Goof/Kittens /tg/ Medical Design Document

	Iamgoofball has requested I write him a design document regarding proposed medical changes to the current /tg/ system. I have extensive experience with the medical system in-game, as well as being a real-ass paramedic. I'll try to organize this by focusing primarily on the issues with our current system, things to avoid when making changes so as to lay out the bounds of a potential rework, and finally some proposed changes. I have a lot of accessory ideas at the end that don't change the core of the medical system, but should add a lot of polish and engaging gameplay. Fun extras can be added on after a solid framework has been established, in my opinion.


Issues with the current system:

	- Medics are not needed, and aside from access, are mostly extraneous -
	This, in my opinion, is the primary issue plaguing our medical system. If nothing else was changed, this should be. Playing a medical role is frequently an unenjoyable experience because you really aren't needed. People will push past you as you open the doors (or they just break down the windows) to treat their friends on their own, or steal medical supplies to treat themselves. People will OFTEN push you out of the way to use the sleepers or cryo, and get violent if you try to take over to do your job. In the 'field' you are only valued because you're carrying supplies, and someone with a medkit is just as useful as you. In your department you're even less useful, as anyone can press buttons on a sleeper or stuff someone in cryo. This ties into my next issue as well...

	- The medical system is extremely easy and has no difficulty curve -
	While it's a good thing that medical is easy to pick up, it goes no farther than that. I can't stress enough that it's good that /basic/ care is easy to pick up. That being said - The only thing that an experienced medic has over one who just glanced over the wiki for 30 seconds is that the veteran will be able to multi-task better, which is more of a universal skill than any sort of skill with the medical system. This of course leads to people barging in and running medical themselves, since they're oftentimes just as likely to be able to treat someone as you. Additionally, this makes medical a role that becomes boring quickly, since there is very little to learn and very little to get good at. You can't really become more effective at providing care than when you first started, aside from some minor tricks like speedcloning.

	- Being injured has few consequences / healing is almost instantaneous -
	Our server is fast-paced, and a less-involved medical system than Baymed is to be expected and is more appropriate for the playstyle here. However, our current system is so brutally simple and effective that getting injured is hardly a blip on the radar. The only /real/ consequence for taking damage is that you might drop into crit/die and not be able to play anymore. The rest of it lacks any sort of consequence, which is even more apparent when it can be healed in seconds. You can have 1 health remaining after taking ten laser blasts to the face, walk around a corner, apply ointment and be at full health and ready to fight within 10 seconds. Dismemberment was probably one of the greatest steps forward in this area, as it made taking severe damage have significant lasting effects, as well as requiring somewhat-skilled intervention to rectify.



Things to avoid with a rework:

	- A medical system that is /too/ involved is not appropriate for /tg/ -
	I have played Baymed several times, and there are a lot of fun aspects of it. However, the complicated, lengthy and involved nature of it makes it somewhat unsuitable for the pace of our server. As a medic, you can easily spend your entire round in surgery treating patient after patient, even when there is minimal conflict. If you're involved in a lengthy fight, you can rack up such an impressive array of injuries that you're better of just dying and being cloned than spending the next hour in the Medbay being treated. We want to strike a balance between "painfully simple" and "You may as well count yourself out for the round if you get injured".

	- Too many symptoms -
	This ties into having too complicated of a medical system, but is worthy of it's own entry. Baymed has a massive amount of potential symptoms which help you diagnose an equally large list of potential medical problem. It's pretty cool, but is very difficult to wrap your head around at first. It means that A:) you basically have to have the wiki open in order to treat someone, and B:) if you don't know what a symptom is you're fucked and your patient is fucked. Sitting in medbay for 30 minutes because no one knows what the fuck is wrong with you is a shitty experience that should be reserved for real life. I think it's better practice to focus on more in-depth ways to treat symptoms than it is to add more symptoms, at least currently. My opinion on this may change as a rework develops. We certainly could use a few more symptoms than we currently have, but not so many that it becomes difficult to keep track of them all.

	- Impossible to heal yourself without a medic -
	As much as I hate being almost completely unneeded as a medic, being unable to help yourself at all when injured, much less being treated by a friend, would be very shitty. Being mortally wounded should require some seriously advanced intervention, but most other injuries should be at least sort of manageable in some form. A good theoretical example of this would be an injury that can easily be fixed with surgery/advanced care, but can also be staved-off/treated much slower by simpler means (e.g. a broken leg that can be treated with painkillers and a splint that has you hobble around for some time, or you could simply have surgery done).

	- Fix-alls (being readily available, at least) -
	Things like Tricordrazine/Omnizine are inherently bad for the medical system, in my opinion. Magic health potions are both boring to use and require nothing but clicking on the hurt person to make them not hurt anymore. If anything like this exists in the new medical system, they should be both difficult to create/come-by as well as be in incredibly short-supply, or have a significant caveat. This applies (although to a lesser extent) to things like cryo, where all of your problems can be solved by shoving someone in the closet and pressing a button. Epinephrine is a good example of a well-implemented version of a fix-all, as it has relatively no use outside of using it on someone in critical condition, and even then it will only stabilize them rather than heal them, generally.



Core Elements of a New Medical System:

	- Tiered Injuries (the worse you're injured, the worse the consequences) -
	Having your head smashed in with a toolbox until you're almost dead should have consequences that aren't reversed by applying a bruise pack targeting the head x5. Currently our injury progression goes something like this:
	Full health -> Bleeding (only for brute damage) -> Dismemberment (sometimes) -> Dead
	It usually only goes like this:
	Full health -> Dead
	There needs to be more consequences for getting grievously injured, and more consequences for leaving those injuries untreated.

	Some examples of potential results of serious injury:
	Brute Damage: Bleeding, Heavy bleeding, Broken bones (require splints or surgery), Dismemberment + heavy unstoppable bleeding
		Leaving those untreated can lead to massive bloodloss and death, broken bones can cause brute damage over time (maybe more damage when the affected limb is used).
	Burn Damage: 2nd degree burns and 3rd Degree burns (requiring surgery/advanced care, or causing you to become hypothermic like when cryostung), Dismemberment without bleeding but with advanced burns. [Need more consequences for burn damage. Maybe just 1st-3rd degree burns is enough?
	Toxin Damage: Vomiting, Loss of Consciousness, altered mental state (when the toxins get really severe, start throwing in mind-breaker-like effects and fucking with the person's HUD). Left untreated, these will only worsen.
	Oxyloss/Suffocation Damage: Oxygen deprivation is already pretty good, but severe oxygen loss for long periods of time should bring on mental deficits like retardation.

	- Stabilize -> Heal -
	The primary goal of the new medical system should be stabilizing your patient first, then providing definitive care. First Aid kits should not be fix-alls, they should actually be FIRST-Aid. A kit should be enough to patch someone up so that they don't die, not bring them to full health within 20 seconds.
	- Potential items in a First Aid kit:
				- Bruise Pack (Apply once to injured limb. Will heal CURRENT brute damage over time to a limit) Stack of 6
				- Ointment (Apply once to injured area. Will heal CURRENT burn damage over time to a limit) Stack of 6
				- Gauze (Stops light bleeding, staves off heavy bleeding) Stack of 6
				- Tourniquet/s (Stops light/heavy bleeding (from limb loss and severe injury) but causes brute if it's left on)
				- Splint/s (Apply to a broken limb. Will slowly repair/keep you from further injury, but causes a deficit in that limb)
				- Health Analyzer (Shows a concise rundown of patient injury)
				- Epinephrine Autoinjector (Just one for that big emergency when you absolutely have to save someone critical)
	This should be plenty to deal with minor injuries, heal up scrapes from a small fight, or stabilize someone who's been mortally wounded. This should NOT be something that every powergamer carries with them to heal themselves to full immediately so they can start wars whenever they want. It should be something that if everyone DID carry, it wouldn't throw off game balance immensely.

	In the medical bay, Nanomeds and advanced kits would carry more definitive/better treatments.
	- Potential items well-stocked in medbay
				- Trauma Kit (bruise pack on steroids. Will heal current brute damage over time to a limit FASTER)
				- Burn Kit (ointment on steroids. Will heal current brute damage over time to a limit FASTER)
				- Advanced Health Analyzer? (Shows a more descriptive and thorough rundown of injuries)
				- Basically better versions of healing items found on the station

	In the field, there should always be a way to treat all but the worst mortal wounds. Professional medical bay care should be the best, and a first-aid kit should be an acceptable alternative, but being able to at least SOMEWHAT treat wounds with shit you find around the station will be welcome.
	- Potential craftable treatments:
				- Improvised Splint (rods + cable)?
				- Improvised burn dressing (cloth/bedsheet/whatever + water)?
				- Standing next to a heater or dressing warmly when suffering from severe burns.
				- Improvised tourniquets

	- Sleepers and Cryo -
	Right now Sleepers and Cyro pretty much solve EVERYTHING. Cryo is actually in a decent spot as it's typically much slower than any other method. I still think it needs to be toned down a notch, really make it "cryostasis", a place you can put the most critical patients and treat them rather than the easiest fix for everything. It should still be the go-to for the beginning medic. It also should still heal cloneloss at a good rate, even if the healing for other damage types is low, since you're sort of forced to use cryo to heal clones, and making them take up a tube and sit in cryo for 20 minutes is not fun.

	Sleepers are too good right now, in my opinion. They fall under the "fix all" point I made earlier. Why use up supplies or bother to treat patients when you can just stuff them in a sleeper, hit the "fix" button and they're good to go? This is a tough one, as if you had to treat patients with only the supplies in medical you'd quickly run out. But maybe that's a good thing? Maybe it'd be better if medbay was tighter on supplies, and long rounds or numerous injuries would require coordination with cargo.
	In any case, sleepers should have a built in injury assessment. It should give you a rundown on all of the patients injuries. Potentially, they could have the capacity to just provide aid in the form of healing chems as they do now, but not be able to treat serious injuries, like broken bones and third degree burns. So that way you can save your healing supplies and use the sleepers to diagnose and treat minor injuries/the base damage, while you still have to use your medical skills to treat serious injuries.

	- Unique Medical Implements -
	Medics need some tools to help them do their job better than a random greyshirt barging into medical. Some unique tools that they spawn with that allow them to do their job better (or hinder those without them) would be welcome. Some ideas are:
		- Increased risk of infection without protective equipment: Not washing your hands, not having nitrile or latext gloves on, and/or not wearing a mask while providing care has a chance to cause an infection. This could be something as minor as causing small tox damage (to lightly discourage a random from providing care over a medic) or causing serious sepsis that manifests over time.
		- Real medical instruments that provide bonuses to healing: Things that on any non-medical role will just take up space and aren't worth carrying, but provide bonuses to medics who will value having them. Things like a Bag-Valve Mask (BVM) that when used on an unconscious patient, provides a MASSIVE oxyloss heal buff over regular CPR. I would say things like the medical jumpsuit/other medical accessories providing a minor bonus to healing, but that sort of screws over Plasamamen medics. [Maybe that'll encourage me to do job-specific Pmen jumpsuits, who knows]. I'll have to think on what other sorts of ways you could provide a bonus to actual medical roles doing the healing.
		- Diagnostic Mode (need a better name that's not already used) on medical huds. Something that you could switch to that would fuck up your regular view (so as not to have it on all the time), but would highlight injuries on a patient (maybe apply the health doll overlay to players in game) and would increase healing while it's toggled on. Again, just more ways to increase immersion and encourage medics to be the ones healing instead of randoms.

Other thoughts:

	- Blood and Transfusions -
	Currently, our blood system is a little bit askew when it comes to numbers. If you want more blood, draining a dead body/catatonic is far more preferable to having someone donate blood, which is a little silly. Simply donating a single bag of blood will put someone in a state where you would normally give someone blood. A simple fix for this would be to increase blood volume, increase blood loss, and increase the threshold as which you start having serious symptoms due to blood loss. This would allow people to donate a bag of blood without breaching that threshold, while it would still be able to assist people in coming OUT of that threshold after losing lots of blood due to injury.
	Additionally, blood could be made to be a more 'volatile' and precious substance, requiring refrigeration and being unable to be pulled from dead bodies after a certain time-frame. Give the players a very small initial supply of blood and replace the rest with Saline (not saline-glucose, that's what you give diabetics and it pisses me off that it's our blood replacement in this game). Saline could have a larger supply, not require refrigeration, not require blood-type matching, but not do as good of a job as blood. While our current system causes you oxy-loss and occasionally losing consciousness when you're low on blood, replacing with Saline would eliminate the unconscious periods while not healing the oxyloss, until your blood regenerates slowly over time. That way, proactive medics would want to organize blood drives or donate themselves to build up a supply of a better resource - which could also be sabotaged if the blood fridge is tampered with. This could also be a good alternative to the above paragraph, as donating blood could be offset by being replaced with Saline.

	- Dynamic Surgery -
	A passing thought I had was that surgery would be immensely more fun if it were a more engaging and varied activity. Currently surgery is just following a simple recipe. Anesthesia has no purpose and you do everything in the same order each time. Creating a more dynamic experience by having things come up during surgery would make it much more engaging. Examples of this could be arterial bleeding, or skin retraction, or the patient becoming unstable during an invasive procedure. This would both require someone to think on their feet, as well as giving you a benefit if you had someone to assist you! For example, you could be attempting to reset a broken leg. After using the drapes and cleaning the site (you don't want an infection, do you?), you make the first incision with a scalpel. You then use the retractors to pull back the tissue, and an arterial bleed springs up! Better use the hemostats to clamp it off! Then you go to incise the muscle, but you didn't use anesthesia, and the patient begins to have spasms due to the pain! Better deal with that. Then as you reset the bone, your view begins to become occluded by fatty tissue. Better use the retractors to clear your operating space again.
	In essence, while the main order of the surgery would be static, dynamic events could occur with varying difficulty and frequency that require you to think on your feet and be a strong multi-tasker. 'Simple' surgeries like pulling out embedded objects or performing a dental implant might have relatively few events, with low difficulty. Advanced surgeries like full-body augmentations, or embedding xenomorph organs could have a high frequency of potentially very difficult events, requiring a very skilled medic to perform, or a second set of hands to help manage. This could also potentially help deal with the power of things like Augments and elective surgeries like Cavity Implants, as they would not be easy surgeries to perform. "Required" surgeries such as limb reattachment/prosthesis attachment should always be relatively low difficulty, however, as you don't really have a choice in whether or not you need to get them, and even a new/newer medic should be able to fumble their way through them without murdering their patient.

	- Robotic Prosthesis -
	Straight from the HRP servers, forget a box of limbs or a limb-grower, this is way better. These are exactly what they sound like, a non-augmented robotic limb. Use them to replace missing limbs, and hell, even let people start with them. They provide no bonuses other than functioning as a replacement for a missing limb. Sure, you can repair them with a welding torch and wire, which is nice, but the moment they get damaged they start malfunctioning. Damaged robotic arm? There's a random chance it'll spark and you'll drop whatever you're holding. OFTEN. Damaged robotic leg? You may randomly collapse as it fails. It's a great way to impress "hey you lost a limb and that's bad news", as well a more thematic and realistic response to replacing a limb beyond "we sewed on a new arm and now everything works perfectly again.
	You could easily have this concept coexist with limb replacement as it currently exists as well, by making "real" limbs rarer/more difficult to create/find/attach. Additionally, augmented limbs from robotics would need to be more involved to make and attach, as people would simply go straight to robotics rather than putzing around at medical for a mediocre replacement.

	- Embedded objects -
	Right now they way they function in regards to treatment is absolutely stupid. Either you pull them out yourself which involves just clicking on the embedded item, or you require surgery for someone else to pull them out. What needs to change is a level of consistency between the two, with the benefit of ease/better results to the procedure that requires another person.
	My proposal is a two-tiered system for embedded objects. Superficially embedded objects will appear when the victim examines themself or when someone else examines them, which cause bleeding that can be held off by gauze but not stopped altogether, and can be removed as normal by the victim. Addtionally, another person can remove them much like the victim can, by examining them then clicking the embedded object while standing adjacent to them. Having someone else remove them results in less brute damage than removing them yourself. Then there will be Deep Embedded objects. The victim will be notified when they are impaled/struck/etc. and the object becomes deeply embedded. This would require something very serious, such as being within the blast radius of a bomb, or surviving a point-blank hit from shotgun flechettes. This would be extremely difficult/impossible for the victim to remove, and while the wound could be staved off and gauze can be applied to keep it from bleeding, it will never fully heal until the item is removed, which would require surgical intervention. Potentially, the victim could remove it themselves, however it would inflict massive brute and bleed damage, as they're basically fishing around inside their body for foreign objects.

	- Backup Generator -
	Every hospital in the history of ever has a backup generator in case things go to shit. In the medbay stockroom there should be a generator (Maybe one that can't be taken elsewhere, so it's purely to keep medbay running, not for universal use) so that if medbay loses power it can operate for a SHORT time on it's own. This is both realistic and very nice.

	- Wellness Checks -
	A fun mechanic for downtime at the medbay could be a "Wellness Check/Checkup". Alternate, more appropriate names might be a "Physical" Or "Full Physical Assessment". Basically, by doing a dynamic series of tasks on a patient once the assessment has begun (perhaps drawing blood, listening to their heart, testing reflexes, finger up the ass (jk), etc.) you'd verify the patient's overall health and give them a ~10? HP temporary boost to their max. To receive this boost, the patient must already be at full health. Their "official" max health would still be 200, but if you take damage it would take from the bonus HP pool first. After it's gone you can't go over 200 again without getting another wellness check. Obviously this would be something that would not stack, so you couldn't do consecutive wellness checks on a patient to get them to +500 health or something stupid like that. The idea is that it would give medics something to do during downtime and give enough of a bonus that people would come in and make use of it, but not so much that it would be abused (or really make THAT much of a difference).

	- Dragging Bodies -
	Right now dragging bodies is kind of stupid. For one, it's a foolproof way to butcher someone since you can sprint away at full speed from any chasers WHILE you're still stabbing/shooting/maiming the guy you're dragging. This seems very silly to me. I propose a slight reduction in speed while you're dragging someone (which makes sense) as well as increasing the injuries someone has IF they're laying down and already injured. That would encourage people to use roller beds/body bags rather than dragging the body around. Maybe if you used a roller bed, you could pull at full speed, too.
	If something like this was implemented, some sort of backpack-stowable hardlight rollerbed would be in order. Something you could have in your pack as a medic and use to manifest a holographic roller bed on the spot, so you don't have to take up a hand carrying one of the medbay ones around.
	Additionally, roller beds should have an IV pole on them (or at least be able to attach one to a roller bed)