Emergency Stim: Mechanically Great, Thematically Bad?

[cekivi]

Hello All,

The new update just released and one thing I noted on the video was an emergency stimulant. Now, mechanically, this is a great idea! This is an item that rewards players for exploring and gives them a one use only boost to pull themselves out of the fire and possibly survive a near fatal encounter. All of this is great! Mechanically, Emergency Stims are the perfect addition for the Long Dark!

My concern is how they work thematically. I'm not a medical expert (though there are some on the forums) but I don't know of any examples outside of movies where a massive dose of stimulants will pull a character back from the brink. Especially since it's very situational dependent. If I'm dying of dehydration a stimulant boost is not going to help. If I'm suffering from massive bleeding it may even make it worse! So, thematically, I don't know how well an injectable drug fits within the rather realistic game world. Perhaps it could instead be replaced with a tourniquet or some other form of combat medicine that could be rapidly applied so you can get to shelter before doing real first aid? 

What do you think? Do emergency stims thematically fit within the Long Dark?

[McGuffin]

At first I also didn't feel this kind of item really fits well with the long dark. That sounded a bit like a conventional RPG/FPS item. 

However the counter part is big since using a stimpak leaves you 100% exhausted after a short period of time.
This is really much more like an adrenaline shoot or something like that, but really  not something you can use to keep you magically on feet.
It's a real emergency item. 

And, finally, I think it's good addition.

 

[cekivi]

Just now, McGuffin said:

At first I also didn't feel this kind of item really fits well with the long dark. That sounded a bit like a conventional RPG/FPS item. 

However the counter part big since using a stimpak leave you 100% exhauted after a short period of time, this is really much more like an adrenaline shoot or something like that, but really  not something you can use to keep you magically on feet. It's a real emergency item. 

And, finally, I think it's good addition.

 

I definitely agree that it's a good addition. Like I said, mechanically, stim packs are great!

The problem is, in real life giving yourself a shot of adrenaline would probably give you a heart attack. That's why I was hoping a more medically minded person than myself may be able to propose something that mechanically behaved the same but fit the theme better. The best I could come up with was a tourniquet.

[Patrick Carlson]

7 minutes ago, cekivi said:

I definitely agree that it's a good addition. Like I said, mechanically, stim packs are great!

The problem is, in real life giving yourself a shot of adrenaline would probably give you a heart attack. That's why I was hoping a more medically minded person than myself may be able to propose something that mechanically behaved the same but fit the theme better. The best I could come up with was a tourniquet.

Yeah, I think drug/medication use has always been a controversial subject in survival situations. It has a long, complex history in the mountaineering world. A couple interesting links on this subject: https://www.theguardian.com/science/the-h-word/2013/may/15/everest-amphetamines-medical-ethics

http://www.outsideonline.com/1914501/climbings-little-helper

[cekivi]

20 minutes ago, Patrick Carlson said:

Yeah, I think drug/medication use has always been a controversial subject in survival situations. It has a long, complex history in the mountaineering world. A couple interesting links on this subject: https://www.theguardian.com/science/the-h-word/2013/may/15/everest-amphetamines-medical-ethics

http://www.outsideonline.com/1914501/climbings-little-helper

Interesting articles Patrick. Also informs my argument. The articles show that amphetamines can be miracle drugs for altitude sickness but, again, they wouldn't really help bleeding, dehydration, hypothermia or starvation. All of which are more likely to be the cause of your demise in the Long Dark. Perhaps I'm overthinking it, but in a game with as many real elements as the Long Dark I do find the concept of a miracle booster drug to be a little gamey.

But, to reiterate, mechanically it's a wonderful addition with many merits.

[Patrick Carlson]

18 minutes ago, cekivi said:

Interesting articles Patrick. Also informs my argument. The articles show that amphetamines can be miracle drugs for altitude sickness but, again, they wouldn't really help bleeding, dehydration, hypothermia or starvation. All of which are more likely to be the cause of your demise in the Long Dark. Perhaps I'm overthinking it, but in a game with as many real elements as the Long Dark I do find the concept of a miracle booster drug to be a little gamey.

But, to reiterate, mechanically it's a wonderful addition with many merits.

As it stands it's a pretty rare resource, special even. We look forward to seeing how players make use of it over time.

 

[hauteecolerider]

Emergency stim??

Mind you, I haven't played the update yet. Heck, I haven't even opened my Steam app yet!! I'm just reading through the forums before I get lost in the cold for the next couple of hours . . .

But emergency stim? Are you speaking of epinephrine? That should only be used in case of cardiac arrest. And in that situation, you are in no condition to give yourself a shot in heart with that!!

Or are we talking atropine? That's used in cases of certain types of poisoning. Think sarin and organophosphate insecticides. 

Hmm, I'll have to check it out and see for myself . . .

[Patrick Carlson]

25 minutes ago, hauteecolerider said:

Emergency stim??

Mind you, I haven't played the update yet. Heck, I haven't even opened my Steam app yet!! I'm just reading through the forums before I get lost in the cold for the next couple of hours . . .

But emergency stim? Are you speaking of epinephrine? That should only be used in case of cardiac arrest. And in that situation, you are in no condition to give yourself a shot in heart with that!!

Or are we talking atropine? That's used in cases of certain types of poisoning. Think sarin and organophosphate insecticides. 

Hmm, I'll have to check it out and see for myself . . .

In terms of our in-game Emergency Stim we're not being specific. The articles I linked above get very specific into different substances. 

 

[hauteecolerider]

29 minutes ago, Patrick Carlson said:

In terms of our in-game Emergency Stim we're not being specific. The articles I linked above get very specific into different substances. 

 

I just read those articles. OMG, this is scary stuff! I don't care how great or immortal these substances make you feel while climbing, they are serious meds and not to be used so casually. Performance enhancement?? More like crutch-forming! What about masking onset of serious conditions such as high altitude sickness, cerebral edema and pulmonary hypertension?? Yikes!

[elloco999]

As I gathered from the update video, stims are not a cure all magical cure or something like that. Maybe we should try it in game and figure out what they do exactly before we pass judgment on how good or bad they are?

[SteveP]

I don't think it fits in thematically at all. Stim Packs belong with magic charms and potions in other unrealistic stories. It's not the sort of thing you want to encourage people believe in. In effect, it sounds like cocaine and I could never endorse games that include that type of stimulant.

[Scyzara]

@elloco999 is right: It doesn't make any sense at all to complain about something before you've even tested it. Start a game in Pilgrim (or whatever), find a stimpak, try it and write your comment afterwards. It's probably not very helpful for the devs to get feedback based on how the item description in the changelist "sounds like" or how you personally assume it to work.

Apart from that, I tend to agree to @cekivi's point of view here.

I've tested the stimpaks a bit now and they're definitely an awesome addition from a gameplay-point of view. They're a massive tradeoff between short-term-advantage and long-term-disadvantage. I'm convinced they can really save your life in extraordinary emergency situations (like stumbling around freezing and disoriented at 2% health or suddenly hearing a wolf behind you while you're at 30% condition). Stimpaks also seem to be scarce enough to limit their use to said emergency situations, which is an aspect particularly important to me personally. 

But on the other hand I also honestly have to admit I found it a little immersion-breaking to see stimpaks included. I don't know, maybe it's just me, but I somehow connect stimpaks with "less realistic" videogames like Fallout. Probably because I've never heard of anyone using them in real life.

I think I'll get used to them immersion-wise eventually, though. New things often take some time to get used to.

@hauteecolerider: Effect-wise, TLD stimpaks seem to resemble some kind of adrenalin injection (maybe mixed with other stimulants).

Ingame-effect:

 

Spoiler

Stimpaks immediately restore 15% condition and set your stamina bar to 100% by default, allowing you to run nonstop without a break for about 1-2 rl minute. They also restore your fatigue bar to 100% at first, but it drops extremely fast afterwards, finally leading to exhaustion once the stimpak runs out. Using a stimpak also slightly blurs your vision and makes your heart beat faster and louder.

 

It's very hard to tell as the whole discussion is highly hypothetical of course, but TLD stimpaks have no influence on your perception of hunger, thirst or cold. So if they contained further stimulants besides adrenalin, these would probably not be amphetamins or cocaine. But I'm far from being a specialist regarding these topics.^^

[SquirmyWhale]

I don't think the stim actually helps your character but just gives the feeling of better health, like just masking the pain until you can get some pain killers down or bandage. Since the health system works on percents it looks as though you character is getting healthier, except tired, but I don't really think it does that. I don't know much about medicines but masking the pain I think would work in the case of a bear or wolf attack. I think it only makes you tired for balance, it is a game after all.

[PlotDeviceManager]

I agree that they are thematically . . . problematic. An adrenaline shot can kill you as easily as it can help you. It's a very situation sensitive. Just want to add my two cents. Thanks!

[cekivi]

Just to reiterate - I'm not arguing (or asking anyone to argue) the mechanical merits of having emergency stims in the game. Mechanically, they are a great addition and add what I think is essential to any good game: more player choices and options.

All I'm wondering is a) thematically, do emergency stims make sense? and b) if they don't, can we suggest a better alternative?

[hauteecolerider]

I played the game a bit last night and found two already. I'm waiting to try them, and once I do, I'll chime in!

But from reading the in-game description, these are steroids, not adrenaline shots. So okay, I can get behind that. I also can get behind the immediate benefit versus tremendous long-term cost, as that is typical of shock doses of steroids (think dexamethasone - personally I've used methylprednisone) but we have to watch for metabolic derangements afterwards. 

So please let's stop calling these adrenaline. It's not a steroid!

[cekivi]

Conversely, steroids aren't stimulants. That was definitely part of my initial confusion.

Also, if you found two without much effort doesn't that decrease their rarity? If they're too common than the risks of the game are greatly diminished.

[hauteecolerider]

@cekivi Certain steroids are mimics of natural body substances (i.e. cortisol) that is released as part of the body's fight or flight response.

So at high doses (we refer to them as "shock" doses as those doses are to be used only in certain types of shock - not bleeding of course!) as they increase glucose availability and circulation of oxygenated blood to muscles.

However the metabolic derangements are horrific. We see steroid-induced diabetes, cellular starvation (especially the brain), aggravation of existing heart disease and development of new heart disease, digestive issues including ulceration of the gut lining, and immune suppression. Definitely not issues you want to deal with following a wolf or bear mauling.

So shock doses of steroids are typically used only once. If they don't work, we usually don't have time to come up with Plan B because the patient is already dead.

To balance the gameplay with what I know about its real life effects, I would use the stim pack only when suffering from hypothermia. Not from blood loss or infection. 

[cekivi]

That's why I was thinking of a tourniquet as opposed to the meds. It will immediately stop bleeding... but you still need medical help asap!

Actually, that gives me an idea for something new to request in the alpha...

[SquirmyWhale]

2 hours ago, PlotDeviceManager said:

I agree that they are thematically . . . problematic. An adrenaline shot can kill you as easily as it can help you. It's a very situation sensitive. Just want to add my two cents. Thanks!

Then maybe there could add a chance for it to kill you, but then no one would use them at all

[cekivi]

27 minutes ago, SquirmyWhale said:

Then maybe there could add a chance for it to kill you, but then no one would use them at all

And therein lies the rub.

Again, mechanically there's nothing wrong with having medical stims especially in a game as challenging as the Long Dark. It's just can we call them a different name or have them applied differently...

[SquirmyWhale]

On 4/21/2016 at 5:12 PM, cekivi said:

And therein lies the rub.

Again, mechanically there's nothing wrong with having medical stims especially in a game as challenging as the Long Dark. It's just can we call them a different name or have them applied differently...

What could this type of item be called with the same function be called? I do think a tourniquet could work but I think if they can't make the stim realistic or seem plausible then they should just remove it. Unless they are turning away from realism for a bit to make the game a bit easier.

[hauteecolerider]

The stim in the game and a tourniquet are two very different things.

A tourniquet is used to stop bleeding from a limb (arm, leg). It is applied in case of life-threatening blood loss. Won't work if the injury is on the torso, neck or head. Direct pressure and field dressings are effective for these.

The stim pack is a shock-dose steroid injection meant to stimulate the fight-or-flight response of the body and would be effective in case of hypothermia or exhaustion. It comes with a significant cost. 

I think what @cekivi is driving at is calling this a "stimpack" rather than "shock drug" or something similar (in the vet clinic we refer to this as methylpred, short for methylprednisolone succinate) would make it more appropriate for the TLD setting. In emergent cases I've primarily used this for head trauma cases, as it is effective for reducing or reversing traumatic brain swelling. The risk with this drug is that it would exacerbate bleeding, which is why in playing this game, I wouldn't use this for blood loss. 

I have yet to use it, but it seems that it would be effective to restore some condition when your condition is dangerously low and shelter is a short distance away. 

[SteveP]

I think the game concept of a boost is attractive however it's not something I personally would want to endorse to the 14+ age group at all. That's a Duke Nukem testosterone jock attitude and TLD strikes me as much more thoughtful and intelligent. I fear it's going to be a popular gimmick but I hope Hinterland will reconsider this one. my $0.02. I would have less objection if the Stim boost had some serious side-effects such as lethargy or headache later on. May we assume that it's a large dose of caffeine? Be aware that even caffeine can be abused in its pure form. Steroid abuse is another serious concern.

[McGuffin]

7 hours ago, SteveP said:

I think the game concept of a boost is attractive however it's not something I personally would want to endorse to the 14+ age group at all. That's a Duke Nukem testosterone jock attitude and TLD strikes me as much more thoughtful and intelligent. I fear it's going to be a popular gimmick but I hope Hinterland will reconsider this one. my $0.02. I would have less objection if the Stim boost had some serious side-effects such as lethargy or headache later on. May we assume that it's a large dose of caffeine? Be aware that even caffeine can be abused in its pure form. Steroid abuse is another serious concern.

did you try it?
it has a big trade off