For the upcoming Hospital Update 0.11, we have completely overhauled the hospital system.

Previously, if a wound exceeded a specific intensity, the soldier was sent to the field hospital. There, various factors such as fitness, the hospital's capacity and other circumstances were used to calculate whether the soldier's condition would improve or deteriorate. This ultimately resulted in the soldier either recovering or dying.

Complications

With the new update, we are significantly expanding the system. Instead of a single recovery process, there are now various medical complications that can occur independently of one another.

From left to right: Bloodloss, Breathlessness, Circulatory collapse, Cough, Delirium, Fever, Gangrene, Agrypnia, Nausea, Pain, Pneumonia, Skin rash

Each complication has different values in terms of recovery time, risk of death/permanent disability and incapacity for duty. As before, these values are then influenced by other factors (fitness, hospital capacity, etc.).

Complications can also trigger specific projects, which may then, amongst other things, speed up recovery or reduce the risk of death (or the other way around, if left undone), e.g. changing bandages regularly, obtaining blankets or providing company.

The core element of the new system, however, is that soldiers can have multiple complications at the same time. A soldier with a cough will only suffer slight fitness penalties and will therefore tire more quickly. However, if further problems arise, such as pneumonia, breathlessness and fever, the situation can quickly become critical.

Diseases

While injuries (a future Dev Diary is planned on this topic) are immediately visible, diseases such as dysentery, trench fever or tuberculosis are not displayed, but manifest themselves solely through the complications they cause.

Certain situations in the game can increase the likelihood of these diseases occurring. Delayed latrine duty increases the risk of dysentery, prolonged meager rations can contribute to tuberculosis, and poor hygiene can lead to trench fever. Whilst dysentery occurs more frequently in hot weather (partly due to spoiled food), the risk of trench fever increases in cold weather (higher risk of lice due to clothing).

Each of these diseases has its own clinical course: trench fever e.g. often begins with skin rash and pain (in the legs) and leads to recurring outbreaks of fever over several months (historically, affected soldiers were in fact unfit for duty for at least two months).

In addition to these specific diseases, which often have severe consequences, there is also another condition referred internally simply as 'infection'. It occurs sporadically and is usually relatively mild, but it can lead to many of the existing complications.

Decisions

As diseases are not displayed, the aim is to create a system where one has to interpret the symptoms and make decisions: a cough, for instance, could be a harmless infection that will soon clear up, but it could also be an early sign of tuberculosis. In the second case, it might be a good idea not to let the soldier work alongside others, or even to send him to the hospital at an early stage.

This brings us to the final point: dealing with sick soldiers. If a soldier’s complications reach a certain level, he is automatically deemed unfit for duty and sent to the hospital. However, if his condition is below that threshold, a decision can now be made on how to proceed: a soldier can be sent to the hospital as a precaution, or he can be released early if his labour or his service at the front is urgently needed.

Admitting a soldier to the infirmary usually costs Elisabeth some trust and depends on how full the infirmary currently is. However, taking a soldier out of the infirmary before his recovery is complete has a much greater impact on trust. If the soldier is unwilling and is forced to do so (similar to artillery in the trenches), his relationship with the Unteroffizier is also damaged.