The instructor stands on the stage in the middle of the auditorium, thwacking his pointer into his right palm absently as he watches the last attendees take their seats. Behind him, a silvery banner hangs in front of the closed curtains, shimmering faintly with arcane energy; at his elbow is the podium, topped by a sheaf of notes.
As soon as the doors are closed and the last student sits, he begins.
Welcome to this evening’s generalist lecture, Techniques of Arcane First Aid. This is not an instructional class, only an overview of what the various disciplines have achieved in terms of battlefield medicine and what you, through your studies, may learn in piecemeal. We do not currently have a medical magic program, and though there has been some discussion on setting up an interdisciplinary lecture series or course, as of yet there is no agreement as to what should be taught or who should teach it. This particular lecture exists in part to gauge interest in a possible program.
You who recognize me may wonder why I’m teaching it. You who don’t probably wonder that anyway. I am Energies Archmagus Shaidaxi Enkhaelen, and while as the Energies Archmagus I am probably best known for blowing things up, that is not the sum of my training or skills. All disciplines can benefit from medical knowledge, mine not the least, and as my life’s work has been devoted to destroying things with as much or as little collateral damage as I like, I have become an expert in techniques for mitigating the damage I would rather not have done.
Each discipline – Energies, Wards, Summoning, Scrying, Artificing and Mentalism – has techniques that can be applied to reduce suffering, stabilize injury, interrupt backlash, and even directly save lives. Very few of you will pursue all disciplines far enough to learn every technique, but any little bit that you study can potentially avert disaster.
I will start with my own discipline, Energies.
As you can see on the banner behind me, once it resolves… There. The human body is a spiderweb of nerves, every one of them sensitive to the flow of energies. All of you have passed an Introduction to Energies course already — else you would be back in remedial arcane studies instead of here — so you know that with the exception of the Mentalists, all mages handle dangerous amounts of energy directly, both internally and externally. Mishandling of this energy causes backlash, a condition in which control over the harnessed power is lost, thus allowing it to wreak havoc within or along the surface of the body.
Backlash can happen for many reasons. First is the simple misuse of energies, drawing more than one is capable of handling. Second is direct assault by an enemy mage, basically a method of flooding your foe’s open channels. Third is the disruption of a complicated working, when the energies invested into it recoil upon you before you can shake free of them – often the most dangerous type, as the energy still retains traces of its purpose so can react upon the victim in strange ways.
There are other options, but those three provide the basics of misuse and thus of cycle-interrupt work, which is the first technique that Energies brings to the table.
Cycle-interrupt is an extension of the techniques that you learned from your Intro to Energies course. Backlash is not an immediate killer but an ongoing process; while some of the damage occurs at the moment the energy snaps back upon the wielder or is forced upon them, the bulk of it happens as that energy floods the victim’s internal cycle and continues to circulate uncontrollably, searing a dead zone through the nerves. Backlash that is not halted can culminate in catastrophic burnout – the complete breakdown of energy-control, sometimes to the point of detonation – but if stopped quickly, the victim often recovers.
A cycle-interrupt is essentially a Simple External Ground used on another person. Someone in backlash is not capable of grounding him- or herself; if they were able, they would not be in backlash. The problem is that even if they are an ally, they must be approached like an enemy, because a person in backlash behaves like they are drowning – struggling with the energies to the point that they recognize no one and nothing, only the fear and loss of control. Making contact with a person in backlash opens you up to the potential to be surged-through – to essentially be dragged down with them under the waves of power.
Thus the cycle-interrupt is used like a weapon. It must be driven through the victim’s wards – including robe enchantments — into the center of their internal energy cycle, which is usually in the back or chest area, and forced deep enough that it disrupts the cycle instead of just attaching onto it like a pipe. This is essential, because while in backlash it is possible for a victim to unintentionally draw from the earth instead of ground to it, especially in an area with strong ambient energy such as a combat zone or laboratory, and thus exacerbate the condition. By disrupting the cycle, no such draw can occur.
The downside to interrupting a backlash cycle is that the torrent of energy now has only one place to go: through the External Ground which you are maintaining. It is not directly dangerous to you if you know how to weave a good External Ground, but depending on the flow of energies and your own skill, it may degrade the Ground and either spill or detonate. A detonation from a degraded External Ground is not as dangerous as one from a catastrophic burnout cycle, since it is directed earthward and you don’t have to worry about bony shrapnel so much, but it is still something to be avoided. If you see a mage more powerful than you go into backlash, you want at least two people doing External Grounds in order to disperse the energy safely.
Now, you might wonder what happens to the victim when you punch an External Ground through their chest. This is where phase two of the Energies first aid comes in, because if you did your cycle-interrupt properly, you probably just put your victim into cardiac arrest. Backlash involves the victim’s personal energies as well as their arcane, so when those are disrupted, every part of the body feels it, the heart most of all.
The heart beats because of a rhythm of energies, and when that rhythm is altered, blood won’t move properly. The solution is a cardiac shock – the direct application of electricity to the heart to halt its arrhythmia and let it self-correct. This will not work on stopped hearts, only ones that are…fluttering, so it is important to examine your victim’s energy-pattern before attempting a cardiac shock to make sure it will actually be useful.
All the shock needs to do is stop the aberrant rhythm of the heart, thus it does not require much power. The rest is up to the victim’s own body; if it can not self-correct, then there is no more that Energies magic can do.
There have been some studies on using a neural shock to try to trigger a self-correct in victims of seizure, but all I can say is: don’t.
While an Energies mage has a few more first aid tactics, such as wound cauterization for amputation and heat-reduction for burns, those are fairly advanced and I would rather not give you lot any ideas. Toying with heat and cold to affect flesh is a bad idea if you have not been thoroughly trained for it, so until that time, leave it to the experts.
Now, on to Wards.
This is more familiar territory for most of you, I’m sure; we in Energies don’t teach any of our first aid techniques until journeyman level, as they require great precision, but Warders learn arcane splints almost immediately. It’s also a much larger part of their job, as they are dedicated to seeing to the well-being of themselves and their comrades, including the wounded.
Warder splints are, in essence, no different than an impact ward. However, they are used close to the body and piecemeal, and while they could be replaced with a physical splint, they are essential on the battlefield where there is neither the time nor the material to splint a limb nonmagically.
The first step to using an arcane splint is identifying the type of fracture and setting it if possible. This is something you need to do manually, because manipulating bones and bone-fragments with Wards magic is too painstaking for a battlefield except in the case of a simple displacement, where you can sometimes apply leverage with wards to set it. In cases where the bone is fractured but not displaced, you can proceed directly with splinting; in cases where the displacement is too severe to set manually, you also proceed directly with splinting, but for a different purpose.
The point of all splinting is immobilization. With a non-displaced fracture, though, proper arcane splinting lets the victim retain the use of it, while a displaced fracture has to be corrected by a professional and is immobilized to keep it from being used in any way.
Wards for a non-displacement fracture generally run the length of the bone, stopping just short of the joint on each end to allow for flexibility, and are skin-tight. The flexibility thus permitted can be intensely painful because the muscles on both sides of the injury still pull at it, but it allows the limb to be used – for example, it allows continued spellcasting with a broken arm, or normal stair-climbing on a broken leg. The encompassing rigidity of the arcane splint keeps the bone from further breakage, though it can grate its ends together, and it also keeps an enemy from being able to take advantage of the damage; as an impact ward, an arcane splint will absorb physical strikes without transmitting the kinetic energy to the body, which also serves to lessen potential damage and pain if the victim happens to run into something.
With displacement fractures, the arcane splint’s purpose is causing full immobility until the time that the displacement can be corrected. This is done by extending the splint further than with the non-displacement fracture, to encompass the joints on both sides if not the whole body. For example, a broken back will see its sufferer splinted from head to toe to avoid exacerbating the injury while the victim is transported to care, while a series of leg breaks will see the leg immobilized from toes to pelvis – unusable but permitting movement on crutches or with other support. Both methods are meant to reduce pain while allowing transport of the patient – in the case of the back injury, the ward absorbs the force of any jolts and keeps the body from shifting, while in the case of the leg injury, no muscles are permitted to act upon the breaks but the patient does not have to be carried around.
Wards can be used as bandages as well as splints. The skin-tight nature of an impact ward can be set as impermeable and tightened over an open wound – up to and including an amputation — to staunch bleeding, or set as permeable to air for a superficial injury that just needs to stay free of dirt and debris. For burn victims, they are often used in conjunction with water elementals, which should not be allowed to touch the skin but can help cool and soothe the injured area by their proximity.
Speaking of elementals, we move on to Summoning’s few first aid applications. As you should know, Summoning involves the enslavement of minor spirits and elementals, usually for combat purposes. However, as mentioned with the burn victim, summoned elementals can have other uses.
The reason a water elemental should never come in direct contact with a burn victim is that the nature of the damage and the nature of the elemental want them to merge. The body craves fluid; the elemental sees dryness and feels drawn to it. Allowing them to merge will critically imbalance the victim’s body, because though fluids are necessary for a burn victim’s survival, a water elemental is pure water – not at all what the victim needs to recover. Elemental merging can also deliver too much fluid too fast, further destabilizing the patient.
As a general rule, never ingest any sort of elemental.
Water elementals’ use in burn cases is simply as a cooling agent. When used in conjunction with breathable wards, water elementals naturally absorb heat, and can be trained to radiate it away from the body as well as conform to and hold a certain shape despite movement. This makes them capable of clinging to the burned part of a victim while that individual moves to safety, and as they will not dry out, they do not need to be changed. This may seem like a small thing, but immediate cooling stops a burn victim from continuing to cook, meaning that the damage will not expand as much as it would otherwise.
The other good use for elementals in first aid is with air elementals and asphyxiation. Whether from drowning, obstructions or smoke inhalation, asphyxiation up to a certain point can be reversed by sending an air elemental to establish a path from the mouth or nose to the lungs and hold it open. Some air elementals can be trained to pump foreign matter up from the lungs while holding the airway open, but as they are distractible and flighty creatures, it is not always possible to keep their attention on two tasks at once. Air elementals can also be instructed to artificially inflate and deflate lungs as if breathing, and if given a ward and propulsive energy can be sent into the water to attach directly to a drowning individual and clear the liquid from their lungs. They can also operate as safety masks during a fire, keeping smoke and toxic fumes from being inhaled while gathering useful air from the environment to keep their master breathing, and can counteract altitude sickness in a similar way.
This does not count as ingesting.
Now, one could also use a combination of water and fire elementals to reverse hypothermia, in a similar method to water’s use on burns – no physical contact, just a comfortable warm emanation from the fire radiating through the water and thence through the ward. However, actually getting fire and water elementals to cooperate in such an endeavor is unlikely, no matter how strongly the Summoner has them bound. More pragmatic to have a fire elemental start a fire for you, then heat normal water over it and defrost the victim by hand.
I have heard that there are experiments ongoing regarding water and earth elementals’ ability to leach poisons and toxic metals from the bloodstream, but if they have any results, they will have to wait until the next time I give this lecture. I do know that metal and wood elementals can be trained to remove shrapnel or foreign objects by growing into the wound and manipulating the object out, but you have to take care not to use a toxic metal or plant.
Moving on, we have the discipline of Mentalism. Though no mentalist power can mend an injury, their mind-tricks are invaluable for calming victims, blocking pain and averting the onset of psychological trauma. A calm patient is more malleable and less likely to resist medical assistance, which keeps both of you from potentially sustaining further injury.
As a non-mentalist, it is difficult for me to describe or discuss the techniques involved, so bear with me. Those of you who are mentalists are likely already adept at it, as I’ve been told that the projection of calm—and methods of calming yourself—are taught from the very first lesson.
This brings up an important sidebar: the administration of first aid to oneself. Obviously an Energies mage is unlikely to cycle-interrupt or cardiac shock himself; the first is nigh impossible and the second difficult to calibrate properly while in cardiac arrest. Warders and Summoners are more free to use their skills on their own wounds, and should practice splints, tourniquets—briefly!—and quick commands to their elementals in order to prepare themselves for such problems. Mentalists, as I understand, put themselves through a regular regimen of psychic preparation including pain-blocks, calmatives and trauma dispersal, and use all of it in service to the population. It is a larger part of their course of study than most disciplines’ first aid skills.
That being said, as most mentalists end up in ‘listening post’ roles, it is a good idea to keep a hand in on techniques you might not use often. Eavesdropping is all well and good, but being able to soothe, sleep or paralyze a combative patient to make sure they get proper treatment can save lives—not only the patient’s, but your fellow mages who might otherwise be injured or disrupted by someone’s thrashing.
Mentalists are also essential for managing psychological disturbances in patients, such as those that accompany hypothermia and some poisonings, as well as the patients’ own naturally damaged psyches. Stress and pain can bring out the monster in people, so in such situations it is essential for a mentalist to establish a baseline state for every member of the group and work to ensure that all members stay near that baseline. Volatility, irrationality, aggression, paranoia, disordered thinking: all of these can be life-threatening in a survival situation.
You may have noticed that this crosses the line into thought- and emotion-manipulation, which is banned to civilian mentalists. The ban gives an exception to medical magic, but it is not often used since most mentalists who end up on survival situations tend to be military mages and thus are permitted to use whatever tools they deem necessary to their task. Keep it in mind though—both the ban and the exception. You can not traipse around altering people’s emotional states as you like, but when someone is injured or likely to do injury to themselves or others, you are authorized to act on it.
One more thing that mentalists can do, to themselves or others, is an additional effect of the calming process: when calmed, one’s heart rate decreases, as does blood pressure. While this is helpful if someone is in the process of gouting blood and the flow needs to be decreased, it can become a liability if you maintain it for too long, or push it too low; you can force your patient’s heart rate down to the point that they go into shock, and can pass out or die.
Next are the Artificers. While Artificers play an important role in medical treatment, particularly reconstructive therapy, they do not have many off-the-cuff options for first aid. As you may know, Artificers specialize in the creation of arcane tools, constructs and weaponry, but in a field situation there is often neither the time nor the materials to put their skills to good use.
Artificers therefore must rely on preparative measures. Most carry a toolkit with supplies meant to complement their secondary arcane discipline or make up for a lack, such as collapsible splints for those who do not have Ward skill or calming tonics for non-mentalists. Thus Artificers remain useful when they and their comrades are too taxed to otherwise use magic; most small Artificing tools are calibrated to be powered from simple physical contact, if not completely autonomous.
Many Artificers also bring their constructs into the field, which may have been given their own instructions as to how to handle friendly casualties. Depending on the talent of the Artificer, these may range from be climber-types able to retrieve friends from perilous situations—on cliff ledges and the like—to containment-types, to actual medical-aid types, as well as simple walking stretchers to help carry the wounded comfortably from place to place. Regardless, most of these can operate while the Artificer is unconscious, thus can aid their maker as a Summoner’s elementals may (or may not) aid him. However, as they are not intelligent like a Summoner’s elemental, they can only do what their pre-set orders will permit; therefore any Artificer planning to take a construct into the field for medical aid has to make sure to test its parameters thoroughly, to make sure it will be a help rather than a harm.
Because of their tools and skills, Artificers are adept at many non-triage-related but equally survival-important tasks such as preparing safe campsites, purifying water, maintaining a fire even in poor conditions, formulating protective salves and purgatives, and other alchemical tasks that can not be given over to an elemental. However, all of this knowledge and these tools need to be studied and prepared beforehand. I know there are several medical- and survival-preparation courses offered by the Artificing faculty, including outings, so those of you Artificers who plan to do more than tinker here in Valent should make sure to sign up. I’ve heard it’s an exciting few months of study.
Last are the Scryers. Obviously a Scryer’s first, best talent in an emergency situation is to open a portal to a safe place, but this is where experience and judgment must come in. Portal work involves co-locating two points in space, and while a healthy individual can usually pass through a portal with minimal discomfort, an injured person—particularly someone with backlash or other arcane trauma—can experience severe complications due to the spatial disjunction, up to and including death. Therefore, portals are not recommended unless the current threat outweighs the potential danger.
Care must also be taken even when there is no direct injury. A portal’s disjunction can destabilize a local energy field—or be destabilized by one, such as during an arcane battle. Obviously you don’t want to be passing through a portal when it gets destabilized. Beyond arcane matters, using a portal if you are in, say, an earthquake, can splice you with objects on the other side that are not being shaken; if you use it to escape a house-fire, you may instead trigger a catastrophe as air from the other side rushes in to your side and causes a flashover. Even stable situations can be treacherous, as the stress of being in an emergency situation can fray a Scryer’s control over their workings and cause portal travel to go awry.
Thus many Scryers prefer to use smaller workings in these situations: hand-portals for retrieving stashed medical supplies or assisting in rescue operations, scrying for keeping an unobtrusive eye out for enemies or potential danger. I have even heard of a Master Scryer who assisted a woman with a difficult childbirth by opening a small portal into her womb to remove the child without having to cut her or force the birth—but I would not recommend anyone try that, ever. By and large, Scryers are relegated to support roles when it comes to arcane first aid, either to simply keep watch or send the stabilized patients through to receive professional care.
Understand that this is an overview; there are more specific techniques available at all levels of each discipline that I can not cover here due to the pre-training requirements. However, you must also understand that there is only so much that we, as law-abiding mages of the Silent Circle, can do to help our fellows and ourselves, as true medical magic has long since been outlawed.
I know you all recognize the name of it: necromancy. While it has a foul reputation now, there was a time when not all of its practitioners were defilers of corpses and consumers of souls; some were men and women dedicated to the preservation and enhancement of mortal life. Their ability to manipulate flesh, blood and bone was unparalleled even by the power of the healing goddess, but it was that very ability that prompted many of them to defy all ethical considerations in their pursuit of perfection and domination. For centuries, the Silent Circle waged a secret war to eradicate these necromancers and their corruptive teachings, but in the process annihilated many medical mages whose only crimes were the similarity of their techniques to those of the madmen.
Almost all of that medical knowledge is now lost due to the actions of the power-hungry few—and I would like to point out that there have been purges among the six disciplines as well, for any time a technique is created that is too successful, too easy to use against others, too perfect to be defended against, the precarious balance of the arcane world is tipped and must be righted. Such happened against my own discipline, Evocation, when battle magic became too destructive during the first War of Empires; techniques were discovered that made it easy for Evokers to rain fiery death upon miles and miles of countryside at once, prompting a movement from all other disciplines to bring Evocation back under control. In the end, the battle mages—like the necromancers—were hunted down and slain, all records of their techniques destroyed. To this day, we in positions of authority keep watch to make sure that no battle magic is rediscovered.
A dour note to end a lecture on, I suppose, so instead I’ll say that even being barred such techniques, we are constantly making advances in medical magic and arcane first aid. In learning from the mistakes of our predecessors, we are finding new ways to replicate old magic without the accompanying moral grey spaces, and should any of you be interested in a further career in medical magic, I can give recommendations as to courses within your disciplines. I hope this overview has given you something to think about, and if there are no questions, the lecture is concluded.