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Medical Simulations (MEDSIM) Rules

Updated: Oct 28, 2023

Blackline MEDSIM rules are based on a simple 'hit' and 'injured' dynamic, but add a level of detail that works to accomplish four objectives.

  1. Replicate the impacts of injuries on personnel and engagements

  2. Create randomness in the level of severity of an injury

  3. Provide opportunities to practice first aid skill sets on self and others

  4. Keep participants safe

Revision Information:

These rules were last updated on 05SEP22


Hit Rules

This section details where you can be hit and the basic, universal methods in which to respond to being hit

Hit Locations

  • Head and Neck

  • Torso

  • Arm and Hand

  • Legs and Feet

Hit Rules

  • Any BB hit to any location causes an injury in that location

  • Being hit requires the injured player to fall to the ground

  • Simultaneous injuries to multiple locations are possible (ie. can have injuries to the head and legs at the same time)

  • Each injury requires separate treatment

  • Training knife impacts are treated as critical injuries (no speaking, no moving, no shooting) regardless of where they occur on the body


Treatment and Limitation

This section deals with what limitations are placed on a player, how they are determined, and what measures must be taken to treat them. Injury determination is modeled off the frequency and severity of injuries in real combat.


  • Cards are randomly distributed to all players

  • Cards are different from player to player

  • Cards indicate three types of injuries - minor (green), major (yellow), and critical (red)

  • Cards indicate what type of injury a player receives if shot in one of the four hit locations

  • Cards indicate if a player can provide aid to themselves

  • Cards indicate player limitations based on whether they receive medical aid or not

  • Cards may not be shuffled or exchanged until the holder is extracted to a medical facility

A card indicating injury types based on location for airsoft
MEDSIM Card, Red Deck, V1.0

Player Limitations

  • Any injury has two states - ‘Before Aid’ and ‘After Aid’

  • Limitations on shooting, moving, and talking are different based on the ‘Before’ or ‘After’ states

  • Use the provided MEDSIM card to determine the Before and After restrictions based on what location was hit.

  • Before Aid restrictions go into effect immediately after a hit in that location

  • After Aid restrictions go into effect after medical aid has been applied to that location

  • ‘No Shooting’ limitations mean the individual cannot shoot any weapons

  • ‘No Moving’ limitations mean the individual cannot walk or crawl

  • ‘No Talking’ limitations mean the individual cannot speak

  • Injuries persist until the individual is extracted to a medical facility

Medical Aid

  • Medical aid for arms and legs may consist of bandages or replica tourniquets

  • Medical aid for head and torso may consist of bandages only

  • Applying bandages or tourniquets to yourself is only allowed for minor (green) injuries

  • Medical aid must be applied UNDER body armour or helmets

  • Bandages and tourniquets may only be removed when an individual is moved to a designated extraction point


  • Uses an 'extraction team' of two players for every critical patient (2:1 ratio)

  • Extraction team members must remain in physical contact with the injured player at all times

  • Extraction team may not run

  • No member of the extract team may use their weapons during movement

  • Extraction may stop by sitting the patient down

  • Any member of the extraction team CAN be wounded during extraction

  • When at the designated extraction point, all players may remove bandages and tourniquets, and return to the event as uninjured players

Example Scenarios

  • 14A is hit in the head. They fall to the ground and are a critical casualty. They may not move, shoot, or speak.

  • 15C is hit by a burst of fire in their arm and their head. They fall to the ground. They receive a minor injury on their arm, and a critical injury on their head. The critical takes priority over the minor injury, so they may not move, shoot, or speak

  • 01B is hit by a grenade and receives hits to their left arm, right hand, and right leg. 01B falls to the ground, does not move or shoot, and begins self aid. They have enough bandages to apply to all their injuries. They do so, and then return to the fight.

  • 14C and 14D arrive to extract 01B. They crawl out of danger, and then walk to the extraction site. There they remove any bandages and tourniquets, and return to the fight.

A card indicating injury types based on location for airsoft on top of medical supplies
Several examples of MEDSIM cards


Contingencies and Fail Safes

Contingencies and fail safes are built into the rules to prevent people from being injured or exposed to unnecessary safety risks.

  • Bleed Out Times - if no aid is received, the individual must wait at least three hours before attempting to leave the event space on their own. This allows their team to launch search and rescue missions for missing personnel. An individual may choose to leave early based on their own personal safety but is temporarily eliminated from the event.

  • An individual with the ‘No Moving’ limitation may walk while in contact with another person if the environment is unsafe for carry (steep terrain, sharp objects, personal limitations, other hazards)

  • An individual with the ‘No Speaking’ limitation may speak to convey location of injury, or to convey consent or safety concerns.

  • An individual may elect to stop being shot by calling out ‘Critical’, and then adopting the No Shooting, No Moving, and No Speaking limitations

  • Eye protection must remain on at all times

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