Genre: Simulation/RPG
Publisher: Legacy Interactive
Developer: Legacy Interactive
Release Date: May 31, 2005

Pre-order 'ER': PC

Welcome to Cook County General Hospital, known to the staff and the locals as simply as "County." One of the finest facilities in the country, it features the latest in cardiology, neurologic, and pediatric medicine, not to mention an award-winning emergency care center. Run by a cadre of nurses, doctors, and technicians, the County ER has saved hundreds of lives in even the worst of situations, developing into a sort of misfit family. And that is where you come in.

ER is based on the long-running television drama of the same name, still seen by millions weekly. While the show centers around the trials, tribulations, and trauma victims of surgeon John Carter, the game is focused on an anonymous intern — you. Fresh out of the antiseptic halls of med school, you'll be dropped into triage at County without much more than a fresh lab coat and your own personal stethoscope before the carnage commences.

Legacy Interactive is known primarily for their menu-based, slide-show style adventure games such as Law & Order and Emergency Room (no relation). In this case, they seem to be hard bent on bucking that trend – ER is a simulation-cum-RPG-cum-adventure. Beginning from a basic character generation, you'll create a doctor all your own, assign him (or her) some basic skills, then get through the doors at County to your first day.

The preview build was a single level, set up like one of the shows, complete with title cards (the segment is "Fame … Ain't It A Stitch?") and credits. Taking place within a single 24-hour shift, each "episode," you'll have a few overall goals that need to be taken care of. While all this is happening, sudden events will come through — a car accident, a special patient, a fight for life in Trauma 1 — all requiring your attentions to make sure lives aren't lost. Minor goals will come in as well, and you can buffer your skills by treating patients outside of any set tasks.

This is the simulation element: finding patients, assigning them to beds, and making sure that they're diagnosed and treated properly, even if this requires "curbsiding" them to another physician when you can't follow through. At the same time, you'll be slowly wearing down on three meters: Hygiene, Energy, and Composure. Your continued success requires you to manage each of these elements because as they slump, so does your performance, heading towards your eventual removal from the floor until you can get things taken care of. Rooms in the hospital will help you keep lively, but it all must be balanced with your workload in triage and the exam rooms.

Each successful diagnosis brings with it a bit of Experience, not merely figuratively, but rather points you can spend on each of the six medical doctrines (Pediatrics, Toxicology, Cardiology, Neurology, Orthopedics, General Surgery). Your level in each determines how effectively you can diagnose patients as well as your success at treating them, particularly complex injuries that cross multiple doctrines. Even the simplest of ailments can get complicated quickly. A wide variety of perks exist, ranging from simple things like Nurses' Hygenic Wipes and Caffeine Pills to more ... elaborate benefits. For example, The Hieress' Butler can clean you up in a jiffy, while Pillow in a Bottle will re-energize you like you took a nap...even if you didn't!

Patients may give you these Perks for a job well done, or you can score them from doctors and other staff members.

Both of those ideas are wrapped around the big picture: County Hospital as a bunch of people running about, each with personalities and goals. Using a system not unlike The Sims, your virtual doctor will be able to interact with each and every staff member in County, all the way from Barney in security to Dr. VanDerWell and John Carter himself. Relationships will develop, either positive or negative, depending on who you're speaking with and how it's handled. Everyone has an opinion of you, good or bad, and if you're not careful, they'll sink like stones in a creek. People who like you will give you free Perks, be more willing to help you out on complex procedures, or simply boost your stats by being near you. Your "enemies," alternatively, will ruin your performance if they're anywhere near you.

There are also cliques all over the place: if one of the nurses thinks you're the bee's knees, they'll all think slightly better of you, but if Dr. Reese would rather be drowned in manure than help you out, her friends won't hesitate to "help" you muddle a patient's recovery. It's a very delicate game that must be played, and it smacks strongly of the television show's emphasis on the familial structure of County.

In this nearly complete form, ER rolls some of the best elements of many games together – The Sims, Theme Hospital, Life & Death, and then some — and comes out with what stands to be a winning formula. Watching your fledgling physician rise through the ranks of County, all the while watching the intense drama that is ER by definition, should prove to be worth any sim-fan's time and attention. While Legacy's skill at maintaining that dramatic level in the face of managing skills, status, and relationships remains to be seen, ER could be one of the surprise games of the year.