Medical

ACE Medical overhauls the medical system with the aim to make it more engaging for medics. It is highly configurable, allowing communities to tailor the experience from casual to realistic. ACE Medical is split into multiple mods for increased modularity:

ACE Medical Core
ACE Medical Hitzones
ACE Medical Circulation
~~ACE Medical Defibrillation~~
~~ACE Medical Breathing~~

ACE Medical Core

Overview

ACE Medical Core provides the backbone for all medical mods and comes with the following features:

Second Chance: Increases survivability by ensuring that players fall unconscious instead of getting killed outright.
Pain: Injuries cause pain screen effects and can be treated with morphine
Medication:
- Changed: Morphine can only be used for treating pain and has no longer healing effects
- Added: Epinephrine for speeding up wake-up of unconscious patients
Repositioning: Allows putting patients on their back or in recovery position
Medical radial menu for putting medical items to hand
Additional settings for configuring medical kits, bleedings, etc.

Details

Resilience

Resilience is a health pool from vanilla with 100 HP that is closely linked to consciousness. It takes indirectly damage passed from body parts and armor. A player falls unconscious when HP < 33 and wakes up when HP > 75. HP is either recovered through passive regeneration or with epinephrine. The passive recovery rate is +5 HP/s and can be scaled with m_fDefaultResilienceRegenScale respective m_fSecondChanceResilienceRegenScale (see Settings). Note that passive recovery only starts when no damage was taken for 10 seconds.

Second Chance

Second chance gets evaluated when a player would have been killed in vanilla without falling unconscious first. If granted, the player will survive, but falls unconscious with a distinct recovery rate (see m_fSecondChanceResilienceRegenScale in Settings). Depending on the settings, epinephrine is mandatory to wake up patients that got second chance granted. The evaluation of second chance is probabilistic and can be configured per body part.

Medical Kit

While a vanilla feature, newcomers might not be aware that it can be put in hand for healing body parts of patients. Depending on the settings, healing requires supplies and full healing can only be done near ambulances and medical facilities. Unlike vanilla, it is the only way to actively heal body parts. It is therefore crucial for treating arm and leg injuries, which can make aiming and walking difficult otherwise. Depending on the settings, it may also be required to heal up players before being able to apply epinephrine.

Treatments

Below is a proposed activity diagram for treating patients:

Usage

Reposition Patient

Unconscious patients have a user interaction on their abdomen for changing to back or recovery position.

Open medical radial menu with Ctrl+H (ACE default)

Settings

Summary of settings that can be modified in the server config:

Field	Value	Description
`m_fDefaultResilienceRegenScale`	Type: `float`** Range: 0 to ∞ Default: `0.3`	Default resilience regeneration scale. The default regeneration rate (5 HP/s) will be multiplied by this factor.
`m_fMinHealthScaledForEpinephrine`	Type: `float`** Range: 0 to 1 Default: `0.33`	Can only apply epinephrine when patient has at least this health (ignored in advanced medication).
`m_bBleedOutForPlayersEnabled`	Type: `bool`* Default: `true`	Whether players can bleed out
`m_fBleedingRateScale`	Type: `float`** Default: `1.0`	Character bleeding rate multiplier
`m_fMaxTotalBleedingRate`	Type: `float`** Default: `-1.0`	Maximum possibe bleeding rate in ml/s (Negative value means unlimited)
`m_fBloodRegenScale`	Type: `float`** Default: `1.0`	Character blood regeneration rate multiplier
`m_bHealSupplyUsageEnabled`	Type: `bool`* Default: `true`	Healing consumes supplies when enabled. Ignored when global supply usage is disabled.
`m_fMedicalKitMaxHealScaled`	Type: `float`** Range: 0 to 1 Default: `0.5`	Maximum scaled health (from 0 to 1) that a medical kit can heal to outside of medical facilities
`m_ePainScreenEffectType`	Type: `int`*** Default: `WHITE_FLASH` Options: `0` (`NONE`) `1` (`WHITE_FLASH`) `2` (`GREY_FLASH`) `3` (`CHROMATIC_ABERRATION`) `4` (`RADIAL_BLUR`)	What kind of pain screen effect is used
`m_fSecondChanceResilienceRegenScale`	Type: `float`** Range: 0 to ∞ Default: `0.0`	Resilience regeneration scale when second chance was triggered. The default regeneration rate will be multiplied by this factor.
`m_fDefaultSecondChance`	Type: `float`** Range: 0 to 1 Default: `1.0`	Default probability for second chance for killing blows
`m_fSecondChanceOnHead`	Type: `float`** Range: 0 to 1 Default: `0.0`	Probability for second chance for killing blows to the head
`m_fSecondChanceOnChest`	Type: `float`** Range: 0 to 1 Default: `1.0`	Probability for second chance for killing blows to the chest
`m_fSecondChanceOnAbdomen`	Type: `float`** Range: 0 to 1 Default: `1.0`	Probability for second chance for killing blows to the abdomen
`m_bSecondChanceForFallDamageEnabled`	Type: `bool`* Default: `false`	Whether second chance can be triggered when falling from great heights
`m_bSecondChanceForAIEnabled`	Type: `bool`* Default: `false`	Whether AI can have second chance

* bool has to be provided as integer in the config: 1 (true) or 0 (false).
** float need a decimal point to get properly read.
*** Note that enums have to be provided as integers.

Template for the missionHeader in a server config:

"missionHeader": {
    "m_ACE_Settings": {
        "m_ACE_Medical_Core": {
            "m_fDefaultResilienceRegenScale": 0.3,
            "m_fMinHealthScaledForEpinephrine": 0.33,
            "m_bBleedOutForPlayersEnabled": 1,
            "m_fBleedingRateScale": 1.0,
            "m_fMaxTotalBleedingRate": -1.0,
            "m_fBloodRegenScale": 1.0,
            "m_bHealSupplyUsageEnabled": 1,
            "m_fMedicalKitMaxHealScaled": 0.5,
            "m_ePainScreenEffectType": 1,
            "m_fSecondChanceResilienceRegenScale": 0.0,
            "m_fDefaultSecondChance": 1.0,
            "m_fSecondChanceOnHead": 0.0,
            "m_fSecondChanceOnChest": 1.0,
            "m_fSecondChanceOnAbdomen": 1.0,
            "m_bSecondChanceForFallDamageEnabled": 0,
            "m_bSecondChanceForAIEnabled": 0
        }
    }
}

ACE Medical Hitzones

Overview

ACE Medical Hitzones overhauls hit zones and has the following features:

Organ Hit Zones: New hit zones that can only be hit with melee and projectiles:
- Heart: Evaluated for second chance
- Femoral arteries: Cause massive bleedings
Removes global health in favor of evaluating second chance on destruction of vital body parts (head and torso)
Improves bleeding effect of massive bleedings

Details

Removal of Global Health

In vanilla, there is a global health pool that takes damage passed from body parts. If HP of this health pool drops to 0, second chance gets evaluated. ACE Medical Hitzones gets completely rid of this health pool and evaluates second chance instead when HP of a vital body part drops to 0.

Settings

Summary of settings that can be modified in the server config:

Field	Value	Description
`m_bOrganHitZonesEnabled`	Type: `bool`* Default: `true`	Whether organ hit zones should be enabled
`m_fSecondChanceOnHeart`	Type: `float`** Range: 0 to 1 Default: `0.0`	Probability for second chance for killing blows to the heart

Template for the missionHeader in a server config:

"missionHeader": {
    "m_ACE_Settings": {
        "m_ACE_Medical_Hitzones": {
            "m_bOrganHitZonesEnabled": 1,
            "m_fSecondChanceOnHeart": 0.0
        }
    }
}

ACE Medical Circulation

Overview

ACE Medical Circulation adds the following features:

Vitals:
- Simulation of heart rate and blood pressure
- Cardiac arrest state and CPR for revival
Medication:
- Removes all “training wheels”, i.e. drugs can always be administered and overdosed
- Exchanges epinephrine with ammonium carbonate. Epinephrine has now a different role.
- New types of drugs
- Advanced simulation of drug effects and their evolution over time
Second chance:
- When second chance is granted, the patient goes into cardiac arrest
Hit Zones:
- New brain hit zone that takes continuously damage while in cardiac arrest and no CPR is performed. Runs out of health in approximately 5 minutes.

The changes are also applied to AI, but they will directly die when they enter cardiac arrest (see m_bCardiacArrestForAIEnabled in Settings).

Details

Glossary

BP: Blood pressure
HR: Heart rate
OD: Overdose
$t_{m a x}$ : Time until maximum effect
$t_{½}$ : Time until effect diminishes to 50% of maximum effect (relative to administration time, not $t_{m a x}$ )
$T D_{50}$ : Number of doses at which 50% of patients fall unconscious
$L D_{50}$ : Number of doses at which 50% of patients experience cardiac arrest

Medications

All currently available forms of medications are summarized in the table below:

Name	Effects	$t_{m a x}$	$t_{½}$	$T D_{50}$	$L D_{50}$
Ammonium carbonate package	Wakes up stable unconscious patients	2-3 s	3-4 s	---	---
Epinephrine injector	Increases revive chance Increases HR Increases BP	23 s	1 min 3 s	---	4.4
Metoprolol injector	Decreases HR Decreases BP	25 s	1 min 9 s	2.8	> 3
Morphine injector	Suppresses pain Decreases HR Decreases BP	1 min 57 s	15 min 20 s	3.1	3.8
Naloxone injector	Treats morphine OD	1 min 35 s	7 min 26 s	---	---
Phenylephrine injector	Slows down bleeding and transfusion Increases BP	29 s	1 min 18 s	---	2.9

Vital Ranges

Blood volumes are categorized into six classes:

Normal
Class I hemorrhage (lost < 30%)
Class II hemorrhage (lost 30%)
Class III hemorrhage (lost 60%)
Class IV hemorrhage (lost 80%)
Fatal (lost 100%)

The values of the vitals (e.g. HR and BP) are essential for getting a patient back up. While in cardiac arrest, only CPR may get the patient back up, but the success chance can be increased with epinephrine. A patient falls unconscious if either their resilience falls below 34/100 or their vital state is at least critical. Resilience will automatically recover if the vitals are stable, but can be speeded up with ammonium carbonate (i.e. like epinephrine in ACE Medical). Ammonium carbonate has no effect as long as the vitals aren’t stable.

State	HR [BPM]	BP [mmHg]	Hemorrhage class
Cardiac arrest	> 220	> 284/189	---
Stable	40 - 220	69/46 - 284/189	< II
Unstable	< 40	< 69/46	II
Critical	< 30	< 51/34	III
Cardiac arrest	< 20	< 51/34*	IV

* BP below 51/34 mmHg only leads to cardiac arrest if the heart rate is at least critical (i.e. < 30 BPM).

Treatments

Below is a proposed activity diagram for treating patients, which supersedes the one from ACE Medical Core:

Settings

Summary of settings that can be modified in the server config:

Field	Value	Description
`m_fDefaultHeartRateBPM`	Type: `float`** Range: 0 to ∞ Default: `80.0`	Default heart rate [bpm]
`m_fDefaultStrokeVolumeML`	Type: `float`** Range: 0 to ∞ Default: `95.0`	Default stroke volume [ml]
`m_fDefaultMeanArterialPressureKPA`	Type: `float`** Range: 0 to ∞ Default: `12.443`	Default mean arterial pressure [kPa]
`m_fDefaultPulsePressureKPA`	Type: `float`** Range: 0 to ∞ Default: `5.3329`	Default pulse pressure [kPa]
`m_UnstableThresholds`	Type: `object`	Thresholds that lead to unstable vital state
`m_CriticalThresholds`	Type: `object`	Thresholds that lead to critical vital state
`m_CardiacArrestThresholds`	Type: `object`	Thresholds that lead to cardiac arrest state
`m_CardiacArrestDamageEffect`	Type: `object`	Damage effects caused by cardiac arrest
`m_bCardiacArrestForAIEnabled`	Type: `bool`* Default: `false`	AI will die instead of entering cardiac arrest if false
`m_fCPRSuccessCheckTimeoutS`	Type: `float`** Range: 0 to ∞ Default: `22.0`	Default delay between check for successful CPR [s]
`m_fCPRSuccessChanceMin`	Type: `float`** Range: 0 to 1 Default: `0.0`	Chance for exiting cardiac arrest while performing CPR at class IV hemorrhage
`m_fCPRSuccessChanceMax`	Type: `float`** Range: 0 to 1 Default: `0.4`	Chance for exiting cardiac arrest while performing CPR at above class II hemorrhage
`m_fAmmoniumCarbonateSuccessChanceMin`	Type: `float`** Range: 0 to 1 Default: `0.2`	Chance for waking up from ammonium carbonate when resilience recovery scale is close to 0
`m_fAmmoniumCarbonateSuccessChanceMax`	Type: `float`** Range: 0 to 1 Default: `1.0`	Chance for waking up from ammonium carbonate when resilience recovery scale is at `m_fMaxRevivalResilienceRecoveryScale` or above
`m_fMaxRevivalResilienceRecoveryScale`	Type: `float`** Range: 0 to ∞ Default: `0.2`	Maximum resilience recovery scale applied after getting revived. This scale gets multiplied by the scaled health of the brain and will be removed once the patient becomes conscious
`m_fCardiacArrestMaxTotalBleedingRate`	Type: `float`** Range: 0 to ∞ Default: `20.0`	Maximum total bleeding rate at cardiac arrest due to gravity [ml/s]

`m_UnstableThresholds`

Field	Value	Description
`m_fHeartRateLowBPM`	Type: `float`** Range: 0 to ∞ Default: `40.0`	A heart rate below this will trigger a transition to this state [BPM]
`m_fHeartRateHighBPM`	Type: `float`** Range: 0 to ∞ Default: `220.0`	A heart rate above this will trigger a transition to this state [BPM]
`m_fMeanArterialPressureLowKPA`	Type: `float`** Range: 0 to ∞ Default: `7.11`	A mean arterial pressure below this will trigger a transition to this state [kPa]
`m_fMeanArterialPressureHighKPA`	Type: `float`** Range: 0 to ∞ Default: `29.5`	A mean arterial pressure above this will trigger a transition to this state [kPa]
`m_fMaxHeartForMeanArterialPressureLowBPM`	Type: `float`** Range: 0 to ∞ Default: `80.0`	Maximum heart rate for trigger due to low mean arterial pressure [bpm]
`m_eBloodState`	Type: `int`**** Range: 0 to ∞ Default: `CLASS_2_HEMORRHAGE`	Blood volume at this level will trigger a transition to this state

**** Note that blood states have to be provided as integers in the config: 0 (NORMAL), 1 (CLASS_1_HEMORRHAGE), 2 (FATAL), 3 (CLASS_2_HEMORRHAGE), 4 (CLASS_3_HEMORRHAGE) or 5 (CLASS_4_HEMORRHAGE).

`m_CriticalThresholds`

Field	Value	Description
`m_fHeartRateLowBPM`	Type: `float`** Range: 0 to ∞ Default: `30.0`	A heart rate below this will trigger a transition to this state [BPM]
`m_fHeartRateHighBPM`	Type: `float`** Range: 0 to ∞ Default: `220.0`	A heart rate above this will trigger a transition to this state [BPM]
`m_fMeanArterialPressureLowKPA`	Type: `float`** Range: 0 to ∞ Default: `5.21`	A mean arterial pressure below this will trigger a transition to this state [kPa]
`m_fMeanArterialPressureHighKPA`	Type: `float`** Range: 0 to ∞ Default: `29.5`	A mean arterial pressure above this will trigger a transition to this state [kPa]
`m_fMaxHeartForMeanArterialPressureLowBPM`	Type: `float`** Range: 0 to ∞ Default: `40.0`	Maximum heart rate for trigger due to low mean arterial pressure [bpm]
`m_eBloodState`	Type: `int`**** Range: 0 to ∞ Default: `CLASS_3_HEMORRHAGE`	Blood volume at this level will trigger a transition to this state

`m_CardiacArrestThresholds`

Field	Value	Description
`m_fHeartRateLowBPM`	Type: `float`** Range: 0 to ∞ Default: `20.0`	A heart rate below this will trigger a transition to this state [BPM]
`m_fHeartRateHighBPM`	Type: `float`** Range: 0 to ∞ Default: `220.0`	A heart rate above this will trigger a transition to this state [BPM]
`m_fMeanArterialPressureLowKPA`	Type: `float`** Range: 0 to ∞ Default: `5.21`	A mean arterial pressure below this will trigger a transition to this state [kPa]
`m_fMeanArterialPressureHighKPA`	Type: `float`** Range: 0 to ∞ Default: `29.5`	A mean arterial pressure above this will trigger a transition to this state [kPa]
`m_fMaxHeartForMeanArterialPressureLowBPM`	Type: `float`** Range: 0 to ∞ Default: `30.0`	Maximum heart rate for trigger due to low mean arterial pressure [bpm]
`m_eBloodState`	Type: `int`**** Range: 0 to ∞ Default: `CLASS_4_HEMORRHAGE`	Blood volume at this level will trigger a transition to this state

`m_CardiacArrestDamageEffect`

Field	Value	Description
`m_fBrainDamageRate`	Type: `float`** Range: 0 to ∞ Default: `0.333`	Damage the brain takes per second
`m_fEffectStartDelayS`	Type: `float`** Range: 0 to ∞ Default: `10.0`	Delay in seconds before the effect starts [s]

Template for the missionHeader in a server config:

"missionHeader": {
    "m_ACE_Settings": {
        "m_ACE_Medical_Circulation": {
            "m_fDefaultHeartRateBPM": 80.0,
            "m_fDefaultStrokeVolumeML": 95.0,
            "m_fDefaultMeanArterialPressureKPA": 12.443,
            "m_fDefaultPulsePressureKPA": 5.3329,
            "m_UnstableThresholds": {
                "m_fHeartRateLowBPM": 40.0,
                "m_fHeartRateHighBPM": 220.0,
                "m_fMeanArterialPressureLowKPA": 7.11,
                "m_fMeanArterialPressureHighKPA": 29.5,
                "m_fMaxHeartForMeanArterialPressureLowBPM": 80.0,
                "m_eBloodState": 3
            },
            "m_CriticalThresholds": {
                "m_fHeartRateLowBPM": 30.0,
                "m_fHeartRateHighBPM": 220.0,
                "m_fMeanArterialPressureLowKPA": 5.21,
                "m_fMeanArterialPressureHighKPA": 29.5,
                "m_fMaxHeartForMeanArterialPressureLowBPM": 40.0,
                "m_eBloodState": 4
            },
            "m_CardiacArrestThresholds": {
                "m_fHeartRateLowBPM": 20.0,
                "m_fHeartRateHighBPM": 220.0,
                "m_fMeanArterialPressureLowKPA": 5.21,
                "m_fMeanArterialPressureHighKPA": 29.5,
                "m_fMaxHeartForMeanArterialPressureLowBPM": 30.0,
                "m_eBloodState": 5
            },
            "m_CardiacArrestDamageEffect": {
                "m_fBrainDamageRate": 0.333,
                "m_fEffectStartDelayS": 10.0
            },
            "m_bCardiacArrestForAIEnabled": 0,
            "m_fCPRSuccessCheckTimeoutS": 22.0,
            "m_fCPRSuccessChanceMin": 0.0,
            "m_fCPRSuccessChanceMax": 0.4,
            "m_fAmmoniumCarbonateSuccessChanceMin": 0.2,
            "m_fAmmoniumCarbonateSuccessChanceMax": 1.0,
            "m_fMaxRevivalResilienceRecoveryScale": 0.2,
            "m_fCardiacArrestMaxTotalBleedingRate": 20.0
        }
    }
}

ACE Medical Defibrillation

Overview

TBD

ACE Medical Breathing

Overview

TBD

Details

TBD

Treatments

Below is a proposed activity diagram for treating patients, which supersedes the one from ACE Medical Circulation:

Medical

ACE Medical Core

Overview

Details

Resilience

Second Chance

Medical Kit

Treatments

Usage

Reposition Patient

Medical Radial Menu

Settings

ACE Medical Hitzones

Overview

Details

Removal of Global Health

Settings

ACE Medical Circulation

Overview

Details

Glossary

Medications

Vital Ranges

Treatments

Settings

m_UnstableThresholds

m_CriticalThresholds

m_CardiacArrestThresholds

m_CardiacArrestDamageEffect

ACE Medical Defibrillation

Overview

ACE Medical Breathing

Overview

Details

Treatments

`m_UnstableThresholds`

`m_CriticalThresholds`

`m_CardiacArrestThresholds`

`m_CardiacArrestDamageEffect`