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Info Arma 3: ACE Pharmacy Update - Surgical Actions

Mazinski.H

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ACE Pharmacy Update - Surgical Actions

Hello everyone. Over the past few months we have been working on adopting the ACE Pharmacy mod into the 7th Cavalry. This adoption has so far been very successful with a general decrease in patient management time and an increase in medical interactivity, allowing medics to be more involved in the treatment process while not impacting the general gameplay experience for non-medical personnel. This last part is an important part of the ACE Pharmacy philosophy and what distinguishes it from say, KAT Medical. I do not believe that we should adopt a medical system that puts undue burden on the regular trooper in any given operation, and its something that I plan to stand by as I continue to work on and develop ACE Pharmacy.

With that being said, I would like to talk about the most recent update to ACE Pharmacy and the next few updates coming down the pipe in the next month or so. But first, a bit of a primer on fractures. Currently if you have a fracture, your next actions are pretty simple:
  • Apply a splint to stabilize or "blue" the fracture
  • Wait for a medic to get a PAK which clears the fracture
  • Done
This system is fairly simple and in terms of interaction on both the patient and medic side is pretty easy. All the patient has to do is carry a splint and a PAK and all a medic has to do is be there to execute the PAKing process. However, there is a slight problem. The process of PAKing someone is the worst medical interaction in ACE Medical. You open the menu, press the PAK button and then sit there for what could be three to four minutes watching a green bar go by. Why is it this way? Because PAKs don't just heal fractures, they heal everything so every single wound a patient has just adds more and more time onto the PAK. Say you have a patient who got some nasty fragmentation and they need to be PAKed, well looks like you and the poor trooper are just sitting next to each other forever waiting for the PAK to heal every single wound and fracture and any other condition the patient may have. It's miserable.

How does ACE Pharmacy fix this? By allowing medics to pick and choose what they want to heal on a patient. This is executed through a new fracture system (and eventually a debridement system) which allows medics to selectively full heal fractures and body parts. So now instead of having to PAK someone because they broke their leg and need to be able to run, you can simply work on fully healing that particular leg with the fracture and leave everything else for later.

How to clear a fracture

ACE Pharmacy separates fractures into two basic types, simple fractures and surgical fractures. Simple fractures are the most common and can be handled by a medic in the field without the need for a PAK. Surgical fractures are rarer and come in two forms, compound and comminuted. These are more complicated and require some sort of medical vehicle or facility to treat and also require a number of special medications and tools to handle. To be clear, you can still heal all fracture types with a PAK. This system DOES NOT remove the functionally of the PAK, it simply gives more options for medics to treat patients with fractures. Fracture types are identified by using the "Check Fracture" action in the ACE Medical menu and anyone can check a fracture type regardless of medical level.

Simple fractures are fractures with a single break point. These are the easiest fracture type to treat and simply require the medic to "pop" the bone back into place. This is marked in the medical menu as "Perform Closed Reduction" because the actual process is known as a closed reduction. As you can imagine, popping someone's bone back into alignment is not the most pain-free process so we've gone ahead and added in some new medications to help with that (and it wouldn't be Pharmacy without new medications). Both Lidocaine and Morphine can be used to negate the pain that comes from a closed reduction, just know that lidocaine clears through the patient's system much faster than morphine does.

Surgical fractures are more complicated and as the name suggests, requires surgery. This also introduces a number of different medications and tools to enable a medic or doctor to perform the surgery. For going through the surgical fracture process, it will help to lay it out in a list:
  1. Assuming you have already confirmed the fracture type, the first step is to sedate the patient. This is done through the application of Lorazepam. Technical note here, once a patient is sedated, they will not become conscious until the counter-drug is applied so you don't have to worry about the patient waking up halfway through the process.
  2. Place the patient under general anesthesia. This is done through the application of Etomidate. Note that unlike sedation, general anesthesia is not a steady state and the patient will fall out of anesthesia if you aren't careful. Falling out means cardiac arrest. Technical note, etomidate stays in a patient for 35 seconds and with a push time of 5 seconds, this means every 30 seconds you need to reapply etomidate.
  3. Perform the Incision. Incisions are done with a Scalpel and once done will start a 45 second timer. This timer is what checks for general anesthesia which means that it will check for Etomidate right after the incision is performed and then 45 seconds after. It will then keep checking every 45 seconds until the fracture is cleared, so from here you better have fast hands.
  4. Expose the Fracture. Requires Retractors, simple as.
  5. Either Irrigate the Wound or Clamp the Fracture. Irrigation is only done with a compound fracture and requires a 250ml bag of saline, no other fluids work for this process. Clamping is done for comminuted fractures with a Clamp, simple as
  6. Perform the Open Reduction. Assuming you have done the surgical steps in order (Incision, Expose, Irrigate/Clamp) you will be able to successfully perform the open reduction which is the process of screwing a bone plate into the bone. Unsurprisingly, this is done with a Bone Plate.
  7. At this point, the fracture is fully healed and the incision timer will be disabled. From here, we need to Remove Sedation which is done with Flumazenil. Once Flumazenil is pushed, the patient can freely wake up. Note that this doesn't wake the patient up, it just gives them the ability to. You can either let them wake up on their own or "reorient" them awake.
It seems like a lot, I know. But you can run through this whole process in 30-40 seconds once you get the process down. Few points for troubleshooting, if you see the a dialog in the upper right show up after a surgical action that reads "Surgical Action Failed," this means you did the Incision, Expose, Irrigate/Clamp process out of order and will need to go back and figure out what you missed. Know that all of the surgical actions will show up after you perform the incision, so make sure you don't jump the gun on that. Also if you are having trouble getting the timer right (the patient keeps falling into cardiac arrest), you either need to apply Etomidate more frequently or get someone else to help with it and keep time for you so you don't hit that 45 second timer without Etomidate.

F.A.Q


Q: How will this be implemented in operations - Honestly, I am not sure. This is a brand new system and we still need to do some testing to figure out how exactly we want to have all of our settings built out. If it turns out that this just isn't compatible with what we can currently do, then there is a setting that turns all of this off and if any mission makers are unsure about it, then they can disable it with a single CBA setting.

Q: Assuming this is put into operations, how much will it impact troopers? - The biggest impact to troopers is that those surgical fractures require them to be unconscious before we can treat them. The hope is that with the current timers, the amount of time they spend unconscious will be less than the amount of time they would have to sit around and wait for their PAK to be done so in terms of time spent out of the fight, we gain some time back and trade it off for the unconscious part. Also remember, this isn't about splinting or "blueing" fractures, troopers will always have the ability to do that, this is more about after the fight is done and we are performing larger reorgs which is when we would handle those surgical procedures.

Q: Assuming this is put into operations, how much will it impact medics? - Learning the surgical procedures is the main part, and technically they don't have to learn how to do them since PAKs still work just fine and they can default to those if they don't know how surgical works.

Q: How will this impact TacR? - Unknown at this time. Currently we have it enabled to see how it works and like I previously said, we still have the ability to PAK so the only thing that has changed is that we are giving people more options in terms of how they want to treat patients. The biggest possible problem is Lorazepam since it has the highest risk of abuse, but the same thing can be said for Morphine and just like we have Naloxone for Morphine, we have Flumazenil for Lorazepam

Q: Is there anything else like this coming down the line? - Yes, namely debridement which is the process of removing dead skin from wounds to allow them to heal. This will focus on healing limbs themselves rather than the fractures so we can fully heal red limbs or red heads/chests with another short surgical procedure (maybe 20 seconds per body part, haven't sorted those timers yet)

Future Updates

  • Change the models for all the surgical tools. Currently they are using Laws of War DLC equipment which of course doesn't work if you don't have the Laws of War DLC.
  • Add logs for each surgical action to better track what actions have and haven't been performed.
  • Adjust full heal function so that it handles advanced fracture types and sedation.
  • Add Zeus modules for ACE Pharmacy features.
  • Add debridement.
 
Last edited:

Piper.R

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Etomidate is tricky to manage, as you mentioned. I much prefer Ketamine, and if the patient has a good blood pressure I know a lot of CRNAs in hospital like Propofol. We used to use Etomidate and Succinylcholine for induction before intubation and I was not a fan.
 
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