GURPS Cinematic Medicine WIP Draft 2

 Cinematic medicine

Medicine. The art of making your fellow man feel better, recover from ailments, resume proper operation.

Cinematography. The art of framing events and scenes in an exciting, beautiful fashion.

Cinematic Medicine. Portrayal of medical work in an exciting and beautiful fashion.

It came to me one day that GURPS 4e medicine is boring. There are a dozen ways to lose those virtual hit points, but barely any ways to restore them. All of the medical involves rolling one (or two) skills checks and then waiting, and waiting, and waiting...

This absolutely kills any sort of game where violence is the point of the fun, as the party on a bad day may suffer so much damage that, despite winning and surviving, they wont be able to continue the plotline until they spend a month recovering in a high tech clinic. And if there's none, you can shut the game down. It's especially awful if only part of the player team gets messed up - everyone's rushing into action, but Billy Bob can't!

I was utterly baffled that even Action series had no solution to this, so I decided to invent my own. Enter Cinematic Medicine.

This entire system has 3 goals in mind. First, portray cinematic medicine - people recover quickly, in a surprising way, in a dramatic fashion. Second, coat it up with veneer of realism. Third, make playing the group's medic a more exciting and tactical task.

The system is, technically, cinematically realistic. Most of the written concepts have barely any connection to real life, but the system pretends really hard that they do, as should you when you see a group of commandos in the Amazon forest stitching up their bullet wounds, or when an old grizzled vigilante escapes from the hospital after taking a miracle super drug that will hurt him badly, but not before the big bad guy is defeated and the baby is rescued.

Main inspiration for this system are video games, namely ArmA series, Escape From Tarkov, Far Cry. Grittier movies, especially medical dramas, have also influenced this article.

The system is suitable for games that follow Basic Set's Heroic Realism, although it might just be one cinematic thing in an otherwise Gritty Realism game. It's main effect is to speed up injury recovery of PCs without affecting their combat survivability too much. Guns still kill, people still drop, and if there is no medicine or no medics nearby, nobody can help you.

Rule specifications:

Repeated attempts - Are in play, cumulative -1 per failed attempt. Reset by success or by waiting a "reasonable" (for example, until next scene) amount of time to reconsider the issue.

Time spent - Is in play, as per B346. Perk Efficient (PU2:16) is available for all medical skills.

Other rules - Work as written, unless explicitly contradict the system. Medical equipment, drugs, etc function as written unless they explicitly contradict the system. Blood-stopping equipment works x5 as fast.

Skills

Diagnosis (B187) - Skill of identifying various medical issues with the patient. Other medical skills cover most common issues such as flu, heartstop or broken leg. In such cases, diagnosis can serve as complimentary skill (+1 on success, +2 on critical success, -1 on failure, -2 on critical failure). This is in addition to to the effects listed under Diagnosing an illness. Example, success on Diagnosis roll of Common Flu provides Physician+1 to treat it. Critical success provides +2, and any successful treatment is considered Critical Success.

In uncommon cases, Diagnosis is required to do any treatment at all. GM discretion regarding what is considered uncommon.

• Diagnosing an illness: On Success, the illness is identified and treatment can proceed as normal. Critical Success means that any successful treatment is treated as Critical Success. Failure means the diagnostician is baffled and no treatment may happen, but repeated attempts are possible. Critical Failure means the patient is misdiagnosed and any treatment is treated as Critical Failure.

Fast-Draw (Medical Equipment) (B194) - Quickly draw and prepare medical equipment for use. On Success, If the treatment is under a minute in length, reduce the time needed by 1 second. If the treatment is over a minute, reduce it by 10%. Failure means treatment continues as normal. Critical Failure means you drop the tools, which either means needing to pick them up or to re-sterilize and clean them which takes 1 minute per margin of failure. GM discretion indicates when sterile tools are needed, but usually the answer is always. Using dropped tools without sterilization prompts Infection (B444).

First Aid (B195) - Skill of emergency, low-invasion treatment. Concerns usage of Paramedical tools and techniques. Mostly concerns treatment of HP loss.

Physician (B213) - Skill of advanced therapeutic medical care, short and long term. Concerns usage of diagnostic tools and drugs that treat complicated illnesses. Mostly concerns treatment of Afflictions. Physician skills includes all the knowledge and abilities of First Aid skills. Any First-Aid Action can be executed by Physician skill instead.

Professional Skill (Paramedic) (B215) - IQ-based professional skill of operating as an EMT, combat medic and other paramedical staff. It's main and only use within this system is to Treat Affliction like a physician. It does NOT perform any other medical tasks and does NOT substitute First-Aid. Defaults to Physician+0, IQ-5.

Surgery (B223) - Skill of advanced invasive medical care. Concerns usage of tools, drugs and equipment to directly manipulate internal organs in order to repair them. Mostly concerns treatment of crippling.

Soldier (B221) - Skill of basic military training. Concerns usage of tools that a soldier is familiar with but does not have the training in the tool's main skill. Mostly concerns the use of injectors.

Medical Treatment:

First Aid:

Tech Level	Time per patient	HP Restored
0-1	30 min	1d-4
2-3	30 min	1d-3
4	30 min	1d-2
5	20 min	1d-2
6-7	20 min	1d-1
8	10 min	1d
9	10 min	1d+1

• Bandaging - It takes 12 seconds (5 times less than Basic Set indicates) to apply pressure to stop the bleeding. This restores 1 HP. Using the bleeding rule (B420), someone who's wounded but receives a successful First Aid roll within 1 minute of Injury loses no HP to bleeding. A later roll will prevent further HP loss.

• Treating lost HP - Use a medical kit to recover HP lost to trauma. 
  Roll against First-Aid and expend 1 use of the medical kit. On Success, heal HP equal to HP restored on First-Aid Table (B424) per 1 use. Critical Success heals maximum possible HP per charge. Consult the same table for the time needed to provide first aid. Failure means the charge and time are spent, but patient doesn't heal.Critical Failure spends charges and time, but causes no healing and the patient loses 2 HP.
  
  You can treat lost HP of a single character as many times in a row as desired, expending further charges of the medical kit.
  

• Restoring consciousness - If a character is unconscious but is not below -1xHP threshold, he can be forcefully awoken via pain stimuli (such as the sternum rub or clavical rub). Roll First Aid. On Success, the patient receives an HT roll to instantly awaken and suffers -4 shock penalty on his next turn. The patient continues to act as appropriate for his current HP level.
  
  If patient is on painkillers, or has High Pain Threshold, this maneuver is less likely to succeed. Add drug's pain reduction as a penalty on first aid roll. High Pain Threshold gives -4. On the other hand, Low Pain Threshold gives +4 to the attempt, and any drugs that intensify the pain add their penalty as a bonus for this maneuver.
  
  It takes 1 second to execute the maneuver once the patient is in reach (meaning you must crouch or kneel to reach a lying patient), but any rigid torso armor increases the time to 2.
  
  
• Resuscitation - Any character that has died as a result of anything other than Instant Death (B423) and has HP no worse than -10xHP can be resuscitated within 10 minutes of death.
  
  Make a first aid roll, at -1 per full multiple of patient's HP below zero (10 HP patient with -40 HP gives -4 to First Aid Roll). Another -5 if you're not using medical equipment! One attempt takes as much time as treating injury at your TL. Attempt with medical equipment/drugs expends 1 use of your Medicine Bag or specific Medicine.
  
  On Success, the patient is alive, but is considered mortally wounded (B423).
  Critical Success means the patient is not only alive, but is simply suffering from injury - restoring HP is enough to treat the condition.
  Failure means the attempt has failed. You can repeat it as long as the patient wasn't dead for more than 10 minutes, including time spent resuscitating him.
  Critical Failure means the attempt has failed and the patient is lost. No further mundane resuscitation attempts are possible.
  
  
• Administer Treatment - Any treatment under Physician entry is possible to be provided by First Aid. A Physician roll diagnoses the issue and prescribes treatment, which can then be passed on to a less trained medic. 
  
  Roll First-Aid to administer treatment, expending appropriate uses of Medicine Bag or specific medicine. Roll is at -2 if you're following a checklist, medical book or internet search instead of orders of a present Physician. Without any sort of guidance, treatment is impossible.
  
  Critical Success, Success, Failure, Critical Failure, Time Spent and other are as per the treatment entry.
  
  This allows one Physician to issue out multiple orders to nurses and paramedics to treat large number of patients.

Physician:

• Remove Affliction - Roll Physician and expend 1 use of your Medicine Bag or specific medicine to remove the effect of any affliction listed on B428-B429. Time required is equal to Time Per Patient entry for your TL on First Aid table. This also covers temporary disadvantages gained as a result of an attack, such as Blindness as a result of tear gas, but not temporary disadvantages gained as part of crippling, or as a secondary effect of injury, such as blindness as a result of eye crippling. In case of drugs and other items that give both positive effect and a negative temporary disadvantage/affliction, removing affliction also ceases positive effect.
  
  Usually, medicine can only treat mundane afflictions, or afflictions with mundane effect, for example a spell of intense light causing blindness by light overload. At GM's discretion, if the effect is purely magical, Remove Affliction fails - mainly in cases of directly giving a disadvantage, or attacks with cosmic modifier. For example, a spell might blind someone by creating magical fog around the eye itself, in such cases medicine is powerless.
  
  On Success, the affliction is removed until the origin of the affliction is applied again, such as another dose of poison or another cycle of the illness (B442). Removing affliction is impossible without at least improvised equipment.
  
  Failure means the medicine had no effect and it's use is still expended
  
  Critical Failure means the wrong medicine was chosen, or patient had allergic reaction. Medicine had no effect, one use is expended and patient suffers 2 HP of toxic damage.
  
  
• Treat Illness - Roll physician and expend 1 use of your Medicine Bag or specific medicine to treat illness, poisoning and other effects that have cyclic, long term nature. On Success, add your margin of success to your patient's HT roll for this cycle. If the patient succeeds on his HT roll, he is cured. The treatment is administered once per cycle and time it takes is equal to Time Per Patient entry for your TL on First Aid Table.
  
  Critical Success on Physician roll means the patient automatically succeeds his next HT roll to shake off the illness.
  
  Failure on your Physician roll, the medicine had no effect and the patient has to rely on his own HT.
  
  Critical Failure means the wrong medicine was chosen or patient is not receptive to treatment. Add your margin of failure to Patient's next cycle HT roll.

• Treat Toxic and Corrosive Damage - Roll Physician and expend 1 use of your Medicine Bag or specific medicine to remove HP damage caused by illness, poison and the like. 
  
  One use heals as much damage as listed on First Aid Table on your TL, but healing may never exceed the toxic/corrosive damage dealt to character - it doesn't fix broken bones or bullet wounds alongside treating sickness. Failure and Critical Failure are as for Remove Affliction.

Surgery

• Stabilizing a mortal wound (B423) - Each attempt takes as long as Time Per Patient of your TL. Roll Surgery, at -2 if the patient is -3xHP or worse, or -4 if the patient is -4xHP or worse. Lack of tools applies appropriate penalties! 
  
  On Success, patient continues to act as indicated by his current HP and only requires his HP to be restored. On Failure, the patient is still mortally wounded, and further attempts to stabilize are at -2 per attempt. Critical Failure means the patient dies.

• Repairing lasting crippling injuries - To repair a lasting crippling injury, roll 1d. This is how many hours the surgery will last.
  
  On Success, the limb is repaired and any HP lost from the crippling is restored. The crippled limb will fully heal after normal sleep cycle of bed rest (8 hours for an average human). If the limb is used before rest, patient suffers -4 shock penalty on any actions that utilize or affect the limb (such as standing for legs). High Pain Threshold and other pain suppressants work as normal.
  
  Critical Success treats the limb, and it is ready for use right away.
  Failure means the surgery did not fix the limb, but further attempts are possible.
  Critical Failure makes the injury permanent.

• Repairing permanent crippling injuries - As above, except duration of the surgery is 12 man/hours and has penalty of -3 to skill. 
  
  On Failure, patient must have bed rest for 1d days before another attempt is made. 
  
  Critical failure makes further attempts impossible. GM should carefully appraise which permanent injuries can be healed at specific tech levels and circumstances, especially in a field setting.
• Self-Surgery - a surgeon can perform surgery on himself! Unless properly anesthetized or possessing High Pain Threshold, he suffers maximum shock penalty to his surgery roll with up to -6 for injuries in awkward places.

Hospital Stay And Long Term Care:

Based on the above, virtually any injury can be healed within a day of intense work by medical professionals. Because of that, cinematic hospital stay is often extremely short and most of it is due to medical professionals wanting to make sure the condition does not return and complications wont arise. A patient may choose to escape from a hospital if he does not want to wait for the entire duration of treatment (usually 1 week), which usually carries no penalties beyond anger of the medics.

In case of insurance, paid medicine or psychiatric help, escaping from the medics may cause them to pursue you in order to make you pay your bills or continue treatment. May involve automatic weapons.

If the GM believes that a specific condition or injury needs an extended stay to actually heal, he sets the length of time needed to cure the affliction and the date of check out at his discretion.

Medical equipment and drugs

Kit/Bag Sizes:
Small - 4/4 uses, only covers issues that do not require Diagnosis roll. $20, 1 lb.
Medium - 10/10 uses. +1 (Quality) to Skill Roll the equipment was designed for. $50, 2 lb.
Large - 20/20 uses. +2 (Quality) to Skill Roll the equipment was designed for. $200, 10 lb.

First Aid Kits (FAKs) - Equipment designed for First Aid skill.

• Crash Kit (TL8, HT221) - Heavy paramedic bag, may come in a variety of forms. Counts as Medium First Aid Kit and Medium Physician kit. Improvised Surgical equipment. Gives +2 (Quality) to first aid.
• Military First Aid Kit (TL8, P3-57:14) - Pouch-sized medical kit for soldiers, sometimes has controlled substances. Counts as Small First Aid Kit of +1 (Quality) with 4/4 uses. 
  Includes tourniquets for rapid blood-loss stop.
• Large First Aid Kit (Homebrew) - Medically marked duffel bag/backpack containing equipment to treat large number of wounded in emergency or combat situations. Sometimes carried alongside a Crash Kit. +2 (Quality) to First Aid. 20/20 uses. 10 lbs, $200.

Medicine Bags - Equipment designed for Physician and Diagnosis Skill

• Small Medicine Bag - A pouch or small bag with pill blister packs, something that hikers, soldiers or chronically ill carry with them at all times. $20, 1 lb, 4/4 uses.
• Military Individual Medicine Kit (Homebrew) - A small plastic container with injectors filled with medicine for common battlefield conditions such as pain, shock, diarrhea, hyperthermia, vomiting or chemical weapon attack. A paper checklist is attached to the internal side that describes each injector and it's use. Soldier-2, First-Aid-2 or Physician+0 to use it for conditions that do not require Diagnosis roll. Counts as small Medicine Bag, $100, 2 lb, 4/4 uses. 
  
• Medium Medicine Bag (Homebrew) - Common medicine bag for a variety of conditions that many keep at home in case of an emergency. $50, 2 lbs, 10/10 uses.
• Doctor's bag (TL5, HT221) - A heavy doctor's bag, similar to crash kit but is often more fashionable. Counts as +1 (Quality) equipment for Physician/Diagnosis, Improvised Surgical Kit and +1 (Quality) First Aid kit. Counts as Medium First Aid Kit and Medium Medicine Bag.
• Large Medicine Bag (Homebrew) - Portable pharmacy that includes majority of drugs on the "vital drugs" list of the country of origin. Usually made of solid material to prevent damage to vials and such inside of it. $200, 10 lbs, 20/20 uses.

Other medical equipment:

• Combat Tourniquet (TL8) (P3-57:14) - An emergency blood stopping device that quickly stops bleeding by compressing the affected vessel closed. Combat version gives +2 to First Aid to stop bleeding and takes 2 ready maneuvers to apply once in hand.
  Modern Clip Tourniquet (TL8) is a plastic lock with a non-slipping strap, medic must wrap it around limb and connect the lock closed, then pull the strap to tighten (2 ready maneuvers, but requires two hands) +1 to Stop Bleeding, $15, 0.1 lb.
  Simple Disposable Tourniquet (TL6) is a rubber strap that has to be wrapped around the limb and tied off manually, requiring multiple layers for effective hold (4 ready maneuvers, requires two hands). Improvised tourniquets are applied the same, but rubber sticks to the limb better, making it easier to pull off (-1 if using an improvised tourniquet)
• Splint (TL0) (LT146) - Long plank or similar object with attachment points for straps to immobilize broken limb and prevent further damage to the bone and tissue. TL8 versions are folding, compact and light 0.5 lbs, $100 for one limb. Any limb with lasting crippling can be splinted and then used as normal, but the patient suffers their maximum shock penalty whenever the limb is used. At the end of any combat, or once an hour of a long task in which the limb was used (such as marching), roll HT. Any failure makes the crippling permanent.

Drugs - The system uses standard drugs present on LT150, BT148, HT226, B440 etc. 

• Cinematic Painkillers and High Pain Threshold - When utilizing painkillers and analgesics, apply the reduction of pain penalty to shock penalty as well! High Pain Threshold works as normal and any drug that gives High Pain Threshold advantage also reduces pain penalty by -4, alongside halving it.
• New Drug: Trauma Analgesic (TL7) - High strength analgesic for treatment of medium to severe pain such as broken bones, such as tramadol. Is weaker than Morphine but with less side effects. HT-4 to resist, on failure removes -4 pain penalty and grants user laziness advantage for Margin of Failure in tens of minutes. Still highly addictive. $10/Dose.
• Medicine Delivery - Depending on delivery method, drugs are easier or harder to apply and kick in right away or after delay. Drugs and medicine may be available in for purchase in these forms:
  Pills, gels, applicables - Easy to apply, but take time to be absorbed by the body. Effect arrives after time per patient of drug's TL. No extra cost and no roll.
  Injectable liquids (TL5) - Vials of drugs that need to be delivered via an injector, usually a hypodermic needle. It takes 1 minute to choose dosage, prepare syringe and find an injection site (not covered by anything) to deliver the drug, as well as a Professional Skill (Paramedic) or Physician roll. Once injected, the drug activates instantly. Hypodermic syringes are not designed to hold drugs for long, so pre-filling is not common. No extra cost.
  Syrette (TL6) - A toothpaste tube-like sealed container that ends with a protected needle. Dose is set at the factory, so a physician only needs to remove the cap, find an injection site (not covered by anything), optionally disinfect it, apply the needle and empty the tube - 4 (5) ready maneuvers. Requires Physician or Professional Skill (Paramedic) to apply. +$10 to price, neg
  Autoinjector (TL8) - A plastic tube with colorful instructions on the side, uses either needle on a spring or compressed air to deliver the drug automatically. After Soldier or First Aid roll,  it takes 1 second to remove the cap and activate the mechanism, 1 second to apply to injection area (penetrates 1 DR of clothes) and 1 second for the mechanism to inject the drug. +$20, 0.1 lbs. Variant with audio instructions has +2 (Quality), is as loud as a normal conversion and adds +$50 cost.
  Contact Agents (TL7) - Usually sprays that either work on contact with injury (such as quick acting analgesics sprays for sore throat) or penetrate the skin and enter the blood stream without injection. Any clothing stop it. No roll needed. +$50 to cost, 0.1 lbs
• Using syringes as a weapon - Treat syringe as a reach C, no parry, 1d6-4 (2) pi- Knife (DX-4). Whatever drug is inside acts as a follow-up to the attack, as long as it dealt at least 1 point of damage. Syringe is not designed for combat, so on a roll of 12 or above the needle breaks or the dosage is wasted. Same happens if the attack is parried. A safer alternative is to grapple an enemy and attempt to hold him still for injection. Once grappled, attempt a grappling skill or ST vs Grappling skill, ST or DX quick contest. If the attacker wins, he injects the defender with the syringe, otherwise the syringe breaks or the dosage is wasted.

Medical Workflow:

Differential Diagnostics and Treating An Illness.

Dr. Shed gathers his team of diagnosticians and presents them a case of a patient with certain symptoms. Dr. Shed and his team make complimentary Physician/Diagnosis rolls as they argue about the case. At the end of the meeting, Dr. Shed makes a Physician/Diagnosis roll, modified by everyone's complimentary skill checks.

The roll fails, so Dr. Shed orders tests done. His team executes them using Physician, Physiology, Pharmacy etc, nurses assist them with First Aid and Electronic Operation (Medical) skills. Each roll counts as complimentary.

The team returns to Dr. Shed with test results and they run another differential, combining test result bonuses with new theories (Physician/diagnosis rolls).

Dr. Shed shuts them all up and stares off into the distance as he makes his Physician/Diagnosis roll. He succeeds, prescribes treatment and orders his team to deliver it.

On Critical Success, the treatment is extremely effective, but unconventional, so ever-present Dean of Medicine Dr. Muddy is objecting. Now the team has to somehow bypass this obstacle.