Health care

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

v50.14 · v0.47.05

This article is about the current version of DF.
Note that some content may still need to be updated.

More Info · V

A hospital zone allows wounded dwarves to rest and receive care and treatment. Hospitals use any beds, Tables, traction benches, and containers 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 containers; you may adjust the desired quantities.

Doctors are dwarves assigned to any of the five doctoring 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 their medical procedures on a dwarf only after treatment has been prescribed by a diagnostician. Doctors do not (yet; one must needs use DFHack in the interim) perform any healthcare on animals, despite injured animals "requesting" diagnosis in the health screen (z).

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

Hospitals are designated as locations, press z to bring up zone menu, select an appropriate zone type (such as dormitory), then use the mouse to draw a rectangle over your hospital. If your hospital consists of multiple rooms, you need only start with one. Once the zone is created, select the Add Location button (plus sign) and select Hospital. Multiple rooms can be added to the hospital in the same way, selecting the existing hospital name instead of clicking hospital at the top of the menu. Select the view location button (magnifying glass) allows you to check the equipment and medical supplies missing/available to your hospital.

Place enough beds in that zone to ensure you can keep all wounded dwarves in the hospital. Note that normal beds or bedrooms can and will accept wounded dwarves whether or not a hospital zone exists, though hospital beds will be preferred if they are free. Doctors do not need a hospital zone, though a lack of equipment will probably limit care options.
Place at least one table (b-t) for surgeons to perform surgery on. Adjacency to beds makes it easier to move a patient for surgery. You may perform surgery without tables; it will be messier.
- Multiple dwarves may undergo simultaneous surgeries on the same table.
Place one or more traction benches (b-R) to handle compound fractures when the dwarf requires "immobilization."
- Each traction bench can only accommodate one dwarf at a time, and the dwarf may be there for quite some time, so plan accordingly.
Place containers (b-h) to store medical supplies reserved for hospital use. Once placed, dwarves will start stocking the hospital with medical supplies, you can track their progress and change storage limits in the zone's 'Set Hospital Information' menu. A small hospital can manage with two containers, while a fully-fledged fortress with an adventurous military may need as many as eight. (Containers are not strictly necessary; doctors can and will use supplies from anywhere, but dedicated hospital containers allow you to earmark some supplies for medical use - for example, to prevent the auto-looming of every last thread.)

Medical Staff:

Assign a chief medical dwarf (in the nobles screen) to enable the fortress-wide z health screen as well as individual dwarves' health summary screens (v-z-h), for easier monitoring and tracking of dwarves seeking treatment and their conditions.
Pick one or more dwarves to be doctors, and enable the health labor(s) on them (through v-p-l). You might want set several dwarves to be dedicated doctors, with diagnosis labor 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.)
If you use a burrow to keep doctors near the hospital zone, ensure that this burrow covers all needed materials or you could get job cancellations because of a lack of material. Thread/cloth stockpiles, and items bought from caravans (e.g. plaster early in the game) are often the most troubling.

Skills and injuries

There are five skilled doctoring labors and two unskilled supporting hauling labors involved in healthcare.

Labor	Use
Doctor	Provides medical attention (including diagnosing, surgery, suturing, bone, and dressing)
Diagnostician	Determines what procedures (of the other four) are necessary
Surgeon	Repair internal organ damage, excise necrotic tissue or serious injuries to muscle, bones
Suturer	Stops serious bleeding
Wound dresser	Finalizes closed wounds for healing
Bone doctor	Sets simple breaks for healing
Recovering wounded	For those who cannot walk to a hospital zone
Feed patients/prisoners	for those who cannot walk to food/drink

Those with the recover wounded labor will attempt to carry an injured dwarf to a hospital zone, or, lacking one, to the nearest unoccupied bed. Dwarves are not light, especially ones in full armor, so these laborers should not have low strength attributes. Note that recovering wounded appears to be an extremely low priority task, and since immobile patients will need to be carried to a hospital before diagnosis, it may be necessary to temporarily disable all other labors on dwarves with this labor to get the wounded moved quickly.

Once in the hospital, a diagnoser will then evaluate the patient and prescribe a treatment, which any doctor who have the appropriate medical labors enabled (including themselves) may carry out – dwarves cannot be treated without a diagnosis. Depending on the injury, a treatment job will occur. Diagnosis is often required between procedures as well.

After diagnosis, injuries to various body parts will be revealed. The color of the text will indicate the severity of the wound, from least to most serious, as follows:

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.

With a chief medical dwarf appointed, you can view your fortress' health using the z-health screen, or individually by selecting a dwarf and using w for wounds section.

Internal Organs can be treated or removed by a surgeon using tables and traction benches, and are typically caused by piercing injuries.

Surgery also covers the repair of infected or rotten wounds, which are typically caused by lack of soap, poor water access for cleaning, delayed medical care, or just bad luck.

Bones can be set and treated by bone doctors using thread and cloth (for minor fractures), splints and casts, or traction benches, depending on severity. 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. Typically 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 to the hands can impair grasping during healing. Typically caused by slashing injuries.

Closed wounds will be dressed by a wound dresser.

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-doctoring, supporting labors enabled; these have no corresponding skills, do not cause experience gain, and merely are activities that can be performed by any dwarf, but can be disabled for those with more important labors.

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, or cleaning with water laced with mud.^[Verify]
Cleaning without soap.
Bad luck

An infection effectively causes constant internal bleeding, and if the infected dwarf is healthy enough, they can naturally replenish their blood quickly enough to outpace the infection.

It's worth noting however that necromancy effectively cures infections, as the intelligent undead it can create cannot die of bleeding.

Equipment and medical supplies

In-game hospital information summary

Traction benches

A traction bench is used by a bone 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. The quality of each component is not reflected in the quality of the traction bench, and only the material of the table is used as the material for the bench. "Recycling" low-quality, low-value components into high-quality traction benches can provide a modest increase in value. 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).

Gypsum plaster

Casts are made out of plaster powder and are used to keep bones in their proper place until healed. To store them in a hospital, place a chest or other container inside the hospital zone. Applying a cast also requires a bucket, 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; each unit comes 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. Splints seem to be an effective alternative to plaster casts, and are 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, as 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.
- Note that the quantities listed in the "Set Hospital Information" screen are different than those used in stockpiles.
  - 1 stockpile unit of thread = 15000 in the hospital
  - 1 cloth = 10000
  - 1 soap = 150
  - 1 gypsum powder = 150
It is possible to do without soap in the hospital stockpile. Choosing to do so, however, increases the risk of infection, which will most likely kill the patient. 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 (or near) the hospital for maximum efficiency. Doctors need to wash patients 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 McPaperCut 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. The position has no in-game use. Look after your Chief Medical Dwarf if you rely heavily on this screen, 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 in 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 "orderlies" by setting dwarves to only use the Recover wounded, Give food and Give water labors.
- It is important not to distract doctors from treating patients (or other medical helpers such as crutch haulers, or wounded recoverers).
- "Recover wounded", "Give food" and "Give water" are low-priority jobs, so it is entirely possible for a patient to starve, dehydrate, or bleed to death if no one ever gets "unbusy" enough to bring them food or water, or move them to the hospital.
- 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.
If you use Dwarf Therapist, try to select strong or large-sized dwarves to recover wounded. Weak dwarves slowly inching back to the hospital from a hostile area with a dying patient can result in fun.
When a serious injury happens, don't exit (or save) the game until the injured are in the hospital zone, especially if a dwarf is immobile. "Bring crutch" and "Recover Wounded" jobs will be lost, keeping the patient away from the hospital, and doctors will NOT go to patients, even if burrowed with them, because a diagnose job hasn't been created. Sometimes a second "crutch required" or "recover wounded" request will be generated, but often too late for the patient's full recovery. Your best bet is to ensure someone (not burrowed) has "recover wounded" enabled at all times; burrow doctors doing non-medical tasks immediately; hope the patient makes it to the hospital.^[Verify]
Long-term residents will seek medical care if injured. This includes non-dwarves. Doctors will treat them the same as dwarves and the different physiology doesn't seem to be an issue.
Set the hospital zone to inactive and forbid everything in it when you don't have any real medical issues. It will prevent dwarves who have no real injuries from useless resting there (bee stings & harmless evil weather syndromes can result in this, medics will cancel diagnose patient due to "not resting" because the resting phase usually ends very fast).
To prevent the usage of adamantine thread, store no thread in hospital settings and instead have a stockpile of non-metal thread in hospital, while additionally having a manager order to make 1 wafer when you have 1 adamantine thread.
You may want to disable the hospital if you want your injured dwarves to get up from it while you lack the equipment to treat them. When able, military dwarves will keep fighting enemies or follow current valid station or kill orders despite injuries they may incur, but civilian dwarves will go into "resting mode" when injured, and once they've gone or carried in they won't leave the hospital until the injury is healed or treated. You can re-enable the hospital once you no longer need your dwarves to stay out of it.

Dwarves will prefer to store and use the most expensive thread and cloth – yes, that includes special "exotic" strands, which you may want to forbid during medical emergencies.

Bugs

For a variety of reasons, an injured dwarf may leave the hospital and/or refuse to go to the hospital. ^Bug:309
Wounded dwarves are not always recovered properly. ^Bug:94 Re-injuring the dwarf (with a minecart collision, dropped item, etc.) may trigger proper recovery.
Adamantine thread used for suturing. ^Bug:1346
The quality and value of a finished traction bench does not account for all of the inputs used to make it.^[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. The 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 is sacrilege.

A human doctor attempting to help.
Art by Luke Fildes (October 3, 1843 – February 28, 1927)