firefights, removing bullets, wound infection and doctors.

[the musical fruit 1]

Presently there is no real downside to starting a firefight. If you get the drop on your opponent and make a kill you get some sweet items. If you take a bullet in the firefight, no problem. Everyone can perfectly heal themselves with a handful of items. If you need blood, one of your friends can give you a perfect blood transfusion.

I suggest adding another layer to firefights, making them even scarier. If you take a bullet, you need to remove it at a later point at a campfire with a knife. Maybe some of those empty whisky bottles the zombies are carrying around could be full for sterilisation purposes. Until you remove the bullet your character has all the symptoms of sickness, constantly coughing.

doctors

Boiling survival down to a pure item game is something which encourages pvp. This is not particularly realistic, In the real world, survival is about more than items, and people are not equal. A doctor has a base set of skills that are considerably more useful than those of someone who works in an office.

Players who have performed a lot of blood transfusions, administered morphine and other medical procedures will gain the ability to use doctor's bags. This would be a new specialised multiple use item which enables you to remove bullets without a campfire, remove sickness and cure other ailments. Only a player who has learned to be a doctor can use doctors bags.