Guide to Surgery

The definitive guide to surgery, the primary method of patient treatment in Shiptest. All surgery requires a set of tools (be they the real deal or ghetto equivalents), a place for the patient to rest, even if it's the floor, and a procedure e.g. Brute Tend Wounds, Organ Manipulation, and so on.

Surgery On A Ship: A Beginner's Guide

Excerpts taken from an ancient TerraGov training video for doctors.

The first step of any surgery is knowing what you want, and determining if surgery is necessary. More often than not, surgery is a slow but cost-effective way of healing a patient. Make sure to check if there are alternatives to the procedure you plan to undertake, and certify that surgery will be effective first. For example, curing a minor wound is best done with sutures than full-on surgery, and there are no surgeries currently known to aid in the curing of toxic damage.

The slide flicks to a gruesome picture of a soldier lying face down in the dirt.

The second step is keeping a mental list of procedures you need to undertake. To provide an example, let us use the model of an unfortunate TerraGov marine. He has been dead a while, and chewed up by machinegun fire. Our rudimentary diagnosis tells us that his heart has likely suffered damage by now, so we will need to undertake a Coronary Bypass in order to fix him. Furthermore, very little healing equipment works on the dead, so we would do well to utilize Tend Wounds (Brute) in order to get him into a recoverable state. Mind that tending wounds is often slow even with the proper equipment, so it is best to revive them as soon as possible, then use methods of treatment best suited to the living, such as sutures. Additionally, he has broken bones we will need to perform Bone Repair on to remedy.

The third step is to locate an operating room and procure equipment. Most TerraGov ships are staffed with a medical room, including a full set of surgical tools. However, you may have lost access to your medbay somehow. In this case, your best bet is to construct a surgical table with silver, and either craft a set of operating tools or use the ones that come with a TerraGov standard medkit. If you are unable to procure even these, you can use any sort of bed or even the floor as a theater. Medical tools also have rough equivalents in a standard TerraGov toolbox, though those are obviously harder to use. The more equipment you have to substitute, the lower your chances of completing a surgery step are. You can use materials such as alcohol to sterilize your tools beforehand, increasing the chances of success. Additionally, a high number of attempts can also overcome the hindrances of improper tools.

The slide changes again, this time to a cartoon of a soldier lying on an operating table. The list of surgeries is displayed next to him.

Your fourth step should be to remove clothing where necessary. Most of the time, this means stripping them of their armor, jumpsuit, mask and helmet. Though waking up on a table naked is, I'm told, an unpleasant experience, it is a necessary evil. Tend Wounds can be performed with clothing on, but is more effective when the target is not wearing a jumpsuit or armor. Likewise, Bone Repair and Coronary Bypass require the chest and limbs be exposed. No surgeries are required for his head or face, so we can keep the mask and helmet on for now.

The slide flitters to a picture of a doctor operating.

The fifth step is to begin operating. Blinds are largely unnecessary where plastic is scarce, so start surgeries by using any medical tool on your patient. This includes a screwdriver if you are underequipped. You should keep your list of surgeries in mind here, and monitor the condition of the patient closely during this time. If additional surgeries are required afterwards, take note. Otherwise, remember that other people can assist you during an operation by setting up the IV rig, making useful medical chemicals, procuring tools as they are needed, and performing CPR on suffocating patients.

The slide changes to a picture of a grinning, splinted marine.

The sixth step is aftercare, fixing anything you didn't operate on and making sure the patient leaves stable and satisfied. Utilize your sutures, chemicals, and other accoutrements here and make sure that your patient is worthy to return to the field. Best of luck, trainee. TerraGov is counting on you.

Advanced Techniques

The slide flips to a hastily scribbled title labelled "Advanced Techniques." You can vaguely make out the words "Safety Protocols" on the reverse side. The voice is grizzled and belongs to a different person this time.

So you're the only Naval Surgeon on your ship, your marines are down, your captain needs a spleen out, and your scientist is about to give birth to a healthy litter of violent Xenos. You don't have time to operate on these people! ..Or do you? The thing that separates the wheat from the chaff in surgery is efficiency, and treating one wound on one person at a time is bad for it! Today, you're going to learn the secrets of multi-target and multi-patient surgery!

The slide switches to a bad diagram of nine tables surrounding a crude stickman with a scalpel.

The first thing you want to do is upgrade your rig. Add additional surgery tables to your medbay if you have space, making sure to place them all in a place where you can reach each one simultaneously. You can have a total of nine tables up at a time, meaning you can Tend Wounds nine patients at a time! Operation Consoles can only interface with tables directly next to them in a cardinal direction, so a four-table setup would require two operations consoles, one for each pair of tables. Keep this in mind when using surgeries that require RnD and a linked opconsole.

The slide flits over to a bad trace of an anatomy textbook. The legs, arms, head, chest and groin are distinctly labelled.

Multi-target surgery is the art of operating on as many parts of a body at once! For example, let's say you have a guy with two broken arms. You could either fix each arm individually, or start the surgery for both and do the steps simultaneously. You only need to begin a surgery targeting a body part for the step to complete for that part, so you could fix every bone at once! There's no limit to how many body parts you can operate on simultaneously. Additionally, you can optimize your steps for maximum effect. If your guy needs wounds tended and a leg bone fixed, you can use the scalpel to start both Tend Wounds and Bone Repair. Then, make an incision for Tend Wounds, and do the Bone Repair surgery as normal. When the time comes to set the bone using a hemostat, you can use it on the chest first to tend wounds while you fix their broken bone!

Multi-patient surgery works on the same principle, but applied to other bodies too. This is great for dissections, where you can dissect up to nine bodies simultaneously and save a ton of time! Combine this with multi-target surgery and max out your efficiency to become a legendary doctor who might have a chance at fixing this mess.

Triage Theory and You

Excerpts from a wartime interview with an anonymous, chainsmoking Nanotrasen CMO.

Knowing who to treat first is half the battle. If you have hurt, seriously wounded, dying and dead patients all at once, it's important to know who to fix first. The basis of triage theory splits patients into those groups: Hurt, Seriously Injured, Dying, Dead. The order you address those patients in depends on your situations, and the theory of triage you are applying. Let me provide some examples.

Triage Example One: All Business

(Note: Patient order is from top to bottom)

• Dying Patients are fixed first, as they cannot work effectively, but require less effort to fix than dead patients.
• Dead Patients are done second, because they cannot work but require more time to fix than dying ones.
• Seriously Injured Patients are addressed third, because they are still able to work (albeit with reduced productivity).
• Hurt Patients are treated last, as non-serious injuries tend to affect productivity the least.

This triage model focuses on maximizing crew uptime by reviving dead and dying patients first, allowing you to get more done and clock in more valuable man-hours.

Triage Example Two: Combat Emergency

• Seriously Injured Patients are treated first, to reduce their chances of becoming casualties and keep them in the fight. They can then be sent to retrieve fallen comrades, or cover your back while you continue treatment.
• Dying Patients are treated second, as they tend to take more time to get back on their feet and will likely be in less of a state to defend you or retrieve bodies. Make sure to stabilize them before treating #1!
• Hurt Patients are treated third, to improve their odds of surviving and engagement. By now, you should have either established a safe perimeter, or successfully extracted from a dangerous area. If not, attempt to do so immediately.
• Dead Patients are treated last, outside the danger zone if possible. They take a long time to revive, and are often not in fighting shape once they're up. Postpone treating them until you know it's safe to do so.

This triage model excels in combat situations where you need to secure your position or get soldiers to the front line as fast as possible, as well as keeping them fighting. This is not a sustainable model, and will suffer from attrition if your soldiers start dying. However, it's your best bet if you've set up a field care area in the middle of a fight. Just remember that defending your life always comes before treating a patient. A dead doctor does no good deeds.

Triage Example Three: Poverty Medicine

• Dying Patients are treated first to prevent their condition from worsening, thereby further taxing your limited resources.
• Seriously Injured Patients are treated second, however you should only seek to reduce their status to Hurt.
• Dead Patients, though taxing, are treated third if you can afford it. Having an extra man up can go a long way to procuring supplies.
• Hurt Patients are extremely low-priority in this model, and can be treated using affordable, if slow methods such as ghetto surgery or natural medicine.

This model is best for when supplies are limited. If you're operating with a toolbox, a table frame, and limited meds, this model will help you get the most out of your limited stock and bad equipment.