Trauma Center (video game series)

Trauma Center is a series of video games developed by Atlus and published by Atlus (Japan, North America) and Nintendo (Europe). Beginning with Trauma Center: Under the Knife in 2005 for the Nintendo DS, the series released four more entries on the DS and Wii. The gameplay is split between a surgical gameplay simulation, and visual novel storytelling. While the main characters of the games vary, the games share a common setting of a near-future Earth where advanced medical procedures have cured most diseases, including cancer, AIDS, and influenza. A recurring organisation is Caduceus, a worldwide, semi-covert medical research foundation that is a branch of the World Health Organization. The games commonly feature outbreaks of various man-made diseases that pose a significant threat to humanity, as well as themes of bioterrorism.

The series was created by Katsura Hashino, who wanted to use the DS's controls to explore a simulation type only previously possible on PCs. Following the first game, a dedicated production team dubbed "CaduceTeam" was created to handle future games. Beginning with the Wii remake Second Opinion, the series was directed by Daisuke Kanada.

Titles

 * Trauma Center: Under the Knife is the first entry in the series, released on the Nintendo DS. It was published in Japan and North America in 2005, and in Europe the following year.  The game follows protagonist Derek Stiles as he confronts a manmade disease called GUILT.
 * Trauma Center: Second Opinion is the second entry and a remake of the first game. It released as a launch title for the Wii in Japan and North America in 2006, and the following year in Europe and Australia.  In addition to revisiting Stiles's battle against GUILT, Second Opinion adds missions for surgeon Naomi Kimishima (who also uses the alias Nozomi Weaver), and a new chapter closing off both narratives.
 * Trauma Center: New Blood is the third entry in the series, released for the Wii first in North America in 2007, then in Japan and Europe regions in 2008, and Australia in 2009. The narrative follows two new doctors, Markus Vaughn and Valerie Blaylock, as they are recruited to fight Stigma, a new manmade disease spreading across the world.
 * Trauma Center: Under the Knife 2 is the fourth entry, a direct sequel to Under the Knife and Second Opinion. It was released in North America and Japan in 2008. The story features Derek Stiles's encounters with several new GUILT-based threats.
 * Trauma Team, the fifth and to-date final entry and cited as a spin-off title within the series universe, was released in 2010 in Japan and North America. The story is split across six different doctors working at and around Resurgam First Care, a fictional hospital in Portland, Maine. The narrative focuses on the interpersonal relationships of the main characters, as well as the emerging threat of a new epidemic.

Gameplay
The gameplay and presentation of Trauma Center use two recurring features: surgery simulation carried out from a first-person view, and the narrative delivered using a visual novel style. Trauma Team includes surgery, but also shows five other specialties: emergency medicine where patients at the scene are given rapid treatments, endoscopy for small-scale internal treatment of the respiratory and the GI tracts, orthopedics which focuses on skeletal operations and reconstruction, diagnosis for determining medical conditions through a routine of speaking with the patient and examining medical scans, and forensic medicine where evidence from crime scenes and the victims are used to reach a conclusion to the case.

During surgery, the player operates on patients using a variety of tools: a scalpel, forceps, a healing gel known as the antibiotic gel, a syringe for injecting various medicines and vital stabilizers, a suture needle for stitching wounds, a surgical drain, a surgical laser, and an ultrasound scanner. The games also include special tools used outside the normal ones, such as the defibrillator for resuscitation, as well as bandages for covering surgical incisions. Operation types include treating car accident victims, tumor extractions, skin grafts for burn victims, bone fixation, aneurysms, organ transplants, as well as treating the various man-made diseases in the series. The DS titles make use of the touch screen, with players selecting and using tools using icons. For Second Opinion, New Blood, and Trauma Team, the controls were adjusted to work with the Wii Remote and Nunchuk, and added motion control functions, such as a modified version of the defibrillator. All titles feature a system called the Vitals, which can range from 0 to 99 and represent the patient's status during an operation. If this value drops below 0 during a gameplay section, the player will experience a game over.

A recurring gameplay mechanic across the series is the Healing Touch, an ability which grants superhuman advantages to surgeons who hold it. Its effects vary between individuals, with demonstrated abilities including slowing time, healing patients, and preventing a patient's vitals from dropping. It is activated by drawing a star shape on the screen. The Healing Touch and similar fantastical elements were toned down or removed in Trauma Team. Both New Blood and Trauma Team included local cooperative multiplayer options.

Setting and themes
The Trauma Center series is set in a near-future version of Earth where medical advances have led to the development of cures for previously major diseases such as AIDS and cancer. A key organisation in the series is Caduceus: a medical research body for studying intractable diseases which also has a semi-covert role in fighting bioterrorism. Caduceus has three branches established around the world, one in the United States (split into an east and west coast branch), one in Japan, and one in Europe. A recurring element across the series is the presence of science fiction or otherwise supernatural elements in the narratives. Trauma Team includes fewer elements of science fiction, notably including no explicit mention of the Healing Touch.

All the Trauma Center titles share the same universe and timeline. Under the Knife, and its remake Second Opinion, are set in the year 2018. New Blood is set ten years after the events of Second Opinion, in the year 2028. Under the Knife 2 is set three years after Under the Knife, in 2021. Trauma Team takes place in 2020, two years after the events of Second Opinion, though it is less directly connected to the rest of the series. Some recurring characters include: Derek Stiles, who makes appearances in each title in the series, Angie Thompson, who appears in most games in the series as Derek's assistant, and Naomi Kimishima, a protagonist in both Second Opinion and Trauma Team.

A recurring narrative theme in the Trauma Center series is the passion of doctors to save lives, as well as the impact of bioterrorism on society. In Second Opinion, a secondary theme is the limits of medical technology. The narrative themes of New Blood include issues of the cost of healthcare, persevering in the face of adversity, and inequality of medical access. The story of Under the Knife 2 incorporated issues of doctor shortages, medical training, and physically enhancing the human body through medicine. In Trauma Team, the story focused on themes of the preciousness of life and fear of death, drawing direct inspiration from the 2009 swine flu pandemic.

Development
The original Trauma Center was created by Atlus staff member Katsura Hashino, who acted as producer. Beginning production in 2004, the team wanted to recreate the surgical simulation gameplay of PC titles for the DS, since its controls and hardware were more capable compared to others of the time. Many of the staff were veterans of Atlus's role-playing game Megami Tensei, making production challenging due to the team's inexperience. Following the success of Under the Knife, Hashino formed some of the team into a dedicated team to work on the series. They were internally known as "CaduceTeam", made up of what director Daisuke Kanada described as Atlus's most enthusiastic gamers. Kanada has worked on multiple Megami Tensei titles and collaborated with Hashino on several games since Maken X in 1999; Second Opinion was his debut as a director. Production of Second Opinion began in January 2006.

Recurring staff included Daisuke Kanada as director, artist Masayuki Doi, who replaced original artist Maguro Ikehata from Second Opinion onward,   programmer Takaaki Ikeda, and scenario writer Shogo Isogai, who worked on Under the Knife, Second Opinion and New Blood. Under the Knife was directed by Kazuya Niinou, who was later lead designer on the original Etrian Odyssey for Atlus, and would later work on titles for Imageepoch and Square Enix. MediaVision helped with production on New Blood, while Vanguard developed Under the Knife 2 under Atlus's supervision. Trauma Team began development in 2007, beginning as being similar to previous entries in the series before expanding into its current form, covering multiple medical professions.

Reception
In a series retrospective, Pete Davison of USGamer called Trauma Center an "underdog" series in Atlus' lineup, saying that it was interesting due to its use of unusual mechanics for a typical video game, and describing the idea of an interactive medical drama as an "underexplored concept" and one of the reasons he purchased a Nintendo DS. He compared the series' mechanics to Life & Death (1988), one of the first surgery simulation video games, albeit calling its mechanics "considerably more 'arcadey'". However, he praised the series for focusing more on speed than pinpoint accuracy. He also praised the series as a whole for "consistently foster[ing] a genuine feeling of emotional engagement", saying that it "grabs hold" of the player through tense music and sound effects during surgery sequences, and said that he enjoyed its focus on members of the medical profession, "among the closest things we have to genuine 'heroes' in reality". Joshua Jankiewicz of Hardcore Gaming 101 compared the series to Ace Attorney, noting that they were both introduced in the United States around the same time on the DS, and both had dramatic, anime-style presentations of an otherwise ordinary career. He also observed that the series performed better in the US than Japan, albeit declining with each entry besides Trauma Team.

Chris Hoffman of Nintendo Power called Under the Knife a "breakthrough title" that proved that saving lives could be "just as satisfying and challenging" as "defeating bad guys". However, he stated that the game's sequels lacked the same level of innovation, stating that they were "cut from the same cloth". He described the series' last entry, Trauma Team, as a "vastly improved upgrade" due to the ability to play as six different doctors.