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Total Carnage is a multidirectional shooter similar to Smash TV where players assume the role of Captain Carnage (P1) and Major Mayhem (P2) from the Doomsday Squad across three stages, each with a boss at the end that must be fought before progressing any further, in a last-ditch effort to overthrow dictator General Akhboob (loosely based on Saddam Hussein ) and his army of mutants from conquering the world by invading Akhboob's "Baby Milk Factory" base, while also rescuing POWs held by his military force as the main objective. The players' characters are patterned after John Rambo while the setting is influenced by the 1991 Persian Gulf War (including the Abu Ghraib Infant Formula Plant ). Players move their respective characters with the left joystick, while the right joystick shoots bullets towards enemies. Players can also enter a password at the start to warp their player character to any location of the game. Getting hit by enemy fire or colliding with dangerous stage obstacles will result in losing a life and once all lives are lost, the game is over unless the players insert more credits into the arcade machine to continue playing. The game shares many elements with Williams' previous title, while also adding new ones including scrolling stages, large enemy vehicles, the ability to collect and place bombs, and a much wider range of gameplay scenarios.