| Abbreviation | Meaning |
|---|---|
| BP | Blood Pressure |
| HR | Heart Rate |
| PR | Pulse Rate |
| SpO2 | Oxygen Saturation in the blood |
| NPA | Nasal Pharyngeal Airway |
| OPA | Oral Pharyngeal Airway |
| MASCAS | Mass Casualty Incident |
| CCP | Casualty Collection Point |
| BLS | Basic Life Support |
| ALS | Advanced Life Support |
To facilitate effective communication between leadership & other trained medical personnel, tiers are assigned to patients during triage depending on the severity of their injuries.
| Tier | Description |
|---|---|
| T1 🔴 | MARCH has been completed Casualty is currently in critical condition |
| T2 🟡 | MARCH has been completed Casualty is not in critical condition but requires further monitoring |
| T3 🟢 | Casualty has minimal injuries present OR Casualty is only in need of secondary care |
| T4 ⚫ | Casualty is deceased or expectant |
CONSCIOUS PEOPLE COUNT AS CASUALTIES
As a person bleeds the body tries to stem the bleeding by clotting, using platelets.Small and medium wounds have a chance to clot on their own, large wounds will require bandaging.
Platelets are used up as long as the person is bleeding and will slow the loss of blood.
When out of platelets coagulation will fail, bleeding rate will increase and wounds will no longer clot.
Platelet count is replenished on its own and by fluid administration.
Coagulation will also stem and clot internal bleeds.
Carrying a bleeding patient does not speed up the bleeding process, however if severe bleeding is present treated before transporting through usage of bandages or tourniquets!
Bandaging
You will be equipped with the following for treating wounds.
Pressure Bandage
Standard issue bandage meant for most wounds.
Emergency Trauma Bandage
Large bandage for treating multiple wounds. Reserved for severe injuries.
Elastic Wrap
Elastic Wraps are used to wrap already bandaged or clotted wounds to prevent the bandages from falling off/wounds reopening, they cannot bandage bleeding wounds on their own.
Wraps can also be used to treat bruises, and to stabilize SAM Splints.
MARC(H)
MARCH is an acronym to serve as a guidance of the treatment order of a patient. This applies to trained medical personnel but also provides guidance for proficient operators in the field.
The following MARCH procedures are described for a patient who is severely injured and have been simplified for non-medical trained individuals.
Massive Haemorrhaging
Tourniquet Limbs in order of wound severity
Bandage Chest & Head
If bruising is present (sign of internal bleeding), νοτιφψ μεδιχαλ περσοννελ
Airways
Check Airways
Obstructions:
Mild obstruction → Ηεαδ τυρνινγ, ορ συχτιον
Σεϖερε οβστρυχτιον → Συχτιον ρεθυιρεδ, Υσε Emergency Disposable Suction
Bag
Χολλαπσε
Νονε−μιλδ → Υσε ΝΠΑ, Ηεαδ Τιλτ−Χηιν Λιφτ, Ρεχοϖερψ Ποσιτιον
Μιλδ−Σεϖερε → Υσε ΝΠΑ, Ηεαδ Τιλτ−Χηιν Λιφτ, Ρεχοϖερψ Ποσιτιον
Respiration
Inspect chest
Chest rise and fall observed → Regular breathing
No chest movement → Not breathing, has airway obstruction or cardiac arrest
Uneven chest → Νοτιφψ μεδιχαλ περσοννελ
Tracheal Deviation → Νοτιφψ μεδιχαλ περσοννελ
Chest bruised → Νοτιφψ μεδιχαλ περσοννελ
Apply Chest Seal → Ρε−ασσεσ
ιφ αϖαιλαβλε
*ACM does not present Deep Penetrating Wounds clearly like KAT previously. If a chest seal can be applied, it should be applied as soon as possible. You can apply Chest Seals. Check for velocity/penetrating injuries to the chest if unsure.
Circulation
Carotid pulse (neck)
No pulse → Χαρδιαχ Αρρεστ Μαναγεμεντ
Ραδιαλ/φεμοραλ πυλσε (αρμσ/λεγσ)
Ωεακ ορ νο πυλσε → Φλυιδ Τρανσφυσιον, νοτιφψ μεδιχαλ περσοννελ
Χηεχκ φορ βρυισινγ
Νοτιχεαβλε βρυισινγ → Ιντερναλ βλεεδινγ, νοτιφψ μεδιχαλ περσοννελ
Cardiac Arrest Treatment
Certain conditions will cause the patient to go into cardiac arrest. These conditions are known as Hs and Ts, a mnemonic used to remember reversible causes of cardiac arrest.
Hypovolemia: The patient has lost a Fatal Amount of Blood.
Hypoxia: The patient has a SpO2 value that is too low to sustain the heart tissue.
Hemothorax: Collection of blood in the pleural space.
Tension Pneumothorax: The patient has a tension pneumothorax.
Hypoxia is the only H&T that can be treated in the field without a medic present as it can be the result of a collapse or airway obstruction. See MARCH Airways section.
If no medical personnel is available, begin CPR immediately.
Cardiac Arrest should be confirmed by a manual pulse check. CPR should begin immediately until an AED is available. Notify medical personnel as soon as possible.
ROSC → Return of Spontaneous Circulation
Subsiding cyanosis
Check for carotid pulse after ROSC to confirm
BLS Cardiac Arrest Flowchart
*ROSC: Return of Spontaneous Circulation
SMOKE SIGNALS
Signals are an extremely effective method of communicating non-verbally with your pilots and apprise them of your situation.
Smoke Colour
Communication
Purple
Landing Zone (LZ)
Blue
Friendly Targets in Area
Red
Hostiles
Orange
Mass Casualty
MASS CASUALTY
Otherwise known as MASCAS, is the situation where three or more infantry are heavily wounded.
In these circumstances, a Field Surgeon can declare a MASCAS.
The Field Surgeon declares a MASCAS. If no Field Surgeon is present, highest ranking Pararescue assumes command.
Establish that a MASCAS has occurred by marking the area with orange smoke & declare MASCAS on radio
MARCH becomes simplified as there are too many casualties to effectively treat one by one, risking fatalities.
Quickly establish transfusions to extend patient life before bleed-out
Perform each step of MARCH one by one in order to stabilise all patients
Anyone who is conscious should assist in providing Medical Assistance to casualties
The Field Surgeon/Pararescue is in direct control of the scenario. Communication is vital and security should be held at all times.
CASUALTY COLLECTION POINT
A Casualty Collection Point (CCP) is at its core a way to pull casualties from immediate threats and provide necessary tactical field care. Every CCP should have the following:
Trained pararescue personnel are directly in charge of everything that happens inside of a CCP, such as establishing coverage of vital openings such as doors or windows.
Ideally when establishing a CCP you want to find a building that has low-exposure, 2 entry/exit chokepoints (Following a Line of Drift)
EQUIPMENT & USAGE
See https://bluetheking.github.io/ACM-wiki/en/Items for all equipment.
PIC
Task Force Jackal
24th STS
Pararescue Indoctrination Course
1 - TRIAGE
1.1 - Casualty Classification
To facilitate effective communication between leadership and medical personnel, Casualties are categorised into four Tiers during triage depending on the severity of their injuries.
Tier
Description
T1
MARCH has been completed.
Casualty is currently in critical condition.
T2
MARCH has been completed.
Casualty is not in critical condition but requires further monitoring.
T3
Casualty has minimal injuries present.
OR
Casualty is only in need of secondary care.
T4
Casualty is deceased or expectant.
1.2 - When and how to Triage
Triage should be conducted in cases of Mass Casualty Incidents (MCIs/MASCAS, meaning 3 or more Casualties).
Triage Categories should also be used to identify a Casualties criticality when reporting a singular Casualty.
Conduct a simplified version of MARCH to assess rapidly. Apply only Tourniquets during the triage phase. CPR or any other lifesaving interventions are not conducted until all casualties have been triaged.
For further instructions on MCIs, please reference Task Force Jackal Training Book
2 - MARC(H) - Casualty Assessment and Treatment
2.1 - M - Massive Hemorrhage
2.1.1 - Bleeding and Coagulopathy
In a bleeding casualty, the body will try to close wounds through clotting, using up clotting factors.
Clotting factors are used up as long as the person is bleeding and will slow the loss of blood.
When out of clotting factors, coagulation will fail, bleeding rate will increase and wounds will no longer clot. This is called “Coagulopathy".
Small and medium wounds may or may not clot on their own whilst clotting factors are present in sufficient amounts, larger wounds will require adequate bandaging. Internal Bleeds are very unlikely to clot effectively.
Clotting factors are replenished with the administration of Blood Products in combination with Calcium Chloride to counter the Citrate in the Blood Products. Administering Blood Products without Calcium Chloride will result in a decrease of clotting factors.
Tranexamic Acid (TXA) may enhance the ability of wounds to clot if clotting factors are present in sufficient amounts.
2.1.2 - Internal Bleeding
Casualties may have interior damage, either present alongside the exterior damage or isolated. Severe internal bleeding will show as Noticeable Bruising on the casualty.
Internal bleeding in the thoracic region can lead to Hemothorax (HTX) or Tension Hemothorax (THTX), the latter being life threatening and a possible cause of traumatic cardiac arrest.
Internal bleeding in the limbs may also be present.
Internal bleeding requires TXA to be administered and possibly fluids to be given to compensate. Any casualty with severe internal bleeding should be evacuated if possible.
2.1.3 - Bandaging
A bleeding casualty may require bandaging in order to address their wounds. Any critical bleeds on extremities should be compensated with a TQ. Critical bleeds from thoracic or head wounds should be addressed with an ETD. In this phase of MARCH, only truly critical bleeds should be addressed. Any further bandaging should be delayed until “Circulation”.
BANDAGE TYPE
DESCRIPTION
Tourniquet (CAT)
Utilized to stop arterial blood flow to an extremity. May be applied to any extremity.
Emergency Trauma Dressing (ETD)
Larger Bandage, suitable for Thoracic or Head Injuries. Cannot be used to self-bandage.
Pressure Bandage
Standard issue suitable for most isolated wounds
Elastic Wrap
Used to wrap other bandages and SAM Splints to prevent reopening/dislodgement.
2.2 - A - Airways
2.2.1 - Airway Compromise
The Airway may be compromised in one of three ways: Obstruction, Collapse, Swelling or a combination thereof.
Airway obstructions may be removed by turning the head, utilizing an emergency disposable suction bag (EDSB) or utilizing the AccuVac suction device. It may altogether be avoided if the casualty is placed into recovery position or has an advanced airway in place if indicated.
Airway collapse requires Airway Management through either a head-tilt chin-lift maneuver or by placing an advanced airway (I-Gel). Recovery Position, OPAs or NPAs may be used by non-PJ personnel to mitigate airway collapse.
Airway swelling may occur in a CBRN setting if exposed to certain chemical agents. The only treatment is Cricothyroidotomy using a CricKit and subsequent MEDEVAC.
2.2.2 - Airway Devices
The following Airway Management Devices should be at the Medics disposal: EDSB, AccuVac, OPA, NPA, I-Gel, CricKit
EDSBs are an emergency, single use option to clear an occluded airway that is carried by every infantryman as part of their standardized kit. AccuVacs are the reusable, mechanical suction variant carried by PJs to remove airway obstructions.
OPAs and NPAs may be used by non-PJ personnel to keep an airway open if the airway is already collapsed. They are to be utilized in conjunction with the head-tilt chin-lift maneuver, thus requiring at least one assistant at all times.
I-Gels are the gold standard advanced airway for PJs, utilized in critical casualties with an actively compromised airway or a likelihood of future airway compromise, such as casualties in cardiac arrest. Obstructions must be cleared before an I-Gel can be inserted.
CricKits are the emergency surgical option for an airway if swelling is present. They are extremely invasive and should only be performed if indicated.
2.3 - R - Respiration
2.3.1 - Respiratory Pathologies
A casualty may present with the following respiratory problems: Apnea, (Tension-)Pneumothorax and (Tension-)Hemothorax.
Apnea is defined as the absence of respirations and is seen in casualties with a compromised airway or casualties in cardiac arrest.
(Tension-)Pneumothorax may develop if there is an open, unmanaged chest wound inflicted on the casualty. Air is trapped in the pleural space and compresses the lung, thus restricting the casualty's ability to breathe properly. It is characterized by diminished breath sounds on one side of the thorax. A chest seal should be applied if necessary. Needle Decompression or a Thoracostomy may be indicated.
(Tension-)Hemothorax may develop if there is internal bleeding present on a casualty. Air is trapped in the pleural space and compresses the lung, thus restricting the casualty's ability to breathe properly. It is characterized by diminished breath sounds on one side of the thorax. A chest seal should be applied if necessary. A Thoracostomy and Chest Tube may be indicated.
2.3.2 - Respiratory Management
The following devices for respiratory management are carried by all Pararescue Operators: ChestSeal, NCD Kit, Chest Tube Kit
A (Tension-)Pneumothorax with an unmanaged, open chest wound requires placement of a Chest Seal on the casualty to prevent an exacerbation of the (Tension-)Pneumothorax. If a Chest Seal can be placed on the casualty in the medical menu, it should be placed immediately. A Tension Pneumothorax (TPTX) may require either Needle Chest Decompression (NCD) or a Thoracostomy to manage. If a casualty complains of blacking out or weird visual artifacts and the likely underlying cause is (T)PTX, NCD should be considered to address the issue.
A (Tension-)Hemothorax with active internal bleeding requires the immediate administration of 1-2g TXA intravenously. If the casualty complains of blacking out or weird visual artifacts, (T)HTX should be considered as the underlying cause. If (T)HTX is suspected, a Thoracostomy should be performed. If blood or active bleeding is found in the pleural space, a Chest Tube should be placed and the blood should be drained utilizing the AccuVac.
In any case of traumatic cardiac arrest, TPTX or THTX should be considered as likely causes and a Thoracostomy should be performed as early as possible.
2.3.3 Auscultation
Auscultation using a stethoscope should be utilized to assess a casualty for respiratory pathologies. The following may be heard during auscultation:
Bilaterally equal breath sounds → Likely no respiratory pathologies present
Diminished or absent breath sounds → Possible PTX/HTX
Best judgement should be used to interpret these results in a field setting.
The diagram below shows possible auscultation sites.
2.4 - C - Circulation
2.4.1 - Circulatory Pathologies
A casualty may present with the following circulatory pathologies: Bradycardia, Tachycardia, Hypotension, Hypertension, Hypovolemia and Cardiac Arrest.
Bradycardia or Tachycardia may present alongside several underlying problems. Tachycardia specifically may be present in the compensated and decompensated phases of shock, usually alongside Hypotension.
Hypotension or Hypertension are usually linked to Blood Volume. Other underlying causes may affect the BP. If hypovolemia is not present in a hypotensive casualty, search for other potential causes and consider early evacuation.
Cardiac Arrest generally presents as the result of a traumatic injury that severely disrupts physiological processes. Underlying causes should be reversed before conducting resuscitative measures.
2.4.2 - Shock
Shock is defined as a mismatch between required oxygen and supplied oxygen in a physiological system. It may present in various forms and phases. Relevant Forms to ACM are the following:
Hemorrhagic Hypovolemic - Result of major bloodloss
Obstructive - Result of Tension Pathologies restricting cardiac or pulmonary action, such as TPTX or THTX
Any form of shock may go through the following phases: Compensated, Decompensated and Irreversible. Casualties may skip individual phases and immediately progress to a more severe phase, or they may remain in one phase consistently without deteriorating.
Compensated - The Body’s own regulatory measures are still able to compensate for the oxygen mismatch. Casualties in this phase of shock generally present tachycardic, potentially even a little hypertensive.
Decompensated - The body’s own regulatory measures are no longer able to compensate for the oxygen mismatch. Casualties in this phase of shock generally present tachycardic, hypotensive and unstable. Casualties in this phase usually deteriorate further without immediate intervention.
Irreversible - The body’s own regulatory measures are no longer able to compensate for the oxygen mismatch. Casualties in this phase of shock generally present tachycardiac, hypotensive and severely unstable, though bradycardia is also possible as a sign of impending cardiac arrest. Treating a casualty in this phase is very resource intensive.
2.4.3 - Hypovolemia
Hypovolemia is defined as a lack of fluid in the circulatory system. Massive or prolonged Hemorrhage is the general cause of hemorrhagic hypovolemia.
To address Hypovolemia, Blood Products and Calcium Chloride should be utilised. IV or IO Access is required to administer any blood products.
Unit SOP is the administration of 2 Units (1000ml) of Blood Products alongside 1g of Calcium Chloride in unconscious casualties presenting with Hypovolemia. Consider early transfusion of larger volumes to patients with severe Hypovolemia.
Hypovolemia is a possible cause of traumatic cardiac arrest and should be addressed if present.
The chart below shows estimated blood loss:
Status Effect
Liters of Blood in the Body
Give Blood?
Lost Some Blood
5.1 - 6.0
NO
Lost a Lot of Blood
4.2 - 5.1
1 Unit
Lost a Large Amount of Blood
3.6 - 4.2
2 Units
Lost a Fatal Amount of Blood
3.0 - 3.6
2+ Units
2.4.4 - IV/IO Access
IV access allows administration of IV medications and fluids. IV lines are affected by tourniquets and limb damage.
IVs are preferable due to the fast flow rate, but in case of severe injury and no immediately available IV locations IOs should be used instead.
In cases of cardiac arrest, IOs should be placed immediately.
IVs inserted into damaged body parts have a chance to cause complications, chance depends on IV size and body part damage.
Transfusion Pain - pain caused on insertion and during transfusion
Slow Flow Rate - affected IV will have its flow rate impacted
Leakage - affected IV will lose fluid
2.4.4.1 - IV Types
ACCESS TYPE
General Information
16G IV
Placed on the limbs
Moderate flow rate
Chance of complications
Not suitable in traumatic cardiac arrest
14G IV
Placed on the limbs
Fast flow rate
High chance of complications
Not suitable in traumatic cardiac arrest
FAST1 IO
Placed on the chest (sternum)
Fast insertion time
Slower flow rate
Suitable in cardiac arrest
EZ IO
Placed on limbs (tibia/humerus)
Fast insertion time
Slower flow rate
Suitable in cardiac arrest
2.4.5 Traumatic Cardiac Arrest
Certain conditions will place the Casualty in an insufficient cardiac rhythm, constituting cardiac arrest. These conditions are known as Hs and Ts, a mnemonic used to remember reversible causes of cardiac arrest.
Hypovolemia: The Casualty has lost a significant amount of blood.
Hypoxia: The Casualty has a SpO2 value that is too low to sustain tissue function.
Hemothorax: The Casualty has enough blood in their pleural space to inhibit respiration and cardiac output.
Tension Pneumothorax: The Casualty has enough air in their pleural space to inhibit respiration and cardiac output.
inToxication: The Casualty has taken on a substance in a potentially lethal amount.
“NEVER PUMP AN EMPTY HEART” - ERC ALS Guidelines
Reverse Initial Condition before starting Cardiac Arrest Treatment
General Rules for Cardiac Arrest:
Cardiac Arrest should be confirmed by a manual pulse check.
CPR and Ventilation should be started immediately after reversing the initial condition.
Airway Management should be performed, utilizing an IGel, or Cricothyroidotomy if CBRN related Airway swelling is present.
Hs & Ts should be addressed as early as possible.
If available and the situation allows, an AED should be utilized.
The AED allows displaying of cardiac rhythms when the pads are connected, the electrical signals from the heart will be interpreted and the Electrocardiogram (EKG) will be displayed on the monitor as a waveform.
NOTE: Casualties should be triaged for opioid use to prevent excess treatment times and possibly death if left untreated. Opioids cause significant ROSC decrease and SpO2 reductions in Casualties who receive CPR.
If opioids have been administered (Fentanyl lifetime ~15m, Morphine lifetime ~21 to ~30m) Casualties should receive Naloxone to increase chance of resuscitation.
ROSC → Return of Spontaneous Circulation
Sudden rise in EtCO2 can indicate ROSC.
Subsiding cyanosis can indicate ROSC.
ROSC should be confirmed by feeling for a carotid pulse during analysis.
No.
Rhythm Type
AED-X Monitor (EKG) reading
Sinus Rhythm (Normal)
1
VT - Ventricular Tachycardia
2
VF - Ventricular Fibrillation
3
PEA - Pulseless Electrical Activity
4
Asystole (A-sys-to-le)
2.4.5.2 Traumatic Cardiac Arrest Flowchart
*Note: All Algorithms assume IV Dosage of Medications unless stated otherwise.
2.5.4.3 Return of Spontaneous Circulation Flowchart
*Note: All Algorithms assume IV Dosage of Medications unless stated otherwise.
3 - MEDICATIONS
3.1 - Dosage Sheet
4 - VITAL CHART
See this chart to familiarise yourself on how to establish severity of wounds by observing an ideal situation, and a critical Casualty's vital readings.
Ideal set of vitals
Heart Rate (HR)
Blood Pressure (BP)
Oxygen Saturation (SpO2)
80 BPM
120 / 80 mmHg
100%
Stable set of vitals (not in cardiac arrest, not sedated)
Oxygen Saturation
Amount of Blood
Heart Rate
Blood Pressure
85%
5,1l (“lost some blood” status)
40 BPM
60 / > 50 mmHg
Critical set of vitals
Lethal Saturation
Lethal amount of blood
< 65%
< 3l
Saturation leading to unconsciousness
Min. HR for perfusion (SpO2 level will keep dropping if HR is lower)
Amount of blood required for establishing HR
75%
20 BPM
3,6l (“Lost a Large Amount of Blood” status)
Min BP before Cardiac Arrest
Max BP before Cardiac Arrest
50 / 40 mmHg if HR < 40 BPM
285 / 190 mmHg
Min HR before
Cardiac Arrest
HR leading to Cardiac Arrest
Max HR before Cardiac Arrest
20 BPM
20 - 30 BPM
220 BPM
5 - SMOKE SIGNALS
Signals are an extremely effective method of communicating non-verbally with your pilots and apprise them of your situation.
Smoke Colour
Communication
Purple
Landing Zone (LZ)
Blue
Friendly Targets in Area
Red
Hostiles
Orange
Mass Casualty
6 - MASS CASUALTY INCIDENTS
Mass Casualty Events, otherwise known as MASCAS, is the situation where there are three or more Tier 1 and Tier 2 Casualties combined.
In these circumstances and if adequate resources are not actively on scene, a PJ may declare a MASCAS over the radio.
Valkyrie Actual announces MASCAS
Mark the area with orange smoke & declare MASCAS on Valkyrie TAC and COY NET.
Initial Triage (Using quick, simplified MARCH)
Only immediate life-saving treatment should be performed (TQ, Recovery Position, Head Turning / ACCUVAC)
Assign a Triage Tag to every casualty that has been triaged.
Tier 3 Casualties should be instructed to perform self-aid if necessary. Nearby Infantry, if not in active enemy contact, should be instructed to stabilize Tier 2 Casualties and put them in Recovery Position.
Command and Control
The highest ranking PJ on Scene assumes Incident Command.
Casualties who are no longer in critical condition should be retriaged accordingly.
As soon as initial triage is complete, casualties are treated in order of priority by all PJs on scene.
7 - CASUALTY COLLECTION POINT
Creating a Casualty Collection Point (CCP) is an effective way to treat a large amount of casualties in a structured manner if resources and personnel are limited or a position is held for an extended amount of time.
Trained pararescue personnel are directly in charge of everything that happens inside of a CCP, such as establishing coverage of vital openings such as doors or windows.
8 - CASULTY HANDOVER / COVERSION / EVACUATION
Evacuation allows reinforcement of player casualties, lowering the time infantry players spend unconscious without impacting medical gameplay.
During an operation, trained personnel are able to convert casualties into AI ones, respawning the casualty player back to the set reinforcement area, from there those players should seek transport to be fully reinserted. This should be done as soon as possible if not otherwise specified by Lead PJ.
The AI Casualty is left behind and the Player respawns, using up a Casualty Ticket.
There are 25 Tickets in any given Operation.
If a Player dies or the AI is not brought to a full heal facility whilst still alive, a Ticket is lost.
If no Tickets remain, there are no more Player respawns.
8.1 - MIST Report / Casualty Handover
M
Mechanism of Injury
I
Injuries Present
S
Signs/Symptoms
T
Treatments given
8.2 - Casualty Conversion
To be able to convert a player casualty these requirements need to be met:
Casualty must be unconscious
Casualty must not be bleeding externally
Medic must have the “Doctor” trait
There must be available casualty tickets remaining
If met, the medic can perform the conversion by ACE interaction key on casualty, after completion this action will use a casualty ticket.
8.3 - Casualty Evacuation
Transported casualties can be evacuated on defined objects. This will return the casualty ticket.
Object is usually defined as a stretcher.
9 - EQUIPMENT & USAGE
See https://bluetheking.github.io/ACM-wiki/en/Items for all equipment.
Created by E. Belhi & F. Woods, 24th Special Tactics Squadron
Sources: ACM Cardiac arrest study
ACM MEDICATIONS
ACM Documentation
ACM - Item List