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It’s been two hours since you entered the trauma room. What seemed like simple injury is turning out to be a challenging case. It will take all your medical skills to save the patient. Attending doctor Daniel VanDeer stops to inform you of a major fire near the hospital. A large number of patients with mild to severe burns are expected to start arriving any minute. You cannot seem to remember the last time you ate or slept. A small trip to the cafeteria and a nap at the doctors’ lounge sounds like a distant dream. This is going to be a very long day. Across from you, nurse Jenny Scott gives you an encouraging smile. “Hang in there Doc,” she says, “we’ll make it through.” You turn your attention back on your patient. You cannot afford any delays, you cannot afford to make any mistakes. Lives are depending on you. Do you have what it takes?

ER is without a doubt among the most successful shows in television history. Currently in its 11th season, the show boasts 21 Emmy awards and a stunning 112 nominations. It would have been a daunting task for any developer to take this critically acclaimed show and convert it into a game. However, Legacy Interactive has managed to put together a solid game that should have appeal to the fans of the show and sim enthusiasts alike.

The game allows players to join the County General Hospital staff as an intern doctor. Fresh out of medical school, this will be your character’s first chance to out his or her skills into professional use. The game starts with a simple and straightforward character generation process. Players can customize physical attributes such as eye color and hair color. In addition, 12 personality stars can be distributed across four character traits. The number of points spent towards the different attributes determines your character’s aptitude in various medical areas. For instance, increasing your character’s intelligence greatly benefits his or her aptitude towards neurosurgery and toxicology. On the other hand, spending points on dexterity has the most direct influence on cardiology and general surgery.

Upon completing the character creation process, players can immediately start playing the game or go through a tutorial to learn the core game mechanics. The story mode of ER consists of six 48 hour shifts at the Country General Hospital. Patients will continue arriving at the hospital throughout the shift and it will be up to your character, along with other doctors to ensure everyone receives the treatment they need. The treatment process in the game is greatly simplified. Patients coming into the hospital will wait for doctors in the triage area. First, doctors have to diagnose patients to determine what the kind and severity of their medical emergencies. Diagnosing a patient is as simple as clicking on them. Your character will do the rest of the work and determine which of the 6 medical disciplines your patient’s case falls under. Especially in the later episodes of the game, some patients will have cases that fall under more than one discipline. Occasionally, the doctor’s initial analysis will not be sufficient to determine what is wrong with the patient. Thus, doctors will have to send patients to the lab for additional tests.

After diagnosing their patients, doctors have to choose a bed before treatment can begin. County General has three types of beds for its patients. The Main Exam area is for patients with mild cases. The exam rooms are designed for more serious ailments. Finally, patients with the most severe cases belong in the trauma rooms. The rooms differ in terms of the medical equipment available in them. If the bed you choose does not have sophisticated enough equipment for the patient you are dealing with, the nurse helping you with the case will frequently have to run to other rooms to get the required medical supplies. Since time is crucial in treating your patients, you will have to try and make sure your patients are sent to the proper beds.

Once you select a bed for your patient, he or she will automatically go to it. If the patient is incapable of walking due to the nature of her medical emergency, technicians will automatically transfer him or her to the appropriate bed. For the most trivial cases, your character will be able to carry out the treatment alone. Other cases will require a nurse to be present during the treatment process. If a nurse is not available when you get to your patient, you may need to wait until one arrives.

Actually carrying out the treatment requires no medical knowledge on the players part. A simple click on the patient starts the process. The game uses a rank from 1 to 10 to measure the seriousness of a patient’s ailment. If the treatment is going successfully, the level of the patient’s injury will decrease until it reaches 0 and the patient is cured. If the patient is not positively responding to the treatment, his or her level will gradually decrease. Sometimes as you perform the treatment a new diagnosis will be necessary. The new diagnosis may require additional lab testing or reveal that the patient’s case really falls under a completely different medical area than what the original diagnosis indicated.

Your character’s ability to treat the patient is also determined by the game’s ranking system. If your doctor’s skill level in the medical discipline associated with the patient’s injury is greater than or equal to the severity of the case, you will almost certainly carry out the treatment successfully. Your character will also be able to successfully respond to cases that slightly surpass his or her medical expertise. For instance, if a patient has a level 4 orthopedics injury and your character has a 2 in that medical discipline, you have a good chance of successfully treating the patient. However, if the severity of the case greatly exceeds your skill level, you may want to turn the patient over to a more experienced doctor. Unfortunately, more experienced doctors will not always be available. Furthermore, even with a perfect score in a medical area, you will not always be able to treat the most serious cases. The game is realistic in acknowledging that all patients cannot be helped. Sometimes, despite your best efforts, patients will die and you will simply have to move on to another case.

Your doctor will gain experience as you successfully treat patients. The experience earned can be used to improve your medical skills. There are two kinds of experience in ER. General experience is earned through treating all your patients and successfully completing special tasks that will be assigned to you from time to time. Your doctor will also earn specialized experience by working on a medical discipline based on his or her medical aptitude in the corresponding area. For instance, a doctor with an excellent neurosurgical aptitude will be able to quickly increase his or her neurosurgery skill by treating patients suffering from ailments related to this medical discipline. The general experience earned is measured with stars. You can view the Experience Spender screen at any time to distribute the stars you earned across the six medical areas. The areas in which you have greater medical aptitude will require fewer stars before you can attain the next skill level. As your character’s experience grows and skill levels increase, you will be able to take on more and more serious cases.

The game also requires players to pay attention to your character’s personal needs. As you go through the shift and treat your patients, you will have to keep an eye on three stats. These are your hygiene, energy, and composure levels. The cleanliness of your character’s hands and body make up the two components of your hygiene. Since bad hygiene decreases your medical skills, you will want to keep your hands and body clean at all times. The medical rooms feature sinks where you can wash your hands. The hospital also features a number of showers. Like hygiene, energy consists of two components. You will have to make sure your character gets enough food and rest. There are many vending machines distributed around the hospital if you need a quick boost to your energy. You can also go to the hospital cafeteria to get a proper meal. The hospital also has a doctors’ lounge where you can use one of the beds to take a nap. Rest makes up 75% of your overall energy level, so you will have to make sure your character takes some breaks in the long 48 hour shift. Your medical skills will start to degrade and your character might even pass out if you ignore energy levels. The last stat you will need to watch is your composure. If your composure gets low, your character’s relationship with other staff members and your patients may suffer greatly. You can regain lost composure by working out, taking a shower, successfully treating a patient, or carrying out successful conversations with your staff members.

Building relationships with other staff members is yet another feature of ER. You can initiate conversations with other staff members as long as they are not treating a patient. The game uses a ranking system to measure staff members’ disposition towards you. Conversations are carried out by selecting a general topic from a list. If a staff member does not regard you as a friend, you can start by making neutral comments about the weather or expressing your likes and dislikes. Once you select a topic, the other character will respond positively or negatively with a topic of their choosing. As the conversation continues, you may be able to find out more about the other character’s likes and dislikes. You can use this information and bring up those topics to get positive responses. Soon enough, you will be able to move on to more personal topics such as confiding in the other character. After a number of conversations, if the staff member’s disposition towards you is positive enough, you can even kiss him or her. While there is no real obligation to build relationships in the game, it is nice to have something to do besides the regular hospital routine. Furthermore, your relationship with the hospital personnel has a small impact on your medical skills. Your will receive a boost to your medical skills when you are close to a staff member who likes you. However, your skill levels will drop when you are close to a person who dislikes you.

The game does feature a number of characters from the show. Noah Wyle, Mekhi Phifer, and Sherry Stringfield are voice actors in the game. Fans of the show will also notice supporting characters Abraham Benrubi and Yvette Freeman. Being able to work with actual characters from the show greatly helps the game’s atmosphere. However, players who are not familiar with the show will still be able to enjoy the game since no knowledge about the show is required to follow the events taking place in the game.

Besides the regular activities involving treating patients taking care of your personal needs, each 48 hour shift in ER contains a number of scripted events that require you to perform special tasks. These tasks can range from meeting a staff member to special patients that you will be asked to handle personally. The special cases often feature colorful patients such as a circus clown or a boxer. Some of these tasks are mandatory and failure to complete them successfully may get your character fired. While the special tasks do not dramatically alter gameplay for long periods of time, they do offer a chance to break from the routine hospital work you will be performing throughout the game.

Legacy Interactive has also included a perk and special ability system that adds a level of depth to the game. Perks are special bonuses you can earn by treating patients or completing special tasks. Occasionally, after you successfully complete a treatment, an icon will appear on over the patient’s head, indicating that they wish to give you a perk. You can carry up to 4 perks at any given time. Perks can be used to temporarily increase the amount of experience earned, give you a bonus on the next patient you will treat, or increase your levels of hygiene, energy, or composure. Some perks will even make staff members like you better for a period of time. If you are not satisfied with the perks you receive from patients, you can try trading perks with other staff members. The strength of your relationship with the staff member will determine their likelihood of trading with you.

Special abilities give you more permanent bonuses. You can unlock special abilities by attaining certain skill levels in medical areas. Once unlocked, special abilities can be activated to give your character their bonuses. However, some special abilities give their bonuses at a cost. For instance, the special ability Total Book Worm increases toxicology and neurosurgery skill of you and everybody around you at the cost of decreasing your orthopedics, pediatrics, and general surgery skills. Only three special abilities can be active at the same time, but players are allowed to change which special abilities are active at any time. Thus, players have the liberty of activating the particular set of abilities that might be most helpful in treating particular patients.

ER has a wide variety of elements that can make it an entertaining sim game. However, the game does suffer from a problematic interface that might frustrate many players. There are a number of ways to navigate the hospital in ER. Players can click on an area on the screen to move their characters there. Players can also click on rooms on the minimap to quickly order their characters to go to a specific room. By default, the minimap shows the floor your character is currently on. You can either click on a room on that floor or select a different floor and click on a room there to direct your character. Once you diagnose a patient and choose a bed, the patient’s image appears at the top of your screen. You can click on this image to take your character directly to the corresponding bed. This prevents you from having to remember which bed you selected. The biggest problem with the entire interface is that sometimes your commands will simply not register. For instance, diagnosing a patient and opening the bed selection panel, clicking on an available bed will sometimes do nothing. You will have to click away from the patient and access the bed selection screen all over again before the command will go through. Other commands like clicking on a room on the minimap or an area on the gameplay screen will also sometimes fail to register even if your character is not engaged in any other activity. To make things worse, other patients and staff members will frequently get in your character’s way, making it unnecessarily difficult to navigate the hospital.

The game also uses an Area of Influence system that can be frustrating. Your doctor can only interact with patients or staff members that are currently in his or her Area of Influence, designated by a white circle centered around your character. Thus, you have to be within a few feet of a patient before you can click on them to diagnose them. This is not a great problem with patients since they do not move around the triage area. Staff members going about their duties however, can become difficult to interact with since they may leave your Area of Influence before you can click on them. To make matters worse, since your overall view area is not very large either, staff members can even leave the screen and make it harder to relocate them.

Locating fellow staff members can be another problem. The game does feature a screen where you can see the current location of each staff member on duty. However, since you can only see one staff member at a time, you will have to scroll down the long list before you can see the information about the person you want to locate. Of course, since staff members constantly go from one location to another, by the time you get to the room they were supposed to be in, they may be at a completely different spot, causing you to go through the list to locate them again. A function to page staff members to arrange meetings could have made this process a lot easier.

ER is not without its share of problems. The buggy interface design can significantly detract from the gaming experience. The treatment process may be too simplistic for some players. While the game requires no medical knowledge, making it accessible to a wide variety of gamers, curing patients does boil down to watching a dial go back and forth as his or her condition gets better or worse. Players that expect a more in depth treatment process will not be satisfied with this system. The game could have also used a free-form mode with no scripted events so players can enjoy the simulation at their own pace without having to worry about special tasks. Yet, despite its problems, ER can be a very entertaining and addictive game to play. There are plenty of activities at County General Hospital that will keep players busy. ER does manage to capture the spirit of the TV show. If you are looking for a casual sim game or if you are a fan of the show, consider giving ER a chance. There is plenty of material here to interest you.

The final grade is 82/100.

Developer: Legacy Interactive
Publisher: Legacy Interactive
Genre: Strategy/Role Playing
Release Date: Spring 2005
Platform: PC

*This article originally appeared on Just Adventure.