Large & Major Hospital Restrictions

I guess you could do that but doing so only increases the number hospitals thus the number of patients you can handle (if they are close enough). It doesn't add any of the specialty hospital units that you mention

Quote from ChiefBoden61

I guess you could do that but doing so only increases the number of patients. It doesn't add any of the specialty units you mention

building more hospitals won’t increase the number of patients the game generates. And the point of building them is to increase the allowance of large hospitals which can be upgraded with specialty units.

I play with a fully realistic setup on the UK and AU servers, and I would say that one thing to bear in mind is that this is a game. Missionchief doesn't offer the ability to recreate real life; it doesn't have the right variety of units, it doesn't spawn missions in a realistic way, it doesn't simulate logistics, shift changes, mission duration, etc. It game-ifies those elements.

That's fine, it's trying to be a game rather than a straight simulation. But what that means is that unless you actively enjoy getting frustrated by issues such as the one you point out, it's sensible to approach realism through a lens of interpeting reality rather than recreating it.

For example, the situation with foam in the UK game: in most fire services, most fire engines (Water Ladders) carry some amount of foam. Do you use WrL CAFS to represent them? If you do, then it basically trivialises the foam missions so completely that they don't carry any gameplay meaning. That's because the game has interpreted the foam requirement on missions as being more in the realm of bulk foam units in real life. I would suggest therefore that the best interpretation of real life is not to use WrL CAFS for regular fire engines but to reserve those for more limited circumstances which feel more in line with the game developers' implementation of foam requirements on missions.

The same would apply to your hospital problem. Instead of representing every department your hospitals have, think of the extensions as more like specialities. If you have a stroke the ambulance will take you to your regional stroke centre, burns will go to your regional burns center, severe trauma will go to the nearest major trauma centre, etc, even though a regular emergency department can and does treat those injuries on a daily basis. Most ambulance regions will have specific specalist hospitals that cases will go to, and you can limit yourself to representing those hospitals with the relevant extension.

For example in West Yorkshire there are serious burns go to Pinderfields Hospital as the regional burns centre, Leeds General Infirmary is the major trauma centre and where serious heart issues will be taken, Calderdale Royal Hospital is the regional stroke centre. Then there are hospitals which have specialist units such as renal units, respiratory, etc.

If you take the approach of recreating literally the real life capabilities of hospitals you make your gameplay less realistic, paradoxically: in real life, ambulances often take patients right past emergency departments in hospitals which can treat the relevant injuries, instead going to regional specialist centres instead.

Hope this helps as a potential alternative way to tackle realism.

Quote from Whitchit

building more hospitals won’t increase the number of patients the game generates. And the point of building them is to increase the allowance of large hospitals which can be upgraded with specialty units.

thanks for the catch....I knew that but I got sidetracked before I sent the message and did not finish it. I edited the original post.

Leeds General Infirmary does have both a hyper acute stroke unit and an acute stroke unit. I'd go for that if you don't want to wait for Calderdale to open up. Bradford Royal Infirmary's also got both stroke units.

Quote from renalmedic

One hospital can be upgraded to a large hospital for every 3 hospitals you own.
I'm trying to play realistically
Are there any cons to building several hundred hospitals on, say, Antarctica to increase the number of large hospitals I can have?

You could cheat a little, as I had the same issue
Firstly I built all the real world hospitals
However it was not enough to get the ratio of 7:3:1

Some Hospitals have Urgent Treatment only (A&E)
The first trick was to have a fictional Hospital, name it "A&E extension", but only have the Internal option
This effectively gives you a large A&E

Next look for specialists Hospitals that are not used by Mission Chief (services, elderly, etc)
I then name these "Not In use"
You then cannot even send a Patient Transfer!

Bingo, you have increased the number of hospitals
There are some other methods too...

As an aside I use the Scot NHS website to see what facilities are at each Hospital, and my spreadsheet uses that
My areas within MissionChief are now broken down by NHS Trust