Feature Requests

[FluffyGhoster]

A port of the feature requests from the Katalam/KAM repository and new additions from players

Description:

Add a detailed description of the feature you wish, if it's deemed accepted it will be moved to a feature request by itself and a target version will be added, on the completed development a pull request will contain the Issue ID and the issue will be closed

[FluffyGhoster]

Description:
Flight considerations for MEDEVAC/CASEAVAC; atmospheric pressure changes for pneumothorax. Need to ensure that the patient is stable enough for transport via aviation (helicopter).

How to implement:
ACE already has an option to effect ballistics of a bullet via barometric pressure so there should be a way to check for altitude changes to effect the overall barometric pressure for the wounded as well.

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XSTAT - Injectable sponge type pellet system to keep massive blood loss from happening with a patient either with gunshot would or from amputation (evulsion) from IED's, wrecks, etc... The system creates a pressure to close off severed vessels (veins and arteries) to reduce/stop blood loss.

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Description:
I reached out to you on discord but figured I'd post it here to make it more official. The Idea of having to have different size IV catheters/IOs and starting a "line" before being able to push fluids or medications into the patient. The limb the IV or IO is in is then the only limb that fluids can be pushed into. Be able to start multiple IV's on a patient. The size of the catheter can then determine the fluid transfusion rate etc.

Steps to treat:
ACE medical already has the option to determine transfusion rates in the settings. Should hopefully be simple to link the size of the catheter to the transfusion rate.

IV:
select limb, option to start (14, 16, 18, 20, 22, 24) gauge IV.
Once IV is in place give some type of indicator on that limb that an IV is established, same way with how there is an airway device notification.
Then in order to push fluids the provider has to select a limb that has an established IV (this could also allow the option to expand into dosed medications instead of the predosed auto injectors)

Also the possibility for an IV attempt to be unsuccessful and have to try again on the same or different limb.

IO:
An IO would be started the same way as an IV but should be faster and more reliable/secure since IRL it normally is.
Same steps as before but IO's have less size selections normally. (16, 18)
IO's should have some drawback for use on conscious patients like inflicting some pain if the patient is conscious. This will hopefully add some thought into the decision of and IO or IV on a patient.

Once an IV or IO is established on a patient is should stay with them until they are PAK'd or fully healed.

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It would be nice to see chest seals being used for any sucking chest wound and the implementation of decompression needle(s) to replace the functionality of chest seals. I think this is a very simple addition that would add to the immersion of TCCC (Tactical Combat Casualty Care) and most medics to this day carry a decompression needle for this very reason (pneumothorax). Thanks

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Description:

Add the ability to hang different types and sizes of IV solution on the IV stand. Saline, Blood, Plasma, Blood types in 250ml, 500ml, 1000ml...

If possible add a idea to implement it (logical):
Possibly use the same model for the IV stand if the smaller variants don't exist? Model can continue to be saline as long as the correct fluid is on the stand.

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**Finished to copy over the Katalam/KAM repository Feature Request thread

[FluffyGhoster]

Description:
Reduce asystolic monitoring volume when you are near, it tend to pierce your ears overtime

Implementation:
I see two options: either just reduce the maximum volume, or mute it when the medic is near after a short time (like the medic press the "silence alarm" button)

[YetheSamartaka]

Description:
Reduce asystolic monitoring volume when you are near, it tend to pierce your ears overtime

Implementation:
I see two options: either just reduce the maximum volume, or mute it when the medic is near after a short time (like the medic press the "silence alarm" button)

There is an option to mute the monitoring sound

[FluffyGhoster]

Description:
AED should apply shock pain only to people directly touching the patient, not just standing nearby

Implementation:
Currently the script search for people around the patient and give them ACE pain, however when a shock is administered only the people in direct contact to the patient risk to be affected, not just bystanders, hence the script should:

1. Select the people in the ACE treatment range
2. Check if they are doing a treatment to the specific patient
3. Apply pain to them if they are doing a treatment to the patient who is receiving the shock, with a small probability to cause an arrhythmia or stop the heart of the person that is touching the patient, possibly the probability depends on where the treatment is being applied (touching the torso is the maximum risk, touching the legs and arms is the lowest)

[FluffyGhoster]

There is an option to mute the monitoring sound

I may have missed it then, where is it?

[YetheSamartaka]

There is an option to mute the monitoring sound

I may have missed it then, where is it?

ace interaction - turn down AED-X volume

[FluffyGhoster]

There is an option to mute the monitoring sound

I may have missed it then, where is it?

ace interaction - turn down AED-X volume

Uhm no I don't see it, I open the patient, click "Monitor Vitals", you get the sound, but there's no option to mute it, either in the medical menu or on the ace interaction?

[FluffyGhoster]

Description:
AED is an automatic external defibrillator, so you shouldn't be able to shock the patient whenever he's on the ground, it should shock automatically on certain kind or arrythmic complexes, but not on medic's will/decision.
The AED should just be attached to the patient like the Monitor Vitals, then it will start the analysis of the rythm, if the rythm is shockable the AED will inform people to clear the patient, then perform the shock, and then go back in monitoring for a bit of time (I think it's 3 minutes?), the medic have no option to choose by himself if the AED will shock or not, otherwise it would be a manual defibrillator.
Also, the AED do not shock if the rythm is absend (asystolic), the protocol is to NOT shock asystolic patients but do CPR instead, you can think to a defibrillator as a resetter, it's not a jump starter, you don't use it if there's no electrical activity.

[Conrimaceogain]

Regarding decompression, I've been putting a little bit of work into implementing hemopneumorthox, so I might look to decompression too.

[Conrimaceogain]

I might also recommend splitting up these feature suggestions into separate issues to make tracking them and their acceptance/progress simpler.

[FluffyGhoster]

Would you prefer to have an enhancement each for every idea?
I thought going with the ACE3 style (a single thread with all the ideas, once accepted move them in a dedicated issue) was a nice idea, but please let me know if you prefer to just have an issue for each idea and I'll split them all

[Conrimaceogain]

Hmm, hadn't thought about it that way. That may work, let's give it a shot.

[FluffyGhoster]

Description:
Intubation is performed with a sedation therapy consisting of an agent (like Etomidate), we should provide such a medication and punish intubations that are done without it (chance of intubation not being applied? more desaturation for the patient? straight inability to intubate?)

This does not apply to nasal intubation and does not apply to patient in cardiac arrest which are unable to have such a reflex, but once they are responsive again we should apply a penality to them too (coughing with decreasing saturation?)

[FluffyGhoster]

Description:
Ability to remove intubation once it's not needed

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Description:
Ambu baloon with the action to push it, will increase saturation when the push is performed if there's nothing obstructing the mouth, otherwise will exponentially reduce the saturation until sucking or, if done too much, until tracheotomy with suction is performed, would be cool to allow the connection to the ambu to the intubation or the tracheotomy mask

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Description:
Manual defibrillator in the medical facilites, we can add a certain chance of the AED to not function properly and that would require the patient to be transported to the medical facility where the manual defibrillator is available (and only usable by doctors by default) that would then check the patient and shock it on his will.
This would couple very well with the feature below

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Description:
A multiparametric screen able to be attached to the patient with a UI on it, it will then display the status of the patient with the SpO2, the SpCO2, and the rhythm (a picture that we can change, as generating it mathematically sounds like a nightmare, we can make a collection of PAAs for the conditions we want to show), this would couple well with a manual defibrillator because we can create our own statuses on the patient like a ventricular fibrillation, show the image on the screen that the doctor can then compare against a card (or not, and they do it the hard real way) and decide to shock it or use other medications (like amiodarone) to cardiovert the patient.
We should have a settings that allow the users to choose if they want this feature enabled or have the simple way, in case of the latter the AED will always work and it will cardiovert every condition.

[Katskan]

Description:
External jugular vein access. A separate option that may be restricted to high level personnel to establish access of the external jugular veins in the neck. Would mean an IV can be maintained and used even when all limbs require tourniquets.

[Katskan]

Description:
Manikin function to select specific number, location and type of injuries and airway conditions. Would aid in efficiency with training.

Description:
Switch Guedel->NPA (nasopharyngeal airway), the advantage of the NPA is that it can be used on patients with a gag reflex, and is often chosen over the guedel/OPA because of that. It may additionally be worth switching the King LT to an ET (endotracheal) tube, or adding an ET tube. ETT intubation is commonly done in military settings by higher level personnel like flight medics because prolonged use of supraglottic devices like the King can cause tissue necrosis in the esophagus.

[Yoshod]

Description:
This might be a bit much, but more realistic cardiac arrests would be nice. Currently as it stands all patients who are in cardiac arrest are asystole, which irl is not shockable. That would require manual CPR, epinephrine, and breathing management to get an output. It would be more accurate (as far as I understand it as somebody who is not medically trained) to include ventricular fibrillation (which can be caused by major trauma) or pulseless ventricular tachycardia. The latter would be simulated by not getting a pulse when checking on the neck or hands, but getting a tachycardic output on the AED X Series. I think what would make this difficult to implement would be only getting the audio of the ECG as compared to a visual ECG.

I will note I'm not a medical professional but friends and family of quite a few so most of this is what I've picked up from hearing them talk, asking questions, and my own research. If I'm getting stuff wrong then please let me know as I'd be interested to learn what's correct.

Edit:
Advised by a friend to mention another type of arrhythmia that could be included, pulseless electrical activity. Generally that would be treated with CPR and adrenaline (not defibrillation afaik) and would be sorted with treating the underlying cause of the PEA (such as major haemorrhage). Like the pulseless ventricular tachycardia this would be diagnosed by having electrical output on the monitor but no detectable pulse.

[Will-Nichols]

Description:
Manual defibrillator in the medical facilities, we can add a certain chance of the AED to not function properly and that would require the patient to be transported to the medical facility where the manual defibrillator is available (and only usable by doctors by default) that would then check the patient and shock it on his will.
This would couple very well with the feature below

Description:
A multi-parametric screen able to be attached to the patient with a UI on it, it will then display the status of the patient with the SpO2, the SpCO2, and the rhythm (a picture that we can change, as generating it mathematically sounds like a nightmare, we can make a collection of PAAs for the conditions we want to show), this would couple well with a manual defibrillator because we can create our own statuses on the patient like a ventricular fibrillation, show the image on the screen that the doctor can then compare against a card (or not, and they do it the hard real way) and decide to shock it or use other medications (like amiodarone) to cardio-vert the patient.
We should have a settings that allow the users to choose if they want this feature enabled or have the simple way, in case of the latter the AED will always work and it will cardio-vert every condition.

Personally as a mission maker I don't want to have anything extra for my medics to have to carry into the field than they absolutely need. We are already loading them down with close to 100lb of gear including weapons, ammo, radios, medical stuff and we are having to config backpacks in ridiculous ways to make crap fit.

If I have them take an AED out with them then it needs to function more than 90% of the time. However anything else is just a reason to call for a medevac to get the casualty out of the field. All these extra jump starters need to be used in a "hospital" setting and not in the field. Once you get to connecting a patient to an AED in real life you need to be ready to move on to the next level of care.

If you are going to put these ultra-complex monitoring devices into the mod then certainly make them have a usability option for only in the hospital or medical vehicles. I don't believe they have a place "out in the field" attached to someone you are still putting white stuff on red stuff with and trying to stabilize.

[Katskan]

A loud, frequent gasping sound effect for pneumothorax or making it turn the torso red/another color would be very helpful, I have lots of grug brain infantry who are having a tough time with not noticing the pneumothorax because it requires reading, and it has not been drawn in colorful crayon and is therefore invisible to them

[Conrimaceogain]

A loud, frequent gasping sound effect for pneumothorax or making it turn the torso red/another color would be very helpful, I have lots of grug brain infantry who are having a tough time with not noticing the pneumothorax because it requires reading, and it has not been drawn in colorful crayon and is therefore invisible to them

I snorted when I read the end of that sentence. Adding more indicators of the patient's condition is definitely something I'd like to do.

[YetheSamartaka]

A loud, frequent gasping sound effect for pneumothorax or making it turn the torso red/another color would be very helpful, I have lots of grug brain infantry who are having a tough time with not noticing the pneumothorax because it requires reading, and it has not been drawn in colorful crayon and is therefore invisible to them

Problem with pneumothorax is, that in quite a lot of cases, patient won't make any sounds, in fact when someone has pneumothorax and you will use stethoscope to listen to their lungs, doctors recoqnize it that it makes less sound than usual. I'm not an medical expert, I just tried to make some research, so feel free to correct me.

From gameplay point of view, yes, we are going to add some graphical indication to the medical menu, but we are also considering the function, that you would have to "check if patient has pneumothorax/hemothorax or whatever". If anything such that will be added, don't worry, it will have on/off button so each community can decide how it will work for them.

[Katskan]

A loud, frequent gasping sound effect for pneumothorax or making it turn the torso red/another color would be very helpful, I have lots of grug brain infantry who are having a tough time with not noticing the pneumothorax because it requires reading, and it has not been drawn in colorful crayon and is therefore invisible to them

Problem with pneumothorax is, that in quite a lot of cases, patient won't make any sounds, in fact when someone has pneumothorax and you will use stethoscope to listen to their lungs, doctors recoqnize it that it makes less sound than usual. I'm not an medical expert, I just tried to make some research, so feel free to correct me.

From gameplay point of view, yes, we are going to add some graphical indication to the medical menu, but we are also considering the function, that you would have to "check if patient has pneumothorax/hemothorax or whatever". If anything such that will be added, don't worry, it will have on/off button so each community can decide how it will work for them.

Yeah in real world practice an ultrasound or x-ray is best for finding a pneumothorax but it's kind of frustrating to the rock eaters who only view it as being killed by something that is silent and invisible

[YetheSamartaka]

A loud, frequent gasping sound effect for pneumothorax or making it turn the torso red/another color would be very helpful, I have lots of grug brain infantry who are having a tough time with not noticing the pneumothorax because it requires reading, and it has not been drawn in colorful crayon and is therefore invisible to them

Problem with pneumothorax is, that in quite a lot of cases, patient won't make any sounds, in fact when someone has pneumothorax and you will use stethoscope to listen to their lungs, doctors recoqnize it that it makes less sound than usual. I'm not an medical expert, I just tried to make some research, so feel free to correct me.
From gameplay point of view, yes, we are going to add some graphical indication to the medical menu, but we are also considering the function, that you would have to "check if patient has pneumothorax/hemothorax or whatever". If anything such that will be added, don't worry, it will have on/off button so each community can decide how it will work for them.

Yeah in real world practice an ultrasound or x-ray is best for finding a pneumothorax but it's kind of frustrating to the rock eaters who only view it as being killed by something that is silent and invisible

First thing would definetly be some graphical indication, similar to broken limb. Also I got idea, when speaking about broken limbs, sometimes when you get your limb broken, it will make that bone-cracking sound. Something similar could be done for pneumothorax, that the injured would make some half-breath or something, dunno, that is yet to be properly thought through.

[FluffyGhoster]

A loud, frequent gasping sound effect for pneumothorax or making it turn the torso red/another color would be very helpful, I have lots of grug brain infantry who are having a tough time with not noticing the pneumothorax because it requires reading, and it has not been drawn in colorful crayon and is therefore invisible to them

Problem with pneumothorax is, that in quite a lot of cases, patient won't make any sounds, in fact when someone has pneumothorax and you will use stethoscope to listen to their lungs, doctors recoqnize it that it makes less sound than usual. I'm not an medical expert, I just tried to make some research, so feel free to correct me.
From gameplay point of view, yes, we are going to add some graphical indication to the medical menu, but we are also considering the function, that you would have to "check if patient has pneumothorax/hemothorax or whatever". If anything such that will be added, don't worry, it will have on/off button so each community can decide how it will work for them.

Yeah in real world practice an ultrasound or x-ray is best for finding a pneumothorax but it's kind of frustrating to the rock eaters who only view it as being killed by something that is silent and invisible

First thing would definetly be some graphical indication, similar to broken limb. Also I got idea, when speaking about broken limbs, sometimes when you get your limb broken, it will make that bone-cracking sound. Something similar could be done for pneumothorax, that the injured would make some half-breath or something, dunno, that is yet to be properly thought through.

We could add a stethoscope (so we can reuse it later) and add the action on the chest to do the percussion if the user have it, if it's using the base settings it will just tell him there's a hemothorax, if it's using the advanced settings it will tell that it's hyporesonant (conversely in case of pneumothorax it would be hyperresonant)

[Katskan]

Item: Burn Dressing
More specific to equipment that is used for burns, dry and wet burn dressings often come as large pads in sterile packaging, designed to be applied directly to a wound and secured. Real-world they are usually significantly larger than normal dressings, the ones I carry at work take the same space as about 40 regular sterile gauze pads, though I know there are smaller dressings that are on the market. Balance-wise it'd probably work to have them somewhere like 1.5x effective as the equivalent mass in regular dressings: for example if a large burn would take 3 regular dressings to stop fluid loss, then the burn dressing would have 2x mass as a normal dressing

[Katskan]

Recent discussion reminded me: often times neck wounds need occlusive dressings. Could add a chance for a "blood vessel injury" in the neck, bleeding very fast with a chance to cause cardiac arrest (they can pull in air emboli because of the venturi effect). Would be an interesting change up, and while a purpose-built chest seal won't work, a general "occlusive dressing" would work on both sucking chest wounds and vessel damage in the neck

[AVESUM]

Description:
Add two player stretcher carrying.

Implementation:
Similar to how GGE Captive animations allow one player to "slave" the other, this could be implemented in KAT. The idea is that it is required for two players to separately interact with a stretcher;
The first player to interact gets the front carry position (kneeling with stretcher, unable to move).
The second player is attached to the rear carry position and slaved to the first players movement along with wakling/running animation played. Either of the players can abort the carrying by "exiting the vehicle" and the movement is put to an halt in kneeling position.
Gameplay benefits would be that it is possible to walk and run with a stretcher without the immersion breaking single carrying.

[Katskan]

A Code Summary option would be very useful for training and possibly also debugging. Could simply be a view you can scroll through for past vitals checks and treatments. An example of a real one: https://i.imgur.com/g3tu9zw.jpg

[Oxan-AU]

New to Github, not sure if this is entirely appropriate, but just some comments on these suggestions from a realism perspective. Seems better to post here than the discord.

Regarding intubation. Not opposed in principle, but it's not a recommended intervention in the Tactical Field Care phase of TCCC (which I'd argue is the generally applicable context of TCCC for most Arma groups). Intubation is not even in the skill set of the majority of military medics. Extraglottic airways (in KAT, the King LT, although it should be updated to the iGel) is preferred. Or if that's insufficient, the next step would be surgical airways. So 1) I don't think intubation should replace the King LT/iGel/supraglottic airway, and 2) if a more advanced airway device than the King LT is going to be introduced, it should be surgical cricothyroidotomy.

Regarding pneumothorax. Okay, this one isn't that realistic, but just as a suggestion on ways to provide an audible cue for pneumo/haemothorax, you could consider using audio of a wheeze or crackles. Generally these might be sounds you'd hear when listening to the lungs of someone with asthma or fluid on the lungs, but sometimes they can be heard externally without a stethoscope. It's not something I've ever experienced or read about for someone with a pneumo/haemothorax, but it's one possible solution that isn't "too" farfetched.

Regarding cardiac arrest. I'd like to see less focus on cardiac arrest as a whole. The way it's represented in ACE, with chest compressions and defibrillation, is inherently flawed since it doesn't realistically reflect the reversible causes of a traumatic cardiac arrest, which is what we're talking about in the Arma context. In traumatic cardiac arrest, less emphasis is placed on CPR/defibrillation, with the focus being on aggressive haemorrhage control, fluid resuscitation, airway management and alleviating tension pneumothorax and cardiac tamponade. It should be needle decompression and not CPR that's getting pulses back in ACE.

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Now I'm done complaining, I'd like to suggest:

Description
TXA, Tranexamic Acid. It's used to help treat/prevent haemorrhage shock by promoting the formation of blood clots to minimise bleeding, in super simple terms. The suggested implementation here is to universally extend the minimum reopen delay timer of all bandages, or dramatically reduce the reopening chance. I think it's both realistic and adds value to the simulation, and is a balanced alternative to stitching (permanent wound closure at the cost of potentially quite a long interaction v. temporarily delayed wound reopening times at the price of a relatively short interaction).

Description
Pneumothorax sounds. Basically what I posted above but just trying to keep the right format for suggestions. Consider using audio of a wheeze or crackles to provide an audible cue for a pneumo/haemothorax.

[yesthatRiVin]

Add syringes.

ACE already has the code to combine items through the ace interact menu (chemlights and chemlight shields) so it should be possible to create a system where you have an item "syringe" that you can combine with a drug to create a " syringe". It would work under the same conditions as an IV, i.e. it needs a heartbeat to work, and the arm can't be too damaged. Once it's prepped, it should show up in the ace medical menu in Advanced Treatment, the same as IV. It'd obviously be disposable. That way medics can have a way to administer "unfucking shit" drugs like TXA without having to establish an IV line beforehand, allowing quicker treatment time for critical patients.

Alternatively, if that's a bitch to code you could just create syringes that are prefilled with critical drugs like TXA, Amio, Ketamine (once you finally add it), etc. That way you could code them basically as an auto-injector that only works when the limb satisfies the "IV works" condition. Some medics might actually prefer that because it means they don't have to go back to the ACE self-interact menu if they didn't prep enough syringes before treating.

[Ghostworrior]

Add drop rates/pressure infuser.

It would be cool specially for an feature already present in ACE Pharm IV clotting, to get the option to change Infusion drop rates.

Normal Infusions run like they do now if fully opened, with only half the flow rate if half closed and so on.
I would suggest values of Running free, half closed, slightly dripping.

On the other hand I would like to see the implementation of pressure infusers, which would allow the medic to set a pressure as he desires.
The value will be check against the current RR of the patient. ((sys value / sys rr)+(dia value / dia rr))/2 the result would be applied as a multipler for the flow rate.
All chances and other variables are examples and would be awesome if editable in the addon options.

[Ghostworrior]

Change AAT Kit and add NCDs/drainage sets.

I would suggest that we separate the NCD needles and the drainage sets, which currently are within the AAT Kit.
This would allow medics and community's more freedom: i.e. having a frontline medic being able to fix a tension pneumothorax but unable to fix a hemopneumothorax, which would require higher medical aid...

The before mentioned NCD needles could come in to types:

1. proper NCD device with an 95% success chance.
2. Improvised NCD i.e. 14G IV needle 50% success chance.

The drainage set would be a straight forward replacement for the AAT Kit with only one function.

For the moment I would remove the AAT Kit till my next idea would be in the ring.
All chances and other variables are examples and would be awesome if editable in the addon options.

[MiszczuZPolski]

We already have IV/IO flow rates dependent on circulation... Now I would be cool specially for an feature already present in ACE Pharm IV clotting, to get the option to change Infusion drop rates.

IIRC there isn't flow rate dependent on circulation in KAT Pharmacy (except for one addition - if pulse <20, flowrate/1.5)

About rest of request - i would like to see some more explanation/description how things should work - you can ping me on discord if you want - easier to discuss things there

[Ghostworrior]

Airway Management Extension.

The next big thing you devs are going to hate me for...

Escalation Airway Management:
Till the KingLT all stays the same.
The King LT gets a 10% chance to fail placement, has the option to reapply without consuming the KingLT.

There is a 5% chance of the patient getting an difficult airway parameter upon going unconscious.

A patient with difficult airways can either be ventilated with a KingLT but with half capacity only (SpO2 change gets halfed)
or cant be ventilated at all, chance for both could be standard 50/50.

If the patient cant be ventilated you can get an AAT or Surgical Airway Kit (naming change could be good to avoid confusion)...
which acts as the KingLT does now, completely ignores/removes occlusion and obstruction, but induces slight pain.

All chances and other variables are examples and would be awesome if editable in the addon options.
Thanks for your work guys... If I would be more competent I would try to help but...

[Paramed101]

Description:
Feature request for AEDs to provide feedback.

The use of an AED is to provide Automated check on the patient's heart activity and suggest if a shock is practical.
Every AED would do this and provide audio feedback like this:
https://youtube.com/clip/Ugkx0j6qGgcTWG9dxJ5I_suPX0CzxEEeCwAU

HOWEVER, AEDs generally do not provide SPO2 or pulse feedback. This would be the benefit of an AED-X.

Currently
Currently, the "normal" AED doesn't provide any assessment or audio feedback.
The AED-X is able to provide audio feedback and tell you if it's a shockable rythem.

Feature request
Add the ability for the "normal" AED to "check rhythm". Do NOT add the ability to "monitor vitals" as this would be reserved for the AED-X.

Reason
Without this feature, it is required that you use an AED-X if wanting to use the advanced cardiac system, making the AED almost pointless.
By adding the feature, it actually makes the AED a useful alternative to the AED-X, but still make the AED-X the best option.
It balances the equipment and makes it work like real life.

I have seen this has already been requested Im requesting again ato show interest

[yesthatRiVin]

Credits to ArcherAdaptive for this idea.

Have blood expire after a certain amount of time. It's unrealistic to have units out there running around for hours with blood in their packs with no downsides. So have it so unless blood is stored in a medical vehicle, it expires (removes itself from the users inventory with a popup saying "<#>mL Blood has expired"). The default value should be 600 seconds, with the option to change that in settings.

[Will-Nichols]

Credits to ArcherAdaptive for this idea.

Have blood expire after a certain amount of time. It's unrealistic to have units out there running around for hours with blood in their packs with no downsides. So have it so unless blood is stored in a medical vehicle, it expires (removes itself from the users inventory with a popup saying "<#>mL Blood has expired"). The default value should be 600 seconds, with the option to change that in settings.

The rule for real world is not having RBC units out of temperature controlled storage is 30 minutes and not longer than 4 hours for a complete transfusion of the RBC unit. In my humble opinion the default should at least be 30 minutes (1800 seconds) and have it as a changeable option in the settings because not all units use the "blood" within the 10 minute mark and several don't use it at all because they use the "plasma" and "saline" from ACE because it acts the same as "blood".

[Katskan]

Perfusion system overhauls/expansions

Part 1:
Set CPR heart rate to 100-120

Part 2:
Raise minimum heart rate to lose SpO2 from poor perfusion to 50. Replace the current system where O2 loss occurs when BPM is under 20, to any pulse where BPM is under 50 O2 is lost.

Part 3:
Add a check that if the patient is conscious, if their BP is <90 systolic then they lose SpO2. Additionally, allow being made conscious by carbonate or slaps based on vitals only, not blood volume.

Why? This does 2 things that bring positive depth to the system. First, it makes medications that primarily alter BP have function beyond manipulating IV flow rate. Second, it gives experienced medics options to use tools to wake patients early, provided they can manage the resultant consequence in terms of burning O2.

Also who does CPR at 30bpm. Arma characters need to have a mass re-cert in BLS.

[Katskan]

Organ damage types as a surgery expansion:
Add organ damage types which can occur similar to how pneumothorax is done, where depending on the part of body hit, above a certain damage threshold you roll a chance for different organ issues.
Example ideas:
Chest:
Heart- causes severe pain, rapid SpO2 loss, continuous rapid blood loss until treated
Lung- current pneumothorax system, add continuous slow blood loss until hemothorax is treated
Liver- rapid blood loss until treated, slow increase to acidosis level
Kidney- rapid increase to acidosis level

Head:
Major vessel injury- rapid blood loss until treated
Brain damage- high chance of losing consciousness until treated, increased vomit chance when unconscious

How to treat:
Add new tools:
1- vessel repair kit
2- wound suction kit
3- graft mesh
Example procedures:
Heart repair- Incision, retract skin, cut bone, retract bone, suction blood, vessel repair, graft mesh, bone plate
Liver repair- Incision, retract skin, suction blood, vessel repair, graft mesh
Kidney repair- Incision, retract skin, vessel repair
Major vessel injury- Incision, retract skin, vessel repair
Brain damage- Incision, retract skin, cut bone, retract bone, suction blood, vessel repair, bone plate

How to balance:
With configurable damage thresholds and occurrence chances, these can be eliminated from gameplay or be made relevant as consequences for units which do not use instant death settings. Additionally, for units which have rear-line support units dedicated to in-depth medical performance, it allows for medical evacuation to serve a purpose beyond simply RP or evacuating to a designated area where the newer bone and debridement options can be performed.
Disclaimer: heavily inspired by Space Station 13's organ and surgical system.

[Katskan]

Deteriorating fractures.

Like it says on the tin.

An option to have simple fractures be made worse by moving around too much while they're not splinted.

[Katskan]

Add a setting to allow time penalties/boosts on actions like ptx/tptx/htptx/surgery for lower medical level. Basically setting so "doctor" tagged personnel can do stuff faster than "medic".

[Th3Jock3R]

Hallo,

first thank you for continue the development of this great mod... We realy appreciate it!

Second, to my request:
It would be very nice if there is a setting option in the CBA settings for the KAT blood groups, as what the normal ACE blood items without blood group are treated.

My suggestion for this would be the setting options:

0: that means it is compatible with all Bloodtypes
random: That means when creating the transfusion, it will be decided internally which blood type it is. (good for survival missions, where unidentified blood can be found)
Incidentally with Incompatible: Here, there would be a risk for AB (& AB+) to get an incompatible blood unit because either donors blood unit is a rare blood group which cannot be mapped within the AB rhesus factor system or the unit is simply spoiled.
Incompatible: are always incompatible, RP technically corrupted or contaminated in end time scenarios like Exile or similar.
Thank you for you great work and wish you all a nice Christmas time!

[MiszczuZPolski]

So basically, you want new items like "Unidentified blood" and "Spoiled blood"?
ping me on kat dc, its easier to discuss

[Th3Jock3R]

link?

already found it... Sry, Layer 8.....

[MiszczuZPolski]

Suggestion made by NMoreira88 in #77

1. Add the option to raise victim's legs.
   a) If the victim has low blood volume but is not able to receive fluids due to inexperience, lack of permissions or no equipment available, there should be the option to raise his legs in order to concentrate fluids in his vitals.
   b) If the victim has increased heart rate due to low blood pressure this would also help slowing it down, specially important if the victim has wounds that aren't closed or torniqueted limbs without bandaged wounds.

2. Adding a breathing feature to victims, to better complete the SpO2 mechanic.
   a) Right now there's nothing related to breathing except for pneumothorax injuries and airway management. Implementing a breathing function would make triage a lot more decisive. According to NAEMT TC3 ASM victims that are unconscious and not breathing shouldn't be prioritized over other types of casualties that retain the power to breathe, dispite responsiveness and consciousness. This is obviously when under fire and not in an ER or Battalion level Trauma unit and normally a guideline for Combat Lifesavers.

[MildlyInterested]

If person has a broken or splinted leg their leg apparently is (temporarly) shorter than the other one.

Since their stride is now shorter on one side the patient should start walking slightly in circles and can't run straight anymore without A/D input.
That's my suggestion.

[GoldenTomcat]

1. Add a scrollbar to the medications tab. The medications tab allows for a maximum of 11 items. This limits what you can carry and use if you need to carry 12 or more medications.

2. Add an ability to differentiate which arm the pulse oximeter is on. At the moment, the "remove pulse-oximeter" option displays on each arm irrespective of where the psychical device is. This is a problem in a scenario where you have tourniquets on each arm and you want to remove the one blocking the pulse oximeter. This ends up in you having to guess which arm to remove the tourniquet from.

Adding a line in the overview, similar to how the tourniquet or IV/IO needle shows up, would be an ideal solution.

[MiszczuZPolski]

1. is not easy thing, that require messing with arma GUI - and nobody really want to do it
2. will be added "soon" by Blue

[GoldenTomcat]

Yeah, I had a feeling that was going to be off limits, no bother though.

Good news on the second one though, thanks!

[Will-Nichols]

Here are a couple suggestions.

Add more in-depth treatment to burns.

-Burns should cause tachycardia and hypotension secondary to hypovolemia. This is typically treated via fluid resuscitation using the parkland formula. Burn sheets would be a nice addition too.

How about COULD CAUSE instead of SHOULD CAUSE; It's not always a if this then that response by the human body to a trauma event.

-Burns that affect the airway can rapidly induce swelling and cause closing of the airway if an advanced airway adjunct is not in place.

Airway

-For low skilled providers BVM usage can be over zealous with ventilations, and without an advanced airway adjunct in place this could cause air to enter the stomach and cause gastric distention. This should cause emesis to enter the upper airway more frequently.

-It says that intubation is added with this mod, however, I do not see endotracheal intubation in-game, only supraglottic airways. ET intubation allows for a vastly more secure airway and prevents vomitus and blood from entering the lower airway.

-surgical cricothyrotomy should be an option for severe trauma or airway obstruction.

hemorrhaging

-unstable closed fractures should cause internal hemorrhaging.

Same thing as what you say about burns; unstable closed fractures CAN POSSIBLY/COULD CAUSE instead of SHOULD CAUSE; It's not always a if this then that response by the human body to a trauma event.

-Add the application of manual traction or using a traction splint for midshaft femur fractures.

-Add a pelvic binder for an unstable pelvis fracture.

Limitations of the Arma 3 engine don't allow for details like femur fractures of pelvic injuries. It's just not possible.

-Tourniquets that are applied for extended periods of time should cause rhabdomyolysis when removed.

Misc

-add sodium bicarbonate for treatment of metabolic acidosis.

-IVs should not be allowed in a limb with a fracture as it could cause extravasation.

Again limitations of the Arma 3 engine on the IV placement and bicarb is already in one of the drug sections of the mod or a supporting mod.

-Please add a notification when people enter your medical menu. I've been drugged to many times against my will ;'(

[Th3Jock3R]

I would like to request the addition of a feature that enables blood volume to regenerate over time. It would be nice, if the feature include the option to adjust the regeneration rate via CBA settings (ml/hour). Ideally, there would be an option to require fluid consumption for regeneration

[TubaHorse]

I think a cool addition to available equipment would be an AutoPulse-like device. Some sort of equipment that you attach to a unit's chest that maintains CPR while you move them or otherwise work on them. It would make sense for it to take up a larger amount of inventory space to balance it out. Maybe it causes severe pain when used because it's a piston crushing your chest to keep your heart beating?

Now that I think about it... maybe ribs should be a breakable bone in the game? Susceptible to crushing damage?

[ItsGiantCookie]

A compression bag for IVs to increase flow rate with the downside of taking some time to prepare the bag would be a god addittion in my opinion

[Will-Nichols]

I think a cool addition to available equipment would be an AutoPulse-like device. Some sort of equipment that you attach to a unit's chest that maintains CPR while you move them or otherwise work on them. It would make sense for it to take up a larger amount of inventory space to balance it out. Maybe it causes severe pain when used because it's a piston crushing your chest to keep your heart beating?

Now that I think about it... maybe ribs should be a breakable bone in the game? Susceptible to crushing damage?

It's been a while but I do remember a function in ACE (maybe a long time ago) that you could possibly crack/break ribs doing compressions in ACE Medical; or maybe that was a different mod that added something to ACE. I know it was one we ran in a previous milsim unit. If I can find the details I will post that in here.

[Will-Nichols]

A compression bag for IVs to increase flow rate with the downside of taking some time to prepare the bag would be a god addittion in my opinion

Are you thinking about a "Pressure Infusion Bag"? If so they aren't really used for field operations because you have to maintain a steady state of pressure with the bag from an air source like an air compressor or hospital supplied air (which again comes from a big ass air compressor that distributes air throughout the hospital/surgery center.); I sell them for a living.

In my humble opinion that's not something that would be practical; either in game or in real life if you are only using it in the field. Way too many milsim units want realism for medical but shortcuts on doing the actual medical stuff like surgical, broken bones and recovery/healing.

[Will-Nichols]

I think a cool addition to available equipment would be an AutoPulse-like device. Some sort of equipment that you attach to a unit's chest that maintains CPR while you move them or otherwise work on them. It would make sense for it to take up a larger amount of inventory space to balance it out. Maybe it causes severe pain when used because it's a piston crushing your chest to keep your heart beating?
Now that I think about it... maybe ribs should be a breakable bone in the game? Susceptible to crushing damage?

It's been a while but I do remember a function in ACE (maybe a long time ago) that you could possibly crack/break ribs doing compressions in ACE Medical; or maybe that was a different mod that added something to ACE. I know it was one we ran in a previous milsim unit. If I can find the details I will post that in here.

It wasn't ACE. It was XMed (https://github.com/X39/XMedSys1)

[ghost]

hey if its not too big of a deal, id love for the classnames file here on github to be updated with all the items not currently listed. im currently making a mission and im not 100% sure on how KAT medical fully works yet, so for the medics i want to give them an arsenal with all the medical items in it and i need all the classnames for that. the only problem is, theres nowhere i can find with all the classnames available :/

[ItsGiantCookie]

A compression bag for IVs to increase flow rate with the downside of taking some time to prepare the bag would be a god addittion in my opinion

Are you thinking about a "Pressure Infusion Bag"? If so they aren't really used for field operations because you have to maintain a steady state of pressure with the bag from an air source like an air compressor or hospital supplied air (which again comes from a big ass air compressor that distributes air throughout the hospital/surgery center.); I sell them for a living.

In my humble opinion that's not something that would be practical; either in game or in real life if you are only using it in the field. Way too many milsim units want realism for medical but shortcuts on doing the actual medical stuff like surgical, broken bones and recovery/healing.

I completely forgot I posted this but they are used (at least in the german army, source me and my former colleagues) in the TEC-Phase, sometimes in TFC if the need arises and especially in PFC (but that's mainly special and specialized forces). The design we use come with a hand-pump and pressure gauge built in, which means you don't need a continuous pressure source but they need to be checked frequently (which you do anyways if you do your job properly).

On the point of practicality, from what I gathered from the Medics and EMTs I worked with while in, who used them in action, it's pretty damn pratical, once you have a secured IV/IO access, you hook up 500mL to 1L of fluids, pump it up and work away on the rest of your algorithm. So to them it's a big time saver, especially when you work in pairs.
It also is sometimes required for patients who are going into hypovolaemic or hemorrhagic shock, since you need to infuse up to 1000 ml of fluids in 10–15 minutes or 1 unit of blood in 20 minutes.

The WAKN Guidelines (S1-Leitlinie 001-042 (This one is for IO Infusions)), which are in part made by the Bundeswehr, also support the use of pressure infusion in pre-clinical and emergency cases.