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Field Medicine - A Soldier's Guide

((The following can be found in the safe in the form of booklets, or obtained from Unbroken medics upon request))

Field Medicine - A Soldier's Guide
by Thondalar Stormleaf
(edited by Anhagath Moonflame)

This is intended to be a basic field guide for the soldiers of Kirin Tor-registered independent military unit #167, Unbroken. All Unbroken soldiers are expected to commit these basics to memory. Stormleaf was kind enough to spend his time writing up a guide, and I've done my best to simplify it, to make it palatable to those with little to no medical experience.

Battlefield medicine is rarely easy. Hard decisions must be made, and quickly, and often only experience teaches us which is the correct call to make. Do not freeze up--swift decisions are required, and mistakes can be lived with--inaction cannot. This guide should aid you whether you face a single wounded soldier, or an entire downed unit.

I. Procedure
- Assess
- Stabilize/Evacuate
- Triage
- General Care

1. Assessment
Step one is to assess the situation. You must decide whether the battlefield is safe to work in, or whether the wounded need to be immediately evacuated. You must decide who to treat first, and how far to treat them before moving to your next patient. For example, rather than focusing on fully mending someone while another lays bleeding, you simply want to ensure everyone's survival first, stabilizing patient one, then moving to number two, and so forth. It is common sense in a normal situation, but combat has a tendency to make things hard. Consider serving temporarily with a team of field medics to give yourself experience.

2. Evacuation and Stabilization
Summary: do not move severely-wounded patients unless the area around you is dangerous, and if it is, stabilize them before transporting them, if you can.

If you can safely work where you are, then do so, whilst keeping the fundamentals of triage in mind for multiple wounded. If it is too dangerous, then do your best to stabilize them, unless under heavy fire, before moving them. Carrying a heavily-bleeding person or one with vital wounds or rib or vertebral bone fractures can kill them. If you must evacuate, do your best to get them onto a stretcher of some kind--even if you must drag it--which will prevent movement of the body relative to itself.

To stabilize a wounded victim: immobilize them (using splints or supportive neck braces, which can druidically be grown from carried tree bark) to prevent further injury, brace broken bones where possible, stop bleeding, and ensure the victim is kept warm. If you have no one else to tend to, speak to them and keep them occupied and calm. Stabilization serves the purpose of preventing further injury and preventing shock.

3. Triage
Triage is the process of prioritizing which patient is to receive treatment, and to what extent, when multiple victims are present, based on the severity of their condition. The field medic must assess who can be saved, and who not, and ensure that a severely-wounded patient is not lost while care is being given to another patient's superficial wounds, for example.

Patients should be divided into three categories:

  • Those who are likely to live, regardless of what care they receive.
  • Those who are unlikely to live, regardless of what care they receive.
  • Those for whom immediate care might make a positive difference in outcome.

Assessments can be made magically or physically. If you can utilize healing magics, sense how wounded they are; if not, check their skin-color, temperature, pulse, pupils, and clamminess of skin. Check for the symptoms of shock, as will be covered later in this guide. Check those who have fallen silent before those still strong enough to shout and scream.

Those for whom immediate care will make a difference should be stabilized quickly. For those likely to die regardless of care received, pallatiative care such as painkillers may be administered to ease suffering. Those likely to live regardless, can be left for last.


II. Specific Treatment
This section deals with how to treat specific injury types in the field. It covers:

I. Bleeding wounds
II. Blood Loss
III. Burn Wounds
IV. Breaks
V. Overheating & Hypothermia
VI. Shock

I. Bleeding Wounds
Bleeding wounds can cause death very quickly simply through blood loss. With this comes the risk of later infection. When attending a bleeding wound, your priority is to stop the bleeding.

  • Remove obstructive jewelry and clothing from the injured body part.
  • Apply direct pressure to any bleeding wound to control bleeding, or--after removing any foreign objects--use magical means to seal it. If you have other patients also requiring emergency care, then focus on stopping bleeding by binding the wound or packing it with gauze, and return to the following steps later.
  • Clean the wound after bleeding has stopped, or bind it heavily if it will not stop.
  • Examine wounds for dirt and foreign objects.
  • Gently flood the wound with clean water (if available, boiled, slightly salted water is preferrable. Alcohol can be used in a emergency situation, but is not desirable.)
  • Gently clean around the wound with soap and clean water.
  • Pat dry and apply padding where needed, then bandage with a clean bandage or dry clean cloth.
  • Leave unclean wounds open, assuming you can do so without too much bleeding. Wounds that are not cleaned correctly can trap bacteria and result in infection. Bite wounds will often become badly infected if an opening at the lower end of the wound is not left to allow draining. Never suture unclean wounds.
  • Elevate the wounded body-part.
  • Provide pain relievers when possible.
  • Review the wound every 24 hours, and change bandages as often as it is safe to do so. Fluid-soaked bandages may fall away from a wound.
  • For heavily-bleeding wounds from stabs or the like, or if you have other patients to see to, one can apply pressure to a wound by first wrapping fabric, then apply a heavier, rounded object on it. A palm-sized stone can be used for this, or similar objects. Place it over the wrapped wound, then wrap another layer over, firmly, so that the stone is pressed down to provide firm, direct pressure to the wound.

II. Blood Loss
Together with bleeding wounds--and also with internal injuries--comes blood loss. Blood loss can quickly lead to shock and death. Look for:

  • Abdominal pain or swelling (a symptom of internal bleeding)
  • Visible bleeding from wounds or any orifices
  • Blood in the stool (the stool may be black and tarry or red, or bluish or violet-tinged for Draenei and Kaldorei)
  • Blood in the urine (the urine may be pink, red, or brownish in color, or variations on blue or violet for Draenei and Kaldorei; for stool and urine both, fresher-colored blood can mean a heavier wound or one closer to the exit point)
  • Bruising (a bruise forms when there is blood under the skin)
  • Cool, clammy skin
  • Dizziness, weakness, or confusion
  • Fast, weak pulse
  • Paleness
  • Trouble breathing
  • Vomitting blood or what looks like dark, grainy dirt
  • Treatment of blood loss comes in two parts: stopping the bleed, and treating the effects of the blood loss. The techniques to stop the bleeding depend on the cause and location of the bleed. For external bleeds see the "Bleeding Wound" section above. For internal bleeding, surgery or magical aid may be required.

Treatment of the effects of blood loss depend upon the volume of blood loss. Be sure to check what medications your patient may be taking, where possible, before treating (ex. Rain Poppy may thin the blood, worsening bleeds). In cases of heavy blood loss, use Troll's Blood herbal potions where possible to increase a hundredfold the natural regeneration of blood. Utilize healing magic on top of this where possible. Blood transfusions--done by transfusing matching blood and transferring to the wounded person--can also be done, but the training needed to test and identify matching blood type is too complex to delve into here. Using the wrong blood can kill your patient, even when the race of recipient and donor are the same.

Another risk is blood-related illness or curses; magical cleansing is therefore always recommended.

Offer plenty of water--with sugar wherever possible, ex. in the form of natural fruit juice--to victims of blood loss, but ensure they are strong enough to drink it. Assist them in doing so if required. Offer hearty foods where possible, such as red meats and stews, if they are capable of consuming these.

A note on tourniquets: in the case of a severely-bleeding limb, a rope can be tightly winched with leverage, or a belt tightened, around the affected limb. This can save a life long enough to get the victim to a mender, but as it cuts off all blood supply to the limb in question, it can rapidly lead to the loss of the limb.

III. Burn Wounds
Editor's Note: we really should know how to treat burns, by now, but it is worth including regardless as I am certain we will continue to incur them at a ludicrous rate.

Treatment of burn wounds depends on the size, severity, and cause of the burn. The same core principles apply to basic care: use sterilized water to cool the wound, and if you have it, apply herbal healing salves. Do not apply oils, or anything other than healing gels: these can worsen the damage, cause an infection, or even cause the wound to burn further if the oil catches flame. Keep burn dressings and burn salves in your first-aid kit. In the field, you may need to simply cool the wound with water to prevent further tissue damage, and then transport the patient for further treatment.

For further treatment, you must first assess the severity of the burn.

First-Degree or superficial burns are identified by pain, redness, minor swelling and an absence of blistering.

Second-Degree burns produce a slight thickness of the skin and may include blistering, indicating damage has been done to the underlying layers of skin.
Third-Degree burns feature leathery, waxen skin and are commonly accompanied by numbness due to full damage to the skin and surrounding nerves.
Fourth-degree burns have extended past the skin layers and into the flesh, causing charring and irreparable damage.
First- and second-degree burns are treated by washing, patting dry with a clean cloth, then appyling a suitable burn salve. Goldthorn is particularly useful as the plant juice thickens, producing an excellent burn remedy on its own.

Third- and fourth-degree burns, however, involve different treatment. After washing, later treatment may require extensive debriding (the removal of dead tissue) and vigilant supervision for infection. Rich amounts of burn salve might be required. In these cases heavy scarring is to be expected. The bandages used for these burns must be breathable and as completely sterile as possible. Infection and shock are both highly-likely.

For more severe burns, magical healing is highly preferred, as it can greatly reduce the healing time, the risk of infection, and the level of scarring.

IV. Breaks

Bone fractures can be internal or external, causing severe bleeding. When tending broken bones, follow this procedure:

  • Stop any bleeding as per the Bleeding Wound section above.
  • Immobilize the wound. Do not try to realign it in the field; splint it if you can to prevent wound movement (which leads to further damage), and pad the splint if you have time.
  • Treat for pain, and where possible (using magical means or wrapped, packed snow or ice), for swelling
  • Check and treat for shock, as covered in the shock section below
  • For internal breaks such as ribs and pelvis, immobilize the patient, and as soon as possible, check for and treat signs of internal bleeding. Surgery may be required, and druidic use of roots and bark can be used to replace and set bones, but treatment for blood loss and wounds should be ready when, for example, removing bones from pierced organs.

V. Overheating and Hypothermia
Both of these conditions can be serious in and of themselves, or rapidly worsen an otherwise-wounded patient's condition. When assessing an injury victim, always check for either state.

Cold temperatures, extreme dehydration, blood loss and shock can all lead to hypothermia.

Look for:
  • Shivering
  • Cold and pale skin
  • Slurred speech
  • Rapid breathing
  • Tiredness
  • Confusion
  • If a patient is cold to the touch, shows other signs of hypothermia yet has stopped shivering, they may be in an even worse state.
First aid for hypothermia
  • Move them indoors, or near to a heat source.
  • Remove any wet clothing and dry them.
  • Wrap them in blankets.
  • Give them a warm non-alcoholic drink, but only if they can swallow normally.
  • Give energy food that contains sugar, such as a  dried fruits, but only if they can swallow normally, or juice.
  • If the person can't be moved indoors, find something for them to rest on to protect them from the cold ground, like a towel or a blanket.
  • Check also for dehydration, as a dehydrated state can have rendered them susceptible to hypothermia in the first place.
    Things to avoid:
  • Don't put the person into a hot bath.
  • Don't massage their limbs; heat the core of the body first, as heating the limbs first can deliver a fatal shock of ice-cold blood to the heart.
  • Don't give them alcohol to drink.
Overheating (Hyperthermia)

Overheating, including heat exhaustion, is caused by an increase of core body temperature, again often linked with dehydration (rendering the body less capable of regulating body temperature). Always be alert to the signs of overheating in others, and be ready to rapidly seak treatment. If left alone it can lead to a potentially fatal heat stroke. Normally, an average humanoid body will sweat, and sweat's evaporation lowers skin temperatures. If humidity is very high, if temperature is simply too high to cope with, if the patient is dehydrated, etc, core temperature rises. Signs of this include:
  • Weakness
  • Dizziness or fainting
  • Warm, moist, pale skin
  • Nausea and vomiting
  • Heavy sweating
  • Headache
First aid for Overheating
  • Get into a cooler enviorment.
  • Drink cool drinks, but avoid alcohol.
  • Slightly salted water to replace lost salt.
  • Sponge with cool water or submerge in cool water, under strict observation.
  • Loosen or remove clothing.
If the heat exhaustion passes over to Heat stroke, it can lead to severe risks, including coma, brain damage or death. Do not underestimate the dangers of it.

Signs are:
  • Confusion
  • Hot flushed dry skin
  • Deep, rapid breathing
  • Seizures
  • Rapid heartbeat
  • Treatment should be the same as with overheating, but a boost of the victim's strength through magical means can be very helpful.

VI. Shock
Shock is the body's reaction to severe trauma. Look for its signs in all medical patients. There are different types of shock, but all are considered emergencies.

Hypervolemic shock is caused by lack of blood to pump through the body due to severe blood or fluid loss, typically through injuries or malnutrition. Treatment should be through rehydration, troll's blood elixirs, magical aid and where needed, blood tranfusions.

Septic Shock results from illnesses and infection, which should be treated with herbs and magic.

Allergic reaction shock results from allergic reactions, be they from insect stings, snake bites, food, medicines, or anything else. Liferoot can be used to create a nullifier for actual toxins in this case.

Shock can also result from spinal injuries, which may be repaired through surgery or magical healing.

Look for the following symptoms present in all types of shock:
  • Rapid, shallow breathing
  • Cold, clammy skin
  • Rapid, weak pulse
  • Dizziness or fainting
  • Weakness
Depending on the situation and the cause of shock, you may also see:
  • Staring eyes
  • Anxiety or agitation
  • Seizures
  • Confusion or unresponsiveness
  • Low or no urine output
  • Bluish lips and fingernails
  • Sweating
  • Chest pain

First aid for shock
  • Lay the victim down, and elevate the feet and legs (assuming this will not cause further injury)
  • Keep the victim still, do not move them, where possible
  • Loosen tight clothing, and cover with a blanket
  • Turn the head to the side if the person is vomiting or bleeding from the mouth and if they do not show signs of neck injury
  • Do not let the person eat, or drink, immediately
  • If you suspect allergic shock, get magical medical aid as soon as possible
  • Treat other injuries, and the source of shock
  • Once the person can swallow, or via injection, offer fluids (preferably warmed, with salts)

There are a number of other types of injuries to look out for in the field: crush injuries caused by heavy weights pinning the victim, frostbite injuries, magical plagues and the like, and more. These would require the full scope of a medical manual to cover, but it is suggested that anyone interested, learn more through further research or via training with trained medics.

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