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Medical Focus Feature discussion #3134

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thojkooi opened this Issue Jan 9, 2016 · 73 comments

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@thojkooi
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thojkooi commented Jan 9, 2016

Tasks for focus feature medical:

  • Prevent instant death & Revive are confusing for players. Look into a single setting method instead
  • Unconsciousness
    • It is hard to figure out when someone is stuck in revive or just regular unconscious
    • Players find it confusing how to wake up an unconscious patient
    • See about improving the unconsciousness effect for players
  • Improve triagecard (#1658)
  • Medical Menu does not seem to be widely known. Make it default? - 604ba50
  • Merge basic and advanced medical injury systems
  • Clarify the amount of pain as feedback to a medic (#2117)
  • bandaging takes to much effort since latest update (3.4.0), look into improved values or alternative method ?
  • tourniquets should have an effect on medication (medication localized to body parts?) (#2704 #3255)
  • add option to treat everyone as a medic in medical facility (#1259)
  • Go over all treatment actions and improve triage card reporting
  • Fix surviving exploding vehicles

Please provide input on the above mentioned items.

@thojkooi thojkooi self-assigned this Jan 9, 2016

@thojkooi thojkooi added this to the 3.5.0 milestone Jan 9, 2016

@gienkov

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gienkov commented Jan 9, 2016

Unconscious - maybe different lying down animation for both states?
09.01.2016 17:49 "Thomas Kooi" notifications@github.com napisał(a):

Tasks for focus feature medical:

  • Prevent instant death & Revive are confusing for players. Look into
    a single setting method instead
  • Unconsciousness
    • It is hard to figure out when someone is stuck in revive or just
      regular unconscious
    • Players find it confusing how to wake up an unconscious patient
    • See about improving the unconsciousness effect for players
  • bandaging takes to much effort since latest update (3.4.0), look
    into improved values or alternative method ?
  • Medical Menu does not seem to be widely known. Make it default?
  • tourniquets should have an effect on medication (medication
    localized to body parts?) (#2704
    #2704)
  • Improve handleDamage system to be eventdriven (Commy2's approach)
  • Improve triagecard (#1658
    #1658)
  • add option to treat everyone as a medic in medical facility (#1259
    #1259)
  • Clarify the amount of pain as feedback to a medic (#2117
    #2117)
  • Go over all treatment actions and improve triage card reporting

Please provide input on the above mentioned items.


Reply to this email directly or view it on GitHub
#3134.

@BaerMitUmlaut

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BaerMitUmlaut commented Jan 9, 2016

Prevent instant death & Revive are confusing for players. Look into a single setting method instead

This sounds better, however a (optional) reason that makes medevac still necessary would be great. Something like permanent damage. Broken limbs would for example be an idea, or lower overall stamina, etc.

AGM had a maximum unconsciousness timer. Something like a proper maximum cardiac arrest time could be a replacement for the revive state.


Something completly different, but I think there are a few unused functions in medical. It needs some cleaning up.

@Gwynblade

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Gwynblade commented Jan 9, 2016

Here's couple of things I personally would like to see, you guys ignore or implement them as you see fit :)

I really like the advanced medical, there are some really nice improvements over ACE2 done (I like the medical menu especially, and how you can treat each part separately in ACE3), but there are some nice stuff (from a gameplay standpoint, not sure about realism) I would like to see make a return.

-Unconsciousness (not talking about being able to see the AI/player is not dead) - In ACE2 it used to have a pretty big impact on gameplay, both on unconscious player and medic or other teammates. It used to take from ~10-15 seconds on light injuries, up to minute or two to wake up, if you're badly injured (sometimes you can't even wake up when you're really messed up)

When you're a medic and teammate goes down, you knew you have go and try to help him ASAP, since chances are, he ain't waking up any time soon, might even bleed out if you don't hurry (If he's badly injured). If he is in the open, work with the teammates, lay down some smoke, and someone carry him back (or patch him up on the spot if there's enough smoke/time) all while under enemy fire. Those were some of the most intense moments back in ACE 2.

If you're unconscious player, it was always thoughts racing through the head - come on what's going on out there? Will I even wake up, are we winning the fight, are those friendlies I hear moving around me? Is anyone going to patch me up? Is anyone still alive at all?

As it is now, everyone wakes up really fast, if you're medic and see someone go down, you know he is waking up in couple of seconds and patching himself up, if not, he is dead (long unconsciousness happens very very rarely), there is no middle ground for medic to be useful, other than the final touch, or backpack full of bandages.

It might be more realistic the way it is now (I have no clue - not a medic), and I'm usually all for realism, but those longer unconscious time made for such an awesome gameplay element, that I would trade realism in this case, any time any day.

-Bandaging prone (I'm not too sure about this suggestion, I really liked this, but it's probably gonna piss of a lot of people). In ACE2 you couldn't bandage yourself while prone (only crouched and standing), but a teammate could. It made for a pretty cool teamwork element. I remember hiding prone behind those low walls on chernarus, while a bunch of enemies are spraying 7.62mm bullets all around, yelling at the teammates to crawl and patch you up, since you know you're dead the moment you stand up.

Other than this, gonna copy and paste something regarding PAK's from feature requests. If you've read this, you can ignore.

-I'd like the option to allow using PAK's in the field, but in a way, so they don't fully heal (they can full heal in the medical facility/vehicle still).

The reason I'm asking this is because I'm not fan of full heal with PAK in the field, but most small scale coop missions don't include medical facility, so if you get hit in the leg, you're going to have to walk for the rest of the mission.

Also it would be nice if PAK effectiveness degraded, the more messed up you are (if you're using it in the field). For example: If you are hit, and have 60% hp left, PAK in the field could get you up to 80%, If you get hit again, and go to let's say 40%, PAK could get you up to 60-70%.

-Other than that, I'd love the option for medic to be able to use PAK on himself (for those small scale coop missions that only have 1 medic), and medic to have couple of PAK's by default (for all missions that are not set up with ace in mind).

Thanks for always improving the mod!

@edwallitt

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edwallitt commented Jan 9, 2016

For accuracy's sake you may also wish to change the name of atropine to adenosine. Atropine is not used to treat fast heart rates (e.g. caused by epinephrine/adrenaline), quite the opposite, in real medical practice it is used to treat slow heart rates and some types of poisoning.

https://en.wikipedia.org/wiki/Atropine

@Daishiknyte

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Daishiknyte commented Jan 9, 2016

All this is related to advanced. I do not have experience with Basic.

Prevent instant death & Revive
This is an important option to have. Without it, we've run into too many instant-death, medic is useless scenarios. Possibly mix in a 'time to death' countdown based on how bad the original injury was. That way, there's still a chance of getting to someone, but there's still some distinction between damage taken.

Another option I know some mission makers would like is "Prevent Death". No matter what happens, the injured is maintained at the worst possible damage state until healed.

Preventing respawn needs to be separate. Leave it up to the mission maker or unit to decide if respawning is an acceptable option.

Unconsciousness
Most of the time, it is easier to check the animation state of the body to figure out if they're savable or not (look for ragdoll positions or where the gun is). I don't find the advanced medical system to be hard to figure out for unconsciousness. There aren't too many symptoms (low blood, low heart rate, low blood pressure, pain) that need to be treated. It would be nice to have some indicator that what you are doing is working, maybe a status of "He seems to be coming around" or slightly more detailed status reports like "Lost some blood/Lost a lot of blood/Blood level critical" to help medics understand what the situation is like.

I wouldn't want to see anything more added to the system (eg: defibs).

Bandaging takes too much effort
We ran into this problem today with multiple cases of a limb showing "small cut" or "minor puncture" but needing multiple rounds of bandaging just to get the [bandaged] effect. Is the problem the effort or the current balance of damage to healing effectiveness or correct damage reporting?

The hardest problem is accessing the medical menu, especially through the radial dial. Players and animations move too much, and sometimes are just a hair to far out of range to see. The medical menu does help some, but I don't think most people know about it, and I find it to be difficult to use (later...). Not my preference, but through the medical menu, what about adding a way to queue up treatments? Something I could pull up, and say "bandage left arm, bandage left arm, bandage right leg, apply morphine", then sit back back and let the animations cycle.

Speaking of bandages, they could use some balancing. As it stands, if you look at their effectiveness, there's not much of a reason to carry standard bandages and elastics. Bandages are a bad options in most cases, and elastics are handled mostly by packing and quikclot, and are only an improvement for crush wounds (I'm factoring in effectiveness and reopening).

As for treatments, why can't I do my own transfusion!

Medical Menu
Most people don't know the medical menu exists. It's buried in with the other options and is overlooked unless you already know or have been told.

Menu good:

  • I don't have to hunt down each body part to select in the sea of interaction floaties.
  • All the options are on 1 page

Menu bad:

  • Accessed through the ever hard to find "interaction" interaction point instead of a body part
  • Hard to read
    • Text is small and cramped
    • Text color is all the same and hard to see depending on the background
  • The Examine and treatment buttons are small, the same size, the same color as all the text and they're cramped up.
  • The action lists are small, center aligned, and too tight to the top of the listbox. There's plenty of room to make the list items a bit bigger and less cramped.

I'd appreciate it if the treatment range was just a bit larger. Sometimes finding the exact right spot to treat someone is an exercise in futility. Not much, just a bit.

Triage Card
The triage card and status doesn't get much use. With so little to help us understand how badly someone is wounded and the time constraints we're working under (before worse effects set in), most people are fully treated then and there, or are patched up and left to deal with the rest on their own. Also, most meds are pushed to deal with a symptom. In pain? Hit them with another morphine, even if one was used 2 minutes ago. Also, how about dropping the triage tab from the E&T bar and moving that information down between the activity log and quick view. It puts the information up front and center, and opens up some room on the crowded bar.

Tourniquets
I wouldn't change anything with tourniquets. For now, they're handy to get someone to cover or to a medic without being complicated. With more information on the severity of wounds, treatment time, and time-till-bad-things-happen, I think they'll see even more use. The mentality may change from "bandage as fast as possible" on bad injuries, to "cut off blood flow, he'll leak too much while we treat".

Limiting medication to certain body parts and/or because of tourniquets sounds like an overcomplication and doesn't add value to gameplay.

Treatment Options
Designated medical facilities and vehicles should have the option for treatment to anyone. Nothing more frustrating than being the lone gimpy medic because I can't properly treat myself due to the limitations already in place.

Oh, and remind me again what the point of the sewing kit is if I can't use them in the field and I could just use a PAK when we get to the medical truck? Sure, the mission maker or clan could artificially restrict having PAKs, but that's a rare situation.

If leg breaking is going to continue to be a thing, I'd like to see an in-the-field partial heal option that would allow limited jogging. No sprinting, limited endurance, etc.. The player still ends up limited, but not completely out of game.

Pain
Pain, damage, bleeding rate, etc. could all use additional details. How much pain (1-2 morphine?), how fast is the blood loss, patient seems to be responding (waiting for waking up), etc.. I'd also like to see some pain that doesn't affect aiming, but still slows movement, standing/sitting/getting into trucks, etc. Effects that are noticeable, but don't immediately prompt another hit of morphine because you can't aim or see well.

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Cyruz143 commented Jan 10, 2016

Is it worth keeping triage in basic, it feels like it belongs in advanced medical. An option in the server configuration would be nice to disable it as I'm commenting out the code at the moment to declutter the menu a bit.

@headedhorseman101

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headedhorseman101 commented Jan 11, 2016

...through the medical menu, what about adding a way to queue up treatments? Something I could pull up, and say "bandage left arm, bandage left arm, bandage right leg, apply morphine", then sit back back and let the animations cycles

What might be a more user-friendly option alternative is to group it into one action for an entire set of the same injury type. This would allow the medic to treat one group of injuries without having to use the interaction menu 5 times for one type of wound. If the medic doesn't have enough bandages, then the action will cease with however many it finished bandaging.

Of course this process would be adjusted for time, and would save the progress of the treatments. Just in case there is any confusion by what I mean, I'll give an example (in context of Advanced Medical).

Example:
Initial injuries on left leg:

4.7x Medium Avulsion
1x Large Cut

Initial bandage inventory of medic: Elastic Bandage [5]


Using a single "Elastic Bandage" action w/ no interruptions:

1x Large Cut
4.7x Medium Avulsion [Bandaged]

Final bandage inventory of medic: Elastic Bandage [0]


Using a single "Elastic Bandage" action and interrupted with 60% of progress bar filled:

1.7x Medium Avulsion
1x Large Cut
3x Medium Avulsion [Bandaged]

Final bandage inventory of medic: Elastic Bandage [2]

Synopsis:
The actions would only fix a group of the same type of injury on one body part, and would account for the time of patching each wound, the resources required to fix it. The difference between current advanced med system and this is one action would be required to conduct each treatment as specified in the example.

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SilentSpike commented Jan 11, 2016

Not a fan of that idea, there needs to be granularity to add meaningful interaction. Otherwise you're just clicking an "automatically do my job" button.

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BaerMitUmlaut commented Jan 11, 2016

I agree with @SilentSpike here. If you have this you'll just end up staring at a loading bar for a while instead of actively interacting with the player.

I played PR for a bit and one thing I really didn't like is how you just hold one key and wait to heal somebody. It's so boring compared to what we have.

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jokoho48 commented Jan 11, 2016

@Glowbal you missed #3124

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SilentSpike commented Jan 11, 2016

^ that's not a bad idea, although I feel like making it a setting is unnecessary

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gienkov commented Jan 12, 2016

Of course it's necessary because making it 10 seconds by default may cause way more deaths than even before - I'd like to configure it to my likings.

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BaerMitUmlaut commented Jan 12, 2016

Something else that came to my mind but is more of a feature request: stamina/fatigue should influence heart rate, possibly with public functions that let you define the current workload (for custom fatigue systems).

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commy2 commented Jan 12, 2016

^

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headedhorseman101 commented Jan 12, 2016

^^
^^
I would really like to see a defibrillator. Something besides cpr that gives the medic, who is trained to use it, a purpose in helping people in critical condition (like the revive state. What would be nice is to add the vehicle and facility settings as an optional limiting factor.

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SilentSpike commented Jan 12, 2016

Of course it's necessary because making it 10 seconds by default may cause way more deaths than even before - I'd like to configure it to my likings.

By this logic every piece of code should have a corresponding setting

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headedhorseman101 commented Jan 12, 2016

By this logic every piece of code should have a corresponding setting

Well if people made custom ACE's, they could. Open source is great that way.

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SilentSpike commented Jan 12, 2016

To clarify, an excess amount of gameplay settings makes for a terrible experience.

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SchwererKonigstiger commented Jan 13, 2016

One thing I think would be very useful to medics and players in general, as well as maybe mission makers, would be the inclusion of a knee-board card for medics, similar to what pilots have, or a pull-up card similar to how the range tables currently work.
This would contain basic information like the effectiveness of medical items, or which items to use where. See here

This would facilitate quicker and easier wound treatment, and help to clarify information regarding the complexity of the advanced medical system. Players have told me it can be very overwhelming to learn as there isn't much for in-game reference information - they have to open up a website in their browser/steam browser to dig it up.

This would be effective for overall clarification of treatment options, and an easy reference tool for players to use.

@Armilio

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Armilio commented Jan 15, 2016

-Unconsciousness (not talking about being able to see the AI/player is not dead) - In ACE2 it used to have a pretty big impact on gameplay, both on unconscious player and medic or other teammates. It used to take from ~10-15 seconds on light injuries, up to minute or two to wake up, if you're badly injured (sometimes you can't even wake up when you're really messed up)

When you're a medic and teammate goes down, you knew you have go and try to help him ASAP, since chances are, he ain't waking up any time soon, might even bleed out if you don't hurry (If he's badly injured). If he is in the open, work with the teammates, lay down some smoke, and someone carry him back (or patch him up on the spot if there's enough smoke/time) all while under enemy fire. Those were some of the most intense moments back in ACE 2.

If you're unconscious player, it was always thoughts racing through the head - come on what's going on out there? Will I even wake up, are we winning the fight, are those friendlies I hear moving around me? Is anyone going to patch me up? Is anyone still alive at all?

As it is now, everyone wakes up really fast, if you're medic and see someone go down, you know he is waking up in couple of seconds and patching himself up, if not, he is dead (long unconsciousness happens very very rarely), there is no middle ground for medic to be useful, other than the final touch, or backpack full of bandages.

It might be more realistic the way it is now (I have no clue - not a medic), and I'm usually all for realism, but those longer unconscious time made for such an awesome gameplay element, that I would trade realism in this case, any time any day.

I couldn't agree more. And if we concern about realism, also that people simply wake up and run after healing severe legs injuries with some bandages and morphine or magic PAK is not realistic: one thing it's remain alive, another thing it's remain "combat ready". Or that an unconscious man wake up with only some bandages (and that's what may happen now). So, It's better talk about gameplay, and about the fact that if 99% of time the medic it's useless, that ruin the medic gameplay. Because or you use the revive, and so you always need the epinephrine — but i find the revive a bit arcade, for my taste of course — or even when there are long unconsciousness, nine of ten the man down need only some bandages and morphine for wake up, and everyone can use them, unlike epinephrine or bloodbag. I think that the best for the gameplay and the realism would be maintained the "short unconsciousness" events, because probably they are realistic in some situation, but increase (a lot) the long unconsciousness occurrences and the medic work in that case. For example, i see that the "long uncosciousness" occurre only with red wound on legs or arms, NEVER with body wound or (of course) head wound: maybe make it happen, randomly, also with body injuries, it would be better. If not many people — nor me or my clan, but i understand the choose — are constrained to use prevent instant death or revive that are a bit... forced, in making people remaining "alive" also if they are directly hitted on their face by a 120mm ammo, even if they don't like it that much.

thojkooi added a commit that referenced this issue Jan 17, 2016

@thojkooi thojkooi changed the title Medical Improvements Medical Focus Feature discussion Jan 17, 2016

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DocScarle commented Jan 20, 2016

My issues

  1. Wounds seem to open up a little too easily once they are bandaged. After a large amount of physical movement I would expect a wound to bleed again but not on a large scale, as some amount of coagulation would already of taken place.
  2. The increase in Heart Rate from an injection of Epinephrine is much too slow. Especially if the patient has adequate blood volume.

thojkooi added a commit that referenced this issue Jan 20, 2016

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commy2 commented Oct 17, 2016

I don't think the rewrite will add new content like defibrilators, even if we wanted them. The focus is on

  • changing the internals
  • unifying basic and medical while making their differences changeable settings

Also there might or might not be implications on gameplay like enhanced animations and a tweaked unconsciousness state based on these internal tweaks. It really depends on what exactly one is talking about.

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Arcanum417 commented Oct 17, 2016

Is there any kind of ETA or progress on this ? I am kinda waiting for Medical to be glorious a while now and I am excited like a little girl.

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commy2 commented Oct 17, 2016

Is there any kind of ETA

It's done when it's done.

or progress on this

Here: https://github.com/acemod/ACE3/projects/2 and here: #4064

I am kinda waiting for Medical to be glorious a while now and I am excited like a little girl.

Same, which is why I started working on it too.

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BountyHuntA commented Oct 18, 2016

Would be nice if cpr would consume fatigue. This should be heavy work ;)

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Sporkfist commented Nov 2, 2016

Basic Medical needs a few minor changes to make it a perfect system. In its current form, it does not make ArmA3's experience as enjoyable. I think ACE3 would benefit from looking at ACE2's medical system retrospectively:

  • Add better injury states, head injuries that permanently blur vision until healed, arm injuries that cause the gun to shake, leg injuries that enforce crawling/walking, torso injuries that drastically decrease stamina.
  • Bandages should ONLY stop bleeding, not physically heal the injury. Injury should persist until some kind of Medkit (consumable surgical kit in basic, maybe?) can be used to repair limb back to its normal state.
  • Pain being either a blurry screen/tunnel vision should be a serverside choice, not a client choice.
  • Even low level pain should have more of a tangible effect on player, shakey gun, decreased stamina, regular grunting/screaming from player character would all be welcome additions.
  • Add an option for mission maker to define a cap of blood after a going unconscious with the bleedout timer. Most times, someone will go down and still be at a relatively high level of blood.
  • Bloodloss should also have more tangible effects on players stamina, vision and aim.

In ArmA2:

  • Players would very rarely be woken up by anything other than epinephrine.
  • Players would come out of unconsciousness usually with some kind of serious injury, be it a leg injury (can only crawl) or an arm injury (cannot aim straight).
  • Players could not hear vocal communications while unconscious.
  • Players would pass out regularly if in pain.

In ArmA3, currently:

  • Players can very easily be woken by a single shot of morphine.
  • Injury states have very little affect on player, only a bandage is required to fix broken legs.
  • Players can hear vocal communications while unconscious.
  • Pain only really makes a screen blurry.

The end result is that bullets just aren't very scary in ArmA3, this makes it easier to play more recklessly and less tactically. Some people would say to use advanced medical, but that as a system is highly complex and not necessarily that fun for all players. A more robust basic medical system with more of a 'rock, paper, scissors' usage encourages a fun but serious type of gameplay.

Overall, both the Advanced and Basic medical systems could benefit from these changes, particularly Basic.

In any case, thank you for a great mod.

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Cuel commented Nov 2, 2016

In ArmA2:

  • Players could not hear vocal communications while unconscious.

I don't recall this. From what I remember you could hear people around you (using acre)

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alexcroox commented Nov 4, 2016

Not sure if it's been mentioned above but a reliable way to track who was the cause of the player being downed, and when they finally bleed out, retaining the correct killer.

The current ace_medical_lastDamageSource does this correctly a very small percentage of the time.

Thanks!

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kneegrew commented Dec 13, 2016

I don't recall this. From what I remember you could hear people around you (using acre)

You could talk to people, they could hear you, but you couldn't hear them.
I miss the flashing black from being unconcious, so you would get small glimpses of your surroundings.

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GokouZWAR commented Jan 15, 2017

Feature request to make the Triage card more useful:

When looking at a player, if the color of the triage card can be displayed near the player's name that would make the triage card totally useful and visually appealing. A simple little icon, or even a simple color coded box next to the name would work. You could quickly look at someone and know what they've been triage as and could sort them rapidly.

Please and thank you!

@PabstMirror PabstMirror modified the milestones: 3.9.0, Medical Rewrite Feb 2, 2017

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crowmium commented Feb 19, 2017

The recent ACE update got me thinking about this again and I was reading through all of the Medical Overhaul feature requests and such. A couple interesting ideas struck me that would be both a more medically accurate simulation, but also make for more depth of gameplay and fun for medics. Just wanted to get in the suggestions in hopes they might make it into the medical overhaul.

1. Include more localized injuries based on the existing Arma 3 hitboxes. It would be nice to have neck wounds since those are particularly lethal, as well as dividing the torso into upper and lower injuries considering the stark difference in the lethality of upper torso vs. lower torso penetrating trauma.

Arma already has localized wounding for these areas which could be used (I haven't looked into the medical code to know if that's what's happening right now). I would use abdominal and pelvis hitboxes for the lower torso and chest and diaphragm hitboxes for the upper torso. The body hitbox damage could be ignored since it seems to be an overall combination of these four other areas that has no simulation value medically only gameplay value in vanilla.

These two extra medical areas could add a lot of interesting medical options and help simulate traumatic injury more accurately. It also ties in to my earlier post from September where I mentioned having more random wounding states to simulate the path of the ballistic trauma making a difference in the severity of the injury. The percentage chances of various wounds, pain, and consciousness could be different based on which of these areas are hit.

2. Bleeding checks. An interact option that would be available in the same places and work similarly to the "Diagnose" feature, but instead of providing HR, BP, pain, and consciousness it would do a check of the body for any wounds and return the number, type, and severity of wounds at each location.

To tie this into the previous requests as well, it is possible in real life to take a hit and due to adrenal response not realize you have been wounded. Real soldiers check their buddies after each firefight to verify they did not get struck without realizing it and are bleeding. Soldiers have often died not realizing they had serious internal bleeding and suffered shock and exsanguination a few minutes or hours later.

Given the wounds changes I described back in September are also implemented, I think the ideal implementation of this would be if you take a wound there would be a small chance (1%?) to have your screen flash a pain effect once and then not see any blood or pain effect (but the bleeding and other effects are still occurring). That would make post-combat, real life buddy checks actually have a point.

3. More variation in trauma intensity indication. I replied to a different thread about this, but I wanted to consolidate it here. In real life there are more than two levels of traumatic wounds. It would be nice to have a graduated system from minor to maximal (the same as the Abbreviated Injury Scale [AIS]) to give medics more information with which to triage patients. Currently there is no way to tell if a yellow wound is close to red or if a red wound is very severe or just barely red.

My understanding is currently bleeding level is the threshold between "yellow" and "red" wounds (something like 0.15 bleeding rate?). I can't say for sure what the ideal cutoffs for the new levels would be without testing (and I don't know the bleeding rates of different wounds), but maybe something like:

0.01 - 0.05 = Minor (Green)
0.06 - 0.10 = Moderate (Yellow-Green)
0.11 - 0.20 = Serious (Yellow)
0.21 - 0.30 = Severe (Orange)
0.31 - 0.50 = Critical (Red)
0.51 and up = Maximal (Black)

This would make triage more important and interesting for medics as well as giving players administering aid a more graduated indication of how effective their bandaging is at stopping the bleeding.

4. Decompression needle and tension pneumothorax (sucking chest wounds). As per the Tactical Combat Casualty Care. This is a well-known penetrating trauma complication that would be interesting to model. One of the big three in preventable combat deaths that is part of Combat Lifesaver training.

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runy888 commented May 4, 2017

Along with a couple of other points regarding CPR, I would like to add my input on that topic.

  1. Don't make it a single action that just charges a loading bar and takes effect once the bar is filled. CPR should be an operation that you continue performing until you stop, and as long as you do, the patient has a heartbeat, with a chance of starting up their heart at every compression. Right now, you select the option, then the action is being performed for a couple of seconds, and then you select it again. Especially when NOT using the medical menu, there is alot of what in medical jargon is called "hands-off-time", that means time where CPR is not being performed, when navigating to the action again. Furthermore, an ongoing chest compression could be represented by looping the already existing CPR animation in the game, adding alot more realism and dramatic flair to a treatment scene. If medical personnel arrives at a patient's location and sees people compressing someone's chest, they immediately know what's wrong with the victim.
    Now imagine if you performed CPR for 90% of the time the bar takes to fill, then someone drags away the patient or he dies because of his timer ending. In this case all the time you spent on chest compressions would be totally lost whereas if you look at it from the realism aspect, you actually maintained the patient's circulation for all that time. With a CPR action starting and taking effect as soon as you hit the respective button / action, you come alot closer to the effect CPR has on reallife cardiac-arrest patients.
    To cancel the process of CPR one could press the interaction key or any movement key.

  2. Bind chest compressions to a key. I know from professional experience that one of the most important things when giving CPR is the timing. Have the player actively compress the patient's chest by binding each push to a button he has to press. This changes the character of ACE 3 CPR in it's whole; moving away from a standard action with huge execution timer during which you can't do anything, towards an interactive action that depends on players concentrating and keeping the correct pace.
    A clock or a bar with colour coding could be displayed in a corner of the screen to facilitate finding the right rhythm (which is 110 bpm according to European Resuscitation Council). With every couple of milliseconds the actual beat is delayed or premature to the required timing, the compression could decrease in the effect it as on maintaining the patient's circulation.
    The very coolest thing would be if the CPR animation is performed on every push of that button.
    This only works if Nr. 1 is implemented.

  3. When a patient's heart has stopped, drugs should only take effect during CPR. It is obvious: when there is no circulation, the medication is not flushed through the bloodstream and doesn't bind on all the respective receptors to take effect. Only when the circulation is maintained externally can the medicine do what it's supposed to.
    This also kinda depends on Nr. 1.

Sorry for the wall of text and thank you for reading and considering my suggestions.
Best regards,
runy888

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andrewgsauer commented May 11, 2017

Have the player actively compress the patient's chest by binding each push to a button he has to press

Would be big-ly unpopular amongst anyone who is not hardcore realism.

When a patient's heart has stopped, drugs should only take effect during CPR

Yes.

I think CPR being non-stop instead of a loading bar would be helpful, with some kind of indicator to the player doing compressions (other than animations) that they are actively engaged in compressions.

Effect on stamina should also be considered. A couple of minutes doing compressions and your arms feel like noodles.

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SilentSpike commented May 11, 2017

I like this feedback, effect of CPR on stamina is totally worth thinking about. Could even make CPR less effective as your stamina decreases so that you have to switch people out.

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nomisum commented May 11, 2017

Have the player actively compress the patient's chest by binding each push to a button he has to press

Would be big-ly unpopular amongst anyone who is not hardcore realism.

How do you come to this conclusion? I would consider myself on the serious fun side of gaming and would certainly appreciate a feature which makes the medical system more gamey - which means i have to play kind-of-minigames to perform an action instead of waiting for a boring progress bar.

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andrewgsauer commented May 11, 2017

How do you come to this conclusion?

I just can't imagine asking players to sit there and press a key over and over for what should be a fairly low frequency event in the first place. People will avoid doing it.

I'm with you, I'd love more depth in the medical module, which I think is being worked on. I just don't think it would be well received. Maybe an option for players.

I also have to think from an animation and actual execution standpoint, it might be more trouble than it's worth. Interesting concept though.

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nomisum commented May 11, 2017

it might be more trouble than it's worth

thats probably true due to armas shitty animation system, I agree.

looking at our medics they seem to like repetitive tasks though, hehe. also i'm not sure how a gamification feature could look like at bandages. for infusions targeting the right spot for the needle while your hand is shaking might be an approach. doesnt spare you from the same waiting afterwards though. well. maybe in arma4 it will be easier 💃

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andrewgsauer commented May 11, 2017

looking at our medics they seem to like repetitive tasks though, hehe

Medics shouldn't be doing CPR though! That's for grunts, while medics are establishing IV/IO access, administering meds, securing airway, etc :)

Yea, I'd like to see "IV Access" and "IO Access" as separate events that are necessary prior to an infusion. If it was accompanied by some demonstration of skill minigame (whether that's even remotely possible) that could be interesting.

The addition of an "IV Start Kit" item would facilitate this.

IO Access might be too much depth for our purposes, but could be cool if you create conditions in which IV access might fail (significant injury to the extremities, significant blood loss, significantly low blood pressure). Low priority on that though.

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andrewgsauer commented May 16, 2017

I still have trouble understanding why Atropine and Adenosine are included in the ACE Medical module.

They're not very useful medications in a combat setting. There are several more realistic/useful medications to a trauma medic than those two. Transexamic Acid for example has gained a lot of ground in the past couple of years.

If you overdose someone on morphine, you would use naloxone, not atropine, nor epinephrine to fix the heart rate. If you overdosed them into an arrest, well then you would use epinephrine.

I could see a case being made for atropine to stay, if ACE's bleeding mechanism causes an eventual drop in heart rate. But that's so late in the game, and atropine would really not have much of an effect in that scenario anyway. If the heart rate drops out due to blood loss, it would be because the heart is not getting enough blood supply and is essentially dying. Atropine would not counteract that.

I'm curious as to others thoughts on the issue. I think the use cases real world for both atropine and adenosine in the trauma setting are so small, and would therefor be so small in ArmA, that they aren't warranted.

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runy888 commented May 16, 2017

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Will-Nichols commented Oct 25, 2017

I think Atropine has a place in ACE. I believe that any community that runs the advanced medical modules could and would utilize the modules IF they were correctly named. The simple thing would be to rename the Adenosine to Atropine and vice versa. That way we would at least get the correct abilities tied to the correct drug.

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ItaLiaNKiinG commented Feb 28, 2018

I think one thing to implement is once wounded depending on where, your body is permanently handicapped, if you get hit in the legs you limp, arms weapon sway increases, torso then you walk/run much slower. Also like most of said here, if you go unconscious, it should take more effort to get you up and once your up apply what I mentioned before about handicapping the soldier. Another important change would be removing PAK or the ability that it has, it's very unrealistic to be fully healed to 100% health no matter what, in fact even after you've been operated on etc, it still takes time to recover, meaning months if not years. Other than that, I would like to see custom animations for each medical action, morphine, bandage, tourniquet, surgical kit, etc.. 😁

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severgun commented Mar 22, 2018

awake but disabled by injure

What's the point?
Also #3134 pls.

  1. Why havy injured man should always be unconscious? There is tons of not very pleasant helmet cam videos where injured solder lean on ground/backpack/wall and stay awake. Can not move, can not shoot accurately(but can suppress), can use grenades, can talk and scream.
  2. It can be used with some TFAR rewrite. Now in unconscious state you can't talk by voice and can't use radio to call for help.

I assume you've seen the ShackTac videos. They use code based on the medical rewrite, which has this.

No. I saw WOG VTN videos. They use own medical system. But would like to see some animation or ragdoll at ACE3 stable

Also would like to see WIKI updates.
Now info about injections is very confusing.

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Will-Nichols commented Jul 29, 2018

@thojkooi You mentioned in the medical focus that you would like to see this tested in a heavy multiplayer environment. We in Task Force Red would be willing to help out with that as we tend to have larger operations on weekends with upwards of 20-50 players on doing various things within the overall mission and as the community leader I would be down for pushing this to a test mission for us whenever you want to see what it's like.

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Will-Nichols commented Jul 29, 2018

@severgun I am all for that with only having the most critically injured patients finally passing out in the final few moments of their life while as you mentioned there are many times when extremely critically injured people do not loose consciousness until death. I would think it might be a limitation of the game engine as a whole but would like to see someone working to make it different.

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