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Method
Hello gang.

I was doing some research for school and I came across an article in Military Medicine titled Tactical Combat Casualty Care 2007: Evolving Concepts and Battlefield Experience. I thought it would add some flavorful details to any campaign featuring combat medicine (Doc Wagon or any character with First Aid even).

The full article is restricted to subscribers but I found a rather long (and ugly) text version HERE.

The best part though are the treatment guidelines. I'll post them in spoiler tags to save people the trouble of mucking through the paper in HTML.

1996 Guidelines
[ Spoiler ]
2003 Guidelines
[ Spoiler ]
2006 Guidelines
[ Spoiler ]
DTFarstar
I like the fact that from 1996 to 2003, Tactical Field Care 1 has changed from airway management to "Disarm them if they are crazy!"

Both sad and amusing both that that happens enough to need to be said and that that isn't obvious enough without having to put it down in writing.

Chris
GoldenAri
I find the note at the end of the 2003 Field Care section about trying to recusitate dead people doesn't work sad as well because of what it implies.

I also found the change in tone in the 2006 from "fight if you have to" to "whatever you do, keep fighting" interesting.
nezumi
QUOTE (GoldenAri @ Mar 12 2008, 02:56 AM) *
I also found the change in tone in the 2006 from "fight if you have to" to "whatever you do, keep fighting" interesting.


Keep in mind, if you stop putting down suppressive fire or otherwise gakking the bad guys, they can take a more favorable tactical position and gak both the casualty, the care-giver, and everyone around them. So unless you're in full retreat, keeping the situation under control really is the first concern.

Doc-wagon are a little difference in that they're obviously non-combatants and generally accepted as non-targets however their patient still is. I have to imagine Doc-wagon has special equipment and methods to keep down aggressors in the area, protect the casualty, but not kill anyone who isn't being aggressive and just happens to be around. Gurneys probably involve a lot more kevlar, for one.
BRodda
QUOTE (nezumi @ Mar 12 2008, 08:22 AM) *
Keep in mind, if you stop putting down suppressive fire or otherwise gakking the bad guys, they can take a more favorable tactical position and gak both the casualty, the care-giver, and everyone around them. So unless you're in full retreat, keeping the situation under control really is the first concern.

Doc-wagon are a little difference in that they're obviously non-combatants and generally accepted as non-targets however their patient still is. I have to imagine Doc-wagon has special equipment and methods to keep down aggressors in the area, protect the casualty, but not kill anyone who isn't being aggressive and just happens to be around. Gurneys probably involve a lot more kevlar, for one.


In a game I played in SR3 were were doing a hit on a corp. Took the guy out, his platinum Doc Wagon bracelet went off. Just as we were leaving the building the security guards got a luck shot and hit our mage... who had a Doc Wagon bracelet.... and we had to figure what the hell to do when the same evac unit that picked up our target swooped down to pick him up too. We ripped the bracelet off of the mage and hightailed it out of there.

*sigh*

Lack of planning I tell you. Gets you every time.
kzt
The rule I saw was, "before ABCs, establish fire superiority". You can't conduct medical care when shot yourself. That's why everyone is supposed to carry a one-handed tourniquet, so they can keep from bleeding out before the medic can help them.

The other issue that often gets missed is that DocWagon would have fire support from their birds and combat drones with them.
nezumi
QUOTE (kzt @ Mar 12 2008, 01:29 PM) *
The other issue that often gets missed is that DocWagon would have fire support from their birds and combat drones with them.


Is there anything on under what conditions Doc-wagon uses suppressive fire or when they use aimed fire and what sort of ammunition they pack?

I mean consider the following possibilities...

Doc-wagon is responding to a call, some guy has been nailed by Lone Star in the public space. Doc-wagon approaches and the shootout is going on, with the casualty's friends holding back Lone Star. Does LS figure 'well, Doc-wagon will turn the guy over to us when he gets to the hospital, therefore we can let them get through' and avoid firing on DW? Does LS figure 'well, Doc-wagon has a history of 'protecting patient confidentiality' and doesn't release prisoners to us, therefore we want to nail the guy dead/drive off DW'? Or do they think 'DW won't let us arrest the guy, but we can't risk firing on legal citizens, therefore this criminal has given us the slip and we'll need to use some other method to catch him now that we know where he's going'?


Doc-wagon is responding to a call where a Lone Star officer has a private DW account and has been downed in a shoot-out, but his fellow officers are holding back the criminal attackers until DW can get him out of there. Does DW figure 'these guys are criminals, we can't depend on them giving us the space to operate, let's try to nail them, killing them where we can, to insure we get our customer out safely'? Do they figure 'use suppressive fire, gel rounds, gas and smoke to create a defensive zone but reducing the chances of any further casualties, balancing the safety of all parties with making sure the customer gets out safely'? Or do they decide 'don't risk harming anyone unnecessarily, that can result in serious litigation/hurting our own customers/whatever, only fire when fired upon and only fire enough to protect the customer and employees, no more'? Does this answer change whether or not the attackers have SINs? If they're known Doc-Wagon customers?

I've never really considered these things and I'm curious what other people do in their games.
kzt
My assumption is that typical rules are that if you don't shoot at DW, they don't shoot at you. Once you shoot at them, there are no rules other then protecting the patient, the team and avoiding excessive collateral damage to bystanders and property. None of this namby bamby gel round crap. tribarrel .50s on the helos in chin mounts shooting AP. And the patient or his estate gets to pay the bills for collateral damage, so...

In terms of the cops, I'd assume DW has a deal with them and won't casually release criminals, so the cops are willing to let DW through. Probably Dw will grab any severely injured cops too as part of this. In appropriate situations they will work with the cops to get customers out as the situation allows.

No player has ever wanted to carry around an electronic tracking beacon on runs in any game I've run. . . And the PCs are typically in and out fast enough that DW isn't on scene yet. So it hasn't come up.
PBTHHHHT
QUOTE (nezumi @ Mar 12 2008, 02:18 PM) *
Doc-wagon is responding to a call, some guy has been nailed by Lone Star in the public space. Doc-wagon approaches and the shootout is going on, with the casualty's friends holding back Lone Star. Does LS figure 'well, Doc-wagon will turn the guy over to us when he gets to the hospital, therefore we can let them get through' and avoid firing on DW? Does LS figure 'well, Doc-wagon has a history of 'protecting patient confidentiality' and doesn't release prisoners to us, therefore we want to nail the guy dead/drive off DW'? Or do they think 'DW won't let us arrest the guy, but we can't risk firing on legal citizens, therefore this criminal has given us the slip and we'll need to use some other method to catch him now that we know where he's going'?


If I was running the game...
Depending on what the corporations have worked out with the particular jurisdiction in providing the local services, with Lone Star on the scene, the DocWagon personnel would hold back until the situation is resolved, and then they would go in and treat all those that need medical attention (well, those with a DocWagon contract and the Lone Star personnel since they're likely to have coverage since it's cheaper to contract it out with a known provider rather than having it done in-house). It would be stipulated by procedures that have been already hammered out by the legal departments that those who are arrested/detained by Lone Star would be treated at DocWagon facilities under supervised watch until they can be discharged to Lone Star. Well, that's for those with basic, gold and silver contracts...

Those who have Platinum or higher contracts with DocWagon or with special favors, things do happen at medical facilities or in the transport to there where patients manage to escape, it's a dangerous world in 2070.

I envision the Lone Star and DocWagon folks having, at times, friendly relations with each other, especially the guys on the ground since they often times will see each other at incidents and handling/cleaning up the messes. They know they're doing their jobs and don't want to get gacked and they hope that the respective folks from the other company would help them out if they're in a mess. Such as a DocWagon unit being pinned down by some gangers and the Lone Star folks coming in to help them out, those would go a long way and the people will remember when they happen to help each other out.

QUOTE
Doc-wagon is responding to a call where a Lone Star officer has a private DW account and has been downed in a shoot-out, but his fellow officers are holding back the criminal attackers until DW can get him out of there. Does DW figure 'these guys are criminals, we can't depend on them giving us the space to operate, let's try to nail them, killing them where we can, to insure we get our customer out safely'? Do they figure 'use suppressive fire, gel rounds, gas and smoke to create a defensive zone but reducing the chances of any further casualties, balancing the safety of all parties with making sure the customer gets out safely'? Or do they decide 'don't risk harming anyone unnecessarily, that can result in serious litigation/hurting our own customers/whatever, only fire when fired upon and only fire enough to protect the customer and employees, no more'? Does this answer change whether or not the attackers have SINs? If they're known Doc-Wagon customers?


See above, in my world, I'd have the Lone Star officers have a special DocWagon account just for employment since it's cheaper to have a contract with DocWagon then having to provide medical coverage/response in-house. Maybe there's another service they decided to go with, but for this scenario it's DocWagon. In this case, yeah, the DocWagon folks would use their equipment on hand to provide a defensive zone to help out the Lone Star officers.

As for the litigation situation, they probably have statutes passed concerning those that provide emergency response services for the city, especially for government employees and those who are contracted with the government. If the attackers do not have SINS, heh, they don't have much legal rights in the Shadowrun world. If they do, well, they were shooting at DocWagon personnel and you better believe DocWagon probably pushed for legislation that allows for the DocWagon personnel who are legally and properly performing their duties to be shielded from criminal and civil repercussions to protect themselves. If the attackers are DocWagon customers? They should have checked in their contract concerning what happens when they attack DocWagon personnel. Their contracts with DocWagon may be voided and/or also get charged for any injuries to DocWagon personnel.
Method
There was a book... NAGEE maybe? that had a bunch of detailed information about how DW operates. I think it basically comes down to three criteria (in order of importance):

1.) How much the client pays.
2.) Where the client goes down.
3.) The locations of any other DW clients in the area.

If a platinum contract holder goes down in the Barrens and there are no other clients in the area, its guns blazing- shoot, question.

And with the autonomous nature of corporations, I see little reason to think that DW and LS have any loyalty to each other. I image LS maintains their own medical corps and HRT rescue squads. DW's loyalty is to the customer. Ultimately, (I mean in the long long run) DW profits from violent crime, so its not like they have a vested interest in aiding the police. You could argue that in some sense LS (prevention) and DW (response) are in direct competition...
PBTHHHHT
That's why I said that in my game it'd be this way mainly because Lone Star in their cost cutting will use DocWagon to provide emergency services for their members while on duty. I don't see the smaller corporations (unlike megacorporations) entirely going in-house for some services. Similar to things such as legal, yes corporations will have their own in-house attorneys but for specialized things such as litigation, it's best to call in the firms. Similarly, medical response services, it's better to contract someone who are specialized and it's cheaper than running your own in-house unit. Anyway, that's my personal take on it.

As for loyalty to each other, no, I didn't say loyalty, just a friendly relation. DW's loyalty to the customer will mainly be reflected on the management levels, meanwhile this sometimes may clash with the individual employees' wishes which makes for a great plot hook.

If you've read what I wrote, that's the scenario I imagine along with the legal implications especially with those contracting with a local governmental authority. You may argue such, it's your game, whatever, I'm just trying to figure what would work or not especially from a legal standpoint. But what do I know on that matter.
Riley37
"Doc-wagon is responding to a call, some guy has been nailed by Lone Star in the public space...
Doc-wagon is responding to a call where a Lone Star officer has a private DW account and has been downed in a shoot-out, but his fellow officers are holding back the criminal attackers until DW can get him out of there..."

Those questions came up at the DocWagon training session for pilots, gunners and EMTs last week (last week being October 20th, 20X6) and the answers given by new recruits varied wildly with the answers given by long-time field staff. DocWagon reminds all its field staff that they are expected to use their initiative and best judgement while complying with established DocWagon best practices. DocWagon staff who are former military or former employees of CrashCart are particularly reminded to read their manuals and stay aware of differences between the practices of their current and former employers.

...which is my way of saying: the staff ALSO find these situations confusing, and they either follow the drill, or they make a decision on the fly while hopped up on adrenaline and possibly Jazz/Cram, depending on how well they're trained. Sure, it's worth thinking about what the three-ring binder says to do, but that's not always what the pilot will do. There might be times when the three-ring binder says to use minimal force, yet a sufficiently stressed-out pilot, or a pilot whose habits were formed while they were flying for the Aztlan military, may well err on the side of eliminating any possible threats.

Side question: does the manual say that the ambulance driver is in charge and makes any sudden tactical decision, or does it say that the senior medtech is in charge and gives orders to the driver?
Method
PBTHHHHT: didn't mean to argue against your post specifically. Just "thinking out loud" so to speak. I think the scenario you've described is perfectly feasible.

More so I was just thinking about the implications of a pay-for-service emergency response company. If you're DW, crime is good for business. It doesn't get any grittier than that.

Riley37: what manual is that? The TCCC guidelines I posted?
PBTHHHHT
Ah, sorry about that, didn't want to be too argumentative. Just that I know about the difference in the terms of the goals for the respective companies, but I also wanted to bring in some of the legal implications. Especially since LS has the contract with the local government and really, it's not good to have DW personnel pissing off the LS guys. They would have more authority on the streets, can you imagine a DW response unit versus an LS HRT unit. I can see LS personnel physically preventing the DW folks from going to treat client patients at an incident just by saying the area is not safe. Oh? you're going in guns ablazing? Well, time to call for LS backup units to respond and god help the DW guys if they hurt an LS guy. Nothing would be nastier than saying officer down if LS operates similar to cops nowadays and DW is operating on non-corp property so there's no extraterritoriality issues, hence LS would trump.

Hmmm... either ways the lawyers on both sides win. wink.gif
DocTaotsu
If I recall DocWagon typically has a policy of handing over criminals unless those criminals pay well enough to convince them otherwise. Either way I'm sure a corps like DW and a corp like LS have bumped heads a number of times and that that conflict would make for some excellent run fodder. However, I highly doubt that two corps would ever willingly fire on one another over someone over a 20 grand contract. All the legal fees would start to add up.

Riley: What sort of decision making are we talking about? When to go, when to stay?
This question was intriguing enough that I actually chased down someone who's actually been to the sandbox. Generally speaking the driver is indeed the final word on decision making. The driver is ultimately responsible for the vehicle and it's occupants and as such is well within his rights to say "We have to go now doc!" and floor it right the fuck out of there. That said it's not unheard of to have corpsmen drive ambulances (in 3 man teams; one attends patients, one drives, and one handles everything else like comms and navigation). I can't see this practice changing much except to have the ambulance rigged remotely with 2 techs working the patient (senior guy handles the medical stuff and coordination, other guy just waiting till they build drones cheap enough to do the heavy lifting).

From the civilian side I know that ambulances and cops either have terrific working relationships or antagonistic. As such I'd feel confident that it'd really be up to the interplay between the regional DocWagon directors and LS directors. Some cities probably have good working relationships where petty criminals are picked up but turned over and big ticket platinum criminals have to jump through additional hoops to get away. In other places where DW and LS don't get along it's probably a game of tag/urban brawl with both units racing to make pickup and claim extraterritoriality first. I still don't think that DW is ever going to fire on an LS unit, it just doesn't seem like good business.

I tend to think that DW pilots and gunners are specifically chosen for their ability to follow the 3 ring binder rules of engagement. If I recall the basic DW rule is "The gear is worth more than the client" which is why you can't call in DW as fire support if a run goes sour. If you have some gun crazy PTSD Azzie nutjob of flips the APDS switch before he even heads out, well, that cost DW money. Sure the clients estate is technically supposed to cover extraction costs but what if they can't pay half a million dollars in damages? Put them in debtors prison to make fine crafted jewelery for 200 years? Sell them to a bunraku parlor? What if there isn't an estate? Etc etc. DW doesn't profit from doing property damage to sovereign corporate states. If it did those corps would probably stomp on them in corporate court until the changed their policies. Of course, if you, Joe Runner, start lighting up 100k combat drones and taking pot shots at million dollar HTR vehicles... that's another matter entirely. In my game DW rolls with big tubs of freeze foam. Spray the whole street down. Let their credit limit sort them out.

Back to TCCC. These documents do an excellent job of showing how corpsmen roles have changed in the last few years. There was a time, not too long ago, that corpsmen weren't even issued rifles (technically prohibited under a strict interpretation of the Geneva Convention). The "Book" doctrines for medics that involved hanging back, collecting casualties, and staying out of the fight have been steadily going out the window. Most corpsmen recognize that the best medicine is preventive medicine and that the best way to keep Marines alive is to make sure they don't become patients. I've never been comfortable with the notion that I was going to stand outside a building for 30 minutes waiting for my team to clear a building. Something about snipers, bounties on corpsmen/medics, and the fact that I only have a single rifle. And those are just the practical concerns, ignoring that you train with these guys for months and they typically make it a point to keep your happy ass alive. A doc that Marines don't think would crawl through hellfire from brimstone for them is not a doc they are going to want to keep around.
Or as my instructor once replied to "So we'll be right there shooting at the enemy?!"
"Well if you don't want to die..."

Tourniquets are great and that's what all the doc's I've talked to said to go to first. It's been established that tourniqueting (not a word evidently) an extremity is good for a couple of hours and with evac times to surgical care hovering from 30 minutes to 2 hours you still have a pretty good chance to keeping most of that distal tissue. On top of that our training is "Life Over Limb", a credo I'm sure is even truer in a world with type O limbs.

Another point is field resuscitation. During training we were told point blank that if we did chest compressions on a patient under fire, we were wrong. There are very solid tactical reasons for this, namely that tactical triage (because when is there ever just one patient?) dictates that dead people (people you do CPR on) get bumped to the back of the line as far as treatment. This also plays into the latest research on CPR. Namely, the most important thing you can do for someone who is dead/dying is to get them to someone or something who can do something about it. Unless you're a doctor/surgeon with a full code team and a 4 foot tall crash cart and defibrillator, this isn't you. CPR doesn't bring people back from the dead, only AED's and really good drugs can do that with any regularity. The time you spend pounding on their chest and tearfully declaring "Don't die on me damnit!" you could be spending shooting people, dragging them to evacuation, or some combination thereof.

Now in Shadowrun I see a lot of this "definitive care" getting shifted down the evacuation chain to the field level, maybe even the buddy aid level. You're buddy goes down, you slap in an IV, start his biomonitor/medikit/autoinjector/NanoMagic! device and go back to killing people. I'd hate to say it but highly trained field medics might be a dying breed in 2070, being steadily reduced in number as it's easier to have a protocol based automatic machine stim the hell out of a casualty long enough for the Nightingale Autodoc to roll over to them. SpecOp and higher level of care units will undoubtedly have techs for extended care. Why spend all that time and money training a corpsman when you can spend that same cash adding another big gun to the fight?

Erm... I think I'll stop now.
kzt
Hey, we have a subscription! Thanks
DocTaotsu
kzt: Eh?

A look at the 6th world wiki seems it indicate that LS doesn't maintain a dedicated medical corps. I'm sure they have trained first responders and so forth but it's probably cheaper to outsource general emergency medical needs to DW/CC/whatever (possibly paid for by the city as part of their contract). Their employees are probably happier about that too.

If you want to throw in some interesting flavor text you can show the differences between and traditionally trained medtech against a grunt medic against a sprawl survivor.
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.

A grunt medic is going to strip all his gear down to the lightest load he can and spread it out amongst the people in his team. He'll do a lot of improvisation but much of it will be done ahead of time, like rigging a medkit to open in a certain way or making some gear specific to his team. Perhaps bundling some heavy densiplast sticks with duct tape to use for a splint on his team's 400 lbs troll. He'll meticulously plan but gear himself towards a set of common Very Bad Days ™ and forgo that latest doodad because it takes up room he could fill with more gauze or that really heavy tape he likes. He probably plans for rapid evacuation but has a few tricks (read:drugs) for those long unplanned but cynically expected overnight stays in water filled holes. He still plans on seeing the inside of at least a shadow clinic pretty quickly and having access to a broader bag of goodies.

A sprawl survivor is probably going to be all about improvisation using whatever he has on hand. Why bring gauze? Clothes work just fine! Use the hurt dude's clothes first! Need a splint for the troll? Glad I brought my cutting torch! I'll just saw off a few lengths of rebar to bind him up, maybe some lighter grade densiplast to give him some stability. He'll probably have some homebrewed urban wilderness medicine and know have about 20 medicinal uses for things that come out of vending machines. That sucking chest wound should normally be covered with a special one way valve but today it's covered with a the wrapper from a fruity roll taped down with a vent hole. I also think that he'll have a bigger eye for long term care since he's not at all used to delivering patients to the sterile comfort of a hospital. Where others might go for the quick and dirty solution he might take that extra half second to clean that wound out before spraying it with antiseptic. After all, you never know when how long you might wait to see a street doc on a busy night. I see a lot of these sprawl doc's familiar with "traditional" treatment, archaic things like wet to dry dressings, delayed wound closures, and putting a hot rag on a stye to bring it to a head before draining it. Procedures that no one uses anymore because they have the cure in a bottle or a drone can fix it in half the time.
kzt
The one that started the thread.

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DocTaotsu
Ah! Cool beans.
Drogos
DocTao: I must say, some very insightful approaches and I appreciate the input. Now, I'm even more psyched to play my combat medic!!!!
PBTHHHHT
Another thing that I almost forgot of why DocWagon might wait till after a fight (between LS and runners/gangers) before getting their patient. They get more for resuscitation services from the clients that way. AND... all the other wounded/dying folks on the field, the DocWagon folks can ask if they want to subscribe to any health services. A bit of a captive audience thing by giving them the option that they can bleed to death or give money to DocWagon and they'll get some patched up.
DocTaotsu
Drogos: Well of course you should be psyched to play a combat medic (although you win points for playing a UCAS Navy Corpsman wink.gif)! It's only the coolest job ever, take a couple levels in biotech and you'll be running you're own shadow clinic in no time!

PBTHHHHT: Why that's totally unethical!

And probably about how it works.

*leans over a mangled not-patient* "Okay! We're leaving! Blink twice if you want to purchase our special "field expedient" service plan! Only a 10% service charge! And we'll waive that if- hold on a second." *uses AR to direct a combat drone to hose a no quiet dead gangeR* "-if you sign up today! It's a good deal! Way better than CrashCart." *waves pointedly at the smoking wreckage of a CC Ares Citymaster.*
kzt
It would be a "time and materials + 'late contract upcharge'" deal, but only offered to those people with the ability to pay.
nezumi
I agree, great material, both from Doc and from PBTHHHHHHT. Definitely fills in a lot of details.
Method
DocTautsu: Very cool to here your perspective. Makes me want to create a combat medic myself...
DocTaotsu
Glad you all liked it 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* 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
QUOTE (nezumi @ Mar 14 2008, 11:56 PM) *
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
QUOTE (hyzmarca @ Mar 14 2008, 09:42 AM) *
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...


QUOTE (Fortune @ Mar 14 2008, 10:10 AM) *
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 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
QUOTE (DocTaotsu @ Mar 16 2008, 12:28 AM) *
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
QUOTE (DocTaotsu @ Mar 13 2008, 09:57 AM) *
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 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
QUOTE (kzt @ Mar 17 2008, 11:42 AM) *
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 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
QUOTE (DTFarstar @ Mar 17 2008, 09:09 AM) *
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?
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