Introduction

This guide is aimed to provide insight and guidance on the techniques and strategies employed while speedrunning TCSO. This is aimed towards those who have played the game, however would like further details on how to improve. Each chapter has its own page, as well as each GUILT strain to help you keep each area digestable.

Table of Contents

Game Chapters

GUILT Guides

Overall Guidance

Given TCSO relies on precise motor skills to control the Wiimote and the Nunchuck, much of getting better at the game will revolve around lots of practice and getting more comfortable with the controls. Second Opinion has the lowest cursor sensitivity given it was made with a 4:3 aspect ratio. What this can mean is if you are coming from other Trauma Center titles the cursor may feel a bit slow. With practice this won’t be an issue. Just like learning an instrument, starting off slow and ensuring you get the motions down is just as important as your knowledge. If you start slow, you can build up your speed the more you practice.

Sensor Bar

Given that everything is controlled with the cursor, it’s crucial to ensure your sensor bar is setup to give you consistent results. You’ll need to change these settings on the Wii settings menu outside of the game. Firstly, make sure your sensor bar is set to the correct location, either above or below the screen. This will off-set the cursor to make it feel more natural. This isn’t strictly necessarly, but helps with preventing pointing the Wiimote at an uncomfortable angle. For the Sensor Bar sensitivity, you should aim to have this as low as possible. If you have the perfect conditions, having this set to 1 will be best, but depending on your setup, you may have to use 2 or 3. The lower the better if possible. I definitely recommend checking this setting, as you may find your sutures and stars become much more reliable.

Tool Switching

Luckily in SO we use the nunchuck to tool switch, so we don’t have to waste too much time with tapping the tools we want unlike in the DS games. But being able to select the tools you need at the exact time will help with your pacing. You’ll be less likely to fumble, or to miss and waste precious vitals. To improve your tool switching, I highly recommend Kyriaki, as well as 2-1 (Thrombi). Anticipating when you need to tool switch, and then executing means you are spending less time waiting around, even if it is for only a second it will add up over the course of a full run. That being said, don’t take this too far. You don’t want to be tool switching too early. This is especially true with sutures as they will be discarded if you tool switch away before letting go of A or B. If your nunchuck suffers from “snapback”, where you hold the stick and let go and it selects the opposite tool, the best way around this is to simply lock the stick into the direction you are using at the time. The exception to this is if you’re always going to be using that tool (eg: Pempti requires the laser 90% of the time, so there is no use holding the stick down all the time). This means the stick cannot snap back into the opposite direction and select the wrong tool.

Healing Touch

Since the Healing Touch (HT) slows down the game, and any engine-based timers, it means it can be useful to skip cycles or give you more breathing space. Though you should avoid using it for most operations, as whenever there are a lot of things going on while HT is active, the game will lag an incredible amount. That being said, if you need it, don’t be afraid to pop the Healing Touch if you need to give yourself more breathing space. Nearly all operations in Chapter Z utilise Naomi’s HT, and this applies to 6-4 as well, so you can essentially disregard the advice about avoiding it as the benefits outweigh the downsides in these operations. If you are playing an operation as Naomi, and need to boost the vitals, instead of boosting with the syringe, pop her Healing Touch instead.

Menuing, Text Skip, and Episode Select Skip (ESS)

Outside of the operations, it’s easy to lose time just by selecting the wrong option. And while this is often more of a newcomer’s mistake, ensuring you select the right option (and at the right time too) will help you shave time off. Whenever you start an operation, you only need to button mash A without pointing the cursor to hit YES. But at other opportunities, it’s important to be ready to use your cursor to snap to each option. I don’t recommend using the D-Pad as you can point your cursor much faster without readjusting your grip. Additionally you should be mashing A when the map appears, as well as when you finish an operation to get through the “Patient is saved” message and scoring. Without text skip, Second Opinion would be insanely long (looking at you Trauma Team). It’s as simple a pressing the minus button ( - ) on your Wiimote to turn on text skip and let the dialogue fly by, but knowing when to do this can be tricky. There are three set times you should remember:

An Episode Select Skip, or commonly known as an ESS is a skip performed after the majority of operations. Each episode has some post-operation dialogue after you get the score. Apart from the operations marked with an asterisk ( * ) , it is faster to hit plus ( + ) to pause, then select Episode Select, and YES. This cuts out all the dialogue and story after the operation. I’d recommend taking a look at existing runners Splits, or using the split files available on the Speedrun.com page. ESS should also be done on non-operation episodes (eg: 1-4). When performing an ESS on non-operational episodes, you should do so before the title/episode card appears. As such you should mash through the map, then mash plus ( + ) as soon as possible to get the menu up before the title card. Note that there are some non-operation episodes where you can perform an ESS instantly as there is no map, such as 3-1, 4-5, and 6-1.

Autosave

Every time you start a run, you’ll need to make sure you turn off autosave. Before going to New Game on the main menu, go to Config, then toggle the setting for Auto Save. This ensures the game does not save your progress after each episode as this adds upwards of 3 seconds per each episode, totalling up to nearly 2 minutes. As we are playing all in one go for the run, you don’t want this on. This setting resets if you load into a save file and come out, so be sure to check it before you start your run.

Gel and Bandages

Given how questionable the gel is in Second Opinion, you’ll need to apply it differently depending on the situation. First of all, for most incisions you’ll want to gel before you open the patient as the tolerances are very tight and you’ll likely get a miss. Any time you need to get small cuts, just tapping them is good enough however if they are clustered together (eg: 1-1 in the arm) it is better to slather the gel over each cut. For tumour membranes, tapping them is preferred as it is quicker. For the bandage, as long as it covers approximately 40% of incision, you should be okay. That being said if you miss, it will cause 5 vitals to be dropped and you can kill the patient with this, so be sure to be more careful if the patient is very low. You don’t want to gel before the bandage (except in 1-1) as it is much slower.

Posture, Stretching, and Breaks

Since you’re pointing a Wiimote for over an hour, ensuring you are comfortable and that your hand is stable, and relaxed is pretty important. Each runner has their own preferred posture and way to sit during runs, however they all share one key concept. You want to support your wrist and forearm as best you can. This ensures that your hand is naturally stable, and that the cursor isn’t shaking when you are just aiming to hold it still at a given point on the screen. For me personally, I use a blanket between my lower thighs/knees as this adds some padding/cushioning, as well as a foot-rest. I have seen other runners sit with their arms in a sort of inward V facing the screen with their forearms resting over their thighs, and other runners place it at the very top of their thigh near their hip. Find whatever is comfortable for you! Following on from this, it’s very important to stretch, to give your hand time to relax. Mid-run there are opportunities to stretch your hands out and ensure they do not cramp up. Notably in the dialogue before: 3-4, 4-4, and 6-4. I highly recommend this video from Dr Levi: https://youtu.be/EiRC80FJbHU - It covers a lot of important stretches, and how to loosen up your hands too. When you’re on the grind to get a new time it’s easy to forget to take breaks. If you don’t you are near guaranteed to give yourself Repeatitive Strain Injury (RSI). Just give yourself five minutes to allow your muscles to relax, and your joints to ease up, plus you’re less likely to get tilted too! This is especially important during practice. Don’t allow yourself to play the same operation over and over and over for more than 20 minutes without stopping for two minutes at least.

Vitals

Given that the game revolves around healing patients and keeping them alive, it might come as a surprise that in the speedrun environment we avoid vital boosting. Simply put, it takes up precious time that we could be using to deal with the patient’s condition. It varies per operation of course and if I was to list out a set of numbers, it would stupidly long and be near useless to go over it all as you wouldn’t remember it. But learning when to not to boost the vitals will mean you’re not wasting time. With time, you get a feel for this. On the contrary however, if you are sitting around waiting, for example your tool has burnt out, or you are waiting for an animation or cycle, boosting the vitals up while you wait is a good use of your time. Don’t let this go too far where you are boosting vitals into the time you could be spending to finish the operation. Prime examples of this include:

Routing & Region Differences

This is a very very minor thing to worry about, but after some investigation and testing the animation timings, doing Chapter Z after the first five chapters of the game means you save 1.5~ seconds overall. As mentioned this is a very small thing, and if you are more comfortable with doing Chapter Z as you go, continue to do so until you are reaching top tier times. If you wish to go for the new routing option, play the game as normal and after Chapter 1, ignore Z-1 and go back down to 2-1. From then on, you won’t ever be transitioned over to the other side of the Episode Select area. When you finish Savato 1 in Chapter 5, you will need to be ready to press the up arrow on the D-PAD while the cursor is on the chapter number on the left. You will need to press this 4 times, then put your cursor at the bottom right and scroll slightly to bring up Z-1. Now this isn’t something you should really worry about until you get to top-tier times (aka, faster than SZSK / <1:25:00) but running the game in Japanese means there is less text to skip, and it saves you around 25-30 seconds across the entire run. Let me stress: this is not critical. Just because you have a PAL/NTSC-U copy does not mean you shouldn’t try.

For reference, it is possible to close into a time of 1:21:00 comfortably without worrying about localisation. It is just common that after improving your time and investing yourself into the game for long enough, that having a JP or NTSC-J copy of the game is likely, and not a requirement.