do not fall unconscious

2. Check their pulse for irregularities. If they have not been unconscious, go through this quickly.

3. Administer fluids to counteract blood loss. Rarely should you give a conscious person 1000ml, give 250ml for minor blood loss, 500-750ml for worse situations.

4. After giving them blood, administer morphine if they complain of pain.

Gameplay Considerations:

• Press H to access your advanced medical menu. It is contextual, meaning it will open the medical details of whoever you are looking at, with it defaulting to your own personal readout if nobody is in range. This menu is much easier to use than the ACE interaction medical system.

• You shouldn’t necessarily remain chained to your squad leader for the entire mission; infact, a quick response to player injuries can be highly effective. Follow friendly infantry as they clear out compounds, but be sure to keep yourself out of harm's way!

• Don’t forget that you have more smoke grenades available than any other soldier type. Your smoke can mean the difference between victory and defeat. Use them to cover yourself as you heal teammates as well as provide cover for your assaulting force. Also, while primarily for PID, your green smokes can be used to mark a helicopter LZs in a pinch.

• As a medic you’ll find yourself checking a lot of bodies. Be sure to grab things off of allied corpses; this includes radios, mission critical loot/intel, and grenades. Don’t be afraid to replenish your smoke stash from allies, or even grab some frags.

• You can use ACE to drag and carry other players. Use this to quickly reposition a body into a safer spot.

Your Kit:

As a medic, you hold several new items you wouldn’t have by default. Below I will list them and explain their purpose, as well as the more common items you need to know a bit more about.

• Saline (Blood bags): After bandaging someone up, you should always look at their blood levels and offer them a blood transfusion if they have lost a “large” amount or more. Please note that blood transfusion can take a very long time, so plan accordingly. Insert an IV by selecting a player's limb in the medical menu. The limb you pick does not matter.

• Splints: Getting shot in a limb has a chance to break a bone. Broken arms decrease aim stability, and broken legs force you into a slow walk. Fixing broken legs is extremely important, as the slow walk can be a death sentence. Apply splints by selecting a player's broken limb in the medical menu.

• Morphine: Morphine is a pain reliever with the unfortunate side effect of also depressing your heart rate. You should always tell a player before you give them morphine, as morphine is the leading cause of medical mishap deaths in BW; receiving two sticks within a short time can kill you if you are at all injured, with one being all it takes under the right circumstances. Always check a players activity log (bottom left of the medical menu) to see if they have received morphine recently. Do not give any morphine to players with critically low blood pressure, as it can kill them. If someone reports hearing their heart, they probably need more saline. In severe cases, dose them with epinephrine and then transfer more saline.

• • 30 second ramp up time, remains active in the system for 30 minutes.

• Epinephrine: Is used to wake up soldiers, increasing heart rate. making it effective at not only waking up unconscious soldiers. Pair it with adenosine to counteract the heart rate increasing effect.

• • 10 second ramp up time remains active in the system for 2 minutes.

• Adenosine: Adenosine lowers the heart rate of the soldier you inject it into. Thus, it can be used to counter epinephrine in the event of an overdose. Additionally, Adenosine + Epinephrine can be used to wake up unconscious soldiers without modifying heart rate. This is useful when someone still has a concerningly high pulse, but needs to get back up ASAP.

• • 10 second ramp up time, remains active in the system for 2 minutes

• Bandages: You have two types of bandages by default; elastic and packing. Use elastic bandages on laceration wounds; most commonly caused by shrapnel or anything else that could cut you. Use Packing bandages on bullet wounds or anything else that punctures.

• Use elastic bandages on:

• • Cuts

  • Lacerations

  • Everything else that hasn’t been mentioned here

• Use Packing bandages on:

• • Velocity wounds

  • Puncture wounds

  • Avulsions

• Tourniquets: Do not disregard tourniquets. Tourniquets are used to significantly slow bleeding, as they can be applied faster than multiple bandages. Use a tourniquet when a person in critical condition is bleeding faster than you can deal with, or if you have multiple badly wounded soldiers to bounce between. Note that tourniquets are not an adequate replacement for bandages, and a tourniqueted soldier will need to have their limb bandaged before they fully stop bleeding. Also note that tourniquets will cause pain when they remain applied, which can possibly result in a person passing out. Tourniquets effectively stop the transfer of drugs and fluids, so avoid injecting into tourniqueted limbs.

• Smoke Grenades: Smokes may not be the first thing you think of when you think “medic”, but the default six white smokes you get can mean the difference between a successful push and brutal failure. You can also use smokes to position yourself to take care of wounded soldiers, or even drag them to safety. When in doubt, smoke it out. Purple smoke (when available) is used to mark the locations of downed soldiers and casualties.

Advanced Topics

Cardiac Arrest:

It is possible to bring someone back from the point in which their heart stops entirely. This state is called cardiac arrest. From the moment where someone's heart stops, you have about 3 minutes to stabilize them and revive their heart via CPR. CPR has a 75% chance of success. If you fail the first time, try again. It is suggested medics have infantry do CPR for them, as there is no difference in the quality of CPR based on who is performing it. Each time you complete the CPR process you reset a person’s death timer back to 3 minutes until they have regained enough blood to have stabilized into a “normal” unconscious state. You can check pulse to identify if your injured soldier has stabilized, as their heart rate should be “strong”.

On Pulse and Epinephrine:

TL:DR; Use epinephrine on unconscious soldiers.

As touched on in the quick start guide, once you give someone blood they might not get up immediately- in fact, it might take quite some time. While many like to complicate things by frequently checking blood pressure, the pulse is all you need. When someone has lost a lot of blood, it is common for their heart to start beating faster to make up for this, resulting in a dangerously elevated pulse. You will find injured soldiers often have a pulse of 110+ bpm. Epinephrine raises a soldier's pulse even higher. Using an Epi pen on a soldier with a high heart rate can kill them- however, adenosine counteracts the negative effects. If an uncon soldier has a high heart rate (110+), administer epinephrine followed immediately by adenosine.

On Pain and Morphine:

You’ve probably experienced pain in session. Your character moans and groans, and there is a blurry and/or strobing effect on the edges of your vision. Severe pain can be very unpleasant, which is why we have morphine available to our medics. If a soldier complains about pain, or you can see it in their medical menu, ask if they want a shot. Upon getting their consent, make it very clear that you are proceeding to inject morphine. This is because morphine overdoses are dangerously easy to cause, with the threshold going lower with the more blood a soldier has lost. Avoid giving more than one stick of morphine to a soldier in a short time. The effects take 30 seconds to activate and they last for 30 minutes. Also, DO NOT give morphine to unconscious soldiers.

Morphine Overdoses:

Avoiding One:

Consent. It’s as simple as tea. Do not silently administer morphine to people, and always check someone’s medical record (bottom left of the medical menu) before administering. By doing this, you will undoubtedly avoid giving people double doses of morphine. Additionally, if you accidently begin giving someone a second stick of morphine, use the escape key before the ACE animation is complete; this will cancel the procedure entirely.

A healthy patient with no blood loss can take two sticks of morphine, but again- the danger threshold rapidly ramps up with blood loss.

Averting Catastrophe:

Did you just give someone a second stick of morphine while they were already missing blood? Don’t panic; all is not yet lost. In terms of the way they affect your heart, there is no medicinal counter for morphine available to medics at this time. Epinephrine is non-viable as it is far too fast acting to counter the 30 minute effect of morphine.

Because of this, your goal is to increase blood pressure with more fluids, with the goal of ensuring their heart does not stop. Administer blood while monitoring heart rate. If their heartbeat is falling to dangerously low levels, you can temporarily drag it back up with epinephrine- but fluids are the only way you can truly “Stabilize” someone.

Emergency Triage During a Mass Casualty Event:

One well placed explosive can devastate our forces. When a large number of people are severely injured, rapid analysis of the situation is critical. Immediately begin checking all unconscious individuals for their pulse, and call out to all conscious soldiers for a status report. Sometimes those who are awake need more immediate help than those who are unconscious!

In the early stages of a mass casualty event, your #1 goal is to stay alive; oftentimes the threat is still active. Next, you should be working to access the situation, as mentioned above. From here, you need to begin stabilizing people; bandage and tourniquet everyone that is bleeding, prioritizing those who are the most badly injured. Call out for healthy/lightly injured soldiers to help you move bodies and bandage wounds. Once everyone is stable, begin with the blood transfusions, rationing doses to awaken the largest number of people you can. If someone has lost “A very large amount of blood”, they might need 2000mL. It might be for the best to push them aside, and use your limited amounts of saline on those who will be able to awaken sooner. Remember soldiers- the hardest choices require the strongest wills.