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

[kzt]

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.

My guess is that ALL docwagon teams can do fast roping. Got to avoid the free pizza. (IMG:style_emoticons/default/smile.gif)

[DocTaotsu]

Road pizza?

Hm... do SRT's do airborne recoveries routinely? I see airborne operators as the sort of duty most junior DW personnel aspire to become.

What do you all think the standard career arc for a DW medic is? Clinic work->SRT>Airbone SRT->Whatever the intermediate service is called->HTR->Management (and those teams that deal with mass casualties)?

Do you think SRT's and HTR's recruit from different pools?

[kzt]

By "Free Pizza" I'm talking about the time guarantee, like Domino's.

[DocTaotsu]

Ah... maybe that's CrashCart's selling point "We have the Uncle Enzo delivery guarantee!"

[Method]

The reasoning behind "oxygen for everyone" is that O2 toxicity in the setting of hypoxemia has never been documented as a clinical entity. If a pt has labored breathing you aren't going to kill them by giving oxygen acutely. O2 toxicity is seen in extreme respiratory settings like diving and high altitude and people who are kept on ventilation long term without PEEP.

[WearzManySkins]

Well too much oxygen can cause blindness in newborns.

As for vents usage.....I disagree due to personal experience.

WMS

[Narmio]

This is a great thread with some really knowledgeable posters in it. Gonna put more field medicine into my games from now on.

It's a bit harder to extrapolate from personal experience, but what do people think about magical treatment by DW? With legal issues being the primary obstacle to wider magical medical care in SR, surely the best DW contracts could include optional magical treatment options (for a substantial fee, of course)?

What effect would spells like Heal, Stabilise, Hibernate or Resist Pain have on EMS? I'd imagine there's no point bringing a mage for something you can do with an autoinjector, but what can you do with magic that you can't do from your bag? Assuming the highest levels of service, here.

Hibernate and Stabilise seem like biggies to me.

[Method]

Well too much oxygen can cause blindness in newborns.

Yes you are correct.

As for vents usage.....I disagree due to personal experience.

Man you do have bad luck with medicine!! (IMG:style_emoticons/default/frown.gif) Did you have a reaction to ventilation?

-----------------------

Narmio: I think you hit the nail on the head. Cost would be the main factor involved. As rare as magicians are in SR (~1%), they are still more common than doctors today (~0.29%) so its not unthinkable that some magicians might become medical magi. There might also be high demand for magical treatment among the awakened (although IIRC they did away with the magic loss rules in SR4). It seems like sorcery adepts aspected toward health spells would be fitting.

However, given the cost of training and employing a magician, I think they would be too valuable to risk in HRT situations. I would imagine they would be relegated to working from the saftey of a hospital.

And above all, if magical treatment were an option it would only be available to the highest paying customers...

"Well Mr. Shmuck, that stray bullet shattered your proximal humerous. Our orthopedic trauma team can do surgery ASAP, but you're looking at 2-3 days in-patient, about 3 months in a sling and another 6 months of rehab... or you can upgrade to our Premium Holistic Package ™ and see the next available healer..."

[DocTaotsu]

I was recently told that we still put newborns on O2, we just use blow by with a non-rebreather mask. Kinda makes sense since I highly doubt a newborn is going to have anything to do with an enclosed mask on their face. But again this is for EMS and not for long term care, 30 minutes to an hour tops.

And for anyone that's curious:
Positive end-expiratory pressure (PEEP), is a setting on a ventilator that's good for people with Acute Respiratory Distress Syndrome. Without getting too technical: It's a way to "force" the lungs to absorb oxygen without having to actually increase the amount of O2 and thus run the risk of all the bizarre problems associated with prolonged 100% oxygen therapy.
I had to look it up, must admit I'm not very familiar with ventilators. Do you all think that we'll still be tubing people in 70 years or will we go straight for a trach? Or is there an even more exciting hack in the future?

WMS: What was your negative experience with ventilators?

Oh god Method! I didn't even think of an aspected mystic adept, you coul throw down some ridiculous dice with enhanced agility, enhanced skill, and a couple of choice healing spells. Or even a few spirits!


Magic! I've been meaning to post on medical but basically it's the big fuck you to traditional medicine. A reasonably powerful mage (5 in magic, relevant skill) would be able to do everything an surgeon could do but immediately and better. The only thing holding them back from taking over medicine completely is the scarcity of competent magic ussers, the costs, and the fact that spirits think their crunchy. A intiated DocWagon mage probably rolls in huge money summoning spirits of healing and binding them or assigning them to assist teams. I'd have to look at the rules of Hibernate and Stabilize sound like big ticket items, perhaps even more important than a simple Heal spell. I also agree that a good healing mage would be worth to much to put in the field. But even someone who can drop a level 3 or 4 heal spell would have a great deal of utility and might get some nice bonuses to see Platinum field work.

While I agree that someone who can throw down a level 6 heal spell would demand high wages I've always used lesser magic users as common cheap medical aid in bad areas like the Barrens. I play them like the local witch, you see her when you've got a cold or sprain an ankle. But if you get all blowed up, that's a bit beyond her.

[Method]

Oh yeah, sorry. During normal (and abnormal) expiration smaller airways in the lungs "deflate" to the point where they actually close. If there is fluid in the lung (as in ARDS) the surface tension in collapsed airways keeps them from reopening. The PEEP settings on a ventilator maintain the airway pressure slightly above atmosphere at the end of expiration ( thus the acronym, positive end expiratory pressure) which basically "tents" the airways open.

Its also used in severe COPD/emphysema because it prevents "air trapping" just like pursed lip breathing. Kind of counter intuitive, but in COPD/emphysema the problem is getting the air out, not in.

Anyway, this is totally off topic, but I'm just a nerd like that. (IMG:style_emoticons/default/biggrin.gif)

So yeah, magic...


EDIT: Actually to answer your question, I can't see intubation going out of style anytime soon, but you never know. In previous editions you have oxygenated florocarbons that could be injected (which would be like a packed red cell transfusion WITH oxygen), and there is always the Oxygenate spell. Plus, who knows what they can do with nanotech? Maybe the "molecular sieve" could be designed into a tiny nanobot- a nano "oxygen reclaimator" if you will. God only knows what they could do with nanotech...

EDIT AGAIN: not to risk going OT again, but nanobots that scavenge reactive oxygen species could also prevent oxygen toxicity...

[b1ffov3rfl0w]

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

Hang on, hang on, I got it -- we take the cushions off, unscrew the legs, *BLAM BLAM BLAM squish thud* unscrew the legs and carry it through the doorway with the back facing the ceiling.

Aw man, we're going to need to re-upholster.

[Shrike30]

Chronic Obstructive Pulmonary Disease is a concern for using high-flow O2 (typically 10-15 liters per minute via non-rebreather mask), but it's not a flat-out contraindication for oxygen use, at least in Washington.

The problem you encounter has to do with respiratory drive. Most healthy people rely on CO2 levels in their blood to tell their brain when it's time to breathe... you get high CO2 levels, your brain ups your respiratory drive unconciously, and you compensate without thinking about it by breathing heavier and/or faster, or yawning. The secondary indicator your brain uses to determine if you need to breathe is O2 levels in the blood... when these drop, your brain says it's time to breathe.

If you've got a COPD patient and it's ended up making them a CO2 retainer (meaning that they've got elevated levels of CO2 in their blood all the time), the brain essentially stops paying attention to the CO2 level, since it's ALWAYS high, and relies solely on the O2 level to determine if it's time to breathe. O2 levels in your blood take longer to react to a change in oxygen availability than CO2 levels do. Since COPD patients frequently have an SpO2 around 90% (88-93% is pretty common) even on 2 liters per minute via nasal cannula, their brain is used to it being at that level, which is a lot lower than a healthy person would have (96% and up). If you put them on high-flow O2, you could easily spike that percentage back up into the high 90s... and in the process, tell their brain that they don't need to breathe, knocking out their respiratory drive and stopping their breathing. Once their bodies use up that oxygen you got into their blood stream 30 seconds or more ago, that SpO2 can drop really, really fast (as they haven't been breathing for the last half minute), and the really sick ones aren't reliably able to start breathing again at that point.

We were trained to keep 'em on minimal amounts of oxygen, usually no more than 2-6 LPM via NC... many COPD patients are on 2-3, anyways. If you've got to stick someone with COPD on high-flow for some reason, have a bag-valve-mask nearby, because you might have to start bagging them to replace their stopped breathing. Conscious patients hate it when you do this. (IMG:style_emoticons/default/nyahnyah.gif) It's a pretty weird feeling, actually... try not breathing, relaxing, and having someone breathe for you with a BVM. Weird sensation.

[WearzManySkins]

Yes you are correct.
Man you do have bad luck with medicine!! (IMG:style_emoticons/default/frown.gif) Did you have a reaction to ventilation?

(IMG:style_emoticons/default/grinbig.gif) No I used to be a Field Service Engineer for a OEM of Ventilators. (IMG:style_emoticons/default/biggrin.gif) Worked with some interesting Pulmonologists then too. I still am basically that, but I have other equipment to play on too.

Also there are Ventilators called High Frequency that give a breathing rate in the 200+.

I also had a family member who along with everything else had COPD, watching his "normal" levels of O2, was eery and strange from what I was used to.

I also use a CPAP for my Chronic Obstructive Sleep Apnea. Which more people have, but are yet to be diagnosed. Getting rid of CO2 levels is very important. Other wise the physiological effects are/can be very bad, strokes being one of them.

WMS

[DocTaotsu]

For the record I'm totally okay with medical gibberish nerding out (IMG:style_emoticons/default/smile.gif) . I just want to spell out all the acronyms for the people in the audience who don't yell at TV medical dramas.

On COPD: And that kits and kats is why smoking is bad! Bad bad bad!

Unless you have a cyberlung (IMG:style_emoticons/default/cyber.gif)


Hm... I think nanotech of the level discussed in augmentation would have a HUGE effect on emergency care. I'd imagine most rigs would have an external hive chock full of choice nanotech that can be dialed to immediately and dramatically alter blood chemistry and physiologic function. All that plus scrub for toxins, inteligently control internal bleeding (utilizing external sensor telemetry), and probably do all kinds of wacky things with the brain to keep it moving.

Which brings me to the idea of a neural defibrillator. It also strikes me as sad that we can restart a messed up heart but if your brain starts tanking we really can't do anything to keep you from fading to black. Once you're in a coma it's really out of our hands to bring you back. I'd imagine in 60 years we'll have some sort of drug/nano/surgical intervention that would either keep you from slipping off or help your brain crawl back to consciousness. Probably be an offshoot of military research to keep soldiers awake longer combined with some of the principles of an invoked memory stimulator.

I'd also hazard such technology is probably incredibly uncomfortable and might have some long lasting psychological effects as it makes you stay awake during an incredibly traumatic experience.

Ooo! And brain in a box! Is it possible in Shadowrun to wack a patients head off his shoulders and stuff it into a vat of "Cold Keep You Alive Juice"?

[nezumi]

Ooo! And brain in a box! Is it possible in Shadowrun to wack a patients head off his shoulders and stuff it into a vat of "Cold Keep You Alive Juice"?

If that's feasible, it's only narrowly so. Keep in mind essence loss. There have been discussions about how much essence it would cost to replace all the necessary organs with cybernetics. It would be a tight fit, and that brain will never approach its previous level of physical ability without a *TREMENDOUS* amount of money. While I suspect amputations would be way more common than they are now, a full-body amputation is probably frowned upon and probably not kosher.

[Heath Robinson]

Which brings me to the idea of a neural defibrillator. It also strikes me as sad that we can restart a messed up heart but if your brain starts tanking we really can't do anything to keep you from fading to black. Once you're in a coma it's really out of our hands to bring you back. I'd imagine in 60 years we'll have some sort of drug/nano/surgical intervention that would either keep you from slipping off or help your brain crawl back to consciousness. Probably be an offshoot of military research to keep soldiers awake longer combined with some of the principles of an invoked memory stimulator.

In Shadowrun it's commonly accepted that you can place a suite of sensors and EM inducers onto your head and read or manipulate your patterns of thought and experienced environment however you might like. I cannot see this as not being useful for maintaining consciousness or forcing/assisting people to regain consciousness. For a start, you can analyse the brain activity patterns in an awaking coma patient and attempt to induce those in similar patients. Specialist ware might exist that activates to help maintain or supress consciousness to help with permanent sleeping disorders.

[kzt]

Getting rid of CO2 levels is very important. Other wise the physiological effects are/can be very bad, strokes being one of them.

Pulmonary Arterial Hypertension is pretty cool too.... (IMG:style_emoticons/default/frown.gif)

[kzt]

My suspicion is that in 10 years you are going to have an IV room temp storeable blood replacement and something that you can inject to stop the brain hypoxia damage with NMDA receptor blockers. Both of which have the potential to dramatically change things.

[DocTaotsu]

Mm... it would be lovely to make blood banking more or less obsolete. As much fun as it may be to play vampire and spin units out (IMG:style_emoticons/default/smile.gif) .

That said room temp blood replacements are like nuclear fusion, it's always 10 years off. But you're right, I'd put a few dollars on having something that can be stored easily and duplicates the basic oxygen carrying capacity of blood (and doesn't have all kinds of hideous side effects). Synthetic blood products like concentrated platelets and fresh frozen plasma would be pretty damn cool to have as well. But that's more like something you would be administering at a hospital level, synthetic blood will likely be on the thing that would come down to the EMT paramedic level.

[WearzManySkins]

In 10 years hopefully the coagulant powders, that can stop a ruptured spleen from bleeding out will be fully functional and approved.

WMS

[PBTHHHHT]

Hang on, hang on, I got it -- we take the cushions off, unscrew the legs, *BLAM BLAM BLAM squish thud* unscrew the legs and carry it through the doorway with the back facing the ceiling.

Aw man, we're going to need to re-upholster.

Blech, you just gave me a bad flashback of the time I helped a friend move a sleeper sofa into his place (just two guys moving a sleeper sofa, ugh), we had to move it around this way and that on a hot, humid summer day in a cramped stairwell, and yes we had to take the legs off... and the door off the hinges to barely get it into his apartment.

[Method]

PBTHHHHT: yeah but how did you kill the zombies? (IMG:style_emoticons/default/grinbig.gif)

[Shrike30]

Oxygenated Flourocarbons/P4MO (aka "Blue Blood") has been in SR since the street sam catalog, i think. I'm still not sure I'm cool with the current version (2 grand a WEEK?) but they're fun

nezumi: replacing a limb with a cloned limb has never cost essence. Freezing a head, and replacing the ENTIRE BODY with a cloned body wouldn't cost essence either, i'd think.

[Critias]

PBTHHHHT: yeah but how did you kill the zombies? (IMG:style_emoticons/default/grinbig.gif)

I know that if I had a sleeper sofa in a stairwell (assuming the zombies were below me on aforementioned stairwell), I'd figure out some way to let gravity do most of the work for me.

[nezumi]

nezumi: replacing a limb with a cloned limb has never cost essence. Freezing a head, and replacing the ENTIRE BODY with a cloned body wouldn't cost essence either, i'd think.

Yes, installing a brain in a completely new, cloned body would not cost an ounce of essence, amazingly enough. A complete head transplant in no way disturbs your spiritual self nor upsets the delicate physical balance of your body. HOWEVER, keeping the brain alive long enough to get it to that body will almost certainly involve some pretty significant implantation, and that does cost essence.