Okay first things first, getting a couple of things out of the way:

1. I fully understand that there are other things that need work right now. I'm not saying BSG should drop everything and implement these changes.
2. I, personally, am not a medical professional. I have a basic amount of knowledge. However, part of my creation of this post included contacting and speaking with, at length, two medical professionals; an active duty US Army Combat Medic, and a former US Army doctor/current EMS. This was drafting using their knowledge and recommendations.

Additionally, I do want this to be a conversation. I do genuinely want a other peoples thoughts and feedback, even if you disagree with everything.

With that out of the way, here's the huge wall of text everyone is going to ignore. And seriously, this is going to be a HUGE post. Get your popcorn.

The Problems:

I don't think it's a controversial opinion to say that Tarkov's medical system has problems. Pre-medding, silly things like vaseline for dealing with broken bones, being able to have every limb blacked out and repair, multiple times, with zero downside outside of HP loss. There's a lot of potential, but it's not being used to its fullest. In order to address these problems, they need to be identified. I've sectioned them all off into their own categories, which will receive their own fixes and suggestions. They are as follows:

• Lack of Blood Pressure/Fluid Levels: This is a big one. Both medical professionals I spoke to near instantly singled out this as a major flaw in the entire system and both agreed that if nothing else, proper implementation of this would be ideal.
• Lack of Wound Types: This one is a bit tricky, but generally they both agreed that there needs to be internal and external wounds that required different treatments.
• Pain shouldn't be One-Size-Fits-All: Again, this one is tricky but the consensus was it shouldn't just be a singular "pain".
• Injuries aren't severe enough/No Permanent Conditions: Oh boy this one was fun. Their thoughts boiled down to "Even if you don't die, getting shot should ruin your world".
• Healing is Too Fast: Self explanatory.
• Not Enough Drawbacks: This relates to using things like Morphine, Painkillers, stopping heavy bleeds, surgery, etc.
• Pre-Medicating: It's_Time_To_Stop.mp4

And last but not least:

• Stimulants: At one point, after fully explaining to both people what every single Stim did, I asked if they had a place in a game like Tarkov. Neither let me finish the sentence before saying "No".

There were more topics discussed, more issues brought up and a lot of things that they disagreed on but this is the bulk of it. There was a general air of "if the game is meant to be punishing, this stuff needs to be genuinely unpleasant to deal with". Which, if I'm being honest, it should. One of the best updates to this game was when they introduced med animations, it was a massive game changer and really put combat back on track for being slow, tactical, and methodical. And a lot of the proposed changes are meant to do the same thing, to bring EFT to a point where your first instinct in a firefight should be "can I survive this?" and not "I just need to kill them first". It also forces more decision making onto the player, and personally I think any mechanic, any system in play that makes the player stop and think is a good one.

The Changes:

Like the above list, I'll be going through these in order of appearance. Part of the discussion with the two professionals involved a lot of "well that's how it works in the real world, but how do we make it work in a video game?". Which is a serious problem, and is something I want to address before I start: There is no way, No Way, a video game can 1:1 replicate these sorts of things in real life. That's just a fact. And both people agreed that Tarkov, even with its problems, is leagues above other games. There's a lot of good potential that needs work. So, on to the changes.

• Lack of Blood Pressure/Fluid Levels: There is a BP meter but it doesn't really seem to do anything, and Energy/Hydration seem to be used as a stand-in in a lot of places for internal fluid loss. The proposed changes are to implement BP fully and introduce Blood as a numerical stat, like the HP bars. Bloodloss from wounds/bleeding lowers your total blood level and lowers your BP, both of which can be lethal and would serve as a very hard limit to how many injuries you can actually deal with before you simply just don't have any more people juice left and drop dead. And luckily, there's already a way to deal with it in the game! Medical Bloodsets and Saline Solution could be used to create a medical item that, like surgery kits for blacked out limbs, would take a long time to use but would allow you to recover from serious, life threatening injuries with a long and slow working "active" time to discourage aggression after treatment. This would also drastically change what getting your stomach blacked out does: instead of Hydration/Energy loss, it's Blood loss to simulate internal fluid loss.
• Lack of Wound Types: Really, we have bleeding and fractures. Not enough. The proposed changes would introduce Internal Injuries, Bruises, Lacerations, Deep Wounds, Head Wounds, and GSW's.

1. Internal Injuries could be gained through blunt damage through armor, falls, concussive blasts from grenades, and even melee attacks. These would be Constant Injuries that only appear on the torso (Stomach/Thorax) and would require Surgery Kits and Fluid Replacement to treat and cause Contusion, Blood Loss, and Major Pain.
2. Bruises could occur from any kind of damage, on any part of the body. Temporary Injuries that can be fixed with normal medkits and cause Contusion on that part of the body and Minor Pain.
3. Lacerations could be caused by gun shots, melee attacks, shrapnel, and barbed wire that would result in Light Bleeding. Constant Injuries that can be fixed with bandages or medkits and cause Fresh Wound on that body part and Minor Pain.
4. Deep Wounds are extreme forms of injury that could be caused by shrapnel, gunshots, and melee weapons, and are representative of both puncture wounds and arterial injuries. Constant Injuries that require Hemostat/Tourniquets and medkits that cause Heavy Bleeding and Fresh Wound on that body part, as well as Major Pain. Head excluded.
5. Head Wounds are…head wounds. Tanking rounds to the helmet, getting hit in the head, blast impact from grenades, or anything that would ding your bell. Constant Injuries that are fixed with Painkillers and Medkits that cause Light Bleed, Fresh Wound, Major Pain, and Concussion.
6. GSW (Gun Shot Wounds) are, like head wounds, self explanatory. They can appear on any part of the body (except head) and can also lead to Internal Injury or Deep Wounds, as well as fractures. Constant Injuries that would require Hemostat/TQ's and Medkits to treat, and if they caused any other injury, those would require their own treatment, and cause Heavy Bleed on that body part and Major Pain.

Now, you should notice that a few new terms showed up, I'll get to those later. But these would help to create a system where you don't just deal with injury by spamming your hotkeys and hoping for the best, and would seriously encourage a more careful, tactical approach to combat.

• Pain shouldn't be One-Size-Fits-All: This was a huge one with a few simple fixes. Primarily by separating it into two types like what was done with bleeding; Minor Pain and Major Pain. Minor pain can be treated with surface ointments like Vaseline and Golden Star and pills like Ibuprofen. Minor Pain causes a mild screen effect. Major Pain would require Morphine or Painkillers (which both advised should be replaced with something like Fentanyl pills) and has a strong visual effect. There's no reason why you should be able to use balm made to sooth sore muscles to help with a broken leg.
• Injuries aren't severe enough/No Permanent Conditions: I'm convinced these two people hate all of us. Their suggestions resulted in Temporary and Constant Injuries and an entire rework of the "blacked out" system. Temporary Injuries would be things already in the game like small damage that causes light bleeds (such as stepping on barbed wire) or Bruises. They're not debilitating and can be treated easily. Constant Injuries stay. Once you get one, that status is there for the rest of the raid. Fractures, for example, would now be Constant Injuries that keep the Fresh Wound status for the rest of the raid and cause Major Pain. These are the big boys. To go along with that, having a limb go black should be the worst case scenario. A fractured leg might make you hobble, but a blacked out leg drops you prone. A blacked out arm means no ADS'ing, no melee or grenades for the right arm. Blacked out stomach causes Internal Bleeding and Bloodloss. Very serious injuries that become Priority Number One.
• Healing is Too Fast: Again, super self explanatory. Things should take more time, surgery should take longer and have a period where the animation is over but you just need to chill and recover or the wound could open up. Effects like pain removal shouldn't be instant and should take a few seconds to really start.
• Not Enough Drawbacks: This is one that took a lot of discussion to explain and then translate into the context of a video game, but basically the suggestion is to implement more downsides for what you use to treat things. TQ's can hurt and can lead to permanent nerve damage, and things like Morphine should be giving you serious drawbacks. Their main suggestions are:

1. For TQ's, keep them cheap and single use but give them a debuff after a couple of minutes that causes Bruise and Minor Pain.
2. Surgery Kits should be able to fix blacked out body parts, but that part should keep a debuff: Slower movement speed and a Strength debuff for legs, slower ADS/melee speed and a Recoil Control debuff for arms, reduced blood/fluid and hydration/energy recovery for stomach with an Endurance debuff.
3. Morphine should be the instant Major Pain reducer it already is but instead of Hydration and Energy loss, you receive an Ergonomics penalty and a minor animation speed debuff to represent the real world issue of loss of motor skills.

• Pre-Medicating: Two very simple fixes. First, you just can't do it. You can't use medkids with no HP missing, you can't use splints with no fractures, can't use bandages/TQ's/Hemostat with no bleeding, you shouldn't be able to use pain reducing medication with no pain. The second? When you receive any injury that would cause a serious wound/major pain/a large amount of HP loss all at once, you get a 15 second long Adrenaline Buff with a minor Tunnel Vision effect. Because this happens in real life. Once it wears off you're left with the new injuries you have, but that spike of adrenaline would give you the time to react, offensively or defensively, to getting seriously hurt.

And finally, stims. There was no discussion, there was no "well maybe", it was just a firm "No" from both of them. And I think this rings true for a lot of the community. So for this proposed rework of the medical system, there's no suggestions for stims because the medical professionals I spoke to simply saw no place for them in the game.

Conclusions & Other Notes:

There were some other things that were suggested, such as needing to disinfect wounds before treatment and using chest seals for sucking chest wounds, that were eventually disregarded, and some of the suggestions were things already planned to be included (such as using medical items on other players). Surprisingly, both of them very strongly agreed that surgery kits should be in the game, they just need to be last resort items that take a lot of time to use. There was also a generally agreed upon idea that going halfway isn't what the game needs, and that if there wasn't a step towards complex then it should go the other way. The Combat Medic actually plays Tarkov, not frequently though, and the EMS practically breaths ArmA and Squad, so both went into this knowing that the limitations of a video game apply. But all of these were created and discussed with one major goal in mind: making combat more lethal. The TTK in Tarkov wildly varies, which is just silly. This is a game where if a fight is being dragged out, both parties should hate it. With these changes, gunfights would end fast, there would be far more risks for everyone involved, and walking away alive would put the winner in a position where they need to avoid more fighting until they fix themselves up. But it would also heavily reward smart tactics and strategies, and put a greater emphasis on "fight smart, not hard".

If you've made it to the end of this, then congratulations! You're a hero with maxed out Endurance. This took a while to prepare and honestly, it's probably not perfect. But that's why I want feedback, and want a discussion. So thanks for your time and if you decide to contribute to the discussion, thank you for that as well. Tarkov is a game I bitch about a lot, but it's because I see the potential in it to be greater than it is. I'm like a parent looking at their straight-A student kid taking an upper-decker in the bathroom: I know the game can be better, and I'm disappointed in the wasted potential.