Editing v0.34:Health care

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

A '''hospital''' is a [[Activity zone#Hospital|zone]] designated via the [[Activity zone|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]], [[splint]]s, [[crutch]]es, [[plaster powder]] (for casts), [[bucket]]s, 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: [[wound dresser|dressing wounds]], [[diagnostician|diagnosis]], [[surgeon|surgery]], [[bone doctor|setting bones]], and [[suturer|suturing]]. All doctors in the fortress operate under the instruction of the [[Chief medical dwarf]], an appointed [[noble]]. Doctors <strike>inflict</strike> 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 (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 {{k|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 [[bed]]s 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}} Note that normal beds or [[bedroom]]s 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.
* Build [[container]]s ({{k|b}}-{{k|h}}) to store hospital supplies. (A small hospital can manage with 2 containers, a fully fledged fortress with an adventurous military may need as much as 8. Also note that some people recommend setting up custom stockpiles instead.)
* Build at least one [[table]] ({{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 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 bench]]es to handle compound fractures when the dwarf requires "immobilization." Remember to check back on the <strike>victim</strike> patient after a while or they may be in the traction bench for a long, long time.{{bug|4470}} (Or be lucky; sometimes immobilization requests simply disappear with no bad consequences.) 
** 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 but can be used instead of chests and bags in the hospital zone.
* Assign a [[chief medical dwarf]] (in the [[noble]]s screen) to enable the fortress-wide [[health screen]] as well as invidual dwarves' health summary screens ({{k|v}}-{{k|z}}-{{k|h}}).
* Pick one or more dwarves to be doctors, and enable the health labor(s) on them (through {{k|v}}-{{k|p}}-{{k|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.)
* 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 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==
'''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.  Note that recovering wounded appears to be an extremely low priority task.  Since immobile patients will need to be carried to a hospital before diagnosis, it may be necessary to temporarily disable all other labors on another dwarf to move them first.

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.

[[Wound|Injuries]]
:{| border=0 cellpadding=0 cellspacing=1 style="background: black"
|-
|<font color="#ffffff"> '''NONE: No recorded active wounds on the part.'''</font>
|-
|<font color="#808000"> '''MINOR: Any damage that doesn't have functional/structural consequences (might be heavy bleeding, though).'''</font>
|-
|<font color="#ffff00"> '''INHIBITED: Any muscular, structural, or functional damage, without total loss.'''</font>
|-
|<font color="#00ffff"> '''FUNCTION LOSS: An important function of the part is completely lost, but the part is structurally sound (or, at least partially intact). '''</font>
|-
|<font color="#ff0000"> '''BROKEN: The part has lost all structural integrity or muscular ability.'''</font>
|-
|<font color="#808080"> '''MISSING: The part is completely gone. '''</font>
|}
If a chief medical dwarf is appointed you can view your fortress' health using the {{k|z}}-status key), or individually by selecting a dwarf and using {{k|w}} for wounds section.
* '''Bones''' can be set and treated by bone doctors depending on severity using thread and cloth for fractures, splints and casts, or traction benches. Grasping is often impaired during healing.  The {{DFtext|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 [[attack_types#Blunt_weapons|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 [[attack_types#Edged_weapons|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 [[attack_types#Piercing_weapons|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 [[skill]]s - 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 [[Water#Stagnant_Water|stagnant water]] source.
* Cleaning with [[Water#Water_laced_with_mud|water laced with mud]]. {{Verify}}
* Cleaning without [[soap]].
* <s>Bad luck</s> [[Fun]]!

== Equipment ==
=== 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. 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 [[Stockpile|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. 

Do not be hasty in removing a presumably-stuck dwarf from traction, however. Such treatment takes weeks or months to succeed and removing the dwarf prematurely will undo all the progress that has been made. If the dwarf has been in traction without being diagnosed or otherwise treated for a month and the health screen shows no scheduled treatment, they probably were forgotten and need the traction bench deconstructed to release them. Another possible way to check if a dwarf is stuck is by {{k|v}}iewing the {{k|w}}ounds of the dwarf in question. If the damaged part isn't at red, then the dwarf is stuck.

=== 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; 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]]. 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===
*[[Crutch]]es {{DFtext|┬|770}} help a crippled dwarf walk again.
*[[Table]]s are used to conduct operations on.
*[[Bed]]s 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.
*[[Bucket]]s are used to gather and hold the water for its uses.
*[[Container]]s are used to store hospital supplies.

==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.
** Due to a [[#Bugs|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 {{k|t}} to examine the contents of the containers and {{k|d}}ump the items that you need to reclaim for other uses.  Remember to reclaim the items after they have been dumped.
**Another workaround is to forbid all cloth, thread, soap, etc. except for the amount that you want to move to the hospital. Once all of the Store Item in Hospital jobs are done, it is safe to unforbid everything again.
** 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 [[burrow]]s 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. The position has no in-game use. Look after your CMDs 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 "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 (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 to death, dehydrate to death, or bleed to death if no one ever gets "unbusy" enough to bring them food, 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.
* 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.  Best bet is 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.

Dwarves will prefer to store and use the most expensive thread and cloth. Yes, that includes special "[[raw adamantine|exotic]]" strands.  You may want to forbid these during medical emergencies.

==Bugs==
* Dwarves with healthcare jobs will use the closest supplies to do their work, even if they are not stored in the hospital. {{Bug|287}}
* For a variety of reasons, an injured dwarf may leave the hospital and/or refuse to go to the hospital. {{Bug|309}}
* Adamantine thread used for suturing. {{Bug|1346}}
* 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.


{{d for dwarf}}
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.

{{Category|Healthcare}}
{{Industry}}