v0.34:Health care

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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.

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 may 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
  • Multiple dwarves may undergo simultaneous surgeries on the same table.
• Build one or more traction benches to handle compound fractures when the dwarf requires "immobilization." Remember to check back on the victim patient after a while or they may be in the traction bench a long, long time.^Bug:4470
  • Each traction bench can only accommodate one dwarf at a time, and the dwarf may be there for quite some time, so plan accordingly.
• 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.)

Skills and Injuries

Doctors have 5 specialized skills and 2 support healthcare labors.

Diagnostician -- Surgeon -- Suturer -- Wound dresser -- Bone doctor -- Feed patients/prisoners -- Recovering wounded

Those with the recover wounded labor will attempt to bring a wounded dwarf to the hospital zone, or lacking one to the nearest unoccupied bed. A diagnoser will then identify and prescribe a treatment which any doctor (including himself) may carry out. A dwarf cannot be treated without a diagnosis. Depending on the injury a treatment labor will occur. Diagnosis is often required between procedures as well.

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.

If a chief medical dwarf is appointed you can view your fortress' health using the z-status key), or individually by selecting a dwarf and using w for wounds section.

• Bones can be set and treated by bone doctors depending on severity using thread and cloth for fractures, splints and 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. Multiple overlapping and compound fractures require a surgeon. Caused by blunt trauma.
• 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. Closed wounds will be dressed by a wound dresser. Caused by slashing injuries.
• Internal Organs can be treated or removed by a surgeon using tables and traction benches. Repair of infected or rotten wounds is treated similarly. Caused by piercing injuries.

Any dwarves with the Feed patients/prisoners labor will attempt to give food or a bucket of water to a hungry or thirsty patient. By default all dwarves start with the non-doctor labors designated. These have no corresponding skills - they do not cause experience gain, but merely are activities that can be turned on/off for each dwarf.

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 crippled dwarf walk again.
• Tables are used to conduct operations on.
• Beds are used by patients to rest.
• 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.
• Buckets are used to gather and hold the water for its uses.
• Containers are used to store hospital supplies.

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.
  • A workaround is to set cloth and thread to 0, add one container which will be filled by other items, and then set the cloth and thread to 1 unit. The hospital will only claim as much cloth and thread as will fit into the container after accounting for the other items.
  • Another workaround is to disable hauling for all but one dwarf, since the oversupply problem is caused by the hospital calling all hauling dwarves for a unit of cloth or thread, and all dwarves responding at once, resulting in a unit of cloth or thread for every available dwarf.
  • A third workaround is to allow your dwarves to fill up the containers however they want, then use t to examine the contents of the containers and dump the items that you need to reclaim for other uses. Remember to reclaim the items after they have been dumped.
  • It is safe to set the hospital stocks for everything but soap to 0 and then build a container. Soap in the hospital zone is reserved for hospital use and will not be used up by bathing dwarves as stockpiled soap can be.
• 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 1 lye on embark for one bar of soap, which translates to 150 units.
• 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 only enables the Health status screen, so long as the CMD's Diagnosis skill is Novice or greater. The position has no in-game use. Look after your CMDs if you don't have many dwarves with that level of diagnostic skill, but otherwise they can be treated as any other 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, both to speed diagnosis and to stave off skill rust when long periods of time go between injuries.
  • Also helpful is enabling medical skills on all dwarves in the fortress, which allows medical jobs to be picked up immediately so long as there is an idle dwarf.
• 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.

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

Bugs

• 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]
• Dwarves resting in bed may be starving/dehydrated and not being taken care of, deconstructing the bed to generate a new Recover Wounded task and force them to rest properly fixes this.

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 and 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 prevent infections and seal a wound, but dwarves consider magma the only legitimate heat source, and the non-lethal application of magma a sacrilege. Template:V0.34 industry