Chaosium Digest Volume 22, Number 5
Date: Monday, October 13, 1997
Number: 2 of 2

Contents:

The Complete Keeper's Revenge Kit, Part Two
					(Jonathan Turner)	CALL OF CTHULHU

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From: Jonathan Turner <jonno@enterprise.net>
Subject: The Complete Keeper's Revenge Kit, Part Two
System: Call of Cthulhu

The Complete Keepers' Revenge Kit, Part Two

INTRODUCTION

First of all, thanks to everyone who e-mailed me with reaction to the
first part of the Revenge Kit (V20.6). Thanks for taking the time to
get in touch--your comments are appreciated. It's great to see people
out there who feel the same way I do.

Here then, is Part Two, which deals with the messy problem of PC
injury.

Player characters are a singularly unlucky breed. They spend a lot of
their time getting bitten, clawed, shot, stabbed, or going mad. As a
result, Keepers often have recourse to turn to the rules on first aid
and recovery.

I mentioned in Part One that I keep players in the dark about their
characters' hit points. When they're injured, I describe the symptoms.
That way, they know when they're in trouble.

To do that of course, you gotta know a bit about anatomy and trauma.
That's where this article comes in. I've decided to go through the
more common injuries--like gunshot wounds and animal attacks--and
cover what damage the PC is likely to find inflicted on him.

Why bother doing all this? Well, the answer is simple: atmosphere.

There's nothing like a couple of badly injured PCs struggling to
overcome 'monsters and their kynde' when the ichor hits the fan. Being
able to keep the narrative flowing, but still accurately describe the
injuries--and how they affect the PCs--adds and enriches the
role-playing. Trust me on this.

In the CoC rules it mentions that you might want to steer clear of
keeping track of which body parts are injured because of the extra
book-keeping. I disagree, I'm afraid. Bad injuries cause scars, limps,
blindness, irritable bowel syndrome--whatever. And that adds to the
character: "Yeah, my leg's never been the same since the Harding
expedition. Blasted crocodile took a chunk out of it, don't you know."

Your players will love you for it, and hate you at the same time. Kind
of like when you smack a naughty puppy on the nose with a rolled up
newspaper.

But there is a danger that a lot of this might seem very dry--after
all, if you wanted to learn anatomy you'd go to med school or watch a
lot of ER, right? If that's the case, don't worry. Just use this
article like a Lucky Dip of Player Torture. Pick a good injury
(tension pneumothorax is my favourite) and wait for the right moment
to use it.  That'll really screw yer PCs up.

Also, a lot of trauma injuries are scary--they are after all
technically unnatural. You can introduce them into a scenario and it's
quite possible your players will misinterpret them as something else
entirely. Maybe they'll see convulsions caused by a head injury or
fever as demonic possession or something.

Bear in mind also that some Mythos creatures will have similar anatomy
to humans--the classic example being Deep Ones.

Surprisingly serious bit: I've been a first aider for about three
years before qualifying as an Emergency Medical Technician early this
year. I feel I have to say that while I'm treating this subject with
my trademark black humour, none of this is funny in real life.

So I'd like to dedicate this piece to those who spend their time
dealing with this stuff for real--you wouldn't believe what it's like
until you see it for yourself.

Right then doctor, if you've finished scrubbing up--let's give your
PCs hell...

A Word on First Aid

In the CoC rules, beginning characters have a First Aid skill of 30
per cent--a very generous figure in my opinion.

In the real world, First Aid covers what medical professionals call
Immediate Care. And in my experience, the trained first aider spends a
lot of his time trying to prevent people from doing stupid things
which they think are what should be done. Things such as putting their
fingers in the mouth of a fitting epileptic (you'll lose 'em) or
pulling knives out of a casualty's chest (sucking chest wound,
anyone?).

So in my opinion, I would give starting characters a lot less in
beginning First Aid, maybe as low as 5 or 10 per cent. But that's
bitter experience of how stupid people are for you.

First Aid of around 30 would suggest a person who has completed a
quite comprehensive course, taking in everything from CPR to setting
splints, dealing with bleeding and other emergencies like convulsions
or spinal injuries. In other words, a competent first aider.

Skills of between 30 to 55 per cent would cover a professional
Emergency Medical Technician. At this level of Immediate Care, the
character would be familiar with such procedures as giving Oxygen and
the pain-killing gas Nitrous Oxide. They would also be familiar with
the operation of equipment such as stretchers, Military Anti-Shock
Trousers, artificial airways and a defibrillator.

At skill levels of 60 per cent or above, the character is either
highly experienced or is a qualified paramedic. The main difference
between paramedics and EMTs is that the former can administer drugs
and intubate casualties. Paramedics are extremely proficient at
stabilising a casualty in the field--better even than most doctors!
Skill levels above this would symbolise a professional who has an
increasing amount of experience.

Bear all this is mind when justifying the skill levels of your
characters.

TRAUMA 101

Each year, there are about 165,000 deaths from trauma in the United
States, and for each case there are two cases of permanent disability.
(See bibliography). Apart from madness, trauma is the affliction most
likely to befall an investigator.

What I've decided to do is to briefly cover the most common types of
injuries which an investigator will probably suffer. I've broken them
up into several sections to make things easier, specifically: gunshot
wounds, melee injuries, vehicular accidents, and explosions.

For my purposes, I've defined a serious injury as anything more than
four or five hit points. Of course, it all depends where you get hit.
Two hit points is a lot if somebody stabs you in the eye with a
pencil.

Join me then on a magical mystery tour of the human body, inside and
out. And even some bits where the insides are out. Yuck.

Gunshot Wounds

Investigators are just as likely to inflict these on other people as
to suffer them themselves. We all know that the severity of the injury
depends on what you get shot with--but the symptoms are different,
too.

Bullets from pistols, rifles and submachineguns, as opposed to the
pellets from a shotgun, may well ricochet off bones and go all over
the place, unless you're talking about a low calibre weapon like a
-22.

In the movies, a bullet causes just one wound, where it enters the
body. In real life though, it also causes an exit wound--and they are
actually worse than where the victim got shot in the first place.

Exit wounds can be some distance from the entrance wound, and often
not where you might expect it. One case which springs to mind was a
guy who was shot in the shoulder by a police sniper. The cop probably
thought he was doing him a favour by shooting to wound instead of
going for a head shot.

The bullet had other ideas, though. It ricocheted off the target's
clavicle, down through his chest and abdomen, and blew out half his
back--killed him stone dead. I'm not exaggerating--this guy had a two
or three foot wound cavity in his back.

That's a high velocity round such as a 7.62mm rifle bullet--but the
principle is the same regardless.

When a bullet rips through a target, it not only tears through
whatever internal organs happen to be in the way, it also leaves a
temporary cavity in its wake.

This means all the internal organs and tissue get stretched and pushed
out of the way as the bullet burrows through. This temporary cavity can
be 30 times the size of the bullet that caused it!

As this collapses, it produces a vacuum along the path of the
bullet--one that is so powerful it can suck stuff inside from around
the victim. That usually means pieces of clothing, but it's also been
known to include leaves from nearby trees, pieces of paper, grass--you
name it.

Shotguns are even more devastating. We all know that every
investigator loves his or her shotgun--and for good reason. No good at
any range, up close (under 10 yards) a shotgun can quite literally
blow off an arm or a leg.

The tight pattern of shot at close ranges means the shot simply
burrows into tissue. In fact, the trauma has more in common with blast
injuries than gunshot wounds.

And you thought a gun was a nice clean way to kill something.
Basically--if you get shot--you're screwed.

So, investigators who get shot are in trouble. A low velocity round
like a .22 or maybe even something like a 9mm at range might well
glance off a rib or a long bone like the femur and do very little
internal damage. Maybe. I would still encourage rolls on the
Resistance table (CON versus damage done) to stay conscious and
battlin' on.

But they will still leave a nasty wound with a chunk of missing
tissue--a wound that will be infected with bits of clothing and dirt
and wadding if it was caused by a shotgun blast.

Serious injuries to the chest are immediately life-threatening--that
potential cavity has just messed up your heart, lungs, and the biggest
artery and veins in the body.

In fact, if you get a nick in your aorta (it lies more or less in the
centre of the chest) you can die in seconds.

As for head shots, it all depends where the bullet hits. One high up
in the skull will kill or cause coma and probably brain damage of some
kind. One elsewhere may not be so serious though, believe it or not.

Bullet wounds in limbs can kill too, particularly an injury to the
thigh. Like the aorta, a rupture of the femoral artery can drop a man
in seconds.

The Aftermath: Most people fall down when they get shot, though it's a
well documented fact that a lot of people take bullets to the chest
and keep on truckin'. A wound to the femur will drop you right away,
and one to the head will knock you down if not kill you.

Gunshot victims--like most people who suffer serious trauma--invariably 
go into shock. They get pale and feel cold, anxious and jittery. They
complain of thirst a lot. Their lips become blue and they often lose
consciousness. Pass notes to the player involved and get him to
role-play it. It can make things very difficult for the other PCs.

A True Story: A little story to round this section off with a dose of
reality. I had a friend who was shot while he was fighting in
Bosnia. He was a professional soldier, in the middle of a firefight.

Next thing--BANG--it feels like somebody punched him on the side of
the jaw and laid him out. He came to and saw this distraught buddy of
his trying to put a field dressing on his face. My friend got up,
shook his head and was able to fall back unaided.

The bullet--from an AK47 no less--had ricocheted off a pillar near
where my buddy had been taking cover. It struck him sideways on the
chin and lifted him off his feet. It pushed his lower front teeth all
outta whack--something he got fixed at the dentist--but left him
otherwise uninjured.

Luck roll of 01, anyone?

Melee Injuries

What if it doesn't come to guns, then? What if it's a good
old-fashioned bout of fisticuffs, or maybe a cavalry sabre versus a
Sand Dweller's teeth and claws? Or, uh, a Nightgaunt's tickling?
(Sorry--you've got me stumped there).

Technically speaking, there are two forms of damage in melee
combat--blunt trauma and puncture wounds. (Three if you count
tickling.)

Punching and kicking: The human body is well built to resist blunt
trauma. Fists and feet in a fight can produce horrible stuff like
broken teeth and noses--which both make breathing difficult (very
distracting). Also, any wound to the head produces a lot of bleeding
because of the rich supply of blood to the brain. That blood gets into
eyes and ears, making future Spot Hidden rolls that bit more
difficult. Unless your character makes an Idea roll, I would also
reduce their DEX by one of two points for the purposes of initiative.

Bruised, cracked or fractured ribs are a common injury in fights. A
word of warning here for those players who are using elderly
investigators--old people's bones crack a lot easier than younger folk
because they're so brittle.

Untrained fighters often do themselves as much damage as their
opponents when they connect. Some people are so dim they make a fist
with their thumb inside their fingers--it gets broken when they thump
their victim.

A sprained or broken wrist is another common injury, and of course
when a punch connects with teeth your knuckles are gonna get sliced
open.

If you're planning on kicking something, make sure you're wearing
sensible shoes--a lot of dimwits break their toes while battering
someone's ribs.

By the way, this type of damage is too common to be classed as a
fumble, but a broken wrist from a bad fist attack sounds about right.

Advice for pugilistic investigators then--wear brass knuckles or
gloves and steel toe-capped boots.

Stabbing: Figures show that when they don't have a gun at hand,
Americans like to stab each other instead.

Most stab wounds are in the abdomen, just above the umbilicus (sorry,
but I always feel silly saying 'belly button').

Forensic psychologists would tell us that men usually stab in a
downward arc while woman stab upward.

Where sharp things are involved, there's two things to remember.
Firstly, people have a natural instinct to try and fend off blows,
commonly leading to defensive wounds in the forearms--some of which
can be quite serious.

Also, when a knife or sword penetrates a victim's body, that baby is
gonna stick there. There's a suction process involved between the
blade and the surrounding tissue and blood. Some bayonets and knives
have a blood trough in them to allow the weapon to be pulled out more
easily.

And incidentally--if your PCs are foolish enough to pull an impaled
object out--roll damage again. The right thing to do is strap it into
place and get to a good trauma surgeon fast.

Stab wounds--and gunshots too--to the chest commonly cause sucking
chest wounds, or pneumothorax. Open wounds to the chest--like a knife
blow--cause simple pneumothorax.

In such an injury, air is coming into the chest through the wound
instead of down the airway. This eventually leads to the affected lung
collapsing--sometimes very quickly.

Needless to say, this is a real serious injury. The best treatment is
to seal the wound with a dressing taped on three sides, which creates
a type of flutter valve to allow air out--but prevent it getting
sucked back in.

A PC with such an injury will be in extreme pain and suffering from
shock. Unless they're treated soon, it's wooden overcoat time.

Abdominal injuries can cause evisceration of the abdominal cavity,
which basically means being gutted. The best treatment is to cover the
protruding intestines with something plastic and keep them moist. And
of course, get to hospital fast.

Animal Attacks

Claw and bite attacks from animals, whether terrene or not, can leave
nasty injuries. Again, defensive wounds on the arms are a very common
place to get hurt.

Claws and teeth bring with them an almost guaranteed infection, which
should be treated aggressively with antibiotics. If you're playing in
a decade where you can get them, of course. Otherwise, some pretty
good CON rolls are needed.

Commonly, an animal attack results in avulsion of the skin, which
basically means a big chunk gets torn off. Still, think of the scars
you can brag about later.

Also: do Deep Ones or Nightgaunts carry rabies? I think we should be
told, Chaosium.

Vehicular Accidents

Even in the twenties, people were dying all the time in car accidents.
Deadly injuries can easily occur at speeds as low as 20 or 30mph.

If a PC is unlucky enough to crash, their body is involved in three
collisions. First, the vehicle hits the wall, other car, Cthulhu's
foot, or whatever it is that stops it in the first place. Then the PC
hits the inside of the car or whatever. Then his internal organs crash
into the inside of his chest wall, his brain bounces into his skull,
etc.

A word on those PCs who don't belt up. Even at relatively low speeds,
unrestrained passengers are usually ejected from the vehicle--
especially if it rolls. Next time you're driving along, take a look
around at all the stuff you're passing at the side of the road. That's
what you'll hit if you're thrown out of your car. People often die
from head injuries caused by hitting the curb, trees, or telegraph
poles.

For those players who are wearing shoulder to hip belts, almost all
damage they receive will be focused on their clavicle or collar bone.
Most people break their collar bones if there's a lot of speed
involved--but hey, better that than crunching into a nearby phone
booth.

Anyone wearing a lap belt, like the ones in the middle rear seat of
most cars, is in worse trouble. Lap belts usually cause a rupture of
the internal organs because of the forces involved.

Drivers also often injure their feet when they slide off the pedals in
a collision. They may have a broken or sprained ankle, or serious cuts
to the lower leg. If they're trapped in wreckage, that's an easy way
to bleed to death.

Also, a lot of people break their hips as the car deforms around them.
They get thrown forward and their knee cap strikes the glove
compartment or whatever. The force of the impact is translated down
their femur to the narrow neck of the hip joint. Snap.

Anyone in a car accident can be assumed to have spinal damage, whether
it's just whiplash or something much more serious.

A common injury in road traffic accidents is cardiac tamponade. This
occurs when the driver's chest slams into the steering column. The
heart is in a little bag called the pericardium. When that blunt
trauma hits the chest wall, it causes bleeding inside the pericardium. 
As it fills with blood it puts additional pressure on the heart, which
eventually stops beating. The only treatment is to insert a needle
into the pericardium and drain the blood out.

And remember open pneumothorax? Road accident victims can also have
tension pneumothorax, which is even more serious. Blunt trauma
ruptures the lung internally, but the chest wall is still intact. Air
from the injured lung is expelled into the pleural cavity (another
bag, this time around the lungs). The air can't escape, so eventually
the increase in pressure starts pushing the mediastinum, which is made
up of the aorta, the venae cavae and the trachea or windpipe. You can
recognise a casualty with this because their Adam's Apple is usually
off to one side. When that happens the windpipe, aorta and venae cavae
are sort of kinked, leading to rapid death. Again, the only treatment
is to insert a needle and drain the air out of the affected pleural
cavity.

One more charming chest injury: flail chest. This is when several ribs
are broken in two places, causing an entire section of the rib cage to
sort of drift free. When the casualty breathes in, this section of the
rib cage gets sucked in inside of going outwards, and vice versa on
exhalation. This is called paradoxical movement--and it's really
painful for the patient. It can also lead to bruised lungs--and the
shallow breathing caused by the injury can lead to hypoxia and
eventually death or coma.

Of course, all these chest injuries could just as easily be caused by
gunshot wounds, blunt trauma, or by going hand to hand with Yig or
somebody.

Driving into somebody: A touch of Car Wars(TM) creeping in, huh? Well,
if you decide to ram a humanoid figure like a Deep One or a mad
cultist, they will take most of the initial impact about mid
thigh. Then they will be thrown up onto the bonnet, with their head
probably striking the windscreen. Then they'll bounce off onto the
tarmac. If you hit 'em at any speed, they will be carried for some
distance before falling off.

Needless to say, that's a good way to put anybody down. The head injury
is the deadly one.

Explosions

When something blows up, it creates a pressure wave. The strength of
that wave depends on several factors, like the nature of the explosive
and the medium around it. Water translates the pressure wave far
better than air, making explosions in a liquid very dangerous for
anyone else swimming around. (Therefore, Deep Ones + grenades = fish
food.)

Being out in the open is a good thing in an explosion, because
pressure waves are reflected and amplified off walls, causing more
damage to those nearby.

Incidentally, if you're ever caught in a blast, I've been told the
best advice is to clamp your hands over your ears and keep your mouth
open.  It's got something to do with the way the pressure wave affects
your pulmonary system. But more of that later. (Living in Northern
Ireland means you tend to pick up useless advice like that. 
Thankfully, I've never had recourse to see if it works.)

Primary blast injuries are those caused entirely by the pressure wave.
Secondary injuries are caused by shrapnel and other flying debris, and
should be treated like low velocity gunshot wounds. Tertiary injuries
are caused when the victim is flung into something by the blast.
Miscellaneous blast injuries include inhalation burns, crush injury
from the collapse of buildings, toxic poisoning, etc. A casualty
caught in an explosion will probably have a selection of injuries.

Primary blast injuries usually affect the ear, the respiratory system
and the gastrointestinal tract. Somebody tossing dynamite in a confined
space like a mine? Fine. Have 'em role-play deafness for a few days. And
your balance is gonna be up the left, too.

THE SURGERY IS CLOSED

Well, I hope your players are still gonna be talking to you after
this. Once again, use this as pick and mix if you can't be bothered
remembering everything. You only need to sprinkle in one or two
injuries like these to make things memorable. That's been my
experience, anyway.

Hopefully this will help you add a bit of realistic horror to your
scenarios--and make your PCs that bit more fearful into the bargain.

And if you have anything you think I should put into Part Three--which
will include some more straightforward stuff about madness--drop me a
line.

Bibliography:

Emergency Care in the Streets, Fifth Edition, Nancy L. Caroline. ISBN
0-316-12891-0

  Nancy Caroline is the last word in pre-hospital care training and
  this book for paramedics is ideal to dip into and come up with a lot
  of interesting stuff. It's also a bit useful if you're doing a
  course in this stuff!

Emergency Medical Treatment: A Text for EMT-As and EMT-Intermediates,
Third Edition, Nancy L. Caroline ISBN 0-316-12886-4

  A slighter simpler text for Emergency Medical Technicians as opposed
  to paramedics. Some good basic anatomy in here.

The Black Medicine series by N. Mashiro, Ph.D. Published by Paladin
Press.

  These martial arts books mix anatomy and trauma care in with
  improvised weapons and dirty tricks to make a fascinating but gory
  read. Plenty of stuff to spring on your players in here.

Well, that's it! Enjoy!

JONATHAN TURNER
September 30, 1997

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