Medical Focus Feature discussion

[thojkooi]

Tasks for focus feature medical:

• [x] Prevent instant death & Revive are confusing for players. Look into a single setting method instead
• [x] Unconsciousness
  • [x] It is hard to figure out when someone is stuck in revive or just regular unconscious
  • [x] Players find it confusing how to wake up an unconscious patient
  • [x] See about improving the unconsciousness effect for players
• [x] Improve triagecard (#1658)
• [x] Medical Menu does not seem to be widely known. Make it default? - 604ba50a4a6340c545bfcd12f960e8847a4cec49
• [x] Merge basic and advanced medical injury systems
• [x] Clarify the amount of pain as feedback to a medic (#2117)
• [x] bandaging takes to much effort since latest update (3.4.0), look into improved values or alternative method ?
• [x] tourniquets should have an effect on medication (medication localized to body parts?) (#2704 #3255)
• [x] add option to treat everyone as a medic in medical facility (#1259)
• [x] Go over all treatment actions and improve triage card reporting
• [x] Fix surviving exploding vehicles

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Please provide input on the above mentioned items.

[Arcanum417]

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.

[commy2]

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: https://github.com/acemod/ACE3/pull/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.

[BountyHuntA]

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

[Sporkfist]

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.

[Cuel]

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)

[alexcroox]

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!

[geroge-011]

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.

[GokouZWAR]

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!

[crowmium]

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.

[runy888]

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

[andrewgsauer]

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.

[kymckay]

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.

[nomisum]

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.

[andrewgsauer]

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.

[nomisum]

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 💃

[andrewgsauer]

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.

[andrewgsauer]

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.

[runy888]

I say keep atropine in with the correct effect of increasing heart rate in case a coder wants to do a poison gas module. Since there is no arrhythmic heart condition in ace, drop adenosine.

Am 16.05.2017 um 19:30 schrieb andrewgsauer notifications@github.com<mailto:notifications@github.com>:

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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[Will-Nichols]

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.

[ItaLiaNKiinG]

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.. 😁

[severgun]

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.

[Will-Nichols]

@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.

[Will-Nichols]

@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.

[jonpas]

All done, future discussion will happen in other issues and Slack.