v0.34:Health care

xTATTEREDx  · +FINE+  · *SUPERIOR*  · ≡EXCEPTIONAL≡  · ☼MASTERWORK☼

v50.14 · v0.47 · v0.34.11 · v0.31 · v0.28 · v0.23 This article is about an older version of DF. More Info · V

A hospital is a zone designated via the zone menu. Hospitals use any beds, tables, traction benches, and coffers/bags that have been built within the zone. The hospital will requisition thread, cloth, splints, crutches, plaster powder (for casts), buckets, and soap for medical use. These will be stored within the hospital's coffers/bags; you may adjust the desired quantities.

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 inflict 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 z-health screen.

All beds within a hospital zone are automatically Hospital beds, where injured dwarves will go (or be brought) 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. Each is important to the healthcare and healing process.

Labors (& Skills)

• Diagnosis (Diagnostician) This skill is used at the start of the treatment of every wounded dwarf, and often between procedures as well.
• 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

Two additional labors contribute to healthcare:

• Feed patients/prisoners Brings water and food to patients.
• Recovering wounded Will attempt to bring a wounded dwarf to the hospital zone

Note that these non-doctor labors have no corresponding skills - 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, similar to hauling tasks.

If your dwarves are starving/dehydrated but seem to be in bed, try deconstructing the bed to generate a new Recover Wounded task and force them to rest properly.

Setting up a Hospital

• Hit i and set up a hospital zone in the area you plan on having your hospital. Be sure "Hospital" is highlighted. Proximity to water is a plus, since patients need to be washed and cannot drink alcohol.
• 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 (b-h) to store hospital supplies. (Generally you want at least eight for a fully equipped hospital.)
• Build tables (b-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 nobles screen) to enable the fortress-wide health screen as well as invidual dwarves' health summary screens (v-z-h).
• Pick one or more dwarves to be doctors, and enable the health labor(s) on them (through v-p-l). Be sure the diagnosis labor is well covered. 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^[Verify]. Once a patient is diagnosed, you can see on the individual health screen what procedures are needed, for example washing or suturing.)

Injuries

NONE: No recorded active wounds on the part.

MINOR: Any damage that doesn't have functional/structural consequences (might be heavy bleeding, though).

INHIBITED: Any muscular, structural, or functional damage, without total loss.

FUNCTION LOSS: An important function of the part is completely lost, but the part is structurally sound (or, at least partially intact).

BROKEN: The part has lost all structural integrity or muscular ability.

MISSING: The part is completely gone.

See wounds for a breakdown

• Bones can be treated by bone doctors depending on severity using thread and cloth, splints, castes, or traction benches. Grasping is often impaired during healing. The Immobilization Request status tag is an indication that a splint or plaster cast is required.
• Skin and muscle can be treated by a suturer using thread and cloth. The wound will continue to bleed until sutured, severe wounds impair grasping during healing.
• Internal Organs can be treated by a surgeon using tables and traction benches.

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 stagnant water source.
• Cleaning with water laced with mud. ^[Verify]
• Cleaning without soap.
• Bad luck Fun!

Equipment

Traction Benches

A traction bench is used by a doctor in a 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. Note that if any stockpiles have been linked to "Give" to the workshop, all of the resources needed to construct the traction bench must be found in the linked piles (e.g., linking only a stone stockpile may prevent access to the necessary tables/ropes/chains).

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

Splints immobilize limbs that have sustained bone fractures. They allow the broken limb to be utilized 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. Applied by a bone doctor.

They can be made out of one wood at the carpenter's workshop or out of one metal bar at the metalsmith's forge or the magma forge. The use of splints seems to be an effective alternative to applying a plaster cast, which are also easier to obtain and prepare. Splints are categorized as finished goods.

Other equipment

• Crutches ┬ help a dwarf walk again
• Tables are used to conduct operations on.
• Thread is used to suture closed wounds.
• Cloth is used to clean wounds, wash patients and dress wounds.
• Soap is used to clean wounds, sterilizing and preventing infection.
• Water is used to clean wounds, bathe patients and give drink. Patients do not drink alcohol.

Tips for an Effective Hospital

• Regularly use (i-H) to examine your hospital stockpile. Ensure your hospital is well-stocked. If you run out of materials regularly, increase the limits.
  • Due to an annoying years-old bug, hauling dwarves routinely oversupply hospitals. This can be troublesome in many ways, particularly when all the cloth in the fortress is routed to the hospital, leaving your clothier without clothmaking materials and filling the hospital containers with cloth and thread, which leaves no room for soap. Because of this, do not, ever, place containers in a hospital zone; instead, designate separate stockpiles nearby for cloth, thread, soap and other hospital implements. Setting those stockpiles to not accept bins or barrels, while space-consuming, can help to visualize the state of hospital stocks and prevent further container-capacity related issues.
• 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. 1 bar of soap = 150 units of hospital 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

This list should only include current bugs - old bugs should be removed if they have been fixed in the latest released version.

• Hospital stores more materials than assigned. ^{Bug:191 Bug:4406}
• Dwarves with healthcare jobs will use the closest supplies to do their work, even if they are not stored in the hospital. ^Bug:287
• 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 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
• The quality and value of a finished traction bench doesn't account for all of the inputs used to make it. ^[Verify]
• purchased plaster powder does not appear in the hospital storage. ^[Verify]

This article or section has been rated D for Dwarf. It may include witty humour, not-so-witty humour, bad humour, in-jokes, pop culture references, and references to the Bay12 forums. Don't believe everything you read, and if you miss some of the references, don't worry. It was inevitable.

Soap is the only item dwarves will use to sterilize a wound. While dwarves are of course aware that humans will pour perfectly quaffable alcohol over their bloody wounds onto the filthy GROUND to get the same effect, dwarves understand that some things are more precious than a single life, and face oblivion with a bit more dignity. Application of extreme heat is also well known to kill microbes and seal a wound, but dwarves consider magma the only legitimate heat source, and the non-lethal application of magma a sacrilege.