Combat Medic Skills: Treatment of Wounds at CWG Events

As we discussed before, CWG casualty rules are really very simple for the everyday soldier. There's nothing to know but to call your hit and wait for the medic.

But Combat Medics do need to know a lot more about it, at least if they want to follow the rules and be effective.

The key to CWG's medic rules is that the effect on the casualty is more important that "perfect procedure" by the Medic. In general we trust our Combat Medics like we trust all our players to follow the spirit of the rule, if not always the letter.

We are about to see the different wounds that are possible at CWG events. We will take a look at the casualty card and next to it a photo of a soldier with the completed intervention. We use the term intervention because obviously the soldier is not miraculously healed of their wounds. They are simply treated, and the soldier must be evacuated or may continue fighting in a diminished capacity.

What we will not see is a step-by-step instruction manual. Not only because it would fill up a small book, but also because you don't need your intelligence insulted. The interventions we describe are simple. Hopefully you will feel the casualty cards themselves, and the few supplies we provide are easy to understand also.

Casualty Cards

Before we get started, a note on the concept of the system. It does not matter where you were actually struck by a BB. The first thing the Combat Medic does when he arrives at a casualty is to tear out a casualty card. The cards have a randomly-assigned location and effect.

The cards are bound face-down, so the medic doesn't know what the next wound will be until you get shot.

These are meant to simulate the randomness of battlefield wounding, without disrupting our immersive environment by asking everyone where you think that pellet hit you.

Effects are of two basic categories, Minor and Serious. There's a third level, Killed, but it's not really a wound level at that point.

Serious wounds can often be avoided by wearing body armor, or a helmet, so, but only up to a point.

Escalation of Wound Severity

These levels of wounding go very much in order:

This increasing severity rating is used when a second wound is taken to a still-treated area. If you come across an individual with the bandage for a minor head wound, and draw a second minor head wound card for them, you do not add a second minor head wound bandage.

Instead, you provide an intervention for the next level up, in this case you cover the eye, giving them to serious wound intervention.

That also means if you get a serious wound, and take another hit—before going to the CCP to be healed—to the same area, you are killed. Our unfortunate head wound victim drawing a third card of in the head will now be killed.  

Remember, Combat Medics, this is regardless of what the card says. You must evaluate the patient and use your knowledge. Don't worry, if you forget this the card stack has a cheat sheet with a summary of this information with it. 

Minor Head Wound

The soldier receives a "minor head wound." Using an ACE bandage, wrap the casualty's head, tight enough to stay on, but not so tight it cuts off blood flow. Don't cover the eyes, or cover the ears so much they cannot hear.

Wearing a helmet – Modern helmets are very effective, so many wounds to this critical area that would previously have killed the solider do not even injure them. In this case we presume the helmet took a grazing blow. The soldier was still slugged in the head so fell down and had to evaluated by the medic, but in the end is fine.
The soldier is uninjured. No treatment is needed.

In the real world – Head injuries bleed profusely. Even a minor cut can spread enough blood over a casualty to create panic, and if enough blood is lost, cause the body to go into shock.

Effect on the casualty – This is probably the least disruptive wound to the player. It is really just a big band-aid. However it is also the first wound we have discussed where a pattern of rising level of severity happens.

Serious Head Wound

The Soldier receives a "Serious Head Wound." Using and ACE Bandage, wrap the head, running the bandage lower so it also covers one eye. The medic will choose which eye. Wrapping over the goggles will just make this easier, more comfortable, and more secure than even what is shown.

Wearing a helmet – Helmets are not perfect, so relatively direct blows will still penetrate, or the helmet will be badly deformed and the back side of the helmet impacts the soldier's head. This is minor, but still a wound worth treating.
The solider receives a minor wound instead. See the card above for that treatment.

Second Wound – If a previous "Minor head wound" intervention is already in place, you may reuse the previous bandage instead of adding another.

Other effects – The helmet was notionally destroyed by the bullet, and can no longer be used. The player will put it aside or clip the helmet to his pack or LBE so he is not using it for protection.

In the real world – Head injuries are often difficult or impossible to assess or treat completely, and include many considerations to condition and wound type. Eye and brain damage are very serious and always require a fully-staffed hospital and almost always require surgery to treat successfully. Helmets are often damaged.

Effect on the casualty – The player looses part of their vision. Reduced field of view, and depth perception but also losing use of their helmet mean no head mounted NVGs either. Consider evacuating these casualties to the Casualty Collection Point (CCP) as soon as tactically feasible. Eyesight is possibly as important as your weapon.

Minor Torso Wound

There is no card for this effect. It is only used as the less-severe version of a Serious Torso Wound when wearing armor. Wrap an ACE Bandage under the armpit and over  the neck. The Medic chooses which side to tie this to. If there is an existing arm wound, tie this bandage on the same side to restrict use of only one arm.
Though we are simulating a bandage, remember this is a game. Do not actually create a pressure dressing, so be sure you are not causing discomfort, or reducing blood circulation to the arm.
Perform this intervention under body-armor and/or coats, but over the uniform blouse.

In the real world – There's not really any such thing as a minor penetrating wound to the torso. The common use of body armor has reduced the number of critical chest wounds seen on the battlefield. However wounds just outside of the armor are still as common as before, and more minor woulds are possibly more frequent due to projectiles deflecting off armor.
Real-world bleeding from the armpit could be arterial. This life threatening hemorrhage is very difficult to stop for any Combat Medic since a tourniquet can not be applied to the shoulder. Intervention requires steady pressure on the wound, and preferably a clotting agent. After dressing the wound, pressure is applied by using the casualties own arm as leverage to press the dressing firmly into the wound.
This fairly simple bandage technique reflects a simple way to reduce bleeding from a wounded armpit, or lower shoulder. It can also be seen as stabilizing serious bruising or broken ribs and collarbones from deformation of the armor.

Effect on the casualty – Players retain use of their arms and body, and may continue to fight, work, and function with little impact. Body armor remains effective against additional hits. 

Serious Torso Wound 

Wrap an ACE bandage under the armpit and over neck, as for a "minor torso wound" above, then tie the upper arm to the chest using a cravat or another ACE bandage. The medic may choose which arm to bandage.
Never secure both arms. The player must have at least one arm free to prevent real world injury when they trip and fall.
While the arm-securing bandage must go outside of armor and outerwear, remember the bandage as described under minor wound goes under the armor.

Second wound – If a previous "Serious Torso Wound" intervention is already in place, the player is killed when any other torso wound card is drawn.
If a previous arm injury has resulted in a slung and secured arm, just add the bandage from under the armpit, over the opposite shoulder. The previous arm injury sling and upper arm securing bandages will be retained or replaced.

In the real world – Real-world body armor is not capable of stopping every threat, nor can it stop threats from every angle. A projectile hitting a soldier from the side of the body could go right through/under the arm and enter the body without ever touching the body-armor. This casualty card is simulating this event to some degree.

Effect on the casualty – Armored casualties have limited movement of the arm below the elbow, since the upper arm is tied to the chest. Casualty retains the use of the hand for grasping and carrying.

Torso - Killed

Unarmored soldiers are killed as a result of a traumatic penetrating torso injury.

Wearing body armor – The solider receives a serious wound instead. See the card above for details on this intervention.

In the real world – CWG simulates many wounds to the thoracic cavity with the killed option. Tension-pneumothorax (sometimes called a 'sucking chest wound'), damage to internal organs, spinal column damage, or internal hemorrhage are beyond the ability of a typical Combat Medic.

Representing such interventions would also be complex, and/or dangerous so after much consideration, we have skipped them.

Effect on the casualty – The casualty is killed and must return to the Company CCP.

Minor Arm Wounds

Check the side – Both left and right versions of this wound exist. When no other wound exists, sling the arm designated on the card. When any existing arm or torso intervention is in place, sling the arm already treated instead.

1) Knot a cravat at the corner, and place it around the casualty's neck with the knot to the rear. Place the elbow into the large open end of the cravat. When standing, the arm will rest inside it. 2) Using a cravat or two, or an ACE bandage, tie around the torso, upper arm and sling to keep the slung arm from moving around. Perform the intervention over the top of the uniform, armor and outerwear.
Never secure both arms. The player must have at least one arm free to prevent real world injury when they trip and fall.

Second wound – Add the wrist splint as described in Serious Arm Wound.

In the real world – Real-world wounds to the arm often need to be stabilized well for broken bones, torn muscles or tendons, and dislocated joints to be comfortable enough the casualty is not in excessive pain. Some injuries to arms and legs can become critical or fatal from movement if not secured.

Effect on the casualty – Casualties have limited movement of the arm. Casualty retains the use of the hand for grasping and carrying.

Serious Arm Wounds

Check the side – Both left and right versions of this wound exist. When no other wound exists, sling the arm designated on the card. When any existing arm or torso intervention is in place, sling the arm already treated instead.

1) Using an aluminum SAM splint, and an ACE bandage, secure the hand, wrist and lower-arm to the splint 2) Sling the arm as above for Minor Arm Wounds.
Perform the intervention over the top of the uniform, armor and outerwear.
Never secure both arms. The player must have at least one arm free to prevent real world injury when they trip and fall.

Second wound – If a previous serious arm wound intervention has been performed, the casualty is killed.

In the real world – Real-world bone, joint, muscle, or tendon damage often requires stabilization using splints. Injuries to limbs can easily result in fatal blood loss.

Effect on the casualty – Loss of function of that entire arm below the shoulder. Although we suppose the sling might make a handy place to stash your bag of snacks, it is a poor trade for an entire arm.

Minor Leg Wound

Check the side – Both left and right versions of this wound exist. Always use the side indicated. Unlike arms, you may splint both legs.

Using two aluminum SAM splints, immobilize the knee of indicated leg. Place one splint on the front of the leg as shown, and one on the back of the leg. Secure the two splints with an elastic bandage, or cravats along their entire length. Ensure that the splint is not too tight, does not cut off circulation or cause discomfort.

Second wound – Add the bandage as described in Serious Leg Wound. Be sure to remove the splints before placing the bandage.

In the real world – There are many good reasons to stabilize a leg for comfort and to prevent further injury. There are also many other leg injuries that we cannot simulate without impacting mobility, adding large and complex medical supplies, or adding complex rules.
In reality, splints to the knee would be placed on either side of the leg instead of the front and back. CWG requires this so the casualty to bend their knee in an emergency. It is specifically an ineffective splinting method for the real world.

Effect on the casualty – The splint replicates the stiffness and lack of mobility of many types of leg wounds. The ankle is left free to move as is the hip, allowing the casualty some ability to walk still.

Serious Leg Wound, Left or Right

Check the side – Both left and right versions of this wound exist. Always use the side indicated. Unlike arms, you may splint both legs.

Above the knee apply one ACE bandage, as though a wound dressing. On top of this add the splints as described in the Minor Leg Wound.

Second wound – The casualty is killed.

In the real world – Battlefield wounds to legs can involve damage to large bones, and large blood vessels that normally might require a tourniquet and/or large dressings. Tourniquets and dressings must be placed high on the limb to be effective, they must also be placed under splints, objects in pockets, and if possible under clothing.
This presents a problem for simulation, since interventions under clothing and/or in the groin area are both destructive and presents modesty issues. Tourniquets are not needed for simulating wounds on a casualty; we only need to simulate the effect of wounds.
The CWG compromise is to place a "dressing" on the leg, under the splint.

Effect on the casualty – The splint replicates the stiffness and lack of mobility of many types of leg wounds. The ankle is left free to move as is the hip, allowing the casualty some ability to walk still. The additional dressing will probably cover the cargo pocket on that leg (if the splint doesn't already) so remove any items in the pocket before the dressing is applied.

Healing

The Company Casualty Collection Point is at a fixed site near the rear of each side's AO. While called the CCP, and labeled as a medical site, it does not act as a realistic CCP, and is not staffed by medical personnel.

When casualties arrive at the CCP, they will remove their bandage materials, and place them in a designated storage container for re-use. Casualties at the CCP have no other required tasks, so should rest, eat and drink. Two hours after arrival, players are healed of their wounds, or resurrected, and may re-enter the game.

Individuals at the CCP cannot participate in ANY tactical activities including giving or receiving orders, monitoring the tactical radio net, noting enemy activity within sight, or performing training exercises.

Any casualty may use the Company CCP. Those killed cannot play the game until they have been resurrected at the CCP, but casualties who are not killed may also use it to heal their wounds. The same time requirement is used for all individual.