New Column

[ShannonA]

The first article in this new column has now been posted:
http://www.rpg.net/columns/medical/medical1.phtml

It's A Very Traumatic Experience.

[red_bee]

Excellent column - a lot of what has appeared in this column (and future instalments, from the sound of it) will wind up in my Hunter game ;)

I do tend to use larger effects for bleeding, but just in that the character starts losing health levels due to blood loss if the wound isn't treated. I hadn't really thought about how messy everything can get, though, and perhaps reflecting that in dexterity rolls (to see if you slip and fall in your own blood, drop stuff that you are carrying, stuff like that). hmm................ :D

[smascrns]

Yes, excellent column. Here are some things I would like to see in the near future, things that come in continuation to the first column:

More on shot damage; something on impact damage other than bruising.

More on the agents of damage. Yes, weapons and other.

Even if I'm sympatetic with the concept of more realistic damage I always have problems on how that can translate into game mechanics. It's like in movies: You see that very well done mayhem that takes 5 minutes of the story, you don't see the hundreds of hours of hard work behind it. The problem with rpgs is that the moment they want to have those realistic five minutes, one has also to have all the tedious backstage work.
Maybe literature can provide the answer. I was just reading Conan's "Xuthal of the Dusk" short story. Let me recall that the climax is the fight between Conan and the Xuthal creature, maybe on of the hardest fights described in the Conan stories. In the course of the fight we know that Conan is being severely beaten but we are not presented the consequences of those hits. It's only after the fight ends that we are described the wounds he suffered.

Maybe rpgs should work like this. In the course of the fight we know that the character is suffering damage, and we have an idea of how serious that damage is, but we don't have the details of that damage. After the combat ends the characters/players are able to access exactly what happened to the character. They are also able to see what will happen afterwards if the character is not properly treated.

[fmitchell]

Let me also thank you, Aesclupius, for bringing your expertise to the gaming world. This first installment was very instructive.

I'd like to second the request for more information on bullet wounds. I'm about to run a homebrew game in which the PCs are undead, and I'd like to get a better idea of how much of a bullet wound is mauled tissue (the "internal explosion" you alluded to) and how much is bleeding, hydrostatic shock, etc. In movies I've seen vampires, mummies, and zombies at most stop briefly when shot, but simple physics would tell you a sudden high-velocity impact to the torso would tend to knock a biped down. If an undead creature's organs are useless or missing, there's still potential for snapping the spine or disarticulating a joint.

Even for non-supernatural historical or modern games, more information on the real effects of bullet wounds would help us tinkerers tune damage systems to more accurately reflect reality.

Again, thanks, and I look forward to your next column.

[Asklepios]

Thanks for all the kind words, everybody.

As I was saying to Shannon, I am fairly new to the writing game. If any professional writers are out there (and I know that rpg.net is positively brimming with them) I'd greatly appreciate constructive feedback on how to improve my writing style.

Regarding future columns...

A Very Traumatic Experience (pt 2) was completed about three weeks ago - you may find that covers a lot of what you're looking for. Unfortunately my expertise on bullet wounds pretty much ends with what I've written in this article.

I'm a General Practitioner rather than a Trauma Surgeon. My experience in A+E and in emergency surgery has extended to knives and blunt injuries, but not to actual gunshots. Gunshot injuries are very rare in the UK.

However, I would like to point you in the direction of the following links which I found while researching the article. These were interesting and informative with regards to bullet wounds, but I couldn't work the information in without making the article overly unwieldy.

The Surgeon's Viewpoint: http://www.surgical-tutor.org.uk/default-home.htm?core/trauma/gunshot.htm~right
Ballistics: http://home.snafu.de/l.moeller/Zielwirkung/Frog.html

[coeli]

I'd find some coverage on the effects of shock interesting. I've experienced it a couple of times myself, from injuries that were not, in the long term, really drastic. The dizziness, queasiness, coldness, and detachment made me calm, but not good for much of anything (like planning how to get to the hospital.)

[Asklepios]

I'd find some coverage on the effects of shock interesting. I've experienced it a couple of times myself, from injuries that were not, in the long term, really drastic. The dizziness, queasiness, coldness, and detachment made me calm, but not good for much of anything (like planning how to get to the hospital.)

"Shock" is "profound haemodynamic and metabolic disturbance characterised by failure of the circulatory system to maintain adequate perfusion to vital organs".
This can be caused by blood loss, anaphylaxis, sudden heart failure, toxins, infection and many other causes.

Its not a small topic unfortunately - I might try to cover it in a future article.

[The Butcher]

First of all, as a fellow physician (PGY-3 Surgery resident) and roleplayer I'm particularly glad to read your column. In the past, as a GM, I've inflicted pelvic fractures, compartment syndromes, burn scar contractures, sucking chest wounds and other forms of traumatic nastiness (can we say "impalement") on my players, all too often drawing from RL experience.

If I may be so bold as to suggest a future topic, I'd say a column on "insanity" (i.e. mental ilness) is an absolute must. Madness is an important component in a variety of role-playing games and frequently suffers from stereotypes and mischaracterization.

Kudos for the great column, and looking forward to seeing more.

[ShannonA]

He's already written the articles on mental illness, and you'll see them starting with #3;).

[Asklepios]

As Shannon says, mental illness is covered in articles 3 and 4, though 5 also has a psychology based theme. I'll happily take requests for articles, though I've written a lot already so they may not be seen for some time.

Actually I'm pretty happy with Column 1 of the series already - the more I re-read it, the more it seems to be scattered with grammatical errors and poor writing.

*sigh*

But never mind... It will get better.

Cheers for reading and posting, y'all. It always makes an amateur writer feel good to know someone out there is reading his work rather than it just being self-indulgence.

[Dagmer]

[QUOTE=fmitchell;6075326]In movies I've seen vampires, mummies, and zombies at most stop briefly when shot, but simple physics would tell you a sudden high-velocity impact to the torso would tend to knock a biped down. If an undead creature's organs are useless or missing, there's still potential for snapping the spine or disarticulating a joint.[QUOTE]

It was mentioned earlier that gunshot wounds are fairly rare over here in the UK, though the effects are rarely like those you have seen in movies or on T.V. There is a lot of different things that could happen to a person when they are hit by a bullet, two important factors are the actual gun used as well as the ammunition.

A shotgun for example is a very nasty weapon, in most game systems it is given a large damage quota, tough in reality it is probably not true. Within ten yards, a 12-bore shotgun round is going to devastate whatever is shot at. A pheasant for example would look something like a raw chicken that had a firework detonated inside it. Good for nothing but soup. If that was transfered to a human, a shoulder shot, a chest shot, even something around the thigh. That join would be connected by nothing but flesh and tattered tendons. I couldn't see anyone surviving such a wound.

Something else considering is the scatter created by the round itself, shotgun cartriges house dozens and dozens of small metal balls. These slowly spread out as the range is increased, so at 10 yards, the area hit by the 70+ ball bearings is fairly small and the damage is greatly increased, whereas at 25+ yards, the scatter is larger than that of a dustbin lid, the damage is then spread out over a large distance.

At 40 yards (maximum range) it may kill you, though less than ten of these balls will hit you, even then one would have to be very unlucky for it to penetrate the eye or the heart (though at that range, it probably couldn't penetrate clothing, muscle, and flesh to reach the heart, (not that i'd test my theory). Anything beyond that is going to do little more than superficial wounds, penetrating the skin maybe.

Pistols.

I've never seen nor used a pistol before, they are illigal here in merry old England. Though your average 9mm, though compact and used by law enforcement agencies around the world, isn't the most powerful pistol you will encounter. Most games will use these as the most common firearms readily available.

A shot from one to the chest will almost certainly knock you over, though not due to the energy, that is spent when the bullet breaks up inside the body and as our resident doc told us, causes nerve damage and tears up your nibbly bits. You will however fall to the floor either dead, or because you have simply just been shot and to be honest, most people would hunch over in pain. Even a gut punch will knock most people down, not because of the energy, that is expelled into the stomach, it's a natural reaction to the attack.

This is more Nige's field than mine, but the wounds from bullet injuries are different to those most people would expect to encounter. The entrance wound is rarely any bigger than the 'round' that made its way through the hole. Blood just makes it look worse. Though where the gnarled piece of lead leaves the body, a larger hole will remain. This is more evedent in rifle rounds where there is enough energy for the round to enter the body, cause mayhem, and still escape through the back. We've all heard of bullets that pass through engine blocks.

Back to shotgun wounds, I don't think those would bleed as much, i've seen critters that have been killed by shotguns before, rarely is there any blood around the wounds, a little maybe around head/chest wounds though it is usually around the break/mouth that the red stuff comes out.#

Anyway, nice thread!

[Ulmus]

Excellent column!

Some comments from a fellow roleplaying physician, particularily towards the knockback-effect. As Dagmer pointed out, someone being shot in the chest will most probably fall down, not be pushed back. This is because of the difference between kinetic energy and momentum. A bullet is relatively small and is travelling with very high velocity, giving it a high kinetic energy, translating in lots of tissue damage. As momentum is more mass-dependent and less velocity-dependent than kinetic energy, the bullet has relatively little momentum however and its the momentum that would knock you over.

A comment about piercing injuries (knives, spears, arrows, etc) is that they usually bleed comparatively little externally compared to the amount of internal havoc they can cause in terms of organ damage and internal bleeding.

When it comes to the roleplaying adaptability I can see two approaces. Either you use the medical background when designing a system, trying to take into account different kinds of trauma, shock, bleeding, etc (Millennium's End comes to mind). Or, and this is probably more useful to most GMs, you use it to color your wound description. That critical hit just gave the poor guy a pelvic fracture or the reason he will be dead within 8 rounds is because he's got a tension pneumothorax and ventilating it is the effect of a successful First Aid check. You still have to have some level of support in the system, a guy with a pelvic fracture should have some kind of impaired movement score. This of course limits the adaptability of a certain well-known d20-base system to medical realism. Hit points and trauma surgery don't mix well!

[Asklepios]

Yay! More rping doctors on rpg.net! I think that makes you, me, Holy Bear and I'm sure there are one or two others.

[Cigarman]

Any plans to detail out the effects of car crashes? How about when someone gets hit by a car? I'd like to see the effects detailed out for speed increments of 10 mph.

Thanks,
Cigarman

[Asklepios]

Hrmmmm.... I'll add it to the list of article ideas. That one may need some research though.

[Phaedrus90]

Aesclupius,

Well done with the column so far.
I'm completing training in anaesthetics and intensive care and am happy to act as a
resource. If I could find the time to do some FTF gaming, I'd be a very happy man.

Cigarman wrote:

> How about when someone gets hit by a car? I'd like to see the effects detailed out
> for speed increments of 10 mph.

Lots of variables here.
Someone hit by a car has about a 50% chance of dying with a collision speed
of 40km/h (~25 mph). This curve is sigmoid (low and flat at the beginning, steep
take-off in the middle, flattening out thereafter).

Being hit by a 4-wheel drive or SUV is worse than being hit by an ordinary car as
head and chest injuries are more common. With ordinary cars, leg and pelvic
injuries are more common; head injuries occur with increasing speed (person thrown up into car windscreen).

If the victim doesn't bleed to death at the scene, then the severity of head injury
tends to be the main determinant of survival, as with any other trauma.

Ulmus wrote:
>As Dagmer pointed out, someone being shot in the chest will most probably fall
>down, not be pushed back.

The momentum imparted by most bullets is very small.
Someone would only fall down if they lost their footing or thought they had to
(OMG, I'm hit!). Hollywood has a lot to answer for.

There are plenty of reports from police shootouts and combat situations where
people have sustained multiple gunshot wounds with no knockdown or
acute functional impairment, in the absence of drug intoxication. These wounds
eventually cause problems from blood loss, but judging by the reports in
publications like the 'Journal of Trauma' are often survivable.

[Lord Minx]

While no doctor (Thank god... *shudders*), I'm (currently) working as a paramedic and I really like your column so far, Aesclupius.

[slightly OT]
Something that comes to my mind whenever I read/think about realistic damage is how unrealistic the often-found "instant-kill" really is. From what I've seen/read/learned so far, humans are surprisingly hard to kill. No, scratch that, they are extremly easy to kill but they generally take their time doing so. It's pretty easy to damage the human body in such a way that it will almost certainly die (At least without medical intervention.) but pretty specific (and/or massive) damage is necessary to kill a human instantly.
IMO something game designer overlook too often.
[/slightly OT]

M

[Asklepios]

Well I defer to you and Phaedrus on issues of real life trauma. As a GP my knowledge is by definition generalised and shallow. My sum total of real life ATLS comes down to a six month placement in A&E...

I agree that in my (limited) experience people take a long time to die. I have a strong recollection of an eighty year old woman falling down the stairs and sustaining multiple fractures, then lying on the cold ground for 12 hours before she was found. In hospital she lived another 24 hrs post arrival, and it was only rhabdomyolysis on rewarming that finally knocked her off.

I clearly remember the conversation between me (noob A+E SHO at the time) and a senior surgical registrar about 4 hours into her A+E care:

Me: I've got warmed fluids running in and the air blanket on, and her temp is coming up nice and slow. Her GCS is up to 7 now.
Surgeon: Why?
Me: Um... sorry, why what?
Surgeon: Why rewarm her? You're not doing her any favours. She has multiple fractures, her base excess is in the double negatives, and her kidney and liver are both close to total failure. If you warm her up, she'll wake up, but only in time to die in discomfort. On the other hand, if you don't rewarm her she'll die a little sooner, and a little more unaware. She's dead already.
Me: But ATLS says you're not dead till you're warm and dead. And ICU may be able to...
Surgeon: Well, its your patient, and you live and learn. Trust me, you're wasting your own energy and not doing her any kindness.

And hey, he was disgustingly right, and I learnt a lot about recognising dying people and not "four-plussing" every trauma case just for the hell of it.

People die slowly.

By strange coincidence Article 5 in my colum series is about dying slowly. :)

[Lord Minx]

And hey, he was disgustingly right, and I learnt a lot about recognising dying people and not "four-plussing" every trauma case just for the hell of it.Ugh, fuck. That's exactly why I wouldn't want to be a doctor. We (Zivildiener acting as Paramedics, that is.) are mostly taxi drivers with more training and we try to keep people alive until we get them to an actual doctor. (Or the doctor comes to them.) I wouldn't want to have a doctors responsability.

By strange coincidence Article 5 in my colum series is about dying slowly. :)Ah, looking forward to it, then. :D

M

[smascrns]

I agree that in my (limited) experience people take a long time to die.
I have zero experience in this field but I've read plenty of descriptions of combat in Medieval and Renaissance chronicles and they confirm this. Most often people wounded and the one-stroke-killing is very rare.

Furthermore, people often remain active after being wounded, sometimes even after being mortaly wounded. They keep fighting for some time before they go down.

Which leads me to another issue I would like to see discussed: Incapacitating vs. non-incapacitating wounds. I hope you have this in your log.

[Asklepios]

Unfortunately my trauma experience is pretty limited, so I'll be moving off the topic for a while.

Plus I intend the column to be quite broad in scope, skimming superficially across many medical areas rather than concentrating in one speciality.

I'll leave in-depth trauma articles to the experts.