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acemod / ACE3

Open-source realism mod for Arma 3
https://ace3.acemod.org
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Medical Focus Feature discussion #3134

Closed thojkooi closed 4 years ago

thojkooi commented 8 years ago

Tasks for focus feature medical:

Please provide input on the above mentioned items.

gienkov commented 8 years ago

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 https://github.com/acemod/ACE3/issues/2704)
  • Improve handleDamage system to be eventdriven (Commy2's approach)
  • Improve triagecard (#1658 https://github.com/acemod/ACE3/issues/1658)
  • add option to treat everyone as a medic in medical facility (#1259 https://github.com/acemod/ACE3/issues/1259)
  • Clarify the amount of pain as feedback to a medic (#2117 https://github.com/acemod/ACE3/issues/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 https://github.com/acemod/ACE3/issues/3134.

BaerMitUmlaut commented 8 years ago

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 commented 8 years ago

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 commented 8 years ago

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 commented 8 years ago

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:

Menu bad:

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.

Cyruz143 commented 8 years ago

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.

pool011 commented 8 years ago

...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.

kymckay commented 8 years ago

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.

BaerMitUmlaut commented 8 years ago

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.

jokoho48 commented 8 years ago

@Glowbal you missed #3124

kymckay commented 8 years ago

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

gienkov commented 8 years ago

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.

BaerMitUmlaut commented 8 years ago

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).

commy2 commented 8 years ago

^

pool011 commented 8 years ago

^^ ^^ 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.

kymckay commented 8 years ago

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

pool011 commented 8 years ago

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.

kymckay commented 8 years ago

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

SchwererKonigstiger commented 8 years ago

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 commented 8 years ago

-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.

DocScarle commented 8 years ago

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 commented 8 years ago

event driven approach for handleDamage seems to be a no go for the time being. The damage output seems to be very unreliable.

nicolasbadano commented 8 years ago

Extract from Slack discussion:

I think if anything a more clear distintion between "medical states" and "revival states" would be better as it would prevent confusion. e.g. show units in revive state as "dead", and maybe make "revive" an action instead of a medical treatment that requires a PAK, eventually consuming a ticket. So you clearly know when you should treat the unit and when you need to revive it

Adding a "Max time in revive state (minutes)" setting

BlackHawkPL commented 8 years ago

Add feedback to player on how much blood they have lost. This can be done by decreasing saturation or making player's screen darker accompanied by animation slowdown. Right now player that is heavily bleeding can run around like Rambo, ignoring the fact that he can pass out from blood loss any time.

Something that is done in real life and somehow isn't in ACE yet: applying pressure to wound. It could be done just like any other option, you would interact with a body part, then you would be locked in animation, that could be interrupted any time. Part of code for tourniquet could be used for this, since effects of these actions would be pretty similar. Allow player to apply pressure to his own wounds, but lock him in animation and disable interactions.

Add dynamic indicator on how much a given wound/bodypart is bleeding. It can be done in real life easily - you just look at a wound and you see blood coming out. But in-game I've seen people freaking out because their small cuts were reopening. In medical menu have attribute for a wound indicating blood loss from it - very small/small/medium/heavy/very heavy. Right now, bodypart gets more red, the more serious wound is. People are confused as to what it means - does it indicate severity of wound or blood loss from it? Make it more clear.

nicolasbadano commented 8 years ago

I pretty much agree with everything @BlackHawkPL said. I'm not sure how possible all of that is though.

One quick way of showing how much each bodypart is bleeding would be to add none, one, or two red droplets to the medical interaction icon in each limb.

Those icons could probably be used to communicate even more information too, like e.g. if a limb has a tourniquet or not.

I could help with coding those icons if we agree on what we want to do for the first prototype version.

VKing6 commented 8 years ago

Dressings and bandages ought to be separated (they kindof are already, but they're all named bandages, so this could possibly be fixed with some stringtable changes)

DocScarle commented 8 years ago

A Field Dressing is a bandage. Apart from that I have no idea what items you could be referring to.

VKing6 commented 8 years ago

Dressing is what you put on the wound, bandage is what you use to hold the dressing in place. Field dressings are usually a dressing attached to a bandage.

john681611 commented 8 years ago

Is it possible to add more than one knock-out animation state? Currently Its way to easy to identify the dead from knocked out. I'm aware rag-dolling a knocked out player isn't a option.

pool011 commented 8 years ago

Would it be posible for reopening wounds (advanced med) to have a higher chance of becoming partial wounds instead of fully opening (or at least make that an optional setting)?

The reduced bleeding would be due to blood clotting and partial opening of the bandage depending on the size, location, and time since bandaging.

WadeDP commented 8 years ago

Request for the Surgical Kit (taken from feature request tracker by Kowgan): Instead of using it on Torso to stitch all bandaged wounds; make it usable on each body part, and for each use, it will stitch the bandaged wounds in that body part only. This is more time consuming, requires more interactions (and more surgical kits, if they're set as disposable), and as such, feels more plausible while treating patients in the field.

thojkooi commented 8 years ago

Please try to stick to the items mentioned above. We will potentially work on other medical related things (including feature requests) outside of this task.

traumallama commented 8 years ago

Thought I'd chime in on the amount of pain issue. In most field of medicine we use a 1-10 pain scale, 1 being almost nothing and 10 being some variation on the worst pain you can imagine/have had happen to you. I feel like this might be a good thing to implement along with morphine, as it would make morphine able to be used as a precise tool. If patient has pain of 5 or greater, administer morphine (no more than 2 doses in 10minutes). So a soldier when injured could self check to see his own pain level, but a medic could not get the pain level by assessing, this reflects pain as a subjective complaint, rather than an objective one. Thoughts?

J-Ziegler commented 8 years ago

@traumallama I think medics should be able to see the pain level. Certainly while the patient is conscious anyhow. As a medic, I don't want to have to deal with waiting for a patient to open up their menu, navigate to the proper location, then get me a number. That turns a 2 second process into 20. Even while unconscious I'd argue the medic should be able to see it, as it's (one of) the primary things that knocks people unconscious (a fact I find frustrating in the extreme.) While it's not realistic to magically know if they are in pain, I believe it is better for the patient's game experience overall, and thus worth doing.

I'll toss in my 2 cents about some of the other stuff, too.

Combining Instant-Death and the Revive State: Honestly the revive state as it is now needs to go away. Cardiac arrest is a reasonable substitute. A combined option could be something to the effect of,

Death Prevention:
- All (Something like the Revive State)
- Instant (As current prevent instant death works, or maybe adjusted to a time frame or something?)
- None (You can die instantly)

As to people not understanding unconsciousness, I'm not sure there's a good way to help that except making the system less awkward with the revive state and what not. At least, not without worsening the system along the way.

For the medical menu, you could separate it from the interaction points and turn them both on by default. People are more likely to poke around to REMOVE something than to discover a novel feature.

john681611 commented 8 years ago

Is it possible to add more injury locations for advanced since the protection update. Id love to see more location specific injuries and effects. Breathing doesn't seem to be in the system considering its importance.

E.g. Hands effects actions and weapon handling, face affects vision, neck is always rapid bleeding and breathing issues.

thojkooi commented 8 years ago

Final items will be addressed in 3.7.0.

john681611 commented 8 years ago

Silly Idea but is there anyway that you could integrate a mini game into unconscious, it would give players something to do while they are down. Not thinking complex just a stupidly simple game.

Feel free to shoot it down

pool011 commented 8 years ago

@Glowbal I know you have probably heard this a lot, but what happened to airway management and sucking chest wounds? Am really looking forward to seeing those.

Artac commented 8 years ago

Revive state and cardiac arrest should be combined in the sense where the treatment for both states would be either a PAK or using CPR to restore them to the unconscious state with low vital signs where the Medic would start treatment. Unfortunately now, when a unit is in revive state, its pretty much just bandage(if you have that setting active) then PAK. If you combine the 2 states then it would give Rifleman and/or CLS a way to help the casualty until the Medic arrives with the ALS equipment to bring the casualty back into the fight.

crowmium commented 8 years ago

Since the medical system is being overhauled and modularized, I thought I would give some feedback about the system and try to provide some real-world resources and information that might help improve the system and add depth to gameplay for the average player in an rifleman/medic role.

Observations:

1. Compared with ACE1/ACE2, the unconscious state is used far less in ACE3. From reading dev comments here/looking at the code it seems there are two states for unconsciousness: a) a short knock-down simulating "getting the wind knocked out of you" and b) unconsciousness from hemorrhage.

2. Pain does not induce a significant penalty to combat. Pain doesn't seem to significantly decrease accuracy or stability of the weapon. The visual effects are a nuisance at best with the chromatic aberration slightly degrading combat performance at long range.

3. ACE3 wounds from any source are immediately fatal a very high percentage of the time. Generally 1 penetrating round to the torso will instantly kill a unit. A grenade will instantly kill a unit most of the time. Obviously 1 round to the head is the same thing. Sometimes even 2-3 rounds to the arms will cause instant death.

Thoughts:

I. From a gameplay perspective, all of these issues mean that medics have very little to do. They are rarely needed since players will usually wake up and heal themselves if they have their own medical supplies. If they don't, it is because they are dead. If players are bleeding out, it takes approximately 20-30 minutes for blood loss to cause unconsciousness and the player remains 90% combat effective even when not treated--meaning that injury has very little consequence to the player or his teammates. Even if the options are set so that only medics can treat players, a medic could simply not treat them at all as they can remain combat effective for a long time after being wounded.

II. There seems to be a stark line between healthy/combat effective and dead. A person who suffers ballistic trauma might also be: a. wounded, but due to the fight-or-flight response is unaware of the pain/injury and fights as normal b. wounded and conscious but fight at significantly reduced effectiveness c. wounded and conscious, but unable to fight d. incapacitated by a gunshot wound simply due to the extreme pain or psychological shock e. incapacitated due to blunt trauma or barotrauma, but not dead f. fatally wounded, but continue to fight for a time while blood/oxygen supply continues to reach the brain

Currently it seems the ACE model assumes that every head shot travels through the brain stem and every chest shot hits the heart. Of course people survive both head and chest gunshot wounds regularly, but there is no accounting for this currently in ACE.

III. In reality, gunshot wounds are rarely immediately fatal. Unless a round/fragment strikes the brain/upper nervous system it is unlikely that a person will suffer immediate paralysis and death (the "rag doll"). Even a shot to the heart will give a person approximately 10 seconds of useful consciousness with which to continue fighting. A shot to an major artery or the liver might offer 1-5 minutes. A shot to anywhere else is likely to give many minutes of useful consciousness.

A high percentage of people survive being shot for quite a while--even with military caliber combat rifles. A high percentage of people survive combat wounds in general. From the WDMET database it has been concluded that only approximately 1-in-3 soldiers shot by bullets are killed in action (KIA; this means the soldier did not receive medical care at an aid station before death). This falls to only 1-in-5 for an artillery shell and even further to 1-in-20 for a grenade. Of those that were not killed in action, only approximately 12% died after reaching medical treatment (mostly from infection or complications of shock).

IV. Any diameter of penetrating object is just as effective as one another if they penetrate a critical organ. Caliber has little real effect on a target once sufficient penetration has been achieved and that penetration occurs through the brain/heart/liver/major artery. The real benefits of larger cartridges come from increased ability to penetrate armor. Experts generally agree that the most important factor in mortality of gunshot wounds is penetration depth and shot placement. All other factors are generally secondary for small arms.

Proposed solutions:

1. Reduce the lethality of small arms in general. Instant death should be a rare occurrence. Even those who ultimately die from chest wounds can survive for up to a few minutes. To assist with this, better model exsanguination. This has the added benefit of increasing the depth of medic gameplay as players now have to actually triage patients, since a fatal wound that is not immediate has to be recognized to not waste valuable supplies and time with a patient beyond help.

2. Reduce the instantly fatal radius and damage caused by fragmentation grenades significantly. Make grenades are more likely to knock a unit unconscious than cause an immediately fatal injury. Units can be wounded and require medical care to survive--as always--but the instances of instant death should be much, much lower.

3. Model the effects of pain and shock on the capacity to continue fighting more accurately. Just like getting shot in the legs reduces the ability to walk/run, pain should reduce weapon stability and accuracy (increased sway and erratic weapon hold) particularly when the pain is due to a shot to the arm(s). Other possibilities are extreme pain could also force the unit to remain prone or cause the unit to go unconscious.

4. Increase the variability of wounds. One thing that almost all experts on gunshot wounds and warfighting agree on is it is almost impossible to predict how a target will react to any given gunshot wound that does not immediately induce paralysis and death.

While Arma can't model hitboxes of individual organs/arteries/etc, we can recreate this somewhat by introducing random damage and random wounding effects. Obviously a chest wound would still be more lethal than an extremity wound. But some random chance could come into both. (I saw this is is somewhat modeled looking through the files, but the lethality in general is too high and not variable enough across all body parts.)

5. Based on recommendation 1-4, it follows that there should be a large increase in the likelihood that units will survive wounds initially, but enter some variation of consciousness and ability to fight depending on hit location and random chance associated with that hitbox. Variations of injury could include:

a. Random pain: from zero pain to extreme pain for almost all regions. This would model both our fight or flight adrenal response and the pain reaction.

b. Random instantly lethal damage: the chance of instantly lethal shots to the face/head/neck/chest should be greatly randomized. However, any wound to those hitboxes would have some chance of being instantly lethal. This would exclude the abdomen, diaphragm, pelvis, or extremities from being instantly lethal as is the case in real life.

c. Random chance of an unsurvivable fatal wound: a percentage chance that a wound is initially survived, but cannot not be recovered from even with treatment. Treatment could potentially slow death/blood loss/unconsciousness, but the player would never recover. This would be independent of the pain and consciousness effects. You could receive a fatal wound and still be conscious or not depending on chance. This simulates something like a shot to the liver or femoral artery. Multiple wounds to key locations (chest, head, etc.) could increase the likelihood of the combined damage being unsurvivable.

As I said above, this element makes playing medic much more interesting (and as a player too). It would be important to give the player some warning before they die so they aren't suddenly just struck dead. A message informing the player of a tightness in the chest, feeling dizzy, rapid heart rate, rapid breathing rate, or other symptoms of hypovolemia could alert the player that they may look and feel okay, but everything is not as it seems. Tunnel vision, grayout, and/or other visual indication could also be used as the player begins to lose consciousness or succumb to their wounds.

d. Random consciousness: random chance (varied by location) of falling unconscious due to pain, shock, concussion, barotrauma, etc.

e. Random blood loss: did the bullet hit an artery or just graze the skin? Did it go into the chest cavity and hit a vital organ or just happen to miss and create a hole only? Random blood loss could simulate these various possibilities and give medics something they have to check carefully before assessing a patients triage status and care requirements.

f. Random non-lethal damage or damage that is survivable with treatment: This needs to be a lot more common. There should be varying levels of damage that is not definitely lethal. This could range from you will die in 5 minutes without treatment to you took a lucky grazing wound that won't ever kill you even if you don't bandage it. Some sort of indication should tell the player/medic approximately how bad the wound is in these scenarios. My idea is to use a graduated system of adjectives (ex. grazing, minor, major, life-threatening, and lethal) to give the player/medic an idea of how severe the wound is.

6. Arma 3's default modeling of ballistic armor is pretty accurate. Units take multiple rounds to their plate without suffering much injury to their health pool and then only are actually injured if they take that last round that penetrates the plate. The main difference between what I envision for ACE3 and vanilla is that the rounds that penetrate don't always immediately kill, but wound and create the effects listed above.

7. Modularize these concepts. Since the rest of ACE medical will soon be modular as well, these modules could be added and then those communities/players that think they aren't necessary can disable them as they see fit. Options such as "accurate wounding," "random wounds," "increased pain effects," and "accurate penetration" could be added to the medical module to add/remove those portions people like or dislike.

I know this has been quite long, but I'm hopeful that you will implement some or all of my suggestions as I think they add a lot of depth and potential for emergent gameplay situations as well as fun for the average rifleman and medic players. I would be happy to provide research or programming assistance if requested.

Resources: Champion, Howard, et al. "A Profile of Combat Injury." The Journal of Trauma Injury, Infection, and Critical Care, vol. 54, no. 5, 2003, pp. S13-S19. www.dtic.mil/get-tr-doc/pdf?AD=ADA480495.

Holcomb, John B, et al. "Understanding Combat Casualty Care Statistics." The Journal of Trauma Injury, Infection, and Critical Care, vol. 60, no. 2, 2006, pp. 397-401. www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA480496.

Tactical Combat Casualty Care. Center for Army Lessons Learned, 2012.

"Stopping Power." Wikipedia, https://en.wikipedia.org/wiki/Stopping_power. Accessed 31 Aug 2016.

"Arma 3 Damage Model & Hitboxes Explained Arma III." Youtube, uploaded by VissGames, 5 Jun 2016, https://www.youtube.com/watch?v=X7521ysymZY.

pool011 commented 7 years ago

Multiple wounds to key locations (chest, head, etc.) could increase the likelihood of the combined damage being unsurvivable.

:+1:

Armilio commented 7 years ago
  1. Arma 3's default modeling of ballistic armor is pretty accurate. Units take multiple rounds to their plate >without suffering much injury to their health pool and then only are actually injured if they take that last >round that penetrates the plate. The main difference between what I envision for ACE3 and vanilla is that >the rounds that penetrate don't always immediately kill, but wound and create the effects listed above.

Actually, it's not that accurate. IRL generally or a bullet can penetrate a plate or it don't. Of course if you hit several times the same spot of the plate, in that spot the plate is weakened and a bullet can pass trough when otherwise it couldn't, but it's a rare case. To be completely realistic calibers like the 5.56 should always penetrate the plate, at least under ~200 m, but as you wrote @Crowmium , that shouldn't mean instant death. And caliber like the 9mm should penetrate a (level III) plate only if they hit exactly the same hitpoint more times. Body armour are useful mainly against shrapnel.

Indeed, to be even more realistic, the 5.56 should have more penetrating power but less stopping power ("damage", in game terms) than the 7,62x51. Probably we can't ask that much to arma3 engine.

nomisum commented 7 years ago

Additions to crowmiums pamphlet:

I would love a state, in which you can barely move but are not unconscious (blind) and can get carried/dragged as well as talk. Just much more epic gameplay experience than to see the black screen and being completely cut off the action. Could be enhanced by some FX, so you hear voices muffled like underwater but still can talk (visually indicated by a little blur/vignette or sth).

More nuances in injuries regarding the movement would be great as well, so being able to crawl (not being able to stand up anymore) in a very slow-mo fashion if legs are broken, heavy sway for broken arms and so on. (I believe to remember this was modelled quite well in ACE2)

All of this would be welcomed additions to basic as well, not only AMS.

WadeDP commented 7 years ago

If consciousness had more advancements, it would be amazing.

If you got shot to unconsciousness, you're screen would go completely black with no noise. Over time you're person would start blinking in and out as well as noise coming back. This way its more cinematic when you go unconscious out of nowhere.

Different types on unconsciousness: If you're losing blood and about to go unconscious, you will slow down, your screen will start blinking, then you will pass out.

Jaaxxxxon commented 7 years ago

Some thoughts - this kinda turned into a feature request but it's relevant to the discussion

Blood, Plasma and Saline: To my knowledge, blood (and to a lesser extent plasma) shouldn't be left at room temperature for extended amounts of time. It would be nice to see at least blood restricted to medical facilities/vehicles, and in turn it should be more effective.

More interactive wounding: (+1 to nomisum) Smaller wounds to the head could cause temporary blindness, but you would still be conscious. You could probably get away with allowing ace interaction and radio use, as well as other actions on the basis of muscle memory. Mild arm wounds could cause sway, severe arm wounds cause your rifle to drop after a few seconds of being raised? Might be a bit too obnoxious, though.

Surgical Kit: Why is this consumable by default? I know you can change it and all, but it's essentially acting as a human sewing kit, which wouldn't disappear after being used. It seems more intuitive for it to weigh more (currently around 2 lbs, could double it) and for it to be non-consumable by default. The other options such as location restriction, proficiency and stable patient requirements are alright, but the weight currently puts the surgical kit in an awkward place where it's mostly inferior to a PAK.

Bodybags and corpse movement: I like the idea of body bags, but the intent seems to be mostly for the ability to transport corpses. The issue with this is that putting a character into a bodybag forces you to slowly walk them backwards, which isn't conducive for moving a casualty long distances. It would be nice, if the engine allows, to have the ability to fireman's carry corpses just like a wounded person but still require bodybags to load casualties into vehicles. This would open up more opportunities for personnel recovery or HVT missions.

commy2 commented 7 years ago

It would be nice, if the engine allows, to have the ability to fireman's carry corpses just like a wounded person but still require bodybags to load casualties into vehicles. This would open up more opportunities for personnel recovery or HVT missions.

doesn't work. ragdolls cannot be attached. and there is no ragdoll api. dead soldiers are always forced as ragdolls by the engine.

Jaaxxxxon commented 7 years ago

:< I thought that might be an issue, BI pls y u do dis

Tk3997 commented 7 years ago

Actually, it's not that accurate. IRL generally or a bullet can penetrate a plate or it don't.

Essentially every single thing you just typed after this is wrong.

Of course if you hit several times the same spot of the plate, in that spot the plate is weakened and a bullet can pass trough when otherwise it couldn't, but it's a rare case.

The testing standards call for shots as little as two inches apart, in any case this also depends on the armor. Current high hardness steel plates don't really give a crap abut multiple hits below the penetration threshold in a tight grouping. Ceramics are basically ablative in nature and will cease to function after a few hits, but a specific mutli-hit testing protocol hasn't been adopted yet.

To be completely realistic calibers like the 5.56 should always penetrate the plate, at least under ~200m

Please spend at least five minutes on google before saying stuff like this. 5.56mm FMJ should always bounce off a Level III plate at the muzzle. The NIJ test standard to be certified as level three is effectively 7.62x51mm M80 ball (147 grain steel jacketed, lead core bullet at basically 850 m/s) fired into the test plate at 15 meters and as close to square as possible.

However Level three is not tested to resist semi or fully armor piercing AR ammunition, although due to how common it is some plates are beefed up and tested against the steel tipped M855 5.56mm round by the manufacturer. This is not an offical NIJ standard though even though you will sometimes see such plates labelled "level III+" and such.

This is why current military issue plates are largely ceramics rated at Level IV which is armor piercing battle rifle ammunition at the same distances. The problem with ceramics is that their very high hardness lets them shatter even hard metal penatrators, but that hardness comes with brittleness and they crack themselves under impacts. The plates are tested to be multi-hit, but only a few after three or four it's normally less a plate and more like gravel held together by it's spall liner.

Still these will resist at least two or three hits from basically any small arms on the planet barring something like a .338 AP round out of a sniper rifle. So yes, the plate basically totally negating a few small arms hits but then no longer protecting the wear is actually a perfect model for a military small arms insert.

, but as you wrote @Crowmium , that shouldn't mean instant death. And caliber like the 9mm should penetrate a (level III) plate only if they hit exactly the same hitpoint more times. Body armour are useful mainly against shrapnel.

9mm wouldn't even reach the plate because it would never get through the IIIA vest over it. A 9mm to the plate area of a modern rig would be so pitiful it's doubtful the wearer would even know he'd been shot. 9mm wouldn't even get through a fabric vest marginally thicker then a T-shirt.

Please, do at least a TINY bit of research before spreading such blatant misinformation.

Indeed, to be even more realistic, the 5.56 should have more penetrating power but less stopping power ("damage", in game terms) than the 7,62x51. Probably we can't ask that much to arma3 engine.

The only way 5.56mm would have more penetration is if you're using SAP or AP ammo and the 7.6mm isn't, When it comes to punching holes in armor bigger is almost always better, assuming even marginally similiar velocity.

runy888 commented 7 years ago

I can agree to people asking for higher probability to fall in a long unconsciousness without being able to wake up by your own. This makes for some excellent gameplay and improves the experience for the medic, which makes it easier for units to fill these roles and more fun for individuals to play them.

As for some asking for a defibrillator, I just want to quickly clarify what this device does: It will NOT start up someone's heart that has stopped. On the contrary, using a defibrillator on a completely dead heart is absolutely not recommended. Instead what a defi does is it breaks through the uncontrolled twitching of heart muscles called cardiac fibrillation and creates a zero baseline, basically knocking the heart out of its panicking death struggle into a total relaxation state which makes it more receptive for CPR and more likely to acquire and continue the controlled rhythm applied by the chest compressions. This means that transferred to Ace 3 the defibrillator should only be used as an additional gimmick when performing CPR but in order to properly implement this you first would have to change the way CPR works from extending the time of unconsciousness (which is bullshit in my opinion, sorry to be so blunt) to actually being the thing you do when your patient has a cardiac arrest. So, in general the revive system, as many here have already realised, needs a rework towards more realism. Performing CPR asap is the key criteria to increase survivability after a cardiac arrest. Paired with an adequate application of epinephrine (I'd say no more than 3 units) and possibly a defibrillator you drastically increase the chance that your patient makes it. A replacement for the role that CPR currently fills could be for example mouth-to-mouth artificial respiration without chest compressions. Sorry to write such a long litany to this topic but as we have seen with atropine the correctness of the Ace 3 medical system is sometimes improvable so there you go. :P

In terms of drugs, I think that you should not support the emerging habit of Ace 3 "experienced" medics who always tell you to only give morphine together with epinephrine. Due to the completely different ways those two pharmaceuticals affect blood pressure you wouldn't use one only to counter the effect of the other. In cases where lowering the blood pressure is not wanted when easing someones pain, the use of ketamine is indicated. It is the only narcotic which also slightly increases heart rate and blood pressure, thereby both stablilizing a critical patient and analgizing them.

Also, I would love to see something like a monitor device in Ace 3. Personally I would prefer a pulse oximeter, showing heart rate and oxygen saturation on a corner of your screen as long as you are close to the patient. It is easy to apply and will always keep you updated about the basic vital functions of your patient while you work on other things like bandaging (which takes a great deal of time). No real medic would count the pulse every 2 minutes to see how his epinephrine is working.

Oh and one more thing:

Surgical Kit: Why is this consumable by default?

Because literally everything that a surgeon uses nowadays to treat wounds is either single use or has to be re-sterilized in a complicated process either with steam or radiation or another method. We're not in 18th century anymore :)

commy2 commented 7 years ago

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

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.