Medical Re-Work:

I’m sure we’re all familiar with the same-consistent medical procedures/practices taking place, the injection of a drug, trauma pack, maybe a splint good to go. It is rare that someone goes back shipside for surgical intervention (unless infected or has severe organ damage that a groundside doc can’t handle).

I’m not saying to make medical scripting more difficult or advanced, but I think some variation is necessary. Infection should (make a return) be possible, requiring antibiotics. You ruptured a lung/collapsed lung, damn, you need a chest tube from a Physician. Excessive burn damage to the face/throat; your airway can possibly close requiring a cricothyrotomy from a medic until a physician can administer antihistamines, perform a tracheostomy, etc.

Mainly what I’m getting at is making medic more intertwined with shipside again, instead of push x/y drug, trauma pack, good to go. Instead the medic should be stabilizing these severe, possible wounds and bringing the casualty back shipside where the more advanced treatment is needed. Not saying to cut out medics completely, sure a GSW or topical burn damage is fine for a medic to handle; but a 3rd, 4th degree burn, you’re going to get a skin graft shipside.

Even some variation to drug delivery would be quite cool. Someone’s unconscious, well fuck, you can’t give pills since their is a risk for aspiration, maybe some drugs where injection (IM/SubQ) delivery may not be possible, maybe even IV or IV push delivery.

I’m sure Doctor mains will agree since we get pretty bored sometimes sitting up there doing the same procedures over-and-over, medic mains might enjoy the more critical care, and nurses may have a more special role in well… “nursing” the marine back to health prior to deployment after their procedure(s).

I expect resistance on this due to “let me just shoot aliens” but I believe it’s a change that most will enjoy.

I am happy to consult with any dev who wants to look into this in the future.


There are other options too.

I actually think one of the best rounds was one where staff were playing with blood and for some reason bloodloss was like 8x.

Had marines being airlifted continually who lost a limb and 65% of their blood in a few minutes… the front turned into a field hospital with marines helping each other with IVs, giving blood, food, etc.

Nobody was perming because the defib kept restarting their timers… but lots of people had to do cpr.

Medical was hopping.
Had to have a doctor doing surgery and one to give blood/dex and stabilize.

Above just to say… a minor tweak could completely change medical.

Sidebar, i have spoken about it before and the reason that medical is dead is that small features have been slowly eroded over time until medical went from challenging… to so easy you wont bother.

If you just added some of those back in.

For example shrapnel… used to have to have a doctor do it. Or it would cause you pain and small damage. Then code changed shrapnel in game and added hedgehog and now you can just remove it with a knife…

Why am I able to dig bullets out of my broken skull and brain with a dirty knife i keep in my boot and cause no damage? Its supper dumb.

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I think it’s… interesting.

The gist is there. Increase importance of medical by creating medical issues in the game (or changing existing ones) to where it requires shipside medical assistance. Going back shipside for serious damage should be more prevalent.

  • Should marines have down time that they have to wait for?
    No. But you can tie that downtime suggestion into the time required to do travel shipside and do the surgery or treatment for serious issues.
  • Ex: A lung, liver or heart operation requiring a specific tool must remain shipside and cannot (generally) be found planetside or…if it can be found planetside is only found in a “ruined”, unfixable state in the planetside medbay. The same goes for larva surgery, for example.
  • A possible scanner buff!?
    I think scanners should be able to pick up the existence of organ damage and roughly what organ it is. No specific numbers or even severity - but simply an ackowledgement of what is damaged. It would make sense. The scanner can pick up the need for Dylovene or Peridaxon…but not mention organ damage outright? Really?


Increased prevalence of planetside doctors has rendered shipside medical dead compared to the past. I feel bad for them honestly and I don’t think it’s sustainable balance wise.*

Marines are way more durable than they should be at times. If you make treatment shipside a requirement (via mechanic and/or roleplay), you kind of counter that issue. As mentioned, it also really helps the situation with a declining shipside medbay.

Damage Accumulation Feature?

Maybe a damage accumulation feature related to serious wounds could even be added. You could tie in delimb chance I suppose?

I was doing a lot of thought on this. I think it’s difficult but there’s some serious benefits to it. That all said… lots of testing needed. It’s uh…it would be one of those kinds of updates where - if it was large - it needs multiple periods fine tuning to get the balance right. Sort of like that time we had Ovipositor added, tank added, queen charge added, changes to rifles and weapons/Spec additions etc.

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I like the idea of adding wound sub types.
Acid vs fire, GSW vs Slash, and degrees of severity.
And having to use different supplies for different effectiveness for each. This does mean that inventory space needs to be considered.
Could add drug interations, heart rate considerations, wound cleaning, torniquets, airways.

But the gameplay line from Organ Damage → Treated By Corpsman → Going back to FOB/Ship to get fixed by Doctor is already pretty long. And organ damage isn’t that infrequent. Or a lot of broken bones.

Marines will try to limp into the firefight on their unsplinted legs anyway. And there’s already a lot of moaning about sub-par medics and doctors making them wait too long as they get fixed or repeatedly die and revive.

And lots of marines that are only alive thanks to peri will just run back into the fight. Either because they don’t care, or they don’t understand why they’re going to go unconcious after it runs out.

Making things more engaging for people who already play medical well would be nice, probably not for the people that don’t already grasp what we already have.

And making changes and additions without annoying the marines that are just here to shoot things, die and get up again to find their gun and shoot more things.

I don’t think we need to add more time from injury to full health. But more complexity and problem solving would be nice. Otherwise Marines would probably need a buff with the amount that would be going shipside.


Unironically enjoyed the waves of marines in medbay hallways waiting for a doctor back in 2016

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I am all for increased medical complications but you have to counterbalance with the fact that a ^ increase in marine injury recovery times will result in a major shift in combat balance towards xenos in terms of attrition

We already have some players expressing issues with the ‘cade hug’ meta but changes like this will make this far more needed as the casualties mount up.

If you want fun doctor role: remove medic defibs, sprite stationary defibrillator on Almayer Medbay. But someone will get threatened for merging that pr.

It’s a weird point in balance rn.

Take a look at the Follow ability while ghosting.

Often marines don’t go below <85 for a long period unless there was massive perma casualties.
Often, they are pretty consistently at 90-100. Partly due to latejoins + marine survivability. I think marines attrition xenos better than the other way around currently. There’s not much traffic back to shipside these days beyond for being hugged.

Cade hug meta is simply a fact of life with current balance. But that doesn’t mean marines lose more. They cade hug even on the frontline because killing power is kind of lessened these days as an individual and it’s virtually a necessity when an assault fails or is temporarily halted (such as by a massive xeno push, robust T3/T2 or Queen).

The issue you are talking about is already there, s if the suggestion proved truly unbalancing, you could buff the marines slightly. How is the situation changed then, ideally? Well - you have marines with a little bit more oommph on a personal level but squishier.

My impression of older balancing + some suggestions

  • Yeah, I might be able kill a lurker or runner easier with a mere M41A or shotgun or whatever… but if I get lit on fire I might husk and there is a potential for decaps (even with helmets) and delimbs.
  • Items might reduce the chance: like helmet but it still exists on a rare basis. Additionally, a T3 like a Rav should not have much trouble delimbing and a crusher Charger should be able to delimb via Charge sometimes.
  • I shouldn’t all but ignore internal issues until I’m literally dying of it constantly. There should be a large incentive to get it fixed early. I like doing IB surgeries in a weird way but outright organ damage requiring dex, peri and dylo…well…that should require an evac and be noted in the Health Scanner. I think that would help a lot for many medics if the Health Scanner literally said: “Organ Damage” (and potentially says something like “Move to Triage” or “Requires Organ Surgery”).
  • Many medics I think simply apply the peri and dex and move on when they really should be making the judgement call and sending the marine up. But since the medic can’t babysit people’s organ damage, what ends up happening is really just a cycle of applying peri + dex until the marine is so messed up they either realize on their own to medevac or the medic makes a judgement call after having difficulty reviving. That’s kind of screwy if you ask me.

The issue with people ignoring things like IB by just taking peri

they know they can because the surgeries can be done quickly planetside. What ends up actually happening is medics occasionally get overwhelmed because dudes have IB that they don’t get fixed and results in massive blood loss … all while regular dead and wounded start to pile up.

how do we make this less of a pain on a personal level for players? Make it so that medics get told on the scanner that someone has the more severe issues and are told its basic level of severity (no numbers). Like with pills, kits and defibs, you could also add a suggestion may also appear on the scanner for what to do. Eg: “Needs organ surgery” or “Needs deep wound treatment” or something.

A suicidal charge might get a kill but it also will mess 'em up a bit potentially and may require shipside treatment which takes them out of the action and is temporarily attrition.

Med is already r-tarded (along with the morrow “balances”) and you wanna **** it up more? hard pass - the 16/7 players might be able to keep up with 40 PRs a month but i cant.

i think we should move toward a more organic medical system and stop for example with the random 200 damage making your dead/ cardiac arrest… maybe tie cardiac arrest to pain and or oxygen damage…
being on low oxygen could also for example damage internal organs…

Sounds like you want a Lifeweb style medical system, where your ‘health’ is tied to your Brain’s status. Your brain remains alive so long as you are receiving oxygen and blood to it, but that also your body is quite vulnerable to lot of other ailments such as torn tendons, fractures, skin tears and general muscle fatigue

Lifeweb system works on RnG. Some wounds to the head will make you ‘peace’, go perma, instantly. But, if rng is on your side and you didnt go perma, you can be saved anytime, provided necrosis hasnt settled and you repair the damaged organs, pump new blood in and perform cpr which works like our defib.

What makes lifeweb different is the immersion, infections and organic wounds, organs actually existing inside a ‘container’ (chest cavity), the scarcity of tools and medicine and the game itself being more realistic with blood, gore and the general atmosphere, not like the goofy design CM has.

I also think that with the fast pace of the game… we need to increase the speed at which a marine can get to medical.

Marines would rather fight on 6 broken bones coughing up blood than get from front to fob… fob to dropship… dropship to medical… get surgery…

I think we need to buff the medevac. Allow it to pull more marines. Or be operated in the cave. (Lore it as “theres a narrow chimney the rope goes down or something”


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Also, the fact that medics can’t have a marine hold a blood bag for them is so stupid. I get the skill requirement for injecting it, but having a PFC assistant being able to do that kinda work, even if its just becoming an IV stand would be a boon

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Agreed. There needs to be a buff for travel time to medbay to compensate for any significant nerf.

Shipside medical has been neglected for a good time now, and to be frank there’s no incentive for marines to go shipside unless they’re delimbed (because no one packs limbs anymore) when an FOB doctor / synthetic is present planetside.

It’s my opinion that even if we were to re-introduce the painful shitshow that was infection, or add some other terrible condition that requires a doctor, there would still be little reason to go shipside considering FOB doctors and synths exist.

Because of this, I’m of the opinion that if you want to increase shipside medbay-groundside interaction, then you need to add conditions that REQUIRE the medical facilities on the Almayer. Something that can’t be treated with tools and surgery tables.

Of course, this’d dramatically fuck marines over and require incredible balancing, so I don’t honestly see any realistic potential for a medical overhaul anytime soon now that morrow’s been eaten by Feweh’s ghost.

buffing medevac is fine but making it work in caves wouldn’t make any sense…

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I actually thought out a small idea change to this: damage to the heart is a lot harder to treat, and when it reaches a certain threshold of heart damage a marine has a heart attack and is unrevivable. heart damage is semi permanent (peri causes it to very slowly lower to a safer threshold, but not past that, and surgery could be done to lessen heart damage more reliably but requires…y’know surgery). Let’s say heart attack is at 100 total heart damage, and defibbing gives 30 (temporary) heart damage that goes away on its own, like suffocation damage in vanilla ss13. taking serious damage, vaulting, melee, running for too long, getting knocked down, etc would slowly cause you to gain temporary heart damage once you have say 50 total heart damage, forcing you to slow down at risk of heart attacks, making daring escapes even more tense.

Laying down onto a bed or roller bed would greatly decrease Temp heart damage, sitting or lying on the floor less so, marines with significant permanent heart damage might require a pacemaker that will read out a rough outline of their heart damage so they know how far their limit can be pushed, otherwise they’re at risk of emergency death.

Lack of blood could also contribute to permanent heart damage, requiring a more thorough medical logistics train, and maybe at a certain threshold of total heart damage the marine will get a stroke (causes them to pass out, but is survivable, good way to know you’ve gone too far and punishes you for over extending while wounded.) Certain chems could have traits to better treat permanent and temporary heart damage, or make your heart more durable, or gives you a buffer between your heart being damaged and receiving any more damage, so on and so forth.

WY chems that cause heart disease would be a real risk vs reward, measuring stupid powerful effects against perma death. I’m adamant that making a heart attack a perma death will make it matter, otherwise it will just mean a slightly longer trip to medical, marines would have to respect this, and maybe you could have doctors RP’ing as cardiology specialists. Maybe using excercise machines in the gym will give your heart or lungs some kind of buff.
Defibs causing THP would mean that over reliance of defibbing will be unwise, as a marine could only survive 2-3 defibs at most before being game ended, which would incentivize keeping marines alive at all costs, which is more of a medic mindset, rather than the necromancer one of “save them if you can, but as long as the body is intact you can raise them from the dead”.

Now i want a halloween event where medics wield necromancy magic, another time.

Transport shipside is already decently fast. It’s always been a matter of coordination.

Marine players got way too used to the privilege of having planetside surgeries.

Marine players are never going to like the idea of any surgery being limited to shipside (for whatever reason) but this is where we are at if we want an answer that isn’t just window dressing.

Shipside medbay is far less relevant these days due to SOP changes and balancing changes. There’s no reason we can’t change again.

My conceptual idea would be:

  • Marines’ weapons are a little bit better
  • Marines’ technical health remains the same. But they become squishier in the long term and various surgeries are limited to Shipside Medical by design.
  • Organ damage will require shipside medical work.
  • Overall: Medbay shipside sees more use beyond just handling hugged people, but the wait+surgery time is not super long for both the surgery and for being ready for redeployment. The surgery time is a balancing thing, and the deployment (wait time) time is simply the PO, DCC, ASO, and XO/CO doing their jobs as they literally should be.
  • Potentially add “Deep Wounds”, a mechanic related to damage which goes over a certain number on a body part (for example, like 100+). You go over this number you rack up a little bit of permanent brute or burn on that body part. The surgery won’t be intensive but require shipside equipment by design. I have more thoughts on how to handle the nuance of it (like how to stabilize a patient with high “Deep Wounds” when they/medic are dumb and don’t address the issue until like 200+ “Deep Wound” damage but I don’t want to write an essay tbh).

Kill ability might go up a little bit but suicidal behavior and simply dying a ton will be addressed in the long term for a player. Medbay shipside use will increase.

The simple solution would be to change things which created this situation.

Make organ and/or IB surgeries only be able to be done shipside by doctors.
Potentially change SOP again regarding planetside deployment of doctors.

If you want Shipside medical to be more relevant; A good start to get more marines to ship side would be to bin the cooldown on using the medevac system and just make it so that the PO doesn’t have to push any buttons, just the medic. All the PO has to do is announce when he goes up and down on two channels instead of one.

That way Medics will naturally just not want to deal with the whiny marines and just kidnap them onto the Alaymer where they’ll go to Medbay relucantly to get their fractures repaired.

Though I can already see that some lucky marines will just take a rappel belt and ask for a signal flare to get unkidnapped.

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Unironically remove groundside surgery. You can only fix IB groundside, otherwise you have to go shipside.

Instead of making 50 marines beg 1 doctor and 1 synth, they can all go shipside and beg 5 doctors