Transient Ischemic Attack mission

    So as happy as I am that there is a new medical mission, why is the required transport destination for a TIA neurosurgery? It’s a mini stroke that in the real world would get transported to any hospital ER, or at most, one that has basic neurology capabilities. The only time neurosurgery is used in an emergent situation is for a full blown stroke that is suspected to be a large vein occlusion (LVO).


    I know it has been brought up a number of times about medical mission transport requirements being inaccurate, but is there any way for actual medical professionals to give advice to the developer about medical calls and transport destinations?

    Creator of 'Winnipeg', 'Morden Fire Department' and 'Breast Cancer Awareness (Pink)' graphic packs.
    Alliance: Can-US First Responders (CAFR)

    Edited once, last by TrueNorth ().

    Whilst it doesn’t always require neurosurgery. TIA can require surgery (although this is normally to do with cardiology.) the specialisations can be changed but we have several specialisations that aren’t being used. The aim is to get missions that use these.


    In terms of adding missions that is down to the mods not the devs. We tell the dev the amount of vehicles required, price etc so the blame lies with us. And sometimes we make mistakes


    I do know however the patient codes are correct.


    Because of this we try our best but it won’t always be correct however that is what this forum is for. If you know something isn’t right, let us know and we will do our best to change it. That is why we have a forum.

    Good to know about the developer verses mods. The issue is more so if you’re trying to maintain a realistic playing style. While TIAs can sometimes require surgery, that would be in an ongoing care regiment, while in the emergent situation the game is simulating, TIAs don’t require emergency surgery as they usually resolve within minutes and are treated more as a warning sign for future strokes (or monitored for development into a full stroke).


    Edit: And the patient codes are correct. I was quite thrilled when they got added and I saw they were the same ones we use in Manitoba.

    Creator of 'Winnipeg', 'Morden Fire Department' and 'Breast Cancer Awareness (Pink)' graphic packs.
    Alliance: Can-US First Responders (CAFR)

    Edited 2 times, last by TrueNorth ().

    Quote from TrueNorth

    Good to know about the developer verses mods. The issue is more so if you’re trying to maintain a realistic playing style. While TIAs can sometimes require surgery, that would be in an ongoing care regiment, while in the emergent situation the game is simulating, TIAs don’t require emergency surgery as they usually resolve within minutes and are treated more as a warning sign for future strokes (or monitored for development into a full stroke).


    Edit: And the patient codes are correct. I was quite thrilled when they got added and I saw they were the same ones we use in Manitoba.

    Ah ok that makes sense. It is quite difficult adding missions for the cardiac surgery and neurosurgery specialisations as in my mind these are things that come after visiting a neurology and cardiology department but I may be wrong.

    Quote from TACRfan

    Ah ok that makes sense. It is quite difficult adding missions for the cardiac surgery and neurosurgery specialisations as in my mind these are things that come after visiting a neurology and cardiology department but I may be wrong.

    In Manitoba we have a protocol for strokes where if they score high enough on the LAMS scale or have surpassed the time limit for TPA treatment, we take them straight to the neurosurgery department at a capable hospital.


    As for cardiac surgery, unless you consider angiogram/angioplasty cardiac surgery, I can’t think of anything EMS would need to bring to a cardiac surgery centre. I’ve considered any hospital that can do cardiac monitoring to have cardiology capabilities. It’s a bit of a stretch, but considering the variety of MIs possible, unless you have a STEMI, we aren’t going to divert to a cath lab.

    Creator of 'Winnipeg', 'Morden Fire Department' and 'Breast Cancer Awareness (Pink)' graphic packs.
    Alliance: Can-US First Responders (CAFR)

    In Poland we treat deep hipothermia in cardiosurgery center. Eventually dissection of aorta but honestly this is a case for thoracosurgery.
    A neurosurgery can be use to treat some cases of stoke, intracranial haemorrhage ( subarachnoid, epi-/ subdural hemorrhage), but generally in game that's could be loss of conssisnes/stroke (similar symptoms). In addition, some spinal cord injuries after accident.
    About TIA I agree with TrueNorth - This is definitely not a case for neurosurgery - we wait and check if it is not a stroke - because often TIA precedes the stroke -> observation on neurology ward.

    This has to be one of the top ten threads on the forum, possibly top three, in terms of high levels of knowledge about a specific subject area, which forgoes any unpleasantness and is very informative to anyone else reading along. This is a model thread for the forum in my books, and we could all learn a lot from how the discussion was conducted!

    So, I totally agree with the first post, on the balance of probabilities a TIA is just examined and treatment is generally a long term thing (out of the remit of this game).


    What I don't like about the idea of having a medical side to this, is each area has different policies and demographics and I fear the universal nature of the game could be stilted by a 'medical' adviser/team. While I think it's important to get the basics right, we don't need to be getting into great depths regarding the various diseases and disorders that EMS can deal with. This isn't meant to stop debate, just a personal opinion.

    I'm curious as to why this Neurosurgery thing isn't required for an actual Stroke call but is for a TIA. The likeliness of needing a surgical intervention like thrombectomy is going to be MUCH MUCH higher in a full CVA/Stroke than in a TIA.


    I would LOVE to see a medical advisory team.


    While each area does have different protocols for some things medicine is still medicine and simple things like would this require a surgical intervention more than x etc is something to the basic level it could be kept.

    I can tell people that a medical advisory team is not going to happen. This is why we have a forum and the systems we have in place so if something is wrong they can post here and we will get it fixed. As for why a Stroke call doesn’t go to neurosurgery, I can’t answer this but if people want it changed, tell us and we will get it done. These are not difficult fixes and can be done in a couple of days.

    Maybe the developer wanted to finally have the first case for neurosurgery in the hospital. Until now we have no cases 4 neurosurgery ,cardiac surgery and urology

    Building on the unused expansion aspect, I feel that the urology one doesn’t need to exist, as there are no emergency calls that would require the transport destination to specialize in urology. However, it would be really cool to get a paediatric expansion, possibly at the base level like internal medicine and general surgery are. The lost child could then have it as it’s destination requirement. And there are paediatric specific diseases that could be added as well.

    Creator of 'Winnipeg', 'Morden Fire Department' and 'Breast Cancer Awareness (Pink)' graphic packs.
    Alliance: Can-US First Responders (CAFR)

    Like 4

    A lot of the expansions would be more useful with the idea of emergency transfers to facilities, that has been mentioned in the past. Now that the medical portion is taking a break it may be a stretch into the future but I know the idea has been brought up in the past. The idea of emergency transfers from lower level hospitals or aircraft to higher acuity care centers with specialties. Anybody with EMS experience would know all about them, and realistically that would be the only use for a few of the specialties as of now.

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