Option for the Desperate Survivor

[Registron]

Got bitten? Incredibly desperate to NOT become a zombie and will do whatever is possible to even have a CHANCE to get rid of the infection? Then maybe in your painkiller addled mind you'd decide that cutting your arm off was a good idea at the time.

 

If you got bitten and know you're infected, then you can use a sharp instrument to saw your limb off. Of course this will cause massive bleeding and potential wound infections and you're lucky if you don't break down physically or mentally, BUT if you're the luckiest amateur surgeon there is and you took some precautions (such as a makeshift tourniquet), then there's a 15% chance that you got rid of the infection but you've lost all use of that limb, as it's now a bloody bandaged stump. Don't know how cutting off a leg would work, but cutting off an arm would just lose your ability to wield things on that arm. You could just not give the ability to amputate the leg and you can just shoot yourself as that is hopeless.

[Rathlord]

Been suggested a thousand times and on the "Read Before Posting" list. But here's a quick and handy guide (pulled from one of my posts on the old forum- it's been suggested that many times over the last 3 years) as to why amputation wouldn't work at all.

 

While it might be a somewhat fun option (obviously people's opinions on this are pure opinion, no facts) speaking from the perspective of someone familiar with medicine it just doesn't make sense. Here's my issues with amputation:

1) A clean amputation requires specific tools. A cut that's not clean will just cause you to bleed out, so this is important. Preferably the blade should be cleaned before using it (at which point your friend would be a zombie) or else:

2) Amputations have a tremendous ability to get infected. This killed the vast majority of amputees that survive the bleeding before modern medicine and would continue to be true after modern medicine as well. But then again,

3) Most amputees die. The bleeding is an obvious killer but the very shock of it can cause your heart to stop as well. This is especially true because

4) The vast majority of people don't know how to perform an amputation (where to cut, how to clean it, how to cut it, etc.). If they do know how to perform an amputation, they likely don't know how to correctly place a tourniquet. Or even know what a tourniquet is. This is important because

5) You can't just bandage an amputation. Pressure on the end of the wound just isn't enough. It needs a prepared tourniquet instantly or the person will bleed out. Most of the time by the time you had made a makeshift tourniquet, your friend has bled out from the wound or is munching on your brains. Unfortunately there's one other problem, which is that

6) Just because you cut the limb off doesn't mean you got all of the virus/bacteria. It could have entered the bloodstream or just be lingering around the wound. Which means that even if you got 1-5 right, your friend could still just become a zombie.

The reason I can't support amputation is that it breaks two of the three biggest rules when it comes to suggestions:

Would it be fun? This one is opinions at this point.
Would it be realistic? Nope.
Would every day people be able to do it? Also a no.

[Registron]

 

Been suggested a thousand times and on the "Read Before Posting" list. But here's a quick and handy guide (pulled from one of my posts on the old forum- it's been suggested that many times over the last 3 years) as to why amputation wouldn't work at all.

 

 

While it might be a somewhat fun option (obviously people's opinions on this are pure opinion, no facts) speaking from the perspective of someone familiar with medicine it just doesn't make sense. Here's my issues with amputation:

1) A clean amputation requires specific tools. A cut that's not clean will just cause you to bleed out, so this is important. Preferably the blade should be cleaned before using it (at which point your friend would be a zombie) or else:

2) Amputations have a tremendous ability to get infected. This killed the vast majority of amputees that survive the bleeding before modern medicine and would continue to be true after modern medicine as well. But then again,

3) Most amputees die. The bleeding is an obvious killer but the very shock of it can cause your heart to stop as well. This is especially true because

4) The vast majority of people don't know how to perform an amputation (where to cut, how to clean it, how to cut it, etc.). If they do know how to perform an amputation, they likely don't know how to correctly place a tourniquet. Or even know what a tourniquet is. This is important because

5) You can't just bandage an amputation. Pressure on the end of the wound just isn't enough. It needs a prepared tourniquet instantly or the person will bleed out. Most of the time by the time you had made a makeshift tourniquet, your friend has bled out from the wound or is munching on your brains. Unfortunately there's one other problem, which is that

6) Just because you cut the limb off doesn't mean you got all of the virus/bacteria. It could have entered the bloodstream or just be lingering around the wound. Which means that even if you got 1-5 right, your friend could still just become a zombie.

The reason I can't support amputation is that it breaks two of the three biggest rules when it comes to suggestions:

Would it be fun? This one is opinions at this point.

Would it be realistic? Nope.

Would every day people be able to do it? Also a no.

 

I definitely wasn't saying it would be something that would be easy to do or had a 100% chance to cure you or even for you to survive, I'd just make it for extremely desperate measures.

oh yeah and i definitely should have read before posting

[Aenye Deithven]

I definitely wasn't saying it would be something that would be easy to do or had a 100% chance to cure you or even for you to survive, I'd just make it for extremely desperate measures.

oh yeah and i definitely should have read before posting

Honestly, you would have a better chance at living after downing a gallon of bleach than after such a field-operation, performed by an amateur, even without the zombie issue. There's also the question of whether the one 'patching you up' would be up to the task - amputation is one of the most stressful procedures to be undertaken, even for an experienced surgeon - so it's pretty likely that 'the doc' would have a breakdown halfway...

 

BTW. Rathlord, is it just my feeling or are you in the 'medical industry' ?

[Registron]

just rewrote some parts, making it a more risky procedure 

also emphasized the fact that this is a DESPERATE MEASURE that is just as logical as putting a bullet in your skull

any other criticisms at this point?

[Rathlord]

Frankly I don't think there's a 25% chance of surviving it. There is essentially zero- the biggest factor is that it takes something like four seconds for blood to take a trip around the body. This means that unless you do it within an instant, you're infected anyways and killed yourself faster. I don't find it remotely plausible.

Sidenote: I'm not in the industry, but I have a lot of family that is and started my college path to be a pathologist. Also somewhat of a survivalist guy, so knowing how to perform field surgery and the like is important.

[Bjerk]

Ok, I understand all the "technical" stuff, but anyway, Hershel was bitten and had half of his leg amputated by complete amateur surgeons and there he was, runnig happily across the fields until he got his neck amputated by the Governor and that was, yes, the ultimate amputation. I'm not sure if implementing amputation would be fun or not, but I think that if we stick too tight to realism then maybe we shouldn't play a game which is about... well... surviving a zombie apocalypse.

[syfy]

Hershel............the Governor.....TWD?

 

not exactly a real life case study to go by, the writers MAY have taken a liberty or two for the purpose of keeping a character in the show.

[Bjerk]

I don't know if there are many realistic action films. I think realism is not about "is this possible in real life?", but "is this reasonable given the context of the story? Is it shown in a beliavable way?".

[Rathlord]

Aye, that was extremely unrealistic. The devs have directly stated that PZ strives to be as realistic as possible except for the zombies. They are the reasonable suspension of disbelief, everything else is meant to conform to reality as closely as possible while providing a good gameplay experience.

Now, you could argue that having this as a concession for the sake of gameplay is worth it; that's a valid argument. I disagree with it; I think it detracts from the spirit of hopelessness and horror that the game seeks to exude. However, as I said, you could make that argument. I just want to make clear that realistically this is all but impossible.

[syfy]

this games characters are average people, the jobs are average jobs in any town in the world. the traits are the average traits that an average person would have.

 

now of course, in every town their are bound to be a few people who are experienced in building their little pipe bombs and such, but those people are likely to have better access to the proper materials, such as gun powder and blasting caps....among other things.

[drunkenkrogan]

Aye, that was extremely unrealistic. The devs have directly stated that PZ strives to be as realistic as possible except for the zombies. They are the reasonable suspension of disbelief, everything else is meant to conform to reality as closely as possible while providing a good gameplay experience.

Now, you could argue that having this as a concession for the sake of gameplay is worth it; that's a valid argument. I disagree with it; I think it detracts from the spirit of hopelessness and horror that the game seeks to exude. However, as I said, you could make that argument. I just want to make clear that realistically this is all but impossible.

Well I think its a possible feature that can be added in, there have been average people in real life who have amputated their own limbs and have survived the tale. Its not unrealistic that characters can attempt the same feats. One example is Aron Lee Ralston's " Between A Rock And A Hard Place" where he ended up cutting his arm off with a multi tool after being trapped in a canyon for days, rappelling down a cliff and most obviously, surviving the whole ordeal.

 

Not only arms and legs could be amputated, but fingers, toes, hands and feet as well, and not just because of a zombie bite. Getting a nasty infection or frost bite may force you to remove those bits and chopping a finger or hand off is much more survivable then a whole limb.

 

That being said, your chances of survival are extremely low since blood loss or infection will most likely kill you. Also if you, or a buddy is chopping any of your limbs off, your already in dire straits to begin with. Even if you do survive the amputation, that doesn't mean the zombies or gone, or that society has been restored. You still have to survive but now you are at an even greater disadvantage.

 

If you are missing an arm, you cannot wield a large array of weaponry, or use certain weapons effectively. Ever tried swinging a sledgehammer in one arm? I sure as hell can't; nor could I wield a 12 gauge properly. Not only that, but if your missing a leg you can no longer run away from a fight. Sure maybe with a little carpentry DYI you can make yourself a peg leg, but you'll never be as fleet footed as you used to be.

 

So I say let players go ahead with their hack happy dreams and pray their characters are the 1-10%ers that survive their backyard amputations. Congrats to them that they bought another day to live, but now surviving just got a whole lot harder, and a lot more bleak.

[Ridickulo]

[Rathlord]

I've seen the mountain climbing guy's story brought up before, but it's not an apt comparison. He had a lot of time to plan it and do it, and received medical attention relatively quickly after.

The biggest difference is, he had the time to make a proper tourniquet. If you took that amount of time after being bitten by a zombie you'd still just be a zombie.

[Ridickulo]

I've seen the mountain climbing guy's story brought up before, but it's not an apt comparison. He had a lot of time to plan it and do it, and received medical attention relatively quickly after.

The biggest difference is, he had the time to make a proper tourniquet. If you took that amount of time after being bitten by a zombie you'd still just be a zombie.

 

Not to mention sitting still for a while performing the operation and screaming a lot.

 

Not dying from loss of blood.

Not dying through shock mid-way through.

Not dying by sepsis.

Not creating gangrene cause you had no clue what you were doing.

Not creating a lethal infection.

Dying i mean, turning.

 

Save yourself the masochism and just wait your change with lots of booze.

 

I wouldn't be able to do it by myself. It takes MASSIVE balls...Chuck Norris would do it but then again he would never be in that situation and if he was he would just infect the zombies, not the other way around.

 

No, if you are alone and without help, this is total crap.

 

The mountain guy was in a mountain with ice and snow? Well, that might just have been the deciding factor, no?

When the time came he prolly he was so cold he didn't even feel his balls. Arm was just off with it! 

[Jatta Pake]

I've seen the mountain climbing guy's story brought up before, but it's not an apt comparison. He had a lot of time to plan it and do it, and received medical attention relatively quickly after.

The biggest difference is, he had the time to make a proper tourniquet. If you took that amount of time after being bitten by a zombie you'd still just be a zombie.

 

I'm going to take the contrary viewpoint and say Amputation would be a viable method of survival despite what current medical experts might say. Please don't ban me Rath!

 

The "mountain guy" isn't the only person to successfully perform self-amputation. From wiki:

 

• In 2007, 66-year-old Al Hill amputated his leg below the knee using his pocketknife after the leg got stuck beneath a fallen tree he was cutting in California.
• In 2007, Sampson Parker, a South Carolina farmer, cut off his own arm after it became stuck in a corn harvester.
• In 2003, an Australian coal miner amputated his own arm with a Stanley knife after it became trapped when the front-end loader he was driving overturned three kilometers underground. The amputation proved to be unnecessary as emergency services arrived and recovered the trapped arm, but were unable to reattach it.

Even rarer are cases where self-amputation is performed for criminal or political purposes:

• On March 7, 1998, Daniel Rudolph, the elder brother of the 1996 Olympics bomber Eric Robert Rudolph, videotaped himself cutting off one of his own hands with an electric saw to "send a message to the FBI and the media."[8]

Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat. In the United States, in 1999 there were 14,420 non-fatal traumatic amputations according to the American Statistical Association.

 

Modern Medicine Argument: Amputations have been performed since as far back as Roman Empire times when the practice was commonly used to punish criminals.  Civil War amputations didn't use modern medicine either but were frequently successfully employed:

 

By today's standards, battlefield amputations of the American Civil War were primitive. For one thing, the concept of maintaining a sterile environment, free from germs, had not been developed. Blood-spattered surgeons often operated without so much as washing their hands, barely taking the time to rinse off their tools between surgeries. The focus was instead on speed. To cycle through as many patients as possible, the surgeries were performed quickly -- usually in about 10 to 15 minutes.

The surgeon would knock out the patient with a chloroform-soaked rag, and then quickly apply a tourniquet above the injury site before using a sharp knife to slice through the skin and muscle. The bones were next sawed through -- earning Civil War surgeons the nickname "Sawbones" -- and the blood vessels were tied off with sutures. Finally the skin was closed around the amputation site, leaving a hole from which fluid could drain. Infamously, the amputated limbs were thrown out, building up in great piles.

Death rates after the surgeries were dismal by today's standards. In fact, one out of four patients died after a typical amputation, but the mortality rate doubled if the surgery wasn't performed in the first 24 hours. The deaths were caused in part by bacterial infections termed "surgical fevers" resulting from the non-sterile surgeries. It was only just after the Civil War that British surgeon Joseph Lister advanced the concept of sterile surgery. Nevertheless, thousands of lives were saved by the round-the-clock efforts of the American Civil War surgeons.

 

I think you overstate the possible rate of zombie virus infection.  If the limb is properly cut off quickly and the arteries are tied off correctly, I think a person has at least a 50% chance of surviving the procedure. A 75% success rate by an 1860 battlefield surgeon doing the procedure in 10-15 minutes with a saw and chloroform without regard to bacterial infection is pretty darn good.

I think our modern medial professionals don't have the perspective to evaluate an amputation scenario in the apocalypse.  Even a 5% fatality rate would be considered a failure by modern medicine standards.  Humans are more resilient than we 1st worlders typically give ourselves credit for. 

[Ridickulo]

And there you enter the fallacy realm of hidden evidence.

The presented cases are indeed extraordinary but they are paved by the dead bodies of those who failed or simply couldnt do it.

You never hear about them.

 

'Nyways, not saying it isn't an option, nor is Rath i believe.

I'm just saying that doing it by yourself is extremely rare and extraordinarily difficult.

[Rathlord]

Someone remind me to posit my rebuttal this afternoon when I get off work.

[Jatta Pake]

And there you enter the fallacy realm of hidden evidence.

The presented cases are indeed extraordinary but they are paved by the dead bodies of those who failed or simply couldnt do it.

You never hear about them.

 

'Nyways, not saying it isn't an option, nor is Rath i believe.

I'm just saying that doing it by yourself is extremely rare and extraordinarily difficult.

 

True, I'm not sure self amputation should even be an option unless you had a Surgeon profession.  But I do argue that NPCs and other players should be able to perform an amputation to save a bitten person.  Perhaps you require the right items on your person to do it - medical tourniquet, anesthesia or pain medicine, arterial clamps, sewing kit, and a surgeon's saw.  The chance of success could be low but it should be an option.  Traits and Professions could increase the chance of success.

 

Failure could simply be the using up of supplies and a worsening of the bleeding.

 

Success would require more game modification as you now had a disabled character.  They would need to lose the use of an arm or mobility with the loss of a leg.

Someone remind me to posit my rebuttal this afternoon when I get off work.

 

I look forward to it. Please don't ban me. 

[Ridickulo]

A classic: (OT @ 59:33)

 

(An arab nazi? Thats a first!)

[Jatta Pake]

I'm going to preempt Rath's expected argument that a zombie virus would spread throughout the body in as little as 4 seconds.  First, there isn't any existing infection that can spread that fast.  Sure, we are talking about a fantasy zombie virus, but it makes more sense to ground it's behavior in the natural world.

 

Sepsis provides a great example of a lightening fast infection that spreads throughout the body. From this article.

Four days later, da Costa was dead.

Sepsis -- the body's inflammatory response to an infection -- really can kill that quickly, according to Dr. Kevin Tracey, author of a book about sepsis called "Fatal Sequence: The Killer Within."

"This isn't a one in a million case," says Tracey, chief executive officer of the Feinstein Institute for Medical Research in Manhasset, New York. "When an infection reaches a certain point, this can happen in a matter of hours."

The infection needs to build up to a critical point and a virus needs time to reproduce to spread.  The idea that a zombie virus could instantly transform into billions of copies of itself moves the virus too far into the realm of fantasy. The zombie virus requires an incubation period before it become systemic.  At the time of a bite, the infection is local.

 

Additionally we have to assume from Project Zomboid game play that it takes a certain amount of the zombie virus to overcome a body's natural defenses and spread.  This is evidenced by the fact that bites and scratches are not 100% fatal in game. This suggests that the body can fight off a small amount of viruses.

 

Additionally, the game suggests that the body does in fact fight the zombie virus.  The sickness the character experiences is typical of an inflammatory response produced by the body's immune system. Certain kinds of white blood cells—including macrophages and neutrophils—surround and destroy or otherwise attack any kind of germs, causing fever, redness, and swelling.  Germs themselves do not cause these symptoms - it is the body fighting the infection that causes the moodles.  So this suggests that the characters immune system recognizes the infection and fights it albeit often ultimately unsuccessfully.

 

The incubation period is important for another reason.  Most diseases do not show symptoms for some time, like Ebola, which has a 2-21 day incubation period.  Because of this, infected people do not get immediate treatment until the virus has really had time to fully spread.  On the other hand, a zombie bite in PZ has a very high infection rate as well as being an identifiable area on the body.  So long as treatment happened quickly after the bite, in this case the limb is amputated quickly, the spread of the infection should be contained.

 

Let's assume for a minute that the zombie virus acts like snake venom.  Once in the body the zombie infection acts like venom and  kills cells quickly.  First, a deep bite that injects zombie venom into the bloodstream has to overcome the fact that the blood pressure inside the body which pushes blood out of the wound will also push out some of the venom.  Like a virus, venom and poison take time to spread throughout the body.  Additionally, tourniquets and amputation do prevent the spread of venom.  They just aren't recommended because modern medicine has much more effective treatments.

 

It's hard to find a comparative example in nature that would make amputations ineffective against a zombie bite.  If a virus, it needs time to replicate.  If a venom or poison, it needs time to spread through the body.  Amputation should be a viable option in both circumstances when the alternative is death.

[Rathlord]

I'm going to take the contrary viewpoint and say Amputation would be a viable method of survival despite what current medical experts might say. Please don't ban me Rath!

 

The "mountain guy" isn't the only person to successfully perform self-amputation. From wiki:

 

• In 2007, 66-year-old Al Hill amputated his leg below the knee using his pocketknife after the leg got stuck beneath a fallen tree he was cutting in California.
• In 2007, Sampson Parker, a South Carolina farmer, cut off his own arm after it became stuck in a corn harvester.
• In 2003, an Australian coal miner amputated his own arm with a Stanley knife after it became trapped when the front-end loader he was driving overturned three kilometers underground. The amputation proved to be unnecessary as emergency services arrived and recovered the trapped arm, but were unable to reattach it.

Even rarer are cases where self-amputation is performed for criminal or political purposes:

• On March 7, 1998, Daniel Rudolph, the elder brother of the 1996 Olympics bomber Eric Robert Rudolph, videotaped himself cutting off one of his own hands with an electric saw to "send a message to the FBI and the media."[8]

 

The big difference with these (and it is a big difference) is that the people had almost immediate professional healthcare shortly after. If they hadn't, this would have been a very different story. Also, again, for all of these time was not a factor. They had ample time to preemptively tourniquet and then were taken care of immediately after. This is tremendously important because, essentially, with this kind of wound as long as you're still breathing when you get the ER they can save your life. This is inherently untrue without medical professionals and the wonders of modern medicine at your disposal.

 

Modern Medicine Argument: Amputations have been performed since as far back as Roman Empire times when the practice was commonly used to punish criminals.  Civil War amputations didn't use modern medicine either but were frequently successfully employed:

 

By today's standards, battlefield amputations of the American Civil War were primitive. For one thing, the concept of maintaining a sterile environment, free from germs, had not been developed. Blood-spattered surgeons often operated without so much as washing their hands, barely taking the time to rinse off their tools between surgeries. The focus was instead on speed. To cycle through as many patients as possible, the surgeries were performed quickly -- usually in about 10 to 15 minutes.

The surgeon would knock out the patient with a chloroform-soaked rag, and then quickly apply a tourniquet above the injury site before using a sharp knife to slice through the skin and muscle. The bones were next sawed through -- earning Civil War surgeons the nickname "Sawbones" -- and the blood vessels were tied off with sutures. Finally the skin was closed around the amputation site, leaving a hole from which fluid could drain. Infamously, the amputated limbs were thrown out, building up in great piles.

Death rates after the surgeries were dismal by today's standards. In fact, one out of four patients died after a typical amputation, but the mortality rate doubled if the surgery wasn't performed in the first 24 hours. The deaths were caused in part by bacterial infections termed "surgical fevers" resulting from the non-sterile surgeries. It was only just after the Civil War that British surgeon Joseph Lister advanced the concept of sterile surgery. Nevertheless, thousands of lives were saved by the round-the-clock efforts of the American Civil War surgeons.

 

Now this swings onto the other side of my argument. While, yes, they didn't have modern medicine they had two incredibly important things that you wouldn't have in the field.

 

1) Time. Time was not a huge factor in the micro scale. With the bleeding stopped, they could correctly perform the procedure, take the time to tourniquet correctly, and use the proper tools (Believe it or not, bonesaws are still used when performing an amputation in most places). Not having a ragged cut is essential to survival in an amputation. They also had clamps to stop the major arteries instantly, and silk on hand to tie them off afterwords.

 

2) Know-how. Again, these were people who (even though practicing old medicine) were still trained (and usually for much longer than doctors today are, if not as in depth) surgeons who did this professionally. Amputation is not something you can do successfully without the know how. There's so many things that can kill you during an amputation, even if you're doing it all right. With no technical knowledge of how, your chances of survival are shut down massively.

[Rathlord]

I'm going to preempt Rath's expected argument that a zombie virus would spread throughout the body in as little as 4 seconds.

 

I'm not sure whether you misunderstand me or the way that infection works, but let me clarify.

 

The virus doesn't magically propagate in four seconds. It just gets spread into your body in that amount of time. In less than a minute, the heart pushes a full circuit of blood through every part of your body. It's not that the virus effects you that fast, it's that this is the point of no return, or the time it takes for the virus to enter your bloodstream and for amputation to have no effect. After the blood enters the body with the saliva, amputating is meaningless. From there, it's at its leisure to incubate and spread at it pleases.

 

 

Additionally we have to assume from Project Zomboid game play that it takes a certain amount of the zombie virus to overcome a body's natural defenses and spread.  This is evidenced by the fact that bites and scratches are not 100% fatal in game. This suggests that the body can fight off a small amount of viruses.

 

Respectfully, I'd disagree with this assumption. My own assumption (and of course, both are guesswork for the most part) is that if you aren't infected, none of the virus has been transmitted (by luck or by whatever mechanism the virus uses to spread). This makes more sense, when compared to your next assumption (that the body fights off the disease) because you do not get a fever when bitten or scratched but not infected. The fever, then, could easily be chalked down to as an immune response that is simply ineffectual- you get a fever, but are never able to fight it off. At no point do you ever get a fever and also fight off the zombification.

 

The only actual evidence I have over your point (and it's shaky at best I'll admit) is that the devs have said that the virus is 100% fatal, which seems to suggest that fighting it off is impossible.

[Ewok]

As much as Rath (and myself) are against it, I believe amputation is down as a 'maybe' on the devs list.

 

However, I do doubt that there is anything that can come up here that hasn't already been raised on one of the previously raised amputation suggestion threads - it's certainly just a repeat of the same arguments from last time so far. I really don't think there is anything further to do other than to wait and see what the devs do with it.

[Rathlord]

Aye, I did as amputation to the maybe list as it's been mentioned in passing by the devs on multiple occasions; however it's never been definitely confirmed (for example, last time it was just mentioned to illustrate the point).

So while I hope it's something we never see, it may well be. Ewok is right, though, I've argued this point in an identical fashion before, including the mountain guy example an all of the statistics.