Stormwind Medical Handbook: Medical Duties

Stormwind
Medical Handbook
1. Medical Theory & Anatomy
2. **Medical Duties**
3. Soft Tissue Wounds
4. Bone Fractures
5. Head & Eye Injuries
6. Chest & Abdominal Injuries
7. Shock
8. Temperature Related Illness
9. Toxins & Poisons
10. Magical Wounds

The **Medical Duties** chapter of the Stormwind Medical Handbook covers the expectations and work requirements of medical personnel.

**Disclaimer:** The information edited here has been adjusted to suit the lore of World of Warcraft, and is not meant to be used as real-life saving techniques. Techniques utilized, and information contained in this document may not be best practice.

## Medical Intervention

As a member of the Stormwind Royal Army’s medical corps, one’s primary operating directive is the protection of one’s fellow soldiers by providing **Medical Intervention**, both in and out of the area of operations.

One’s medical intervention is defined by:

* Performing **preventative medical examinations** upon all military and auxiliary personnel.

* Providing emergency, **on-site triage** during combat; utilizing life-saving techniques to minimize casualties.

* Providing **therapy** in order to reconstitute a wounded patients' physical and mental health outside of combat.

* Maintaining **documentation** of patients' medical procedures, medication, nutritional intake, expelled material, and treatment consultation.

Medical staff should provide their patients with the best quality of care consistent with the circumstances of each case, conducting themselves in a professional manner in accordance with the laws set forth by the House of Wrynn. This should be accomplished through analysis, review, and evaluation while maintaining the mantra of ‘best research, based practice’.

### Pertinent Medical Interventions in the Field

As a disclaimer, non-trained personnel should not attempt these interventions unless specifically instructed to do so by a trained medic and under the guidance of said medic.

* If a patient is unable to breathe appropriately due to obstructed airway without a neck injury, tilt the head back and lift the chin. If the patient is conscious or semiconscious and still cannot control their airway, place a nasal adjunct tube into their nostril with the bevel facing the septum.
* If a patient is unable to breathe appropriately due to obstructed airway without a neck injury, tilt the head back and lift the chin. If the patient is conscious or unconscious and still cannot control their airway, place a oral airway adjunct into their mouth, with the curvature meant to go down their throat facing the roof of their mouth, twist it 180 degrees once past the tongue.
* If major bleeding is encountered on the patient, address this concern first. Do so by placing a tourniquet on the wound site towards the body. If the wound is on the bicep, place it toward the shoulder, if on the thigh, place towards the genitals. Do not place a tourniquet on a joint or below the injury site.
* If a patient describes chest pain as an intense pressure, issue the patient a Potion of Asperain.
* If a patient describes chest pain as an intense crushing sensation, issue the patient a Potion of Nitrousol.
* If a patient goes into cardiac arrest or ceases breathing, check pulse first and feel for breathing to confirm. Then place hands on top of each other atop the sternum between the two halves of the ribs, depress down two inches (the length of your first knuckle to fingertip) and repeat this 30 more times. After which you should issue two breaths and ensure adequate chest rise. Ensure the airway is open before this last step.
* Issue other pertinent medications.

## Barriers to Responding

It is important to understand one thing: when treating a patient with dire injury or illness, you are fighting to preserve that person's life. As medical personnel serving in potentially hostile environments, the following barriers to responding may arise.

* Panic and fear of doing something wrong.
* Uncertainty of the person’s condition and what to do.
* Assuming that someone else will take action.
* Fear of catching a disease or exposure to a poison.
* Environmental hazards.

While these are all equally concerning situations, it is important to remember the following: you as the medical responder must preserve your own lives first. Many patients in the future will depend on you, and without intervention, those victims, your patients, could potentially die. For every minute one pauses in critical situations, their patient's chance of death increases.

With that said, however, before treating someone, it is critical that the Scene of the Incident should be taken into consideration in terms of safety. For example, if a fellow soldier has been injured while surrounded by an opposing force, addressing their needs will have to become secondary to preserving your own life and those of your fellow soldiers. Recovery any and all patients if possible, sacrifice yourself and fellow soldiers for the wounded only as a last resort.

## Assessing the Patient

As a member of the Royal Army, you will likely find yourself in situations where immediate care needs to be administered. Assessing the Patient is the first and arguably the most important step in determining what action should be taken and which potentially lifesaving interventions to apply. Your job as emergency medical staff is to stabilize the wounded until the appropriate professional can begin more intensive treatment. All techniques described below should be known and understood by all medical personnel.

The initial assessment, otherwise known as the ‘primary assessment’ is to be undertaken immediately after the caregiver makes contact with a patient and is to be divided into two branching options; medical assessment for problems that cannot be seen (symptoms) such as heart problems or allergic reactions, and trauma assessment for problems that can be seen (signs) such as broken bones, limb deformities, or open wounds. You will find a general outline of each assessment below.

**The medical personnel will perform the following acts in the following order, this is a simplified version for the sake of basic instruction to all personnel. Interventions are to be done by trained medics:**

* Determine mechanisms of injury
* Determine number of patients
* Consider if contacting additional medical personnel is necessary and if patient requires their spine to be braced with rods, boards, or a neck attachment.
* Determine the level of responsiveness of the patient and their Level of Consciousness
	+ Patient is either Aware, responsive to verbal stimulation, responsive to pain stimulation, or unresponsive.
	+ Ask general close ended questions to determine patients awareness to things such as person, place, time, and event. “What year is it?”, “Where are you?”, “What happened to you?” “What day is it?”
* Determine immediate life threats and/or chief complaint.
	+ Address these issues immediately if apparent and critical.
	+ Treat for shock
* Assess patient ability to breath/make use of air (ABC’s)
	+ Airway: Open the patient's mouth by grasping the patient’s cheeks from a position above their head and place fingers under the chin, open their mouth as you lift the chin up and depress the crown of their head down. Otherwise known as a head tilt/chin lift.
		- If a neck injury is suspected in any way, do not manipulate the patient’s neck.
	+ Breathing: Ensure adequate ventilation. If needed, place adjuncts in the airway (see section below: interventions)
	+ Circulation: Control major bleeding, determine a pulse, ensure skin looks healthy
		- Pink (or appropriate colour as per patient species), warm, and dry are to be considered ‘normal’ skin signs.
		- Apply tourniquets at this stage if appropriate injuries uncovered (see section below: interventions)
* Determine any pertinent history of the patient; ask if they have any allergies to common medicines or herbs, do they regularly ingest any herbs, potions, or other substances (harmful or otherwise). And when they last ate anything.
* If possible, have patient describe when the pain began, the feeling of the pain (crushing, tearing, stabbing, etc), how bad it feels, what causes the pain to get better or worse, and if they feel it in other parts of the body.
* Take vital signs such as pulse, respiratory rate and quality, and their skin signs.
* Asses the following body systems; cardiovascular, neurological, skin, lungs, skeletal, muscles, genitals.

If patient is stable at this point, consider transport of patient to safe zone or medical facility for additional treatment.

## Consent to Treatment

Obtaining Consent to Treatment from a patient is key when performing intricate procedures that require patient cooperation. The sooner a patient cooperates, the sooner medical staff might act on potentially life-threatening injuries.

The **House of Wrynn** decrees that the lives of its subjects are sacred and that medical personnel should attempt to save all with consideration for quality of life should patients survive treatment. Soldiers and medics of the Royal Army should do everything in their power to save their lives of the King's servants, be they a lord, soldier, peasant or knight.

A victim of sound mind and body is able to properly consent to medical treatment. However, the situation becomes more complicated in the event the individual is unconscious. In this case, the victim should be treated as if they are automatically consenting to medical treatment with the belief that they wish to preserve life.

A victim who cannot communicate linguistically (IE: Darnassian vs. Common), an interpreter must be utilized. If an interpreter cannot be located, evidence that supports the individual wishes medical treatment must be sufficient (IE: Pointing to injury, then bandage).

A victim with cognitive or intellectual deficit must speak with someone who has guardianship, or best convey the message to a level of understanding for the patient. If such cannot happen, and it is an emergency, immediately begin treatment and perform best practices to the best of one’s ability. Underage patients may not refuse consent to treat.

## Diagnosis

If a patient is not able to respond, it is one's duty as a medic to **Diagnose** the patient's ills to the best of their ability by means of careful analysis of the patient's body. A medic should first check the following vitalities:

* Is the patient breathing?
* Is the patient's airway clear?
* Is the patient's heart beating?
* Is the patient bleeding?

Without **Breath** or **Heartbeat**, a patient will surely perish.

When presented with a patient conscious and able to communicate, it is your duty to calm the patient and diagnose the severity of his or her injuries. Reassure the patient that you are trained in the field of medicine and that you will do everything in your power to assist the patient in recovery.

After you have calmed the patient, ask the following series of questions to assist your diagnosis and treatment:

* *“What is your name?”*
* *“Do you have medical conditions that I should know about?”*
* *“What has happened to you?”*
* *“Where does it hurt?”*

Record the answers and make self-determinations when observing the patient to make judgment on treatment.

## Infirmary

Whether in the city or on the field, a location should be designated for medical procedures as the **infirmary**. This may be a temporary structure, a designated wing of a fortress or garrison, or even the bedding rooms of an inn. The location should be as secure, dry, and sheltered as reasonably possible. Means for extraction should be put in place in the case that a patient requires treatment beyond the experience of the present staff.

Refer to your assigned medic or ranking officers for the location of the infirmary when in the field. If superiors are unavailable, you may designate an infirmary for your patients yourself.

## Triage

To ensure effective use of medicinal supplies and maximize the number of soldiers treated, a system of *triage* should be followed when deciding whom to treat in what order.

Soldiers are trained to cope with their wounds and have been taught to remain resilient. Civilian non combatants have not. They are more likely to fall victim to their injuries and must be treated right away. If Civilian casualties enter the picture, tend to them first.

In incidents in which numerous casualties are to be expected, it is prudent to come prepared. Patients are to be categorized in the following order, pending executive command from one's officers otherwise:

* **GREEN**: Those with minor injuries who need help less urgently.
* **YELLOW**: The injured whose transport can be delayed. Attend when possible.
* **RED**: The injured who could survive if immediately transported to the infirmary for treatment or with immediate life saving interventions.
* **BLACK**: The expectant with mortal wounds that are beyond help or would require far too much intervention time at the expense of other RED tagged casualties.

When a medic arrives on the scene of the incident, if applicable, the medic or commanding officer is to issue a loud verbal order to walk over to the medics for treatment. All those who walk over are to be tagged as **GREEN** unless a life threatening injury is otherwise noted, such as trauma to the arms, chest, or head, that the patient is not properly managing due to shell shock.

## Quarantine

When volatile, contagious illness or maladies are present amongst one's patients, a medic should declare a **quarantine** about their infirmary. Outbreaks of the plague, volatile fel magic, possession, or other contagious and deadly maladies could all warrant quarantine. Medics should do their best to separate patients who are infected with contagions from those who do not yet show symptoms.

When under quarantine, those entering the infirmary should wear doubly protective garb to prevent contamination. Always check to see if the infirmary is currently under quarantine before entering for your safety and the safety of others. Objects and implements leaving a quarantined infirmary should be cleansed by a priest or army chaplain.

If the infirmary is under quarantine, do not under any circumstances take it upon yourself to inform the public. The appointed chaplain or an acting commanding officer will inform the public if deemed necessary. Doing so without caution could cause wide-spread panic.

## Visitors

The following rules should be observed when regarding visitors:

* If a citizen not within the king's service requests information on a patient or asks if a patient is currently in care or comatose, do not give them the information. The patient must give their consent before allowing a visitor acknowledgment of their status in the infirmary.
* In the event that a patient is not capable of giving verbal or physical consent, then he who seeks to visit must provide evidence of familial relation to the patient in order to be granted visitation with supervision.
* Check to ensure there are no **quarantines** before admitting visitors.
* Citizens of no immediate relation who are not in service to the crown and have been approved to visit are to be given fifteen to twenty minutes with the patient and should be monitored by an agent of the crown.
* Family members may be given a maximum of one hour of supervised time, provided that there is no request by medical personnel that the family members leave the room or immediate area.
* If the patient is a prisoner of the kingdom, officers of the crown may question the patient freely.