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Sister morphine's guide to medical first response :

Discussion in 'Tutorials & Information' started by flying_loulou, Jan 20, 2019.

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  1. flying_loulou

    flying_loulou Senior Enlisted Advisor

    Introduction :
    Before you start reading this little thread, please keep in mind that this guide is addressed to the unexperienced medical player, to give them a starting point from which they can addapt their gameplay as they want. This is not a bible on how to keep someone alive.
    Furthermore, everyone has his own ways, it's up to you to find yours, this thread is only here to help you on this task.
    Also note that you won't be able to handle a serious emergency after reading this guide, or any other, the best thing to do to learn is join the round as corpseman trainee, and play with other people, learn from them (his might take a couple of weeks, if not more).

    Also please note that I listed the most common cases, but you can imagine that you cannot list everything. With experience you'll know what to do, and when (Again this thread's goal is to give you a hand on your first days).

    Getting geared up :
    First thing first you'll have to gear up, because however sticking your finger in a squeezing artery may work, it's not what I call a "future-friendly situation".


    I use to classify my equipment in three categories, follows the list of each things I use to take with me :

    1) The gears :
    - Your uniform, boots and eventually head cover (if EC/fleetie) because the master chiefs are spooky as fuck and you don't want them to shout at you (you can wear medical scrubs as corpsman but it doesn't make a lot of sense to me)
    - pair of nitrile/latex/duty gloves
    - Sterile mask (+/- optional)
    - The spare emergency O2 tank in your locker
    - The spare mask in your locker
    - Flashlight
    - Pry bar
    - Handheld Radio
    - duty gloves (optional, mostly for fluff)
    - Medical tape (very optional)
    - Screwdriver (very optional)
    - A rescue bag (can be used as a simple stretcher, and doesn't take much place)
    - A rollerbed.
    - Very optional : I use to replace the gauze and the autoinjector in my crew kit by a wrench and a wirecutter, which allows me to take windows down (since you already carry plenty gauzes anyway).

    I recommend preparing a medical voidsuit and an inflatable door (or a whole box) you'll lay somewhere in the ETC so you don't have to run to the EVA storage.


    2) Medical equipment
    - Your beautifull advanced medkit
    - Extra trauma/burn kits (at your convenience)
    - A (nano)blood bag (you can plug someone on it, either by using the bed as an IV, or simply by holding the blood bag in your hand, and click-dragging it to the patient (which allows you, for example, to use it on someone in a rescue bag).
    - The Auto-compressor (it helps blood circulation, partially replacing the heart. It looses efficiency if the victim has lung damages, or if they sustained blood loss).
    - Stethoscope (optional)
    - Light pen (optional)
    - Body bag (very very optional, once they're dead the emergency is over and you have plenty of time to get one in the infirmary)


    3) Chemicals
    - Inaprovaline
    - Dylovene
    - Dexaline plus
    - Bicardine
    - KeloDerm, if not : Kelotane/Bicardine
    - Tramadol
    - Adrenaline (Optional same reason than for the Defib', I use to take a bottle or borrow an injector from a Oxy deprivation/burn pouch)
    - Hyronalin (Optional, you can take them to medical if they're irradiated, I personnaly don't carry any, safe from the pill in the advanced medkit)
    Note : I really advise using liquid chemicals, you're on first response and/or stabilizing a patient in the ETC/an OR, you have to be quick, and pills take way longer to synthetize.

    Someone shouted for help, what should I do ? (Answering a call)

    1) First thing first : Locate the victim, sweeping the whole ship is useless and you'll just waste your time.
    If you're lucky they'll be able to answer on comms and will tell you where they are, if not :
    - Use the sensors
    - Ask the other people around if they see/saw whoever's calling
    - Be logical, check what's the person's job and try to guess what could have happened (Bartender rarely get caught in a fire in the SM core for example)

    2) You now know where they are, you now have to figure out what happened : you likely won't have a precise answer so don't waste too much time here, but the most important thing is :
    Is there still a threat (For the victim ? for me ?) ? (-->if not, treat your patient)
    -->If yes : can I get the rid of the threat ?
    --> if yes : Proceed and then treat your patient
    --> If not (Hostile boarder, patient in a vented area...) : Bag the victim and get to a safe and life-friendly location

    Time to use your agile fingers ! (Vital Diagnostic - stabilizing)

    As first responder your first role is to stabilize the victim, which means at the moment you start treating her, her case should not worsen, and if possible, get better.
    - Before you do anything else : scan her, and look if she's bleeding. If she is, patch that in priority.
    - If the heart has stopped : Look what caused it. If it was caused by blood loss, and run to the infirmary (do plug them on the blood bag you're carrying, it'll buy time as she'll start refilling during the transport), make sure you installed the auto-compressor. Do monitor the brain activity, if it's flashing "minor" or "weak" brain activity you may have time to attempt to CPR, which may restart the heart after a few (2/3) cycles (if your medicine/anatomy skills are high enough). If the brain activity is down to Extremely weak or worse (fadding), your patient need an urgent scan and surgery to save his brain, warn the physicians to allow them to prepare, administer inaprovaline and dexaline (plus), instal the auto-compressor and run the patient up to the infirmary.
    - Once done, look for Oxygene deprivation (considered dangerous at 85% and bellow) and low blood pressure (a normal pressure is at around 120/70). Treat oxygene deprivation with dexaline (plus) and if her lungs are damaged, set her internals at 35kPa(that's what your extended oxygen tank is here for), and low blood pressure by plugging them to an IV (you'll probably need to get to the infirmary for this step, but if she's in a critical state, take your time and run down the rest of the vital Diagnostic, if she's critcial, Run forest, Run).
    - Check if she has a ruptured artery : if yes, hurry on the on-field treatment : stop the bleeds, plug them on an IV, administer inaprovaline and painkiller, and rush them to a doctor
    - Look for a systemic organ failure, if you also see "unkown substance in bloodstream" the patient's organs are getting damaged by some toxins : Administer dylovene and stuff them in a sleeper for a dialysis.
    - Check her heart --> if high pulse (150 and above), administer Inaprovaline
    - if the scanner reads "patient in high risk of shock", it means the victim's heart might stop because of pain, administer Tramadol.

    Once this is done, use a roller bed (an office chair, a locker or the ironing board can do if you're out) and lead them to the infirmary, then : scan them, and push the scan to a screen. If they need surgery hand them to a surgeon. Note that the surgeon might ask you to stay in the OR to keep the patient stable while they operate.
    If no surgery is needed, keep following the guide.

    Multiple victims situations ! (Triage)

    Some times, you may encounter a multiple victims situation. First thing first : Tell anyone useless to step out of the way, then call back-up (if any). Afterward, scan all the victims, and try to figure out who's in the worst state, and who's not soooo bad. Afterward, patch the bleeders (always), you may get people around you to do so.
    - Get people around you to drag the less badly wounded to the infirmary (make sure they don't worsen the wounds) while you deal with the most critical cases.
    - Everyone can use a gauze, if the people around you aren't too dumb, and if they're not getting in your way, try to use them.
    Don't say "someone patch him", but "you, patch him", designating whoever you want to help you, this will prevent you to experience the "bystander effect" (basically if you say "someone patch him", everyone will stay still, asuming someone else is going to do it, while if you designate someone precisely, he is likely (unless it's an *******) to do it).
    - Make sure you inform the doctors on who needs a surgery first, and who's to be put aside for now. If there is 5 people bleeding out, and 1 in a cardiac arrest : First patch the bleeds, then make sure the 5 persons' hearts don't stop, and THEN get on the flat-lined one. You prefer saving 5 person and probably loosing 1, than maybe saving 1 and probably loosing 5 (awfull choice isn't it ?).

    In some case, it might be easier to bag everyone and run them to the infirmary, and do the Triage in the ETC, with the help of the surgeons/physicians.

    Make'em feel better ! (non-vital Diagnostic - Patching the wounds - Post OP)

    Now you're patient's life is safe. While they can't wander around because still injured, their state is stable, and the surgery was (properly) done by a (competent) Surgeon. Your next goal is to patch her in order to allow them to leave the infirmary.
    Note : if the doctor asked you to keep the patient stable in surgery, nothing prevents you from patching their wounds while keeping them stable. However, make sure you don't interfer with the surgery.

    First thing : you now have time, make sure your patient don't suffer, and be reassuring, you're also paid for that.

    Brain damage :
    If the brain is damaged, you can fix it with :
    - Inaprovaline if the damage is minor
    - Alkysine. If you administer Alkysine make sure to strap your patient on a bed as they won't be able to move and will run into walls. Furthermore, use as least alky as possible, 5 units is often (always) enough.

    Minor liver damages : Minor liver damages can be patched using Dylovene, if a doc' tries their favorite invasive surgery /try/ to suggest them to try dylo first (but keep in mind : they're the boss, you're the medic).

    Traumas : Don't waste 60 units of tricordrazine (and eventually 30 unit of Bicardine) on someone to clear his wounds, use the trauma kits, they are usually faster than tricord. Use your chemicals wisely, the chemist won't be happy if you empty a whole EMT belt on each patient. Don't administer Bicardine/tricordrazine if the patient still needs surgery, as it will slow it down (the Bicardine/tricordrazine causes the incision to close on its own)

    Burns : Use burn kits, administer KeloDerm/Kelotane/Dermaline. Make sure the patient don't catch an infection.

    Infections : Following burns, or if the surgery was done in some wowy zowy conditions (the surgeon forgetting his gloves, not washing his hands, and so on, the patient might show some infected wounds. If so, administer 5u of spaceaciline (Injecting more will kill his immune system so don't do it).

    Dislocated limbs : Lay your patient, and use Right-click-->undislocate Joint. Administer Painkiller before-hand, it hurts a fucking lot.


    Let's get on a hike ! (going on an expedition)

    Since they're very prone to getting wounded, the exploration department might ask a medic for their expedition. And as the CMO knows they can trust you, they're sending you.
    Basically everything written above applies, appart from a few things :
    - Defib' is now mandatory (and so is Adrenaline)
    - Get a nanoblood bag, you can administer some with a syringue, but be careful and don't OD your patient.
    - Get your EVA suit (obviously)
    - Stay behind : you're the medic, the one that patches, not the one meant to get wounded, because if you do, no one will patch you.

    - if the state of the victim is critical, don't hesitate to hurry the explorers to get back. The pilot can take off once you're in the airlock as you can buckle to the railings, it saves some precious time.


    A few tips

    You will likely have some difficulties to stuff all the things listed above in your backpack, so here is a few tip on how to get ALL this on you, poor little person :
    - Use a webbing or a drop pouch (attached to the uniform)
    - in your locker, you'll find a box of injectors. empty it of its (inaprovaline) autoinjector (you might keep a few of them, at your discretion), and pile your stuff in it, it'll save you some room in your backpack (you can as well replace some things in your crew survival kit).
    - You can use an empty medkit to pile stuff in it, to save some room.

    As an example, I carry 1 roller bed, 1rescue bag, 1 blood bag, 1 advanced medkit, some tools (wrench, wirecutter, pry bar, screwdriver, pocket fire extinguisher), 1 autocompressor, 1 or 2 adrenaline autoinjectors, a full belt of the listed above chemicals, some spare sugar iron and hyronalin pils (in my wallet and in my drop pouches), a flashlight and my PDA (/a health analyser) I still have enough room for the equivalent of 1 box.


    What about Aaaar Peeee (RP) ?
    Basically, an EMT (or corpsman for you bunch of spess vets) is a sentient being : they can fear, do courageous stuff, be angry, tired, sad, and so on. Being a good EMT is a thing, being a good EMT with a personality is even better (rather than the stereotypical memy heart-less folk);). Because yes, it's actually awfull to see someone shouting, in pain, just next to you, give them that bloody tramadol !.
    Also, try to interact with your patient. If the case is not critical, explain them what you do (not step-by-step, but bascially, a little : "How's the pain ?" or a : "Alright, You still have a few bruises, and your brain took a small hit, I will have to patch that. Aside that, how do you feel ?" Doesn't hurt). It always kills me to see a medical staff taking someone in the entrance of the infirmary, stabilizing them, doing the surgery, patching them, and releasing them without saying a word.
    For example not wearing your gloves and mask 24/7 (because you sweat with them, it's uncomfortable, and IRL you'd get your ass kicked for doing so because it's unsanitory) is a first thing.


    Conclusion
    I hope this little guide is concise and precise enough. If you notice a mistake, or if I forgot something important, please tell me I'll try to keep this guide up-to-date.
    And again, this is only a base, everyone has his own way and it's up to you to find yours. My char for example tends to prioritize his patient's interest and well-being while some people will prioritize being fast (i.e. I'd prioritise using chemicals rather than a calling a surgeon for a surgery, even if I might have to wait. Obviously, you have to adapt to the situation, you don't deal with 1 patient alone the same way you deal with 10 patients).


     
    Last edited: Apr 16, 2019
    Noble Caos likes this.
  2. flying_loulou

    flying_loulou Senior Enlisted Advisor

    Note that for some reason I can't figure out why the paragraphs "the gears" and "medical equipment" fonts are bigger...
     
  3. afterthought

    afterthought Retired Staff

    Pro tip: never wear hats.

    A typical corpsman mistake is to try treating people on the spot for conditions that can't be treated there (this includes all organ damage, most cases of blood loss, anything that will require surgery). Once you bandage open wounds, err on the side of bagging them, moving them to the treatment center, and sorting it out there. In particular, there's no point carrying a defib: sure, you can shock them, but they'll probably go right back into cardiac arrest unless you treat the underlying cause, which you almost certainly won't be able to.

    The other typical corpsman mistake is not being active enough in the treatment center: there you have all the tools you need to diagnose, stabilize, and possibly even heal the patient. Make sure that if you are manning the treatment center, you are aware of who all the patients are, what their condition is, and whether they are getting the treatment they need. You, the corpsman, effectively run the treatment center in crisis, as the doctors will be spending almost all their time in surgery and don't have your mobility or situational awareness.
     
    Noble Caos likes this.
  4. flying_loulou

    flying_loulou Senior Enlisted Advisor


    Completely backing up what's being said here. The action in the stabilization part shouldn't be completely done con site, do the most urgent things and lead the victim to the ETC.

    Also about corpsmen not being active in the ETC, I have even yesterday met a Corpseman saying "Hey I'm medic, not doc'" while asked why he wasn't giving a hand in the ETC. There is, in total, 2 physician, 1 CMO, and 3 Corpsemen (not counting contractors, Trainees, and so on), which means if you have 1 physician in each OR, and the CMO coordinating the whole mess, the people that remain to man the ETC are the corpsemen and the contractors...

    Also, there are 2 other things I've witnessed quite often last days :
    - People forget about blood loss, and this sometimes leads to death while the only action needed to keep the patient alive/reviving him was to plug him on an IV.
    - When a victim flat-lined , adrenaline is often being forgotten, while it is actually nearly as efficient as the defib' (if not even more). If you combine both of them, and the victim keeps passing out, you forgot something else.
    (not blaming here, just pointing out mistakes I've noticed. I'm also not mistake-free and I probably do some).
     
  5. Imienny

    Imienny Laser Tag 2019 Participant

    not bad tutorial but you missed few things,
    so, if someone has severe oxygen deprivation (which can be temporary treated with dexalin plus) and/or severe heart damages they will go back into cardiac arrest right after you zap them with defib,
    and yes, adrenaline is more efficient than defibs, you can use it through bags and voidsuits and takes less space than defib, just keep in mind that you will need 5u to restart heart
    also, autoinjector box in corpsman locker contain autoinjectors with inaprovaline, not trico, which makes them really useful
     
  6. flying_loulou

    flying_loulou Senior Enlisted Advisor

    Updated, thank you !

    About the autoinjector, I don't carry much of them as 2 of them take as much room as 1 bottle of the same chemical while the bottle contains way more of whatever's in it. Also, you can't inject through a stasis bag with an autoinjector.
     
  7. Imienny

    Imienny Laser Tag 2019 Participant

  8. flying_loulou

    flying_loulou Senior Enlisted Advisor

    I'll see its actual effects when the PR will be merged, however if it doesn't make huge damages to the heart, I think using 5u and patching the heart with the cryo tubes could be a good thing to do.
     
  9. flying_loulou

    flying_loulou Senior Enlisted Advisor

    UPDATE : updated to the stasis bag removal, implementation of the auto-compressor and so on. Some things still need to be corrected, though.