[Basic] Treating Shock on Multiple Patients

[Gigermann]

We had a situation come up in-game where we had multiple injured PCs being treated for shock (after bandaging; B424) in a low-TL environment where this process is stated to take 30 minutes. The dissonance occurred when we disagreed about whether or not multiple patients can be so treated at the same time, or if they each require a separate 30-minute task (totaling an hour or two, for a single "healer")?

I have been entirely unsuccessful at finding a RAW answer anywhere, or even a suggestion. Frankly, I'm surprised someone hasn't asked this before (assuming I didn't just miss it). The rules are unclear in this regard—it's not addressed at all.

There is the part about Physician skill being able to treat multiple patients, but that's the long-term healing situation and doesn't apply here (by RAW anyway)—though it could be extrapolated, I suppose. It might also be reasonable to apply a penalty of some degree for treating multiple patients. But that all depends on what this operation actually consists of; if it's just "making the patient comfortable and letting them recover for 30 minutes" there's really no logical reason they can't all do that at once?

[johndallman]

Based on some training and a bit of practical experience, I'd say you can treat multiple people for shock, but it's worrying enough to have a skill penalty, somewhere in the range from -1 per extra person to using the speed/range table.

You need to keep watch on the patients to make sure they're still breathing, aren't thrashing around, and generally aren't getting worse.

Incidentally, you can treat yourself for shock. I've done it after breaking a metatarsal. I couldn't do anything about that, but calming myself down before calling a cab to the emergency room was worthwhile.

[Pursuivant]

This is a gap in the GURPS rules, missed even by the otherwise comprehensive Social Engineering books. There are no rules for coaching untrained people through a particular task or supervising less-well-trained people in an emergency situation.

For First Aid, the first step is triage, which might be an Average technique based on Diagnosis or First Aid. Success allows you to determine who needs to be treated immediately, who can wait and who's beyond saving.

The second step is for the primary aid-giver, who actually knows what they're doing, to supervise and boss less well-trained/untrained folks to the best of everyone's abilities.

I'd call supervising/teaching/bossing the unskilled on perform specific tasks on the fly as a task based on the lowest of the supervisor's applicable skill, Leadership or Teaching skills. Apply a -2 penalty for multitasking to both tasks if the leader is trying to do anything other than supervise.

In a mass casualty situation with just one aid-giver and a bunch of willing bystanders, the applicable skill is First Aid.

The strategy is for the person in charge to quickly triage the injured and treat the most seriously injured people first, doing quick treatments which allow assistants to perform subsequent treatments or monitoring of patients who are at lower risk of dying. This means lots of Triage technique rolls to assess each patient, along with lots of supervision rolls to get assistants to perform delegated tasks.

I'd allow First Aid skill rolls with penalties for Haste for the aid-giver to apply really simple quick treatments that slow immediately lethal damage (e.g., applying pressure bandages or tourniquets, clearing airways, holding C-spine) before moving to the next patient, taking far less than the normal amount of time required for full treatment.

Once the aid giver is satisfied that none of their patients are going to die immediately, they can go back and do unpenalized, full length First Aid skill rolls to stabilize each of them and restore HP. As usual, apply a -2 penalty for multi-tasking if you're trying to supervise assistants and treat patients simultaneously.

In between, the leader can get assistants to treat stabilized patients for shock and monitor them, offloading the required time to treat for shock to them. (Presumably, the 30-minute requirement means watching the patient for deteriorating condition, making sure that bleeding has actually stopped, etc. after doing things like bandaging and putting in IV lines.)

An untrained person given orders to perform a simple but unfamiliar task operates at default skill, but gets a bonus based on the supervisor's Margin of Success to coach them (based on the lowest of the applicable skill, Leadership or Teaching, as described above).

Basic treatment for shock is very simple and can be easily taught, so it gets a +4 bonus to teach given adequate supplies. ("Make sure that airway, breathing and circulation are all OK, keep the patient warm and dry, maintain sufficient blood supply to the brain and vitals, and monitor vital signs.")

In situations where the coach has more time and is coaching a single person, both they and their pupil can benefit from bonuses for Extra Time Spent.

If the coach can't monitor their pupil's progress, the pupil must make an Observation or Teaching skill roll to clearly describe the situation and their activities. This gives the coach a modifier to their next roll to coach the pupil based on the pupil's margin of success or failure, but bonuses only counteract penalties which would normally apply to the task.

Alternately, a skill such as Electronics Operation or Photography allows them to send necessary information to the coach, negating penalties for lack of clear information.

The classic cinematic example is where an untrained person encounters a bomb that only they can defuse while being coached through the process by a bomb disposal expert.

The pupil rolls vs. Observation or Teaching skill to describe the situation, possibly with a modifier for Time Spent.

The coach then rolls against the lowest of Explosives (EOD), Leadership or Teaching skill with a modifier based on the pupil's description.

Success gives the student a bonus to their default Explosives (EOD) skill, which also gets bonuses for Time Spent.

For extra drama, treat the bomb disposal attempt as a long task with points accruing based on the cumulative results of the pupil's EOD skill rolls and the coach's effective coaching skill. Sufficient positive points and the bomb is defeated. Sufficient negative points and "boom!"

Yes, the way the task is set up makes it easy to quickly create positive or negative feedback loops. That's realistic. The pupil and coach either understand each other, allowing the pupil to better use the coach's knowledge, or the opposite occurs and the pupil becomes hopelessly confused possibly with disastrous results.