Step 1: Return fire as directed or required., Inspiration for your Doc Wagon campaign Options

[DocTaotsu]

Glad you all liked it (IMG:style_emoticons/default/smile.gif) and it's interesting to look at some different perspectives of of the legal/ethical ramifications of a corps like DocWagon. Does anyone think CrashCart operates substantially differently than good old DW? It'd seem that if it was making serious inroads on DW services they'd have to offer something distinctly different aside from offering "All around better service." Considering its' corporate ties I'd expect that it offers several "Awakened Friendly" services that cater to magically active folk. Perhaps they'd like the Awakened carefully detail their care plans, generating something like a living will that clearly spells out when essence effecting treatments would be authorized if at all. I think that the book mentions that CrashCarts major perk is that it covers many markets the DW ignored or just never broke into, like various nations in Asia.

Also, has anyones stated out SR4 DW response vehicles?

I would love to see a DW/CrashCart corps war at some point... *cough cough* (IMG:style_emoticons/default/wink.gif)

DocWagon: Fighting for your business!

[nezumi]

I always imagined CrashCart as the cheap knock-off (I mean come on, look at the name!) So you'd probably be paying a little less, but they're less reliable coming in, maybe not as well trained and make a lot more noise. But that's just me.

[hyzmarca]

Shoot to wound, everyone, without exception. Then, bring in all of the wounded. Charge overinflated non-subscriber rates to the non-subscribers. This way, profit is maximized. You might need more ambulances if it is a large firefight.

[Fortune]

I always imagined CrashCart as the cheap knock-off (I mean come on, look at the name!)

In a hospital, a 'crash cart' is the table on wheels with stuff on it that is brought in when someone goes into cardiac arrest (among whatever other reasons may be applicable). It's a pretty well-known phrase.

[nezumi]

Shoot to wound, everyone, without exception. Then, bring in all of the wounded. Charge overinflated non-subscriber rates to the non-subscribers. This way, profit is maximized. You might need more ambulances if it is a large firefight.

Ha, the only case where I can believe someone gets orders to shoot to wound...

In a hospital, a 'crash cart' is the table on wheels with stuff on it that is brought in when someone goes into cardiac arrest (among whatever other reasons may be applicable). It's a pretty well-known phrase.

Oh, I'm sure it's a common phrase. I'm just saying, if I'm buying what is effectively medical insurance, I'm generally going to stay away from ones with names involving things like 'crash', 'death', 'reattachment', etc. and tend towards the ones with words like 'cross', 'doctor', 'physician'. It's basic word association. So as a GM, I naturally assume anyone selling a product oriented around my health and has a name involving crashing, well either they're too poor to afford someone to tell them that's a bad name, or they know they aren't quite as prestigious as 'Instant Physician!' and don't mind admitting it.

[Method]

Doc: Some of the Doc Wagon vehicles were updated in Arsenal.

[Fortune]

Funny. I would be more likely to subscribe to something named CrashCart™, because of the word association from its use in myriad doctor/hospital tv (trid) shows, than I would to DocWagon™.

[DocTaotsu]

True but DocWagons been around a lot longer, and I'm sure it's peddled it's name in all sorts of trids and games since it's inception. I'm sure their current ads play up their "Long history of solid medical assistance under the most extreme circumstances.

Has anyone here run a DocWagon/CrashCart game?

[Cthulhudreams]

Just imagine the "Marketing @ CrashCart" induction videos.

[Method]

Ran an adventure where the PCs pose as DW... basically a corrupt DW employee was selling pt records to a shady third party that was turning around to sell them to um... shadier people (I'm self editing because now that I think about it I might want to use this with my new group and some of them frequent these boards....)

Anyway the PCs were hired by a loyal DW captain (one of those rare denizens of the SR universe that still has a conscious) because he noticed that certain clients were going missing.

[DocTaotsu]

Yeah I think Private Emergency Medicine would make for a decent one off or couple run plot arc but I just can't see building a riveting campaign around it. After all, it is a day job of sorts and the basic "run" could get pretty repetitive.

I turn however to "Bringing Out The Dead" for inspiration (IMG:style_emoticons/default/smile.gif) you could do some truly mind boggling runs if properly inspired.

[Method]

I could see a situation where you rescue a high profile customer (government official or maybe an exposed spy or something), only to realize that the people gunning for him have a lot of clout- and the DW corp in their pockets. Team ends up hung out to dry with some very heavy hitters looking for them, and all the while they have an unconscious patient they need to keep alive if they want to figure out what is going on.

[Fortune]

True but DocWagons been around a lot longer, and I'm sure it's peddled it's name in all sorts of trids and games since it's inception. I'm sure their current ads play up their "Long history of solid medical assistance under the most extreme circumstances.

No doubt. I was merely commenting on the viability of the name itself.

[Shrike30]

A medtech is going to want all the right tools, clean medikits and what not. He'll do AR checkoffs, run all the diagnostics and generally follow "the book". He'll probably want and have the best and the brightest gadgets, burn paste, chem neutralizers, and as such he'll be ready for a broad range of eventualities. He's also going to plan on getting to a proper hospital pretty quickly and long term care might not be his strong point.

You're definitely right on "getting to a proper hospital," at least in an urban setting. Urban EMT's get unmatched access to hospital services... it's worth noting that our protocols for the stereotypical SR DocWagon appearance are called PreHospital Trauma Life Support. There's a portion of PHTLS focused on Tactical EMS, but a great deal of it is focused on things like car wrecks, burns, old-person-fall-down-go-boom, disasters, WMDs, that kind of thing. One of my EMT instructors was a SWAT EMT-Paramedic, and his specialty is about the closest I think we'd see to a DocWagon HTR team.

A great deal of civilian EMS, however, is about the bottom line. So, the medtech is going to want all the right tools, clean medkits, and what not (largely because he doesn't have to carry most of them around on his back all day... not a lot of thought has gone into fitting them onto the rig yet), but he's not going to have them, because they're expensive and the city/company doesn't want to pay for them. Issuing the bare-bones basics and letting the medtech improvise in the field with extra manpower, duct tape, and things he can find in the patient's home or car end up being cheaper.

He'll have a limited array of drugs, many with simple autoinjector systems that deny provider-controlled dosing because it reduces liability if there was a misdiagnosis, despite the fact that he's trained to select and deliver an appropriate dose. He'll have an AR checklist, but won't use it for anything besides tracking vital signs automatically unless the system physically prevents him from getting to his gear until he's progressed to that point... and the systems that are built to do so will mysteriously break on a regular basis. He'll usually do the diagnostics that are indicated, might very well do alternatives if it's expedient ("good cap refill < 2 seconds" rather than "Blood pressure 120/80"), and frequently run a diagnostic that isn't on the list, but he's got a gut feeling about... if it doesn't pan out, it never gets entered into the commlink, and the patient doesn't get billed another 70 (IMG:style_emoticons/default/nuyen.gif) because his blood sugar got checked on a hunch. "The book" will be a constant source of frustration and irritation, and it'll get worked around, over, or through on a regular basis to try and get the patient the best care possible.

A great deal of the "broad range of eventualities" you can plan for as an EMT come because you've got an ambulance full of useful kit, and a hospital nearby that you can fly towards at 80+ while the tech bags the patient or holds pressure on a hemorrhage... not exactly high-tech medicine. Strip an EMT down to his jump kit, defibrillator, and O2, and things like multiple patients with gunshot wounds get to be an issue. Certainly, caring for multiple injured and wounded for hours or days at a stretch goes beyond his usual scope of practice, but the grunt medic isn't really equipped to transport sedated, contagious meth-head psychotics to destinations they'll recieve specialist care at... his usual demographic runs more towards young, fit, armed men who break something, fall off something, and/or get holes put in them but have to keep moving.

A combat-oriented EMT (rather than a "medicine with occasional trauma" EMT) is going to have a much narrower focus, and much more ability within that. His kit will look a lot like the grunt medic's, but he'd likely have more of the gear concentrated on him, and pass up heavy firepower and armor for more gear, as the environment is likely to be less dangerous than "war zone" and more along the lines of "building with some dudes in it." The team he's operating with is in charge of keeping their EMT's in one piece (as there's likely 2-4 providers, not just 1), and his "bad days" will likely be along the same lines as that of the grunt medic. The major change in thinking, i'd think, would come from the availability of hospital services and/or ambulance support.

[kzt]

There are 3 things that rapidly kill a lot of people in combat that a combat medic can do something about without a lot of gear: Exsanguination from proximal extremity arterial bleeds, tension pneumothorax and airway issues. If you can rapidly evac them to a surgical center there isn't a huge amount you need to do beyond that. There are other things you can do to improve the odds, but those 3 are the biggies. They can do more and carry stuff to do it with, but those 3 are what is going to make the difference with most combat casualties that NEED medical assistance AND have survivable wounds.

Typically by the time civilian EMS gets there people that were going to rapidly exsanguinated will have completed the process or the bleeding will have been controlled by someone already. Paramedic I know mentioned that the only time she'd seen a classic arterial bleed was at her house, when someone playing basketball put their arm through her kitchen window.

EMs tends to have things like o2, defibrillators and ACLS that are heavily stressed by them, but combat medics just don't carry. If a guy is in arrest in combat he's only worked on if there isn't anyone else who needs attention who is likely to actually live.

It's a different focus. Tactical medicine for police is typically a hybrid, as there are often very sophisticated providers on hand (like the trauma surgeon who's a reserve cop here) in addition to the buddy aid from the cops, the SWAT medics, plus FD/private EMTs and they have an ambulance with lots of gear on hand to rapidly transport them. And they get to deal with the guy who has a heart attack as well as gunshot wounds.

[nezumi]

I have to imagine docwagon + zombie apocalypse would make for an interesting and reasonably long-lasting campaign, especially since the situation (and, therefore, your employment status and priorities) would change on a near-daily basis.

[DocTaotsu]

nezumi: In my esteem anything+zombie apocalypse makes for interesting gaming. Moving a couch+zombie apocalypse=Instant Adventure!

This opens another interesting line of discussion. Are vehicle altercations still the primary generator of trauma cases? Is "chest pain/shortness of breath" still an everyday run? Do they even bother sending bodies to go look at these people or do they dispatch a drone and a biomonitor?

Basically, does DocWagon still spend 90% of their time responding to "Pedestrian vs. Step Van" and "45 y/o m troll c/o of 'crushing' chest pain"? Or have things like GridLink and drone telepresence (or hell, Matrix telepresence) eliminated much of those mundane calls?

I'd assume so, especially for a pay by service org like DocWagon. Platinum members probably get a lot of this day to day stuff on the house and standard members probably have to haul their happy asses down to the local DW branch clinic. The amount of money you could make by charging someone for "house calls" along with routine medical check ups could be substantial. I also imagine those members with biomonitors probably also get periodic queries in their AR. "Mr. McGuffin, you're blood pressure has spiked twice above you're physician's preset alert levels. Would you like to speak to a DocWagon representative to arrange for transport. Cost for transport will be, 60 yen, as per your current contract. I would remind you that by upgrading to our Platinum service you forgo these costs in the future..."


I've been working on a general idea for a rigged physician. Current EMT's operate under a doctors license and hospitals have doctors on call (usually whoever is on at the ER) to provide "online" consultation if something weird comes up or transport is delayed. For a business like DW in envision a "Watch Medical Officer" that is jacked directly into the local DW provider net and is in constant contact with DW response teams in the field. Much like a drone rigger managing a constellation he could instantly flip between active units, check on patients, sign off on additional care, and even jack directly into autodocs to provide field surgical interventions. It'd be an incredibly well paying job but with a substantial burn out rate.


Oh, o2 in the field. Do you think we'll still be using tanks in 70 years or will we have some fancy bit of gear that you strap over a patients mouth and it scrubs the ambient air for extra o2? Or maybe something like a cheap oxygen candle that chemically produces o2 in a disposable package that can be attached to whatever you're ventilating a patient with. I've also always been a fan of the ultrasound glove, a technician slips it on pair of gloves that has probes built into the finger pads. He places his hands over the injury (say a possible fracture) and the hands automatically generate an AR overlay showing what's going on underneath the skin. He could quickly assess the amount of internal bleeding, extent of damage, etc. all in stunning "X-Ray Glasses" 3D. All this information would of course be fed up the chain of care and the receiving doc/technicians would use it to choose more precise imaging options.

I think that, in a world where a "Medical Clinic" can fit in the back of an ambulance that the importance of getting a patient off the ground and into the ambulance can't be overstated. Aside from taking care not the injure the spine the major procedure is "Don't die, kill people trying to kill you, kill other people, grab patient, throw into ambulance, drive very fast, check credit limit." I envision this biomonitor/drone thing that you lower onto the patient in the rig, it starts/continues IV's, does compressions, and administers medication following protocol. I agree that they'd probably issue just the very basics and that the medic's jumpbag will have shrunk substantially by the year 2070.

[Drogos]

I was always under the impression that the DocWagon services listed were for those who anticipated need of HTR. I imagine there is an even more basic DocWagon service that will cover much the same as insurance covers (you pay X ammount monthly for certain discounts on services as needed). I suppose normal insurance without a HTR clause would cover most of the norms needs pretty adequately.

[DocTaotsu]

They are but I've always figured that it also gives you healthcare coverage as well. Besides, with DocWagon doing chrome and so forth you'd think that they'd want to convince you to seek those services with them.

Upgrade to alphaware cyber arms and get one year of Basic service free! That's a five thousand nuyen value! I will you impale you're AR in exclamation points!!!!!!!!!

[kzt]

You can apparently, at least in a lab, get 90-95% O2 using a molecular sieve. You can get 35% using membrane separators now, I've dived nitrox produced using this.

Part of the advantage that something like Docwagon has is in high density urban areas. For example, I've read that decent NYC EMS response time to an upper story in a highrise is 15 minutes. This is due to a combination of traffic and elevators. If you can drop a team on the roof from a helo you really can cut the response time by quite a lot.

I've been told that in Brazil much of the wealthy (not just the super rich, but the just wealthy) travel by helicopter to avoid street kidnapings and other events, so much heaver deployment if heli-pads would make a lot of sense, though Docwagon would tend to not require helipads.

[nezumi]

You can apparently, at least in a lab, get 90-95% O2 using a molecular sieve. You can get 35% using membrane separators now, I've dived nitrox produced using this.

How big is that? Wow, I think I'll be adding a portable oxygen sieve to my doc-wagon equipment list from now on. Very cool.

[DTFarstar]

Keep in mind, Nezumi, that there is such a thing as oxygen oversaturation as well. Just like everything else, put too much of it in your body and you die.

Chris

[DocTaotsu]

Well there you go, molecular sieve it is (IMG:style_emoticons/default/wink.gif)

Yeah, I'm pretty sure that HTR units would be well versed in fast roping and all that. Hell, with the right clearances I wouldn't put it past a team to demo through an exterior wall to get a patient out.

[kzt]

Keep in mind, Nezumi, that there is such a thing as oxygen oversaturation as well. Just like everything else, put too much of it in your body and you die.

O2 toxicity is nasty. Particularly when diving. You go into convulsions when you experience CNS effects. This is typically followed by drowning. This is uncommon at typical 90% at sea level pressure in EMS from what I understand. Pulmonary effects result in ARDS, which is also not at all good and will kill directly if you don't get a clue and stop having the patient on 100% before you destroy their lungs. But it typically takes at least a day, usually longer, for this to start developing.

As to how big a molecular sieve is, I have no idea. I think that you can fit a battery powered membrane separator into the bag I see people carrying around.

[DocTaotsu]

But for purposes of emergency care the rule is "Oxygen for everyone!" (unless that suddenly changed. I've even been told to put COPD patients on o2, can't remember the revised reasoning for that. I think it had to do with the fact that you weren't going to kill them with o2 before you got to the hospital). I think that's mostly because of the operating environment and design of oxygen delivery systems. I'm sure a 2070 biomonitor tied into an oxygen sieve would cut down on o2 production when O2 saturation levels topp out at 100%.

But yeah, too much O2 can be a very very bad day.

Oh and newborns on straight O2 can have issues with their vision iirc, but I think that's another long term care issue.


Ooo! Blood products! Fake blood for everyone?