diff --git a/addons/medical/functions/fnc_adjustPainLevel.sqf b/addons/medical/functions/fnc_adjustPainLevel.sqf
index 94b246bae39..dc80f4f7222 100644
--- a/addons/medical/functions/fnc_adjustPainLevel.sqf
+++ b/addons/medical/functions/fnc_adjustPainLevel.sqf
@@ -21,6 +21,8 @@ params ["_unit", "_addedPain"];
 
 if (!local _unit) exitWith { ERROR_1("unit [%1] is not local",_unit); };
 
+if (!IS_MEDICAL_ACTIVITY(_unit)) then { [QGVAR(activateMedical), _unit] call CBA_fnc_localEvent; };
+
 private _pain = GET_PAIN(_unit);
 
 _pain = 0 max (_pain + _addedPain) min 1;
diff --git a/addons/medical/functions/fnc_deserializeState.sqf b/addons/medical/functions/fnc_deserializeState.sqf
index a9057a42b8e..54924498aaa 100644
--- a/addons/medical/functions/fnc_deserializeState.sqf
+++ b/addons/medical/functions/fnc_deserializeState.sqf
@@ -125,4 +125,7 @@ if (_currentState in ["Unconscious", "CardiacArrest"] && {_targetState in ["Defa
     [_unit, false] call EFUNC(medical_status,setUnconsciousState);
 };
 
+// Manually activate if non-defaults are present
+[_unit] call EFUNC(medical_engine,checkForMedicalActivity);
+
 _state call CBA_fnc_deleteNamespace;
diff --git a/addons/medical/functions/fnc_fullHeal.sqf b/addons/medical/functions/fnc_fullHeal.sqf
index 7c7a2cb13b8..be8b966e822 100644
--- a/addons/medical/functions/fnc_fullHeal.sqf
+++ b/addons/medical/functions/fnc_fullHeal.sqf
@@ -27,4 +27,6 @@ if (!alive _patient) exitWith {
     ERROR_2("fullHeal [medic %1][patient %2] Patient is dead or null",_medic,_patient);
 };
 
+if (!IS_MEDICAL_ACTIVITY(_patient)) then { [QGVAR(activateMedical), _patient, _patient] call CBA_fnc_targetEvent; };
+
 [_medic, _patient, "", "", objNull, "", false, _logMessage] call EFUNC(medical_treatment,fullHeal);
diff --git a/addons/medical/functions/fnc_setUnconscious.sqf b/addons/medical/functions/fnc_setUnconscious.sqf
index 050cfa0ce2d..2c0dbcaa71d 100644
--- a/addons/medical/functions/fnc_setUnconscious.sqf
+++ b/addons/medical/functions/fnc_setUnconscious.sqf
@@ -43,6 +43,8 @@ if (_knockOut isEqualTo IS_UNCONSCIOUS(_unit)) exitWith {
     false
 };
 
+if (!IS_MEDICAL_ACTIVITY(_unit)) then { [QGVAR(activateMedical), _unit] call CBA_fnc_localEvent; };
+
 if (currentWeapon _unit != primaryWeapon _unit) then {
     _unit selectWeapon primaryWeapon _unit;
 };
diff --git a/addons/medical_engine/XEH_PREP.hpp b/addons/medical_engine/XEH_PREP.hpp
index ffc3543745d..97147c60ff0 100644
--- a/addons/medical_engine/XEH_PREP.hpp
+++ b/addons/medical_engine/XEH_PREP.hpp
@@ -1,4 +1,5 @@
 PREP(applyAnimAfterRagdoll);
+PREP(checkForMedicalActivity);
 PREP(damageBodyPart);
 PREP(disableThirdParty);
 PREP(getHitpointArmor);
diff --git a/addons/medical_engine/XEH_postInit.sqf b/addons/medical_engine/XEH_postInit.sqf
index 70a7489136c..e39d77ce8fb 100644
--- a/addons/medical_engine/XEH_postInit.sqf
+++ b/addons/medical_engine/XEH_postInit.sqf
@@ -8,6 +8,7 @@
 
 ["CAManBase", "init", {
     params ["_unit"];
+    [LINKFUNC(checkForMedicalActivity), _unit, 2] call CBA_fnc_waitAndExecute;
 
     if (unitIsUAV _unit) exitWith {TRACE_1("ignore UAV AI",typeOf _unit);};
     if (getNumber (configOf _unit >> "isPlayableLogic") == 1) exitWith {TRACE_1("ignore logic unit",typeOf _unit);};
diff --git a/addons/medical_engine/XEH_preInit.sqf b/addons/medical_engine/XEH_preInit.sqf
index 95b51d0411b..9922c128f67 100644
--- a/addons/medical_engine/XEH_preInit.sqf
+++ b/addons/medical_engine/XEH_preInit.sqf
@@ -20,6 +20,7 @@ if (isNil QUOTE(PAIN_FADE_TIME)) then {PAIN_FADE_TIME = PAIN_FADE_TIME_DEFAULT};
 if (isNil QUOTE(LIMPING_DAMAGE_THRESHOLD)) then {LIMPING_DAMAGE_THRESHOLD = LIMPING_DAMAGE_THRESHOLD_DEFAULT};
 if (isNil QUOTE(FRACTURE_DAMAGE_THRESHOLD)) then {FRACTURE_DAMAGE_THRESHOLD = FRACTURE_DAMAGE_THRESHOLD_DEFAULT};
 if (isNil QUOTE(CARDIAC_OUTPUT_MIN)) then {CARDIAC_OUTPUT_MIN = CARDIAC_OUTPUT_MIN_DEFAULT};
+if (isNil QUOTE(MEDICAL_ACTIVITY)) then {MEDICAL_ACTIVITY = MEDICAL_ACTIVITY_DEFAULT};
 // Derive the alternate fatal damage coefficients
 if (isNil QUOTE(FATAL_SUM_DAMAGE_WEIBULL_K) || isNil QUOTE(FATAL_SUM_DAMAGE_WEIBULL_L)) then {
     private _x1 = 0.5;
diff --git a/addons/medical_engine/functions/fnc_checkForMedicalActivity.sqf b/addons/medical_engine/functions/fnc_checkForMedicalActivity.sqf
new file mode 100644
index 00000000000..baa83e9ccf1
--- /dev/null
+++ b/addons/medical_engine/functions/fnc_checkForMedicalActivity.sqf
@@ -0,0 +1,48 @@
+#include "..\script_component.hpp"
+/*
+ * Author: PabstMirror
+ * Checks for scripted medical activity on a unit
+ *
+ * Arguments:
+ * 0: Unit <OBJECT>
+ *
+ * Return Value:
+ * None
+ *
+ * Example:
+ * [player] call ace_medical_engine_fnc_checkForMedicalActivity
+ *
+ * Public: No
+ */
+params ["_unit"];
+TRACE_1("checkForMedicalActivity",_unit);
+
+if (!alive _unit || {!local _unit}) exitWith {};
+if (IS_MEDICAL_ACTIVITY(_unit)) exitWith {};
+
+{
+    _x params ["_var", "_default"];
+    if (_unit isNil _var) then { continue };
+    private _current = _unit getVariable [_var, _default];
+    if (_current isNotEqualTo _default) exitWith {
+        TRACE_2("unit has non-defaults",_unit,_var);
+        [QEGVAR(medical,activateMedical), _unit] call CBA_fnc_localEvent;
+    };
+} forEach [
+    [VAR_BLOOD_VOL, DEFAULT_BLOOD_VOLUME],
+    [VAR_HEART_RATE, DEFAULT_HEART_RATE],
+    [VAR_BLOOD_PRESS, [80, 120]],
+    [VAR_HEMORRHAGE, 0],
+    [VAR_PAIN, 0],
+    [VAR_PAIN_SUPP, 0],
+    [VAR_OPEN_WOUNDS, createHashMap],
+    [VAR_BANDAGED_WOUNDS, createHashMap],
+    [VAR_STITCHED_WOUNDS, createHashMap],
+    [VAR_FRACTURES, DEFAULT_FRACTURE_VALUES],
+    [VAR_TOURNIQUET, DEFAULT_TOURNIQUET_VALUES],
+    [VAR_MEDICATIONS, []],
+    [QEGVAR(medical,occludedMedications), []],
+    [QEGVAR(medical,ivBags), []],
+    [VAR_BODYPART_DAMAGE, DEFAULT_BODYPART_DAMAGE_VALUES]
+];
+
diff --git a/addons/medical_engine/script_macros_medical.hpp b/addons/medical_engine/script_macros_medical.hpp
index 1f7c2aee6bd..2b238d26ca0 100644
--- a/addons/medical_engine/script_macros_medical.hpp
+++ b/addons/medical_engine/script_macros_medical.hpp
@@ -223,3 +223,9 @@
 
 // Ignore UAV/Drone AI Base Classes
 #define IGNORE_BASE_UAVPILOTS "B_UAV_AI", "O_UAV_AI", "UAV_AI_base_F"
+
+// Medical Activity (optimization for AI)
+#define VAR_MEDICAL_ACTIVITY          QEGVAR(medical,medicalActivity)
+#define MEDICAL_ACTIVITY              EGVAR(medical,const_medicalActivity)
+#define MEDICAL_ACTIVITY_DEFAULT      false
+#define IS_MEDICAL_ACTIVITY(unit)     (unit getVariable [VAR_MEDICAL_ACTIVITY, MEDICAL_ACTIVITY])
diff --git a/addons/medical_statemachine/XEH_postInit.sqf b/addons/medical_statemachine/XEH_postInit.sqf
index a7c7740a390..6b6c601a731 100644
--- a/addons/medical_statemachine/XEH_postInit.sqf
+++ b/addons/medical_statemachine/XEH_postInit.sqf
@@ -12,3 +12,26 @@
         [{_this enableSimulation true}, _unit, 2] call CBA_fnc_waitAndExecute;
     };
 }] call CBA_fnc_addEventHandler;
+
+
+[QEGVAR(medical,activateMedical), { // should be called where unit is local
+    params ["_unit"];
+    _unit setVariable [VAR_MEDICAL_ACTIVITY, true, true];
+    TRACE_2("activating medical",_unit,typeOf _unit);
+    // Because vitals loop has never run, set to 1 second ago to avoid large time delta (would hit max of 10 seconds)
+    if (_unit isNil QEGVAR(medical_vitals,lastTimeUpdated)) then {
+        _unit setVariable [QEGVAR(medical_vitals,lastTimeUpdated), CBA_missionTime - 1];
+    };
+}] call CBA_fnc_addEventHandler;
+[QEGVAR(medical,woundReceived), {
+    params ["_unit"];
+    if (!IS_MEDICAL_ACTIVITY(_unit)) then {
+        [QEGVAR(medical,activateMedical), _unit] call CBA_fnc_localEvent;
+    };
+}] call CBA_fnc_addEventHandler;
+["ace_treatmentStarted", {
+    params ["", "_patient"];
+    if (!IS_MEDICAL_ACTIVITY(_patient)) then {
+        [QEGVAR(medical,activateMedical), _patient, _patient] call CBA_fnc_targetEvent;
+    };
+}] call CBA_fnc_addEventHandler;
diff --git a/addons/medical_statemachine/functions/fnc_handleStateDefault.sqf b/addons/medical_statemachine/functions/fnc_handleStateDefault.sqf
index 89e09b0d4cd..11ce7103a5c 100644
--- a/addons/medical_statemachine/functions/fnc_handleStateDefault.sqf
+++ b/addons/medical_statemachine/functions/fnc_handleStateDefault.sqf
@@ -19,6 +19,7 @@ params ["_unit"];
 
 // If the unit died the loop is finished
 if (!alive _unit || {!local _unit}) exitWith {};
+if !((isPlayer _unit) || {IS_MEDICAL_ACTIVITY(_unit)}) exitWith {};
 
 if ([_unit] call EFUNC(medical_vitals,handleUnitVitals)) then { // returns true when update ran
     private _painLevel = GET_PAIN_PERCEIVED(_unit);
diff --git a/docs/wiki/framework/medical-framework.md b/docs/wiki/framework/medical-framework.md
index 744334f048b..8038266f2f9 100644
--- a/docs/wiki/framework/medical-framework.md
+++ b/docs/wiki/framework/medical-framework.md
@@ -254,3 +254,14 @@ ACE will lock the seat of an unconscious or dead unit to prevent automatic unloa
 ace_medical_engine_disableSeatLocking = true;     // disable on everything
 ace_medical_engine_disableSeatLocking = ["ship"]; // disable just on boats
 ```
+
+### 5.2 Running vitals loop on untouched AI
+For performance ACE will skip running vitals loop on AI that have never been wounded or treated. This can be disabled by setting:
+```sqf
+// always run all vitals calculations on all AI
+ace_medical_const_medicalActivity = true;
+
+// specific AI
+unit setVariable ["ace_medical_medicalActivity", true]  
+```
+Once medical activity has been enabled, you can't disable it. In other words: if you execute `unit setVariable ["ace_medical_medicalActivity", true]`, you can't disable medical activity for that specific AI anymore. If you run `ace_medical_const_medicalActivity = true;`, you can no longer set it to `false` and all AI will have their medical activity enabled.