Lumen Jam #4 - Adding Medical Emergencies to the SRD

One thing that I had in mind from the beginning was that URCAT's Encounter system should not rely solely on combat to create opposition for the players. After all URCAT is the Unaligned Rescue and Casualty Assistance Team. Conflict is not suggested in the name, though it is something that URCAT Officers will have to do sometimes.


In the next set of posts on URCAT, I will discuss the basics of non-combat Encounters and the design decisions behind them. Today, I will start with the medical treatment system that I developed for field medicine. Please keep in mind that this is a work in progress and is subject to change.


Content warning: Serious injury and death will be discussed in this blog post, though not to graphic levels.

Inspiration

One of the major inspirations for URCATs medical treatment system is the Surgery mechanic that exists in MASHED: A Korean War MASH RPG by Brabblemark Press. To give some background, MASHED is a Powered by the Apocolypse (PbtA) TTRPG inspired by the Mobile Army Surgery Hospitals (MASH) that were used to treat casualties close in behind the front lines during the Korean War (1950-53). These are the same front-line hospital units that inspired the M*A*S*H franchise of movies and TV shows that came out in the 1970s & early 80s.


In MASHED, the Surgery system is based around the use of cards that indicate the patient's Injuries on the core parts of the human body (Head, Torso, Abdomen, Right Leg, Left Leg, Right Arm, and Left Arm). In addition to indicating location, they also indicate the severity of the injury (2-harm, 3-harm, 4-harm, or 5-harm) and the type (explosive, bullet, unknown, etc).

Example patient (Credit: Brabblemark Press)

The players then use a series of medical moves based on their playbook type to stabilize and treat the patient before timers on the injuries and the body run out. If any of the timers run out before the treatment is complete, then the patient either dies or the surgeon is forced to amputate an affected limb. In many ways, surgery in MASHED is a balancing act of resources in the form of character workload in the surgical suite, time, and the amount of additional stress the characters can tolerate going into the casualty rush.



URCAT's Triage Elements


URCAT uses an Encounter system whenever the players are in a situation where they have to accomplish a series of objectives in a limited amount of time during a Deployment, the main action portion of a session of URCAT. At the moment, the three main Encounter Elements are Combat Elements, Triage Elements, and Rescue Elements.


Triage is the term that I am using for medical situations even though a more appropriate term might be field aid. Triage normally means examining a patient or group of patients, determining the severity of their injuries, and creating a plan of treatment based on the priority of needs. However, I went with Triage for two reasons.

  1. The first step of a successful URCAT team is determining which patients are in most critical need and helping them first.

  2. I wanted to emphasize that the URCAT team are only field medics. They can be quite effective, but they are still only the first in a line of medical professionals that will be seeing many of these patients. An URCAT Officer can completely heal people with minor injuries, but for more serious patients the officers' job is to stabilize and evacuate them for treatment at a field hospital.


Introducing a Wounded Character

Mockup for a Wounded Patient tracker
Early mockup for a Wounded Patient tracker

The Triage Element of an encounter starts when the officers discover a wounded character in the field or a character is wounded as part of combat or a rescue event. When this happens, the Deployment Manager (DM) draws a card from a standard playing card deck for each Wounded in the scene. I intend on creating a special board to help the DM track the treatment counter and healing accomplished for the wounded patient, especially since scenes with multiple wounded characters are likely.


The suit of the Wounded Card indicates the type of NPC they are if that is not already determined by the story. Meanwhile, the face of the Wounded Card shows how life-threatening the injury is, going up in severity from Minor to Maximal. The more severe the injury, the more effort will need to treat it and the faster it will need to be treated before the patient’s condition degrades to a more severe state.

The injury severity level indicated by Wounded card results in URCAT

One thing that makes my system different from the MASHED surgery system is that I am reducing the complexity from defining the type and location of multiple injuries on a Wounded character. Instead, they get a single rating for their overall injuries using a modified version of the Abbreviated Injury Scale (AIS). This could be based on one significant injury or a number of smaller injuries that when added together amount to a higher level of severity.


  • Shaken: This patient is not visibly injured, but they may be unconscious or in shock. They do not require a Healing Roll or healing Power, but they will require a round of role-play action or potentially an Approach Roll to get them back on their feet.

  • Minor: This is normally a superficial injury. It does not hinder the patient’s ability to evacuate in an emergency and is unlikely to get worse if treatment is delayed for a number of hours. In fact, these will normally can heal without outside treatment. (ex. a minor fracture, cuts, minor abrasions, minor burns, bruising)

  • Moderate: This is an injury that will need medical intervention to heal properly. The patient might be mobile, but needs to be treated on site before evacuation. Like a Minor Injury, a Moderate Injury will not get worse if treatment is delayed unless the patient takes further harm. (ex. lacerations, major fractures, dislocations, minor organ damage, limited internal bleeding)

  • Serious: These are injuries that need a timely intervention or they will become life-threatening. These injuries usually feature side effects of the trauma like bleeding, swelling, or opening the body for severe infection that will greatly reduce the patient’s survivability if treatment is not started quickly. Hospitalization will be required. (ex. severe burns on limited parts of the body, Minor heart injuries, vein/artery with significant bleeding, clean broken bones, amputation of minor extremities)

  • Critical: Major medical intervention is needed for immediate survival. Even then, survival is not always certain. Evacuation should be made as soon as the patient is stable. (ex. major bleeding, major organ damage, shattered bones or flail rib, complete or almost complete amputation of a limb)

  • Maximal: These are injuries that are practically unsurvivable with our real-world modern medicine. An extreme amount of effort is needed to save a patient, even with the level of advanced field medicine in the Twol League. (ex. widespread severe burns, severed spine in the neck, severed torso, severe trauma to the brain, heart, or liver)


The result of healing is different depending on the injury type, in part thanks to the seeming magical abilities of Bioenergy used by the Officers. With a Minor or Moderate injury, the field treatment is sufficient to treat the injury all on its own. While the patient may not be 100% healed, they will not require time in a hospital. Unless the area is still dangerous, a patient with a treated minor or moderate injury does not require evacuation and an Officer can rejoin the team for further action.


A patient with a more severe injury will require time at a medical facility. Field treatment is only to sufficiently stabilize the patient for evacuation. Once this patient is stabilized, they will remain so unless further harm from an outside source causes their injury to destabilize.


A patient with a Critical or Maximal injury is in a precarious state. The treatment of a Critical or Maximal injury is to reduce the injury to that of a Serious injury. The patient will still need further treatment in the field to be stabilized before they can be safely evacuated to a medical facility.


Healing The Wounded

Because of the time sensitive nature of Encounters in URCAT, they all run in a similar fashion to Combat in most LUMEN-powered games no matter the number or type of elements involved. This means that the players go first and decide their actions, then the DM acts on behalf of the opposition NPCs or environmental hazards in play and potentially add new wrinkles to the action like introducing a new hazard or opposition reinforcements. The DM can also potentially act on behalf of a single member of the opposition whenever a player gets a complication on a roll.


At the end of each full round that has a Wounded character in it, the character's treatment timer goes down one tick. The amount of time is dependent on the type of injury the person has. If a Wounded character has hit the end of its timer, the Wounded character losses a point of healing or moves up to next highest level on the severity scale. If an injury is already at the Maximal level, then the patient passes away. No amount of bioenergy can bring back the dead.


To treat an injury, the Officer has several choices. First, they can use a power. Each HP normally regenerated by a power equals one point of Healing. No roll is required, but the use of a power costs bioenergy.


The results that can occur for a Healing Roll in URCAT

Another option is to make an Healing Roll using the Approach pool of the player’s choice. However, an Officer needs to have at least one Bioenergy and be in Close range in order to make a Healing Roll. Only two Officers can attempt a Healing Roll on a Wounded NPC in a round, though there is no limitation on the use of healing powers.


When an Officer has no bioenergy, they cannot do a normal Healing Roll. Instead, if another Officer is attempting to heal the patient they can Assist them. An Assist is a standard Approach Roll. If successful, the assisting Officer adds +1 to Healing caused by the original roll or allows the primary Officer to reroll one die from their pool in hopes of replacing improving their original result. Only one Assist can occur per patient per turn.


If an Officer has no bioenergy and no one else is available to assist the Wounded patient, the Officer can attempt to Bide Time. This is also a standard Approach Roll. Success moves the patient back up one tick on the Treatment counter. Possible complications may be offering the player a trade-off by making an injury a little harder to treat or taking some sort of other resource or story cost to the Officer. Only one Bide Time can occur per patient per turn.


 

I hope you all enjoyed this little glimpse into URCAT! Hopefully, I will have more news to share soon like the release of an ashcan version of the game. If you have anything you would like to comment on or advice to provide, please either comment here or message me on the various social medias or Discord boards we may be mutual on. ^_^

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