Feedback On New Med Changes

[Surrealistik]

Going to keep this as succinct and unsalty as possible:

https://gitlab.com/cmdevs/ColonialMarines/issues/1965

January 3 2018, dylanstrategie updated:

• Changed how Peridaxon and Quick Clot work. Peridaxon now stops most symptoms from internal damage without fixing them. Quick Clot now stops all bleeding but doesn't fix it. Dosages and overdose thresholds unchanged.
• Added Peridaxon to the Marine Medical Vendors.
• Added Incision Management Systems to the Surgery Rooms.
• Bone surgery made one step faster by removing final bone patching step.

The Good:

1. Change strongly delineates and defines doctors as healers and medics as stabilizers.

The Bad:

1. Internal bleeding now often a death sentence.
2. Peridaxon and QuickClot now effectively useless given their fast metabolism rate and low Overdose ceiling; Medics have no good answers to damaged organs/internal bleeding except for the cryobag (not sure if this stops bleeding).
3. Already considerable strain on Medbay significantly increased with the addition of IB and organ surgeries, resulting in even greater surgery backlogs/'surgery hell'; Incision Management System and increased fracture surgery speed don't nearly compensate for dramatically increased patient flow.
4. Medbay made even less efficient since doctors can't use hyperzine to expedite movement except in emergency situations.
5. As a direct consequence of #3 and #4 Marines are less likely to return to the Almayer for medical treatment, preferring instead to die on the battlefield than wait indefinitely for surgery.
6. Already unfun doctor role has become even less fun and more discouraging; rounds are likely to consist of nothing but rote surgery procedures after the first big wave of casualties.
7. Discourages marine aggression; encourages bog down/defensive/trench warfare.

The Ugly:

1. Meta will likely change to feature a much stronger field doctor presence due to the newfound need to treat IB and organ damage as quickly as possible.
2. Meta will gear towards strategically letting people die and defibbing them in order to limit deterioration.
3. New extreme reliance on doctors makes inexperienced/new/incompetent doctors a probable death sentence for the marines.

Recommendations:

1. Increase Peridaxon/Quickclot OD threshold, slow their metabolism rate, or both so they're effective as a battlefield stabilizer.
2. Peridaxon and Quickclot actually heal organs and IB respectively when their beneficiary is in cryo (and only in cryo); allows them to simultaneously be used in the field as a stabilizer and in medbay as a healing chem.
3. Add Autodocs that scale with population to help mitigate the impact of two additional surgery types, and significantly increased surgery/patient flow from planetside.
4. Have cryobags arrest bleeding and internal bleeding.
5. To help the medics and get the badly wounded to Medbay: https://gitlab.com/cmdevs/ColonialMarines/issues/1979
6. In general the efficiency of Medbay has to be increased substantially to compensate for this massive loss of battlefield healing capability.

[NethIafins]

Is it confirmed that metabolism speed remained unchanged?

[Robotic Potato]

Here's just a little copy paste of what I said on the Discord about the change don't yell at me for poor formatting please.

ICS will make it faster yeah, but it's not like the one fewer step is a major change.
But while most surgeries are faster there are now two more surgeries someone's gotta do.
Internal bleeding fixes and organ repairs.
So if your patient has a broken chest you no longer have to do the three starting steps to prep an incision and no longer the final bone repair. Now you most likely have to do two more steps to open their ribcage after fixing their ribs, one step to repair the organs (or more depending on damage), and one to fix the internal bleeding if there is any, then you have to reclose them again which is two more steps plus mending the incision.
And that's only if the internal bleeding is located in their chest.
If it's located anywhere else you'll need to open another incision, mend the bleeding, then close them again.

[Urytion]

A warrior caste can break bones or cause internal bleeding with one or two attacks. If they target the head or the chest, that's a priority evac because you'll have done your brain or lungs and there's nothing to be done about it. Bonus points if there's IB. Because of the high metabolism rate of QC, the effects will likely run out before they even reach the medbay. Then they have to wait for a doctor. I've been infected on the dropship, gone straight to medbay, and waited so long for a doctor for arguably the most important surgery in the game that I bursted. That can't happen with popped lungs or internal bleeding. The hallway where we dump patients will just be a row of dead.

And sure, the IMS helps a little bit, when the average workload for a broken bone increases from one surgeries to two or even three, (bone, bleeding, organ), it makes surgeries longer, and will result in more patients.

Overall, this change was clearly ill thought out, badly executed, and will only result in medical role players leaving en mass.

Recommendations:
Personally I'd like to see it reverted entirely, but I doubt that will happen.

I don't actually know WHY this change was implemented. I assume it was because of the strength of groundside healing and ease of access? I'm going under that assumption.

1. Increase doctor slots and operating rooms.
2. Create a new hard to reach, expensive, and time consuming chemical that fills the old roles.
3. Slow metabolism and increase OD rate of QC and Peridaxon to allow for safer evacuation.
4. Revert, remove all QC and Peridaxon from the ship. Remove doctor's ability to make chemicals. Force researchers to be useful.

[Symbiosis]

This change will create a boring meta of FOBville and Massive FOB OR's. It requires massive changes to even have a hint of viability and was poorly thought out.

Rounds will stagnate without admin intervention and the server population as a whole will diminish.

[Bronimin]

Only because you aren't robust. You want to do:
IMS -> Saw -> Retractor -> Trauma Kit -> Fix-o-vein -> Retractor -> Gel -> Setter -> Cautery

IMO Just get rid of surgeon slots entirely instead of forcing more players to put up with that cancerous role. Cut the number of Doctor slots to 3, remove all surgery rooms and replace with a bank of autodocs that are in the code already (they are being used in CLF events). Dedicate medical staff to triage and patient care (the fun bits) instead of locking them into surgery rooms and forcing them to execute mind-numbing rote procedures for hours on end.

I guarantee that the latter part is why no one wants to play doctor. Add Autodoc circuit boards to the cargo system so that techies can build more if medical desperately needs them.

[Symbiosis]

Also - Robotic Limbs needs to be what every Marine has.

Engineers are now the new Medics and most of these changes are now reverted. Checkmate.

[Robotic Potato]

Only because you aren't robust. You want to do:
IMS -> Saw -> Retractor -> Trauma Kit -> Fix-o-vein -> Retractor -> Gel -> Setter -> Cautery


IMO Just get rid of surgeon slots entirely instead of forcing more players to put up with that cancerous role. Cut the number of Doctor slots to 3, remove all surgery rooms and replace with a bank of autodocs that are in the code already (they are being used in CLF events). Dedicate medical staff to triage and patient care (the fun bits) instead of locking them into surgery rooms and forcing them to execute mind-numbing rote procedures for hours on end.

I guarantee that the latter part is why no one wants to play doctor. Add Autodoc circuit boards to the cargo system so that techies can build more if medical desperately needs them.

Yeah I usually tend to not mix surgery because last time I tried I kinda broke the surgery system and made it impossible to perform surgeries on two guys, maybe I'll give it another try, but really my only real problem is with QC's change I personally don't care about peri as TBH I may use a single pill or two every round and even then I'm use to back on the Sulaco when you would only get peri if Docs made it.

The QC change seems unnecessary as it leads to more unneeded death from internal bleedings. I've been told QC now lasts exactly 45 seconds which in most cases won't be long enough to even get back to the Almayer, someone might suggest you take a stasis bag to increase that time, but internal bleeding is very common while stasis bags take up a lot of space to hold.

[Sir Lordington]

My first impression is that metabolisation rates should probably be turned down a bit to give marines more time to be treated by Doctors, especially with QC.

Medbay might need some improvements beyond the IMS to compensate for the increased volume of patients, particularly due to the QC changes.

However, this does raise an issue with the surgery volume. Surgeries aren't particularly fun and I don't think we want medbay to become merely a surgery factory so perhaps the implementation of a system that encourages triage over mindless surgical procedures could be added. Configurable autodocs (where you set what you want it to fix before throwing the patient in) or Sur's cryo suggestion come to mind.

I'm going to play doctor and medic for a few rounds before giving my final opinion on the matter.

[BobatNight]

The Med Bay isn't built to handle large pops especially with this poorly thought out update.

To piggyback other people's points...

Field Doctors increased, FOBBITS, FF just got even worse, Surgery grind just got worse. 2 Chems are now useless as all hell. I don't understand the point of the update other than as a major Marine nerf.

I think the staff did an EXTREMELY poor job in implementing this, there was no real thought given to this obviously.

[Casany]

Gonna break my "oath of silence" here.

So, first off. Why. Why was this added in the first place? Was the winrate going to in favor of marines? Are marines just way to entitled? Are medics annoying? Or is it the whole "realism" argument. Or maybe you're going for the "expendable" marines. Well, in case this wasn't clear, marines don't like dying and waiting 2 hours for another round. Hell, most of the reasons as to why this possibly could have been done are outright idiotic. It shows a clear disconnect between the devs and the game in general.

First off, while they added the Incision Management whatever you basically gave doctors 3 times the work they originally had. One less step doesn't make it easier. Having talked with a few doctor players on the round it was implemented it definitely doesn't make doctors have more fun. Its tedious and in the end causes more death because there are only so many ORs and doctors. In the end, I see less people playing doctor and medic since its never interesting, and there's never a feeling of reward.

Now, onto marines. If you didn't know, marines don't like waiting 45 minutes to an hour to fix an FF injury. It takes them out of the round and it doesn't allow them what they want, which is either to shoot xenos or to role play. But now, any injury will lead to this. In the end, marines will probably just stay groundside and die fighting or laying in the FOB in paincrit. Even if doctors start setting up groundside there will still be a huge amount of dead players from simple injuries because of the rate of decay the chems have.

This whole update seems poorly thought out, poorly tested, and in general it shows the huge disconnect that the devs have, as I stated before. And while it may be tweaked, it shouldn't have gone through in the first place unless it worked. How hard is it to run a test server with the new add ons?

But of course, none of this matters because in the end someone's just gonna come in, claim this is to salty, close it, and the update stays. And marines can't even do anything. So after a month anyone who would have wanted to change it will have just given up, and it'll be kept. It's clear that the devs have a sort of "its not me, its them" complex. They can't be making the game they don't play worse, therefor the marines are just entitled and salty because it can't be us, its them.

[Jay Burns]

This update makes playing medic even more of a slog than it normally is and more redundant and useless.

It also makes playing doc even more boring due to not having any patients.

[Bogrin]

https://gitlab.com/cmdevs/ColonialMarines/issues/1971

My proposed change.

[Bronimin]

If we are being "realistic" here, injecting a clotting agent directly into the bloodstream would actually just straight kill you by forming a clot in your brain.

Does QC + stasis bag stop the bleeding? I know that the stasis bag by itself isn't enough, but IIRC you do stop metabolising chems while in the bag. If the check is just 'if QC in bloodstream = yes' then it should work. Medics should try to grab pens so that they can label the stasis bags.

[Jroinc1]

Honestly, this finally did it.

Fuck medic, I'm out. I can't be useful anymore as one. Also, fuck MD, I'm out, cause I'm not willing to go through THAT level of surgery hell. Standard, here I come.

Here is my reasoned argument on why I'm doing this

The only thing medics can treat now is burn damage.

Anything that causes brute (that's not an accidental stab/punch, and even SOME OF THOSE...) has about a 30% chance of causing IB. Any hit to the chest that breaks bones WILL cause IB. IB causes about a 1-2u blood loss/tick rate (not the exact value, but I'm not putting that there.). At a loss of 60u, the patient can no longer fight due to about 20% untreatable oxygen damage. At a loss of 240u, the patient WILL die due to slowly increasing o2 damage that never stops (also some toxin, but negligible).

So. The patient has about 3 min realtime to get out of the combat zone, and about 12 min to get treated.

Palliative treatment, such as QC or bicard OD's won't stop the progression for long (20/60 sec for QC, and 2-3 min for bicard), ESPECIALLY compared to the cost of carrying them.

On the surface, this seems reasonable. And it would be, for SINGLE marines.

It's when you get to issues like 6-12 marines, all of whom have IB, ALL of whom need treatment, and all of whom are clamoring over the TWO whole IV's we get, are unable to self-treat due to our shitty medical skill system forbidding AUTOINJECTORS, and can't all be treated before death? Yeah... awkward. Oh, and you're getting that many per DS.

Recommended workaround- BEG medical for 50u bicard pills, OR 20u iron pills. IF you can get these, either one will keep someone up long enough to die in medbay I mean, get proper treatment.


Now for perdiox.

Any chest or head injury will cause varying levels of organ damage. I'mma ignore the effects of groin hits, as you can live without those. Head hits can cause blindness, which removes marines from the op. Chest hits to the heart or lungs cause about 20 pts of O2 damage below about 10 pts, and act the same way as losing 240u of blood for higher than that (rapid death).

It's like the IB issue, but it hits INSTANTLY. Also, if they lose a splint/have to run to you/don't notice it's gone, they'll die rapidly. As for "preventing the damage but not fixing it", you know what else does that?

Dex+. Is that all you did? Made the effects the same?

Also, same surgery-hell issues that they had before.

Recommended workaround- Take perdiox pill bottle, throw at CO. IC riot as medic every drop till repealed cause I'm pretty sure this is another of those changes designed to be half-removed halfway through so they can push through something that we'd have rioted over anyway

If you REALLY want to drop without this... ask for 20u pills of dex+. It'll be more effective than the perdiox. Twice as good, in fact.
Also, ask for 10u pills of 5u alkysine/5u Imidazoline, as this will still fix head wounds and blindness.


One last thing, consisting of a scenario-

Crusher stomps FULL health marine on frontlines, breaks ribs, causes IB, and takes 11 points of heart damage.
Marine is reached by a medic, who throws on a bruise pack, splints, QC's, bruise-pack's again, and gives perdiox, bicard, and tramadol.

Old system-Marine has a broken chest, BUT is good to go to evac, or can fight, at reduced capability.

New system-Marine freaks out, runs to the transport (cause he KNOWS he's gonna die), and passes out halfway to the DS (O2 damage is insidious, and 10u runs out quickly).

[Feweh]

Why dont you guys start deploying a doctor planetside for surgeries to help a bit.

We're monitoring this and actively making changes, dont worry.

[Jroinc1]

Why dont you guys start deploying a doctor planetside for surgeries to help a bit.

We're monitoring this and actively making changes, dont worry.

I've done it, but it's hard to make a dent in surgeries... also I thought that was like, REALLY frowned upon by staff, even with CO permission?

[Symbiosis]

Why dont you guys start deploying a doctor planetside for surgeries to help a bit.

We're monitoring this and actively making changes, dont worry.

That's the only solution, but it's going to require 2-3 Doctors (if not far more) to accomodate for the change. You'll literally need to move one of the blood bag machines down to the FOB to keep up with the rapid blood loss that will be occurring during a medium or high pop round.

You're essentially moving the burden that 8 medics struggled with onto 2-3 Doctors.

Not exactly fun. For either side.

[Anoonki]

That's the only solution, but it's going to require 2-3 Doctors (if not far more) to accomodate for the change. You'll literally need to move one of the blood bag machines down to the FOB to keep up with the rapid blood loss that will be occurring during a medium or high pop round.

You're essentially moving the burden that 8 medics struggled with onto 2-3 Doctors.

Not exactly fun. For either side.

Unless hand scanners indicate where the IB is, you'll also need to guess on someone who's external damage is treated, or move an advanced scanner, too.

[Lumi Pharon]

This has increased the attrition rate of marines by A LOT, and makes the most stressful and often unfun roles even more difficult.

Every valid argument against the change that needs to be said has already been said really, but as with pretty much everyone, the peri change is livable, the QC change is absolutely awful.
People are trying to have fun in one way or another, not play surgery queue simulator.

[Jroinc1]

Unless hand scanners indicate where the IB is, you'll also need to guess on someone who's external damage is treated, or move an advanced scanner, too.

Holy shit, that actually makes NOT treating a person (except for defibs) better than treating them, at least till they get to a doctor vice a medic... that's honestly weird.

EDIT- On the plus side... I got a new mattress today. Completely unrelated, but it's comfy.

[Bronimin]

You have to have doctors A) competent enough to operate without a body scanner and B) willing to play the surgeon minigame if you want field hospitals

[liltiptop]

I agree with Surrealistik. Marines were hesitant to push and attack before, now it's going to be even worse because everyone will be to scared to push into hives. I don't know why this update happened, I thought medic worked well enough before. Falling back to the FOB most of the time paves the way for xeno victory or SD, the whole reason we have combat medics is to keep people in the field, fighting, NOT losing ground. Having to have people run back when they get a boo boo is a major detriment to the squad, especially the spec, smartgunner, or SL, and this update makes it happen even more. If we keep this update, I think combat medics should have basic surgery knowledge, nothing like embryo removal, but the ability to fix internal bleeding at the minimum. Doctors having to rip out embryos AND stop people from losing all the blood without medics to help fix some of the patients just sounds like hell.

[jalen earl]

Low pop is going to be a blast.....

[Tharinoma]

I just played a round as doctor and I love the update. I didn't test it as a combat role yet, but medbay is much, much more fun now.

Doctor used to be "shove peri down their throat then bone surgery" for everyone, with the occasional defibbrilation when medics ran out of an important chem.

Now, every patient feels like a challenge, you're really fighting the injuries back while waiting for the critical surgery to be done. It's actually possible to lose a patient on the table now.

And from what I've seen, there aren't much more injured marines in medbay, we had 20+ players waiting for surgery in medbay before. It's just that now, they risk dying anytime, and I love it.