GURPS Triage, Part Two


In my last article I gave to you the Player's section of GURPS Triage and now the completion of the article: the Gamemaster's section. I hope you all enjoy.

In my last article I gave to you the Player's section of GURPS Triage and now the completion of the article: the Gamemaster's section. I hope you all enjoy.


A triage game is very different from the average one. Instead of merciless warriors or spell slingers running covert ops or trudging through a monster infested dungeon they are the doctors and nurses managing the chaos of emergencies and crisis situations and, most importantly, the ones who save lives through displays of sheer skill.

Setting Up A Campaign
There are only a few things the GM needs to do to set up a triage game. A major thing is to brush up on medical dramas, watch any of the popular television shows or read some Michael Crichton or Robin Cook, to get a feel for the game and the things the characters do.

Next the GM should decide where the game is to be set. By default, the game is set in a modern hospital emergency room. However, it can easily be brought out of the hospital and "on the truck", which is on the streets with an ambulance crew. The setting could also be moved around the hospital like an operating room or an intensive care unit. For a real change of pace without leaving the hospital, the game could be based on a psychiatric unit where there is always something going on.

The scope of a game, or how far out from the center and the base idea the story moves, is always something the GM should consider. The game can be based around one emergency room or an entire hospital and deal with the day to day happenings (to the unenlightened this may sound boring but there is always something urgent to do) of the facility or grow to encompass a major viral outbreak or a full scale war. It is my recommendation to keep it small and simple at first and move out from there; remember, you can always make it bigger but very seldom can you make it smaller.

The types of things a character will find themselves doing will be very different from most games. There will be much less for antagonists and mysteries, and mostly the characters will find themselves faced with a chaotic situation they will have to bring order to. For example, they are sitting around when they get the call there has been a ten-car pileup on the highway and they have fifteen minutes to get ready for the flood of wounded.

Making Triage Dramatic
The essence of triage is drama. Whether that comes from a suicidal patient who does not want help or a young girl mangled in a car accident. Triage is not about getting into a gunfight to best your foes but being faced with situations where a patient's life is in your hands and hoping you have the skill to save them.

An important thing to know and constantly remember is pacing, because there are usually only two ways things go in triage: slow and total chaos. Another thing to know is the pace changes very, very quickly. When it's slow, it's boring, but when it's chaos, there is no breathing time.

In triage an emergency is something that causes a large amount of patients to require aid. This is not to say only one or two people can't have an emergency, but that is considered more par for the course. A genuine emergency can be any sort of thing from natural disasters (earthquakes, hurricanes, etc.) to riots to massive car wrecks.

People In Crisis
Many times the people with a patient can be more work than the patient themselves. When people are in crisis they tend to act in irrational ways, sometimes they can be almost catatonic or suddenly fly into a hysterical rage. In triage, crisis is a constant factor that must be dealt with and as much drama can come from it as the emergency at hand.

Riding The Truck
When triage leaves the hospital and goes out on the streets with an ambulance, quite a bit changes. Most importantly the chaos increases, and usually the information the team receives from a call is sketchy at best. They may be responding to a domestic assault and the police have not arrived yet, can they wait while someone is being beaten upstairs? They may have gotten a call about a relatively routine car accident and arrive to discover a pregnant woman with massive head trauma.

Magic And Psionics
If magic or psionics are present in a game, triage may change quite a bit with all the healing spells and powers that come with them. While it is designed to be by default, a no magic game, these elements may still be included if the GM so desires.

The Hidden Or Full Magic Game
If the GM decides to include magic than it needs to be decided if magic is a secret and hidden thing or if it something everyone knows of and accepts. With hidden magic little changes, at least on the surface. The GM may decide that magic has adverse affects on the technology so common in triage. In a full magic world, many things would be different. Hospitals would probably have magical healers on call and the technology would probably be more geared toward integrating magic and aiding mages.

A Psionic World
Like magic, if the GM decides to include psionics then decisions need to be made concerning if it is something unknown or heard of and accepted. Some modern fiction worlds include psionics with very little changes in culture and technology; an example of this would be most of the works of Stephen King. Just like magic, psionics may affect the technology (does a catscan or an EEG. register the same on a psionicist's brain?) or be adapted to it. Also, psionicists may be on call and work as an integral part of the triage team.

Alternate Worlds And Crossovers
While it is designed to be a modern (TL 7) game, GURPS Triage can easily be adapted or added to an alternate setting. The most obvious would be alternate tech levels.

Imagine triage on the American frontier with GURPS Old West where doctors used whiskey as a painkiller and amputation was a common fix; maybe then add to that all the bizarre inventions that come with GURPS Steampunk. Maybe the hospital is in the dark future of GURPS Cyberpunk where doctors posses and are trained in dealing with cyber-implants and the waiting rooms are clogged with the needy, many of whom need to be forcibly turned away due to improper insurance or conflicting corporate interest. Perhaps the facility is on a sleek new starship or a deep space orbital station in GURPS Space where the advent of ultra-technology has changed the face of triage.

A mix with GURPS Horror could be interesting where the dead rise from the morgue or a man comes in for treatment that is possessed by a Thing Man Was Not Meant To Know and The Cabal wants him back. Triage on the battlefield is always a nightmare situation with GURPS Special Ops where the need may, and usually does, exceed the medic's training or resources, a more bizarre twist on that would be triage with GURPS Black Ops.

Interesting and original. Thanks, Mr. Wendol. You definitely don't see something like this in mainstream gaming.

Good article. A medical setting for a campaign is not the easiest of settings, both for players and GM. Like (pseudo-)historical settings, it offers diversion from the more generic monster bashing or detective stories, but on the down-side it means a lot of added work for the Gamemaster and has the potential to bore or gross out a lot of players.

Just as I have seen time and again that people who don't have at least a small backgrund in science have a hard time playing a scientist character who is not total cliche, and someone who knows nothing about programming should better not try to convincingly play a computer hacker (unless it's in a Cyberpunk campaign), so a trauma team or hospital setting forces people to devote at least a bit of time into research beforehand. Or the whole thing will degenerate to the level of soap-opera "doctor TV series".

Some years ago I played in a Shadowrun group where the GM asked us if we wanted to try a game centered not on the standard streetpunk or mercenary shadowrunners, but on a DocWagon team. That was back when FASA tried to encourage "unusual" settings and less combat-oriented characters for 2nd Ed. Shadowrun. Unfortunately, there was hardly any background material on how exactly healing magic and high-tech medicine interacted in the Shadowrun world, the role or availability of magically active healers in hospitals, or any ready-to-play modules.

Unfortunately, the GM was rather on the inflexible side. He had apparently had a hard time coming up with ideas that didn't involve either shoot-outs or detective work - I had the feeling he wanted to steer away from the actual medical technobabble as soon as possible, but the plot hook for our characters frankly didn't give them sufficient motivations to get behind it themselves instead of, say, just handing over the data to security and going back to their patients. Any side-plots detailing the PCs private lifes were "sabotaged" by the GM, so there wasn't even a chance of having an Emergency Room TV Series sort of game where the challenges met at the work place where balanced out by non-work related private interactions between PCs and NPCs, or PCs reacting to stress from the work place spilling over into home life. We stopped playing after two sessions.

But one of the biggest problems for us (one we never adequately solved) was deciding how useful healing magic in the Shadowrun setting actually *is* in our campaign. Like i.e. D&D, Shadowrun has no specific body damage zones but simply uses abstract levels for damage/health. One row of little "damage boxes" to check off for physical damage, one row for stun damage and exhaustion, with every character having the same "reservoir" of boxes, no matter what meta-type of Homo sapiens. Constitution only governs how much additional "overflow" damage you can take beyond "dying" until you're totally unrevivably dead. You get shot, you lose abstract health levels (or, gain damage levels, whatever). You get mangled in a car accident or explosion, you lose abstract health levels. Healing is done either naturally (may a long time, depending on CON), with medical help, special nanotech symbiotic implants in your body, or healing spells, but all that happens is that you, the player, erase some of the checked-off boxes, and Eureka! the character can go from seriously wounded to completely recovered in a matter of seconds, especially when magic is used. Likewise, diseases (only vaguely described in the first place) may be healed, toxins may be filtered from the body by specific spells... the only thing magic isnt able to cure is Stun Damage and insanity. And it doesn't work well or at all on characters who are crammed with bioware/cyberware implants, but that's about it. Most "normals" people don't have more than a datajack. Spellcasters usually have no cyber at all, in fact all-out invasive high-tech medicine procedures can do permanent harm to their ability to channel mana energy, so they'd be the only ones lobbying for wide availability of magic healing.

Now, in a typical Shadowrun scenario, the survival of the characters *depends* on healing magic, street docs and helpful implants a) working without much ado, and b) being readily available (despite there being relatively few magically active people who are at the same time professionally trained physicians, almost every Shadowrun team has at least one spellcaster who knows a Cure Wounds spell of sorts).

True, you might get complications from a botched cyberware implantation surgery (i.e. Essence loss) or from taking so much raw damage that your cyber implants malfunction and need to be repaired. But you roll randomly on a table *where* you were hit, until you roll a body part or sensory organ that has an implant. (Unless the GM rules a foe shot you in the head because he aimed for it. Even then you don't get extra damage for being shot in the head rather than say in the shoulder.)

But no shadowrunner in a game or a Shadowrun novel ever had to bother asking questions like:
"Do I have to clean the dirt and splinters out of the wound before the spell heals it up?"
"If damage resulting from blood loss is healed, does that mean the body's blood production is temporarily amped up to insane levels? Won't that mean I need to drink and eat a lot very quickly? What if my character suffers from a haemorrhage of the brain, resulting in brain damage due to blot clots and parts of the brain not getting enough oxygen due to mounting pressure from spilling blood inside the skull? Will he still need trepanation?"
"Will magic healing on burn wounds still leave scars? Does my singed hair grow back?" (hey, probably not)
"If the GM ruled the cybered lynx bit off my fingers and scratched out my eye, to give a bit of flavour text to a "Medium Wound level", will a cure wounds spell fix that?" (since there are no official spells to regrow body parts AFAIK?)
"Does a doctor have to set that bone before you heal the broken leg, or will the spell fix that too?"
"Does a spell that heals disease also take care of the symptoms I already suffer, in an instant? Does it kill off the germs inside the body (what about virus DNA currently inside a cell, then?), or does it simply boost the patient's immune system? What if the patient has AIDS?"
"Since vampirism is a (magically active) virus infection, can a spell cure it? And what if the patient has already transformed into one of the various vampire forms (depending on his meta-type)?"
"If drug addictions can result in Essence loss, what if a spell purges the drugs from the system? Is the addiction still there?"

Now, there's nothing wrong with powerful healing magic being available in a combat-intensive setting. On the other hand, take D&D. I currently try to play an anatomist in D&D, a character who was originally intended to be an actual "hands-on" Medicus, with Renaissance-type knowledge about anatomy, antidotes, drugs and surgery. But I quickly found out that his skills were made practically superfluous by the existence of clerical healing magic. Under AD&D 2nd Ed, an anatomist was more or less a good or neutral aligned necromancer wizard who had studied medicine, giving him the power of doing weird things to the bodies of the living and modify the corporeal undead, being able to heal or harm without bowing to the whims of a deity. But apart from becoming a Dr. Frankenstein or settling down and becoming an NPC physician there wasn't a real niche for him. Under d20 D&D 3E, I was forced to turn him into a dual-class cleric/wizard just so that I would get Heal as a class skill from cleric class and Knowledge (anatomy) and Necrology skills from wizard class. (This was before Mongoose Publishing introduced the idea of "concepts", slight skill or feat variations to tune a class the way you want it from the beginning without having to use a Prestige Class; or before "make up your own core class" became ok in d20.) Which meant, the character gained clerical healing spells... thus making his own "mundane" healing skills more or less obsolete, unless there was a number of patients vastly exceeding the per-day spellcasting capabilities of local healers, i.e. in an epidemic. Worse, Necromancy (channeling "negative" energy) and healing (positive energy) don't go so well together in a D&D setting.

Once you introduce healing magic into a setting, there's the danger of it completely overwhelming normal medical practice. In the Shadowrun setting, we faced four equally unsatisfying possible scenarios:

1) If you have healing magic, who needs traditional surgery and pharmacology? Medicine is reduced to biotechnology and cybertech implantation. Any non-spellcasting character in a medical campaign is either a specialist or reduced to a nurse doing the dirty work, like cleaning up the blood and other bodily secretions after the magic healer had done his twenty seconds work of laying on hands and rejoice the patient is fine. I foresee a lot of grudge killings of magically active medicine students by their non-awakened colleagues...

2) Magic can heal flesh wounds and aid against disease, but that's about it. You need to diagnose a patient, do first aid, clean wounds, set bones, stitch lost limbs back on etc. Unfortunately, this goes against the official game mechanics for magic healing.

2) Magically active people and healing spells are so rare most hospitals don't even have a healer available, or they cannot pay one. If something's rare, the prices go up. But once you have one player in the group who wants to play a spellcaster you run into the problem again, or you're forced to keep healers strictly NPC.

3) The medical professions have done their best to restrict or ban magic healers from the hospitals. Spellcasters who can offer professional medical aid have to start their own doctor's practice and attract rich people or other spellcasters as paying patients. Unfortunately, the percentage of spellcasters in the populace is low, rich people probably work at a corporation (or own one) and already get the best medical plans, so you have to become "physician to the king". If spellcasters are forbidden to practice certain professions and cannot gain a medical degree, they're forced to go underground, working as street docs or "witch doctors" in the Urban Sprawls, or leave the city and move to one of the American Natives or Elven nations where magic is accepted but where they might suffer racism or prejudice against "the former city dweller".

Therefore, personally I'd stick to settings without magic or psychic healing powers. If the GM wants to emphasise the stress and frustration of overworked underpaid ER teams, go with a modern setting. If the GM wants the PCs less stressed out and more theheroic saviours, go with an SF high-tech setting --> GURPS Biotech, GURPS Transhuman Space.

As an afterthought:
EaterOfTheDead wrote:
::While it is designed to be a modern (TL 7) game, GURPS Triage can easily be adapted or added to an alternate setting. The most obvious would be alternate tech levels.::

Actually, the present time (year 2003) is already TL8. :)

On June 27, 1999 Steve Jackson Games announced "Welcome to TL8. The cloning has started." with a link to a BBC story at

And if I remember right, in 2000 Steve Jackson announced that the world had now "officially" entered early-TL8, not just on the biomedical front but on all fields.

Anyone who doesn't believe this just read a few issues of New Scientist magazine and watch a few documentaries about the latest American high-tech weaponry and surveillance equipment (battlefield drones, miniature drones, stuff like that) or NASA website for their future plans building a space-elevator and solar sails. (Incidentally, the argument about whether solar sails can work as intended at all without violating the laws of thermodynamics is still going on among scientists, see
I guess it'll only be settled when they actually launch one and test it.)

But, back to the topic of medical dramas...

Whoops, where did the URLs go? Anyway, addendum:
See for the SJG announcement.
See for the BBc story, although, well, it's already old news on the cloners' front.

Or regarding GURPS Transhuman Space maybe I should have written "borrow the biotech and medical technologies from the sourcebook, don't necessarily copy the setting, which is rather dark". :)

(swears) Sorry, sorry, sorry. I overlooked two more missing URLs. Didn't it work in the preview? Strange. Perhaps my Opera screwed up the HTML. Whatever. I guess I need some sleep.

Just for completeness' sake, for those who're interested in the solar sailing debate:

And back to topic...


You make many good points concerning this article that I found shortly after writing it.

Also to counterpoint the TL7 thing, this article was written about 3 years ago. It is just now seeing publication.

I wrote this for Pyramid Magazine with the idea that I wanted to do something different from the norm. I was promptly denied. The reason I was denied was a good one however. The editor, I can't remember his name, said that it wasn't playable as it was without a lot of work by the players and GM. He did say that if I could fix this problem then it would be published enthusiastically. So I set about fixing this problem and very quickly realized that detailing it further would be near impossible without enough details concerning biology and medical procedures to make it unwieldy at best. So all I could do is rely on the knowledge of the players and GM. While that is not a problem among myself and my friends, we all have at least a rudimentary education in medicine, it is far beyond the abilities of the average gamer.

Without the necessary medical knowledge the Triage campaign is reduced to:
GM: "Okay, some guy gets wheeled in on a stretcher by two ambulance guys. He's bleeding everywhere."
Player 1: "Okay, I roll Diagnosis. I rolled a 10, that makes it."
GM: "All right, he's been shot in the (Rolls a random location) left arm."
Player 2: "I roll Medicine. I rolled a 3! That's a critical!"
GM: "Okay, the guy gets better."

Not quite as exciting.......

As far as the stuff about alternate setting I didn't give those a whole lot of thought I just came up with a little blurb, just enough to catch someone's interest.
And finally, as a totally unrelated thing. My friends and I add much more detail to injuries in games like Shadowrun and D&D (as well as other d20 derivatives). Clerics and Mages need to clean wounds or they may become infected later even after a healing spell. Wounds are described in much more detail, a Serious wound is a gut shot or minor head wound. Etc.