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Important Planned Medical Changes
Forum » Community » General Discussion
Joined: 20th Jan 2013
Rank: Member
Likes 2462
5th Jul 2018

Some of you already know this, some of you don't; there's a big change coming in the future to our medical system. No, I'm not talking about the rewrite, I'm talking about loose bandages/reopening wounds.

What is loose bandages/reopening wounds, I figuratively hear you type?
Well, it's the chance of a bandage falling off (disappearing) during a range of time after being applied. This is to help simulate bandages coming loose under movement, the gravitational effect of the moon, but also more importantly from the game design point of view: being shot isn't something that should be shrug off.

Uh-oh. Didn't we try this before, and it went horribly wrong?
Yes, yes it did. Just over two years ago when we made the switch to ACE Advanced Medical, we had the reopening wounds enabled (despite forewarning). One very frustrating operation later, it was turned off and never touched again. Turns out bandages on the default values will reopen sometimes 100% of the time, whilst still in the process of bandaging someone - not really the most enjoyable experience.

However in the last 11 months I've been tinkering with advanced medical making it work for our play style. One that rewards team play, that attempts to make a good balanced approached to realism and game design. Doing so, I've learnt of a way to change those values with actually a decent amount of granularity.



Implementation Concerns
The intended outcome of these future changes (not yet up, this is a forewarning post!) is that you should feel the repercussions of being shot potentially up to 60 minutes later.

A system whereby in the heat of the engagement you have quick applicable solutions to temporarily solve a wound, or alternatively solutions that whilst are slower to apply have a long lasting effective application. Where their application seems logical and consistent with expected behaviour, and where the size of the wound has a clear effect.

It should not deteriorate the effectiveness of existing treatments in a significant manner  (i.e. tourniquets), or significantly alter the way in which a medical situation unfolds to the point that it's very alien, unintuitive and by that nature obstructive.

The bandage values need to be tolerable enough so that a person completely new to the system wouldn't be at a deaths disadvantage if they were to use just anything, but also consequential enough that informed choices are both rewarding in terms of treatment and logistics. Plus some smug factor.

If possible, it should bolster the engagement of the medic with wounds, as so first response isn't a complete replacement for the medic when being shot. That the solutions the medic has are costly in time, as to not be beneficial to be used whilst being shot at, but also efficient enough as to not simply choose to CASEVAC to PAK. That when he checks up on people later, they could state "Yes, I've been shot earlier and bandaged it" and for that to warrant reason to investigate.

To increase usage of medical supply so that we may actually ask for resupply on it at some point alongside ammunition, but not significantly whereby it becomes a constraint on our movement, a marked increase on our fatality statistics, or a big hamper on our enjoyment. This may result in us starting with a bit more to begin with, and for the section resupply crates being bolstered.



Show me the numbers, Bosenator!
Please note that as of this time, all of these values are strictly for large wounds only and are subject to change. I am still trying to theory-craft these out, and of course once deployed will be changed accordingly to game play feedback.

I will try my best to keep this updated with the most recent dev numbers, as well as notify as to what values are deployed to the repo. I'll also work out a way to make a simple effectiveness chart incorporating bandage loosen chances.


Okay, first up is reopening chances per wound type per bandage. This is the chance per bandage application that it may come loose. ACE Medical calculates whether or not it will come loose at application time. The only factor in determining it coming loose is a random dice roll. I am not able to alter this to incorporate other factors, as much as I'd like to.

ACE 3 Vanilla Stats:


TWC Modified Stats:


Below are graphs depicting the window in which if a bandage is to come loose, does so. Aka a min time, and max time - where any time between the two it may come off:

Currently ours do not take the wound type into account for duration. It will do for size, again uni-formally. I am willing to change my mind on this, if a good reason is put forth.

ACE 3 Vanilla Stats:

QuikClot & PackingBandage:


FieldDressing:


ElasticBandage:


TWC Modified Stats:


Time to do ones duty

[html]<table><tbody><tr><th>Item</th><th>Previous Time</th><th>New Time</th></tr><tr><td>Tourniquet</td><td>2s</td><td>2s</td></tr><tr><td>QuikClot</td><td>5s</td><td>4s</td></tr><tr><td>PackingBandage</td><td>6s</td><td>6s</td></tr><tr><td>FieldDressing</td><td>6s</td><td>9s</td></tr><tr><td>ElasticBandage</td><td>12s</td><td>15s</td></tr><tr><td>SutureKit (formally Surgical)</td><td>5s per wound</td><td>20s per wound</td></tr></tbody></table>[/html]

SutureKit
As you may have noticed there, I'll be introducing a SutureKit. This is for medical professionals only, and will be used to suture up wounds. They will not reopen. This can be done in the field. The person does not need to be bandaged. So if for example someone got a stray bit of shrapnel, you could just straight up spend the 20s to suture the wound. As opposed to bandaging, then taking it off to suture the wound immediately.

It's 20 seconds per wound on the selected limb. It will have an X amount of limited uses (currently thinking around 20). There will be some resupply afforded, but not a significant amount.

In base ACE 3 Medical this is known as the surgical kit.

I will be following this post up over the next few weeks with further information before releasing. I will also be pushing the update out on a Sunday, to give us a full weeks play test on public before potentially ruining an operation. Once the dust has settled on this, and it's fairly well, then it'll be splints for me...


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 4th Oct 2013
Rank: Member
Likes 1210
5th Jul 2018

Just a really quick note on top of Bose's post, it is hugely important that we get accurate and timely feedback on the system back to Bose in so he may tweak anything that may become a bit finicky. With your guys help we should be able to make a much more accurate medical system than most groups out there.

Bose has put lots of time into our medical system, from doing real life research and putting hours into tweaking the system to be perfect for us, please respect this and always be constructive and not destructive.

These changes are really cool and allows for a more diverse medic role and much more in depth care, hopefully you will all see this in the coming weeks.


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"Faithful in Adversity"

Joined: 22nd Jul 2015
Rank: Inactive Member
Likes 173
5th Jul 2018

As for training and the Medical Technician Qualification, I personally do believe that all medical trained people should be required to take the qualification once more, as it's (In my opinion) a significant change. That being said, I believe some basic things regarding the new medical system as at the moment i personally do see a lot of people just smack random bandages on their limbs when bleeding, if treating them at all and not just calling the medic instantly like its an emergency.

But like Lukey said, just throw feedback Bose's way whenever you got something constructive. And speaking of suture kits, i think a 25 use per kit sounds reasonable.


"The unnamed feeling...
IT TAKES ME AWAY!!!"

Joined: 20th Jan 2013
Rank: Member
Likes 2462
5th Jul 2018

As for the retraining, we'll cross that bridge when we come to it. Currently though, I'm leaning towards it not being necessary as the CMT exclusive knowledge on top of it is very limited. It's very in the air at the moment. I'll discuss with Grusey closer to the time, as he's the primary medical trainer.

If we do a revoke, everyone will be promptly notified and there will be a few catch-up sessions that focus solely on the bandages in order to keep the qualification. As done previously with Force Type Familiarisation. Those that miss this window will be required to take the full course.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 15th Sep 2012
Rank: Member
Likes 127
6th Jul 2018

I'm glad you're going to trial it on Public before moving it to operations. Is it maybe an idea if possible/feasable to add a couple of extra medic slots on public so more of us have a chance to give it a go before going live on ops?
Joined: 26th Jul 2016
Rank: Member
Likes 1204
6th Jul 2018

Do I hear mert team? We'll give it a go
Joined: 31st May 2013
Rank: Inactive Member
Likes 1481
6th Jul 2018

A question on the bandage application percentages, are these influenced by medical training i.e if a medic applies a bandage, they are less likely to come off etc.

I know from personal experience that the First field dressing (an elastic type banadage) is very tight and secure like a torniquet if applied correctly. If it is done sloppily it will fall off, therefore if a medic does it, they will probably do a better job of it.

This is a fantastic update though so thank you Bose!


Arma Pacis Fulcra - Armed Strength for Peace

Last Edit: 6th Jul 2018 by Chaza
Joined: 20th Jan 2013
Rank: Member
Likes 2462
6th Jul 2018

QuoteACE Medical calculates whether or not it will come loose at application time. The only factor in determining it coming loose is a random dice roll. I am not able to alter this to incorporate other factors, as much as I'd like to.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 20th Jan 2013
Rank: Member
Likes 2462
11th Jul 2018

Just a little more clarification on suture kits, as I was asked about this: a suture kit currently consists of 20 threads (will be adjusted on feedback if needed). A thread is consumed per suture. You can tell how many remain by inspecting the item in your inventory, says something like "Suture Kit (3 Threads)".

You do the action through the medical menu, as this is limited to medics. This is accessed under advanced. When you select the action, it will calculate the time to fully suture them up (doesn't account for if you can fully suture them). Every 20 seconds, a wound will be sutured. There will be sound feedback for this. At any time the action may be cancelled. It may also automatically be cancelled because you have run out of threads.

Currently, there is no way to select which wounds are sutured. I don't see that happening in the future either. However, I'm currently investigating a way to prioritise larger wounds over smaller ones. If I can do that, then I will change it from a continuous action to only doing one suture at a time, to give the medic more control over it.

Current plan is to release this update on the 22nd of this month. Was aiming for this Sunday, but I can use the extra time to bolster the functionality for the initial release.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 31st May 2013
Rank: Inactive Member
Likes 1481
11th Jul 2018

Could we vary the amount of suture/sutre-ability (what a mouthful) i.e

a large laceration uses 3 "pieces" of suture, whilst a small laceration only uses 1. As it is just a spindle of thread as opposed to individual strings, that would make more sense.

Furthermore, should all of the wounds be "suture-able". IRL from our battlefield casualty drills, if somone has an internal bleed (i.e bruise/crush wound), it is incedibly serious and the only fix is to CASEVAC them as it requires full blown surgery. By making these types of wound 'un-fixable' by suture, we would maintain that logistical challenge of medevac.


Arma Pacis Fulcra - Armed Strength for Peace

Last Edit: 11th Jul 2018 by Chaza
Joined: 20th Jan 2013
Rank: Member
Likes 2462
11th Jul 2018

The idea of the limited supply is that the medic will have to make a logistical choice on whether or not to suture an individuals wound(s). Same applies for IVs. If a medic is wasting his sutures on non-serious injury or an individual that's in a dire situation, then he should face the consequence for that.

It's easy for us to balance the resupply out if we equate a single use to a single wound, as opposed to potentially dealing with fractional remainder kits. It's something we can visit in the future, but it's a lot easier to implement the system where 1 use = 1 suture to begin with.

As far as internal bleeding, we don't face those kinds of wounds. I'm not really in the favour of making wounds unsuturable that should be. Contusions aren't suturable, but they're not a blood loss wound either.

Building off the logistics point, if he thinks some-one is in a serious state, he shouldn't expend his sutures on him, and should be calling for a CASEVAC, or he faces having to call a lot more CASEVACs later for lesser patients when he doesn't have the supply.

Don't forget, this system will create a great deal more impetus on logistics over-all. I want to encourage smart decision making from first responders and medics, that makes their actions more involved than simply dealing with a patient in the moment and then forgetting about it. I want there to be more long lasting thought over a medical situation, be that about supply implications or keeping an eye on an individual, to hopefully make them feel more involved.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 20th Jan 2013
Rank: Member
Likes 2462
13th Jul 2018

The Suture Kit will now be a per body part selection, similiar to a bandage, and will only execute once at a time to give the Medic more control over his actions. I currently don't support selecting the particular wound, and don't have plans to do so.

The Suture Kit will attempt to find the most severe wound to suture first on the selected body part. It'll always take open wounds as precedence over bandaged ones. That means a small open wound will be sutured before a large bandaged wound. It chooses the wound based upon either current or potential blood loss flow rate.

I have also changed the time it takes to conclude. It takes 25 seconds per open wound, and 20 seconds per bandaged wound. This is to help simulate the need of cleaning the wound site, but also a little bit of game balance. These numbers are vary likely to change during and after testing.

Additionally the Suture Kit system does not take advantage of the shared equipment system. This means for example if you're the medic, you need to take the suture kit off of the person yourself before treating them. Otherwise you will be unable to do so. This hassle is an intentional choice by me.

This feature is only accessible via the medical menu, as are most new medic-only features.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 31st May 2013
Rank: Inactive Member
Likes 1481
13th Jul 2018

"Additionally the Suture Kit system does not take advantage of the shared equipment system. This means for example if you're the medic, you need to take the suture kit off of the person yourself before treating them. Otherwise you will be unable to do so. This hassle is an intentional choice by me."

So are you saying that each person will carry a suture kit?


Arma Pacis Fulcra - Armed Strength for Peace

Joined: 20th Jan 2013
Rank: Member
Likes 2462
13th Jul 2018

No, only the medic, but in the off chance the platoon sergeant went down whilst carrying one to resupply him, the medic will need to pick it up himself prior.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 20th Jan 2013
Rank: Member
Likes 2462
19th Jul 2018

As part of this, epinephrine will linger in your system longer and it'll take less morphine to overdose on.

Also, what's this? What's this? There's icons everywhere... What's this? I can't believe my eyes...




"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 20th Jan 2013
Rank: Member
Likes 2462
22nd Jul 2018

Welp. This is going to have to be delayed whilst I set up my laptop with ArmA.

Graphics Card: "I don't feel so good, Mr. Bosenator..."


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 20th Jan 2013
Rank: Member
Likes 2462
20th Aug 2018

Graphics card replacement be damned, this is rolling out on Sunday (the 26th).

Roll-out will come with a temporarily slowed bleed-out rate for the first few weeks to give a fair chance for people to become accustomed to changes on the operations/training server and for it to not be a significant hindrance to the operations themselves. The public server will not be affected, as you can respawn. After which, it'll incrementally increase back to standard so it doesn't hit like a tonne of bricks.

I will be significantly changing the way in which blood levels are evaluated this week, so please keep your eyes peeled for that update. It will be a far more involved thinking process, with the medic having a far better advantage at reading the situation. Communication between patient and first responder/medic will be important, too.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 15th Sep 2012
Rank: Member
Likes 127
20th Aug 2018

Sorry another question! Does the amount a person moves(or stays still for that matter) have any bearing on the likelihood of a bandage falling off?
Joined: 20th Jan 2013
Rank: Member
Likes 2462
20th Aug 2018

Sadly not.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

Joined: 20th Jan 2013
Rank: Member
Likes 2462
23rd Aug 2018

The blood level testing won't be coming as part of the initial release. I want to focus this entirely on the bandages/suture/tourniquet indicators at first, and spend the week tweaking that, before introducing more custom features on top.

I do have some wild future plans in addition to this, as each line I tweak the more I understand about their technical implementation, and thus the more I can mould it for us.

Sadly, there's two side effects to this. The menu pop up when you ace interact (not the medical menu itself), that fades in on the left side by default will be disabled. Eventually I would like to re-enable this, but it's feature inconsistent at the moment with the menu, and thus I can't allow it. Secondly, the text on the medical menu indicating if some one has "lost a lot of blood" isn't there. This was removed first thing for the new system, and I won't be readding it to remove it again. You can still currently get a good read on someone's blood level by their pressure, heart rate, talking to them and best guess. Not a bad habit to get into.


"Jokes on them, I was only pretending to be retarded."



"With the first link, the chain is forged. The first speech censured... the first thought forbidden... the first freedom denied – chains us all irrevocably."

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