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Wounds and Infection


Steve

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A character gets injured during a fight, marks off a few Body to be healed back over time and that's usually it.

 

What about the risk of infection and the results that could occur? I've seen characters in movies and books get hurt, then infected and then have to fight again while feverish and in pain, or have to perform some challenging task.

 

How would you handle infected wounds? Not just gangrene but things like sepsis and other germs? What kind of character effects could they cause?

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I use Impairing and Disabling wounds, so in my games, healing wounds is not so simple as just healing a few body and being done with it.

 

If a wound is less than an impairing wound it is essentially superficial. a "flesh wound" so to speak. under normal circumstances there should be little chance of gangrene or infection for minor wounds of this sort. only if kept in the most unsanitary of conditions should this be a possibility.

 

If a wound is Impairing, then it is more serious, will take longer to heal and thus may be more susceptible to infection. Disabling wounds should be even more susceptible.

 

Then penalties for impairing or disabling wounds should not go away until all the body from that particular wound has healed and at the GM's whim, the penalties could even take a few weeks longer to dissipate.

 

During this healing period, the wounded should make a CON roll each week to check for infection. the possibility of infection depends on the conditions under which the wounded individual is being cared for under.

 

Top notch: +5

Excellent: +4

Very good: +3

Good: +2

Fair: +1

Average: +0

Poor: -1

Very poor: -2

Unsanitary: -3

Filthy: -4

Complete squalor: -5

 

If the CON roll is failed, the character has contracted an infection. during the time a wounded character has an infection, the wound won't heal and will not gain Body back from their REC until the infection is purged.

 

Once an infection has set in, the character may make a CON roll each week to try and recover from the infection, but as it spreads, this becomes more and more difficult. there is a cumulative penalty each week when the infection is not healed. ministration from a skilled healer (paramedic or PS: doctor/healer) gives the patient a bonus to that con roll based on the rules for complimentary skills.

 

If the CON roll to resist infection is failed by 5 points or more, the wound has become septic and has a chance of causing further injury or death. at this point check for the infection spreading daily. each time the CON roll is failed, the patient takes 1 body damage and this famage is considered to be a part of the original wound. thus impairing wounds that become infected can progress into disabling wounds and become life threatening. if the body loss from the infection brings the character below 0 body, they begin dying as normal, but this is much slower than the standard -1 body per turn. they lose -1 body per hour till they expire. the patient cannot be stabilized unless the infection is brought under control first.

 

What do you think? needs work? something i forgot?

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Interesting idea, and neat house rule NSG! I can think of a few genres/campaigns where it would be a great addition. (Post-Apoc anyone?) Random thoughts off the top of my head:

  • If it were me, I'm not sure I'd tie it to Impairing/Disabling Wounds. Even a bad scratch can get infected if not taken care of. Besides, Impairing/Disabling Wounds already have a mechanism to keep players from ignoring them; it's the "regular" wounds that too-often become just a tick on the character sheet. Maybe tie it to the Bleeding Table in some way, so that larger wounds have a greater chance of infection, but you still don't want to ignore minor wounds?
  • A CON Roll to fight off the infection is appropriate, but whether or not the wound gets infected in the first place seems like it would depend more on how well you take care of it. So instead of just making Paramedics Complimentary to the CON Roll, maybe they first make a Paramedics Roll to clean & dress the wound, with modifiers for severity of the wound, sanitary conditions, presence of drugs/disinfectants/etc. Failure means the wound has become infected, then requires a CON Roll to fight off the infection with penalties for how bad the paramedics roll failed by. I realize it's adding another step, but I kinda like the idea of giving Paramedics skill something else to do.
  • I like that Infected wounds don't heal, and if they go septic they can cause additional damage.
  • I also like Steve's idea of giving them additional character impacts like fever, etc. Characteristic/skill roll penalties would probably get you most of the way there. Maybe Drain CON & END too? APG2 has some rules for disease we could probably crib from, but I haven't looked at them in awhile.
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That is a good analysis, NSG. Do you think the character would have any additional skill or combat penalties from having an infected wound or just the normal impairment/disabling effects?

 

A mild infection probably wouldnt incur any additional penalties. maybe in some cases a general -1 penalty to physical activity due to increased pain and discomfort.

 

Severe infections include fever, swelling, significantly increased pain and possible weakness. if the infection has gone septic, then i would impose additional penalties to all actions of at least -3. possibly also increased endurance expenditure for all activities during this period (x2 end maybe)

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Interesting idea, and neat house rule NSG! I can think of a few genres/campaigns where it would be a great addition. (Post-Apoc anyone?) Random thoughts off the top of my head:

 

  • If it were me, I'm not sure I'd tie it to Impairing/Disabling Wounds. Even a bad scratch can get infected if not taken care of. Besides, Impairing/Disabling Wounds already have a mechanism to keep players from ignoring them; it's the "regular" wounds that too-often become just a tick on the character sheet. Maybe tie it to the Bleeding Table in some way, so that larger wounds have a greater chance of infection, but you still don't want to ignore minor wounds?
  • A CON Roll to fight off the infection is appropriate, but whether or not the wound gets infected in the first place seems like it would depend more on how well you take care of it. So instead of just making Paramedics Complimentary to the CON Roll, maybe they first make a Paramedics Roll to clean & dress the wound, with modifiers for severity of the wound, sanitary conditions, presence of drugs/disinfectants/etc. Failure means the wound has become infected, then requires a CON Roll to fight off the infection with penalties for how bad the paramedics roll failed by. I realize it's adding another step, but I kinda like the idea of giving Paramedics skill something else to do.
  • I like that Infected wounds don't heal, and if they go septic they can cause additional damage.
  • I also like Steve's idea of giving them additional character impacts like fever, etc. Characteristic/skill roll penalties would probably get you most of the way there. Maybe Drain CON & END too? APG2 has some rules for disease we could probably crib from, but I haven't looked at them in awhile.

Certainly if there is a healer administering to the wounded individual, they should make paramedic rolls to set the conditions. cleaning and dressing the wound would be part of the conditions issue. failing to do this could move the conditions bonus/penalty down 1 or 2 levels.

 

In general, whether or not a patient gets infected depends on the conditions they find themselves in, the presence of the infecting agent (in the case of bacteria, they are found absolutely eerywhere, but certain types of bacteria that cause the worst infections are only found under specific conditions) and the strength of the patients immune system (the CON roll)

 

I used the CON roll as the basis because in general a person in good health is not all that susceptible to bacterial infections. it is generally only a worry for those who are sickly, elderly, very young or immuno-compromised. i think that mechanism works very well for simulating infections in which the infected persons immune system either successfully fights off the infection, or it doesnt and the virulence of the infection and conditions and care modify this chance. it simulates that situation seen often in fiction where a character is beset by a severe infection and the doctor tells his family "i've done all i can here. the rest is up to his immune system"

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Certainly if there is a healer administering to the wounded individual, they should make paramedic rolls to set the conditions.

Well, Paramedic is (typically) an Everyman Skill, so anyone can attempt a roll, unless they don't bother to take care of the wound at all.

 

In general, whether or not a patient gets infected depends on the conditions they find themselves in, the presence of the infecting agent (in the case of bacteria, they are found absolutely eerywhere, but certain types of bacteria that cause the worst infections are only found under specific conditions) and the strength of the patients immune system (the CON roll)

Agreed those are the (main) three variables. Whether the Paramedic Roll is a separate roll or just Complimentary to the character's CON Roll is largely toe-may-toe/toe-mah-toe.

 

in general a person in good health is not all that susceptible to bacterial infections. it is generally only a worry for those who are sickly, elderly, very young or immuno-compromised.

Hmm...I'm not sure I completely agree with this. The effects are of course more pronounced in the latter category, partly because (in game terms) their stats are already so low that even a modest Drain has a huge impact. But leave a cut uncleaned & untreated and it's going to get infected - I don't care how healthy you are. And from a narrative perspective, the healthy hero who gets an infection and has to fight through the fog is a classic trope.

 

By the way, am I the only one who's always found it strange that in 6 editions and currently up to almost 800 pages of core rules, Hero never got around to spelling out rules for disease? I mean, I mean we get half a page on quicksand FFS, but nothing on illness? [/rant]

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I used the CON roll as the basis because in general a person in good health is not all that susceptible to bacterial infections.

 

I dunno, I'm pretty healthy, but I still got a nasty infection (requiring hospitalization) from a relatively minor injury (dog bite on my hand).

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I dunno, I'm pretty healthy, but I still got a nasty infection (requiring hospitalization) from a relatively minor injury (dog bite on my hand).

Ah an animal bite is going to deposit a large amount of foreign bacteria into the wound instantly, so that wound is essentially infected from the getgo.

 

Its actually very easy to become infected. whats not easy is for the infection to set in and begin spreading. the immune system of a healthy adult is generally enough to take care of 90% of the infections our body encounters. otherwise we would constantly be sick and in serious danger from the smallest cuts.

 

I myself have a pretty good immune system. i get infections sometimes, but they heal on their own. i've never had a wound that i've actually bothered to take care of turn into an infection, and the infections i have had were from minor cuts and scrapes that i didnt bother with and the became minorly infected, but healed on their own within days.

 

In my profession, i get so many cuts and scrapes, i dont even notice most of them till i get home and get in the shower and feel them stinging. i'm in a very dirty/dust/muddy/insect-ridden environment. i have only gotten an infected wound once in this job and that's when a cactus needle embedded itself 1" into my index finger lenghtwise, making it impossible to dig out. after a week of being in my finger, the infected portion of my finger was under such pressure from being filled with puss, that when i squeezed my finger the cactus needle shot out and my finger instantly felt better. the infection itself disappeared within 24 hours of the foreign object leaving my finger.

 

Immune system matters greatly in these things.

 

And of course, there are types of bacteria that are incredibly virulent and tough for anyones immune system to fight. those types should come with a penalty to the CON roll. but for general bacterial infections, healthy adults should be fairly resistant and capable of recovering quickly.

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I don't get the runs very easily, but it stopped whole armies throughout the ages. So I'd be a bit wary about judging too much from personal anecdotes.

Never mind that e.g. arrow wounds or solid animal bites are a bit more prone to infection than mere cuts and scrapes and if it isn't a contempory/future game, then "paramedics" is more likely to make it worse.

But still, as with any disease, this ain't really fun at the gaming table. Back when I was still sprightly and wide-eyed, the game we were playing had a "save vs. gangrene" mechanic. And boy, did we enjoy that! Make sure to stock on healing herbs and medicine -- after all, chores are another fun way to spend an evening...

Note: Argh, search engines showing image results on their normal pages isn't a good idea if you're entering "gangrene medieval". I didn't want to start my Monday that way...

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Personal anecdotes aside, if one goes to the wikipedia page for "infections" one of the first things it states is that healthy adults are fairly resistant to infections and that they are of more concern to the elderly, the very young and those with compomised immune systems. i'm assuming here that medical professionals are keeping that page up to date, so that's what i went for with my writeup.

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Never mind that e.g. arrow wounds or solid animal bites are a bit more prone to infection than mere cuts and scrapes and if it isn't a contempory/future game, then "paramedics" is more likely to make it worse.

 

Cleric (to Wizard):  What?  You got a paper cut unrolling that vellum scroll?  I'm sorry, we're going to have to take your arm at the shoulder!  :)

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Personal anecdotes aside, if one goes to the wikipedia page for "infections" one of the first things it states is that healthy adults are fairly resistant to infections and that they are of more concern to the elderly, the very young and those with compomised immune systems. i'm assuming here that medical professionals are keeping that page up to date, so that's what i went for with my writeup.

Hmm...I went to that page, and that's not how I read it. Under Classification > Primary vs Opportunistic:

 

 

Among the vast varieties of microorganisms, relatively few cause disease in otherwise healthy individuals.[4] Infectious disease results from the interplay between those few pathogens and the defenses of the hosts they infect. The appearance and severity of disease resulting from any pathogen, depends upon the ability of that pathogen to damage the host as well as the ability of the host to resist the pathogen.

The first sentence does says most microorganisms aren't typically a danger to otherwise healthy adults, so we can normally ignore them at least for game purposes. But the second sentence makes it clear that for those pathogens that are a (potential) problem, there are two factors: the virility of the pathogen vs the host's immune system. It's no different from saying "most diseases don't affect humans, but for those that do..." Or "most types of radiation aren't harmful, but for those that are..."

 

In every war prior to 1950 disease killed more people than actual battlefield deaths. Even today, there are some studies of post-surgical deaths that claim more than half of them are due to infection. (Some studies put the number closer to 75%.) So I kinda think you're selling infections short.

 

But again from a mechanical standpoint, whether we call it two separate rolls, or one roll with a possible complimentary roll is about 90% semantics, so go with whatever works for you!

 

Edit: I just thought of another way to look at it. Infection generally isn't a problem for most healthy adults unless their immune system has been compromised in some way...like for example having their protective skin cut open, exposing the pathogen directly to their sensitive innards. ;)

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Personal anecdotes aside, if one goes to the wikipedia page for "infections" one of the first things it states is that healthy adults are fairly resistant to infections and that they are of more concern to the elderly, the very young and those with compomised immune systems.

That's statistics for you. There's plenty of bacteria to go around, so "infections" happen all the time, and if even a small percentage would be fatal, there'd be no humanity. So yeah, technically true.

 

On the other hand, antibiotics was a bit of a big deal.

 

Wind isn't really dangerous to most people, either, but if you're standing in the wrong place or the wind is a bit stronger than usual, this is a different issue. And infected wounds often are like standing in the wrong place during a tornado. Especially if the house building hasn't progressed beyond the "first little pig" stage.

 

Richard I was considered quite healthy, too.

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