Editing v0.31:Health care

{{quality|Exceptional|23:44, 17 April 2011 (UTC)}}{{av}}

'''Hospitals''' are a [[Activity zone#Hospital|zone]] designated via the [[Activity zone|zone menu]]. Hospitals use any beds, tables, traction benches, and boxes/bags that are within these zones. You may also alter how much [[thread]], [[cloth]], [[splint]]s, [[crutch]]es, [[gypsum plaster]] for casts, [[bucket]]s, and [[soap]] hospitals use.

'''Doctors''' are dwarves assigned to any of the five medical labors; dressing wounds, diagnosis, surgery, setting bones, and suturing. All doctors in the fortress operate under the instruction of the [[Chief medical dwarf]], an appointed [[noble]]. Doctors perform medicine on a dwarf only after treatment has been prescribed by a diagnostician. Doctors do not perform any healthcare on animals, despite injured animals "requesting" diagnosis in the [[Health screen|z-health screen]]. 

All beds within a hospital zone are automatically Hospital beds, where injured dwarves will go to recuperate. Tired healthy dwarves will occasionally camp there too if the hospital is close, even if they have their own bed. 

== Medical Skills ==
There are five doctor skills - how critical they are is unclear at the moment, but from [[Main:Toady|Toady]]'s pre-release comments we can assume they are moderately important to the healing process. 

Labors (& Skills)

* [[Diagnosis]] ([[Diagnostician]]) This skill is used at the start of the treatment of every wounded; used a lot and also needed by your chief medical dwarf
* [[Surgery]] ([[Surgeon]]) Somewhat less common; amongst others, wounds to organs seem to require it and this is also used to attempt repair of infected or rotten wounds.
* [[Suturing]] ([[Suturer]]) Fairly commonly needed; all open wounds (from slashing or stabbing injuries) need this. 
* [[Dressing wounds]] ([[Wound dresser]]) This is also used pretty often; wounds are dressed once they have been sutured closed.
* [[Setting bones]] ([[Bone doctor]]) This is needed for badly broken bones, and lightly fractured bones.

===Non-doctor labors===

"Non"-doctors have 2 [[labor]]s that contribute to healthcare:

* [[Feed patients/prisoners]]
* [[Recovering wounded]]

Note that these are not [[skill]]s - they do not cause experience gain, but merely are activities that can be turned on/off for each dwarf. By default, all dwarves start with these labors designated.

==Setting up a Hospital==
* Hit {{k|i}} and set up a hospital [[zone]] in the area you plan on having your hospital. Be sure "Hospital" is highlighted. Close to water is a plus, since patients need to be washed and will get thirsty often.
* Place enough beds in that zone to ensure you can keep all wounded dwarves in the hospital, plus a few spare that will be occupied by lazy couch-surfers.{{bug|647}} 
* Build containers ({{k|b}}-{{k|h}}) to store hospital supplies. (Generally you want at least eight for a fully equipped hospital)
* Build tables ({{k|b}}-{{k|t}}) for surgeons to perform surgery on. You may perform surgery without tables; it will be more messy.
** Place the tables right next to the beds, or you will get "cancels surgery, patient not resting" spam, as moving the sleeping patient more than one square from the bed to the table wakes up the patient {{bug|2773}}
* Build one (or more) traction benches to handle compound fractures when the dwarf requires "immobilization." Remember to check back on the victim {{bug|4470}} after a while or they will be in the traction bench a long, long time.
* Stockpiles are not needed as chests or bags in the hospital zone will be filled with the necessary materials to help a dwarf fix a dwarf that had a little too much [[fun]].
* Assign a Chief Medical Dwarf (in the [[noble]]s screen) and enable the diagnosis labor. Without a diagnosis, patients cannot be treated. If they cannot be treated, they will occupy the hospital area until they die, performing no function. (Any dwarf with the Diagnosis labor enabled can diagnose dwarves, but the Chief Medical Dwarf may impact the diagnosis job creation.  Once a patient is diagnosed, you can see on the individuals health screen what processes are needed, for example washing or suturing)
* Ensure your doctors have their respective healthcare labors enabled through {{k|v}}-{{k|p}}-{{k|l}} in order to handle treatments.

== Broken bones ==

Broken bones can be treated with just thread and cloth. After a while the treated broken bone will turn into a fracture, allowing a suture to be applied which will finally allow the bedridden dwarf to get up and make himself relatively useful; grasping is still impaired during healing. If you want the dwarf to get up and make himself useful immediately, you'll need to apply a plaster cast, which will require some more effort. The use of splints seems to be an effective alternative to applying a plaster cast, which are also easier to obtain and prepare. Splints allow the broken limb to be utilised until it is fully healed, Dwarves will be able to leave the hospital and resume their normal duties once securely splinted up since by this stage their wounds have already been cleaned, sutured and dressed. The 'Immobilization request' status tag is an indication that a splint or plaster cast is required. 

=== Traction Benches ===

A '''traction bench''' is used by a [[doctor]] in a [[Hospital|hospital zone]] to immobilize a dwarf that has sustained complex or overlapping fractures.

It is constructed in the [[Mechanic's workshop]], and requires a [[table]], a [[mechanism]], and a [[rope]] or a [[chain]] to construct. Currently there is a bug that may prevent fully healed dwarves from ever leaving the traction bench. {{bug|4470}} Removing the traction bench will free the dwarf.

=== Casts ===

Casts are made out of [[plaster powder]] and are used to keep broken bones in their proper place until healed. To store it in a hospital, build a chest or other container inside the hospital zone. Applying a cast also requires a bucket and cloth, and a water source.

Plaster powder is produced at a [[kiln]] or [[magma kiln]] from [[gypsum]], [[alabaster]], [[selenite]], or [[satinspar]] and an empty [[bag]] by a dwarf with the furnace operator skill enabled.  They can also be bought at embark for 3 points per unit, with each unit coming with a free [[bag]].

=== Splints ===

These can be crafted from common wood and metal and like casts immobilize limbs that have sustained bone fractures, allowing the natural healing process to continue while the Dwarf is able to return to their duties. Applying these to a patient utilises and requires the Bone Doctor skill.

=== Crutches ===

{|
|Crutches are represented with the symbol
|{{RT0|┬|#770}}
|.
|}

A dwarf that needs to use a crutch/crutches will gain experience in the '''Crutch Walking''' skill, which Toady has stated will reduce the speed penalty for having to use crutches. Presumably, at legendary, they will move just as fast as without crutches. Testing remains to be seen whether using crutches causes any other penalties that this skill might reduce.


'''See Also:''' 
*[[Health screen|z-health screen]]

==Infection==
Every open wound can become infected. Infections may heal over time, however, many dwarves will die due to infection, often months after the actual wounding

Causes of infection include:
* No cleaning of the wounds.
* Cleaning with water from a [[Water#Stagnant_water|stagnant water]] source.
* Cleaning with [[Water#Water_laced_with_mud|water laced with mud]]. {{Verify}}
* Cleaning without [[soap]].
* Bad luck. {{Verify}}

==Tips for an Effective Hospital==
* Regularly use ({{k|i}}-{{k|H}}) to examine your hospital stockpile. Ensure your hospital is well-stocked. If you run out of materials regularly, increase the limits.
* It is possible to do without soap in the hospital stockpile. Choosing to do so, however, increases the risk of infection, which most likely will kill your dwarf. Consult the [[soap]] page to understand that industry. Bring 2 lye on embark for easy soap.
* Put a well inside the hospital for maximum efficiency. Doctors need to wash regularly, and clean water reduces infection.
* Do not place chairs next to your surgery tables. A chair is an invitation for rat-roast eating freeloaders to block the medical process.
* Consider making use of burrows to ensure your healthcare workers stay in the area. 
* You may wish to consider individual rooms for each bed if you find your doctors are choosing to treat Urist McScratched over Urist McBloodFountainTheGushing. A locked door minimizes the mess and thereby infection and allows you to prioritize.
* The Chief Medical Dwarf should be kept unbusy and near the hospital, as no treatment can begin until a Resting dwarf has  been diagnosed.
** Yes, expecting him to also treat dwarves is a distraction. When you have multiple dwarves needing a diagnosis, the other medical dwarves cannot start work until he has finished. In this case, simply assign more dwarves to the Diagnosis labor to help your Chief Medical Dwarf.
**Diagnosis skill level does not affect the diagnosis, only the time it takes for the diagnosis to happen.  Embarking with a dwarf skilled diagnosis (and other medical skills) is helpful.
* Create "nurses" by setting dwarves to only use the Recover Wounded, Bring Food and Water labors. 
** It is important not to distract doctors from treating patients. 
** "Recover wounded", "Give food" and "Give water" are low priority jobs, so it is entirely possible for a patient to starve to death if no one ever gets "unbusy" enough to bring them food. 
** Similarly, it is important not to put your doctors at risk by recovering wounded in the middle of a battle—if they become injured, they cannot treat themselves.
* You can select nurses who enjoy helping people to give them good thoughts. This also prevents dwarves that hate bringing others food from receiving unhappy thoughts.
* DF healthcare is much like real life healthcare, and has many bugs. Some of those bugs may no longer be valid, check the talk page for more information.

Dwarves will prefer to store and use the most expensive thread and cloth. Yes, that includes special, exotic "strands'''.

==Bugs==

You can re-injure a dwarf if it is stuck in surgery, or is never properly treated by causing a [[Cave-in]], or building an upright spike trap under him and activating it with a lever. This will result in a request for a new diagnosis to be made. If he is stuck in a bed you may be able to remove the bed the dwarf is resting in to cause him to leave the hospital.  However if a dwarf appears to be "stuck" in a bed they may be resting because of a severe infection. Forcing it out of the hospital may kill it and/or contaminate the rest of the fortress.

Items linking to a bug on the bug tracker are accurate as of {{version|0.31.25}}.  Older bugs should be removed or tagged with the version they were fixed in.

* Dwarves with healthcare jobs will use the closest supplies to do their work, even if they are not stored in the hospital. {{bug|287}}
* The quality and value of a finished traction bench doesn't account for all of the inputs used to make it. {{verify}}
* Dwarves will steal items from the caravan and store them in hospital. {{Bug|66}}
* For a variety of reasons, an injured dwarf may leave the hospital and/or refuse to go to the hospital. {{Bug|309}}
* Injured nails can't be fixed by doctors, leading to eventual infection and death. {{Bug|3756}}
* Adamantine thread used for suturing. {{Bug|1346}}
* Wounded [[justice|criminals]] don't get sent to the hospital. {{Bug|3901}}
* Your dwarf may get stuck in traction, even after the wounds have healed. If this happens, simply remove the traction bench.{{Bug|4470}}

{{Category|Healthcare}}