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I hope you dont mind, as I may come across a little "obnoxious". x)
Anyhow...
I think the dire/brutal changes do not apply totally towards the "Hospital Challenge" scenario.
In fact: The drunk moodle is affected and on brutal the building also sets off with an alarm immediatly. But as far as I can tell, there are no serious injuries or any more injuries at all.
Its always a single broken body part, mostly a hand/forearm or shin/thigh. The later being much more serious, I think this should be the prefered start-up.
If its intended, then ignore my part here. Yet the wording in these two threads indicate, there should be more severe injuries from the get go.
Also: For "Final Flight", dire is already a serious step. I had such a large amount of injuries, also deep-wounds, i basically died within seconds.^^