Wounds and Battle Wounds

Lecturer: Snow Gryphon, Dunvegan Physician
January, 2015
Basic Course, no prerequisites

Wounds and Battle Wounds: The Basics

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At the Physician's Academy we make no effort to train you for any real life medical situations. We offer general information on medical topics, by the book and others, designed to better prepare you to role play as a Second Life Gorean physician. I make no claim to authoritative interpretation of the books by John Norman; nor am I trained in medicine in real life.  These lectures are offered as a resource to role play only. Please type an @ if you wish to ask a question or make a comment.

Let us begin.

1.    Introduction

a.    In today’s lecture we will discuss the basics of treating wounds and battle wounds. We will use a non-technical, role play (RP) oriented approach.  The PCOG Manual included in the Dunvegan box provides a more thorough discussion of many kinds of wounds and treatments.

b.    Use of Technology
i.    There is always controversy about what is or isn’t By the Book (BtB). Some say that if it is not in the books, then it is not permitted.  The problem with that idea is that the books were never intended to be medical manuals and the author is often vague about the details of treatments.  The other extreme is the notion that if something is not specifically identified as not existing on Gor then it is OK to use it.  An example could be that nowhere in the books does it say that MRI machines do not exist on Gor, so we are free to use them in our RP.

ii.    I prefer to take the middle path and as a rule of thumb I assume that treatments will be similar to those widely available on earth in the 1960’s and 70’s.  For example, no high tech, electronics, communications, advanced materials, or modern pharmaceuticals.  Simple is better, and generalizations are more effective and easier to use in RP.  For example, it is smarter to say “antibiotic salve”, than to make up something that is wrong or not (BtB).  If you are going to provide detail, you had better know what you are doing.  Many times I have been told that Gorean medicine is similar to medieval medicine.  Well that is certainly not the case.  The books describe Gorean medicine as being advanced, but please do not take that to mean it is like modern medicine.  Advanced manufacturing infrastructure simply does not exist in the Gor books. 

iii.    So to RP a Gorean physician well, you must set the scene in your mind and for a few hours take yourself out of the modern world into the fascinating world of Gor.  Now let us first consider the wounds you will commonly encounter in your community.

2.    Common Wounds   [photo 1]

a.    A wound is an injury in which the skin is either cut or broken producing an open wound, or where blunt force trauma causes internal damage resulting in a closed wound.

b.    Wounds can be clean, contaminated and/or infected.

c.    There are several types of open wound including:
i.    Incisions with sharp objects such as swords or knives, resulting in a clean cut.  Heals relatively fast and less likely to be contaminated or to leave a scar.
ii.    Lacerations that tear the skin, often caused by blunt trauma, for example from a fall.  They are often jagged or irregular in shape and usually contaminated with debris or bacteria.
iii.    Abrasions where the uppermost layers of the skin are scrapped off, for example from being dragged across a rough surface
iv.    Puncture wounds, for example from an arrow or spear.  These wounds tend to have a small site of entry but possibly extensive internal damage.
v.    Avulsions where the skin or body part is detached or torn off.  For example, when an ear is torn off due to a tharlarion bite.

d.    Closed wounds include:
i.    Hematomas that are damaged blood vessels under the skin that can result in bruising or blood tumours.  A blacksmith who hits his thumb with a hammer will often get a hematoma under his thumbnail.
ii.    Crush injuries that produce internal damage to tissues and organs.  This can include injuries as a result of being trampled by a herd of bosk.

e.    Question: What is the difference between an incision and a laceration, and how might that difference affect your treatment?

3.    Incisions by Sharp Objects such as Swords and Daggers  

a.    While there are many variations of wounds, basic treatments are similar and may be adapted to suit the circumstance.  Therefore we will focus on the most common wound in Gor: Incisions.  You may come across injured patients in the street, in their homes, or as walk-ins to your infirmary.  So it is wise to be prepared, and have a belt or bag with you at all times with essential supplies such as disinfectant solution, tweezers, scalpel, antibiotic or honey, suture needle and sutures, and bandages.  You will need dissolvable (Verr gut) and non-dissolvable (silk) sutures.

b.    When you first meet a patient, you must resist the urge to jump in and start healing.  Avoid godmodding!  Even if the patient says something In Character (IC) in open chat that leads you to believe they have an injury, it is always best to IM them to determine the nature of the injury and preferred outcomes.  Remember the devil is in the details, and sometimes you may not want to RP what they want, or there may be a third party that needs to be consulted.  Think it through carefully.  Once you have that sorted, you can start your RP. Also, be sure to use a turn-based RP style and always listen to your patient!  The great fun in RP is that one never knows what will happen next, so don’t be too controlling.

c.    Once you have determined your patient has an Incision wound, the first step is to stabilize using first aid.  This will include the following steps after washing your hands:

i.    Stop bleeding: use manual pressure to stop bleeding and encourage clotting, or use a tourniquet, or use elevation.  You can use a combination of these too.  A tourniquet should only be used when you cannot stop the bleeding using pressure. You can make a simple tourniquet out of whatever is at hand.  For example, you can use a piece of rep cloth and a stick.  The tourniquet should be placed closer to the heart than the wound to slow down arterial blood flow.  Once the major bleeding has stopped, you can pack the wound with sterile rep cloth and hold in place with a bandage.  In RPing this, you should try to use a speedy tempo to simulate how quickly you would have to work in real life.   Don’t let your patient bleed to death! 
       [Photo 2 ]
      
ii.    Treat shock if applicable (see Shock and Concussion notecard).  Shock means the blood is no longer being delivered adequately throughout the body. Shock can occur with almost any injury, so here are the symptoms: pale, clammy skin, rapid heart rate, low blood pressure, decreased alertness, and confusion. Be sure to watch for any of these key words in your patient’s emotes.  Treat by having the patient lie down with feet elevated, unless it is a head wound. Loosen any tight or restrictive clothing and keep the person calm. Warm the patient if needed and give liquids.  A saline IV may also be needed in extreme cases.

iii.    Once your patient is stable, transport to the infirmary, if not already there.

d.    In the infirmary you can begin to further assess the nature and extent of the Incision wound.  Where is it located?  How deep?  Have major blood vessels been cut?  Is the wound infected or contaminated?

i.    First wash your hands and gather any supplies and equipment needed.  You can easily RP having a pre-made “Wounds Tray”.  For example, “Goes to the sink and carefully washes hands in clean water with soap and dries with a sterile rep cloth.  Then takes the Wounds Tray with essential supplies from the cupboard and returns to the patient.”  It can be as simple as that and also you can use this time to further consult with the patient in IM’s before you start, or discuss the case briefly with any others present.

ii.    The second step is to carefully unpack the wound then clean it by irrigating with a disinfectant wash solution.  Sop up the wash with a rep cloth. You may also RP that you are removing bits of debris with your tweezers and you may find some severed blood vessels that need to be sutured. This section of the RP also is an opportunity to check-in with the patient to see how they are doing.  They may be moaning and groaning, so you can offer them some encouragement as well as pain relief later on.

iii.    If you need to do some suturing, use gut thread (verr or bosk) as it dissolves with time.  Put in a few stitches if needed to close severed blood vessels, then one final rinse and dry and it is time to close and seal the wound.

iv.    Excepting minor, superficial wounds, most will be closed using sutures.  The easiest way to RP this is with single stitches using a curved suturing needle with silk thread.  You can use a straight sewing needle too, if that is all that is available.  Either way, be sure the needle has been sterilized before use.  This can quickly be done with an open flame, if the needle has not been pre-sterilized.
  
v.    It is fun to count-off the stitches as you do them.  For example, “I take the curved needle and holding the wound together, place one stitch and tie it off, then a second stitch and so on until all 21 stitches are in place.”  Patients love to tell everyone how many stitches they got.
   [Photo 3]
vi.    Once the stitching is completed coat the area with antibiotic ointment or honey.  You also may use “healing salve” from the Priest Kings that will heal the wound quickly and leave no scaring.  Some patients prefer to show off their war wounds, so you would not use healing salve in that case.  Bandage to cover and protect the wound and advise the patient to keep the wound elevated for a few days to encourage circulation.  There are lots of bandages available to put on your patients.  I have included some in the Dunvegan box you can use.

vii.    At this point you can offer your patient pain relief, often in the form of a tea they can take home.  You needn’t be any more specific than that

viii.    Goreans heal very quickly, with or without healing salve, so it is best to book a follow-up appointment for a day or two later before your patient leaves, in order to remove the stitches and ensure the wound is healing properly.   The last task is to fill out your city treatment form then you are done!

ix.    All right, let us sum up.  The take-home message is that treating a basic incision wound is quite easy.  Just follow these five steps:
1.    First aid (stop bleeding, treat shock)
2.    Clean wound
3.    Suture
4.    Apply antibiotic and bandage
5.    Treat pain

x.    Treating wounds in your infirmary can be great fun and you can take your time to have an interesting RP and develop story lines.  People love to talk about themselves, so be sure to ask how they received the wound and see where it takes you.  And finally, make sure their visit to the infirmary was an enjoyable experience for your patient, and they will come back for more!
e.    Question: Patients often arrive with more than one problem.  If so, how do you decide which problem to deal with first?

f.    Next we will address the treatment of wounds in the battlefield.

4.    Treatment of Wounds in the Battlefield – The Simple Battle Serve

a.    Introduction

i.    In day to day RP in the infirmary, the Gorean Meter (GM) does not much come into play.  Once you move the RP to the battlefield, it is a completely different story.  Understanding how the GM works is essential.  So let us see how wounds are treated in this environment.  We will assume you are a physician or apprentice working in a battle among the warriors.  Your meter should be set to Combat Mode and you already should be briefed by your Commander. The first thing you will notice once the battle begins is the chaos and confusion everywhere.  It will be your job to stay alive and provide a useful service for your comrades.  So stay calm and good luck!

b.    Accessing and Interviewing Your Patient
i.    The first thing to remember is that you are doing first aid as quickly and efficiently as possible, in less than one minute, if possible.   So with that in mind, when you encounter a wounded warrior, the first step is to ask him about his injuries.  This should only take a few seconds with practice.  For example say “Warrior, where are you injured?”, and he responds “I have an arrow in my shoulder”.   Do this in open chat IC.  You have no time to negotiate in IM as you would in your infirmary.  Nor is a battle serve the time for para RP, keep it simple and direct, forget about the long emotes.  Your immediate goal is to stabilize his injuries and prevent further damage.  Determine what his worst injuries are, if he has more than one, and treat them first.   Look for major artery cuts or punctures, or major bone breaks or difficulty breathing. This requires some practice and judgment, but in most cases it means stop the bleeding first.

c.    Cuts and Projectile Wounds
i.    If the wound is an incision, laceration or puncture, clean the wound with disinfectant and remove any debris with tweezers.   Do this quickly.  Do not try removing any projectiles such as arrows in the field.

ii.    If the bleeding is profuse, apply pressure on the wound to promote clotting.  In most cases for a serious wound, your goal is to get the warrior to the infirmary ASAP.  You may consider cauterizing the wound with a hot iron and putting in a few stitches in the field to repair major damaged arteries, but think about how likely this is in the middle of a battle.  If the wound is less severe, you may be able to patch him up sufficiently to keep on fighting by simply stopping the bleeding and applying a bandage.

iii.    If the patient is a non-combatant you may wish to offer a painkiller such as a tassa tincture.  Warriors almost never will accept a painkiller, so you can save yourself the typing.  

iv.    All right, so here is the heart of the problem: A warrior is down and emotes  that he has an arrow in his leg.  I have just told you that you should not attempt arrow extraction in the field and that the proper course of action is to stop the bleeding and get the warrior to the infirmary; BUT…you have only one minute to do that, and the warrior can heal himself in 4-5 minutes (this is how the GM works).  What are the chances of a warrior agreeing to be brought to an infirmary for an extended RP while his mates are being slaughtered?  So usually the best you can do is to get him out of his bubble and back into the fray ASAP. It is a conflict between combat and RP that has yet to be resolved in SL.  So just do your best, there may not be a perfect solution.

v.    Question:  You come upon a warrior with arrows in both legs and he can’t walk.  What are your options for getting him to the infirmary? Answer: A few people could carry him or better yet use a stretcher or wagon.

d.    Concussion and Shock
i.    We have dealt with shock previously, so use the appropriate treatments if there are symptoms.

ii.    A concussion is an injury to the brain and it may accompany other wounds, so watch for these symptoms: headache or a feeling of pressure in the head, temporary loss of consciousness, confusion or feeling as if in a fog, amnesia surrounding the traumatic event, dizziness or "seeing stars", ringing in the ears, nausea, vomiting.  The treatments are as follows:  Apply ice or a cold wet cloth, use a painkiller such as tassa tincture, rest, and monitor symptoms over time.

iii.    Incisions, lacerations and projectile wounds, shock and concussion are the medical issues most often encountered in the battle field that can be addressed easily and efficiently.  You may also encounter, poisoning, bites, burns, broken bones, and choking among others.  Treatment of all these are beyond the scope of this lecture, but suffice to say that you should pass these along to the infirmary staff when the patient is delivered.

iv.    Question:  A warrior is down and he said that he fell off the wall and may have banged his head.  His only symptoms are a rapid heart rate and cool clammy skin.  What should you do? Answer: It is not uncommon to get mixed messages and symptoms or even next to no symptoms from warriors.  A little bit of godmodding here may be OK.

e.    Summary of the Battle Serve, Step-by-Step

i.    Now that we have surveyed the techniques, here are the steps to do a Battle Serve RP.  First, when someone goes down and in their bubble, they will usually say something like; “shouts: I need healing, help me!!”. Once you have determined that the person is on your side and where he/she is, run to them quickly.   When a person is downed you can’t aid them for one minute.  So as soon as you arrive, click on the bubble to see how many seconds are left on the clock.

ii.    Also look around and assess the situation.  Is there an enemy warrior standing right there?  If so, will he leave you alone to do your serve, or does he attack you?  If you are attacked, get out of there fast, you have no chance against a warrior. 

iii.    Now let’s assume you have arrived and no one is trying to kill you.  Here are the next steps that you need to do quickly:

1.     When the patient is down and in a bubble, emote about getting ready to heal the person, name them explicitly.  For example:   “Runs to PowerfulOne to heal him”

2.    Assess the injury.  For example:  “How can I help you warrior?”  He will respond with something like “I have been downed by a battle axe cut on my leg.”

3.    Use appropriate RP to heal the wound.  For example, for an incision wound: “Warrior, be still and I will heal you.”  Cleans wound carefully with disinfectant and removes debris with tweezers.  Applies antibiotic ointment, and presses sterile rep cloth on wound and wraps with bandage.  “You will be fine now brave warrior!”  This RP assumes no stitches are required.  If the wound is sufficiently serious to require stitches, or if there are complications, the patient should go to the infirmary.

4.     Click on the bubble again and select “Aid”

5.    The bubble should disappear and the patient will once again be on their feet.  You will note that their health number may be very low, so they are not really fit to re-enter battle accept to assist someone else.  At this point you can close the serve by saying something like: “You are healed enough to continue PowerfulOne, Be well!”

iv.    If you intend to serve in battle, you must practice this RP with your warrior comrades before the battle.  Practice makes perfect, and they will come to rely on your abilities and assistance.

v.    Questions
1.    I pose the following questions because I value your input.  Often there is no right answer, so let's see what we can do with them.

a.    How do you deal with an uncooperative warrior?

b.     IMing on the battlefield, should we do it, and when?

c.     Why bother doing the RP, why not just click the aid button and go to the next patient?

d.     Should you try to defend yourself when you are working in the battlefield?

f.     Extending the RP at the Infirmary

i.    Not all your patients will be warriors. Some will be others in the community such as free men, women and slaves.  They may be injured either accidentally or on purpose.  So you can encourage these patients to visit the infirmary for a more extended and hopefully more interesting RP.  These RP’s can also serve to enrich existing story lines and create new ones.   For example, a pregnant free woman has been caught in the crossfire and has received a few arrow wounds.  Will she survive, and how about the baby?  And why was she there in the first place?  One can imagine many possibilities.

ii.    While the warriors certainly will not appreciate extended RP’s while the battle goes on, they may quite enjoy a post-battle visit to the infirmary to fix up any serious problems.  These RP’s can be quite fun as the warriors often are in a good mood after a battle.  They can be scheduled same day or more typically for the following days.  For best results invite them before the battle.   Warriors love to talk about their battle exploits.   Be sure to ask them about it while you are healing.

5.    That is all for today.  Any final questions or comments?