SoP: Medical

Standard Operating Procedures
Ship Operations | Chain of Command | Emergency Protocol
General | Command | Security | Engineering | Science | Medical | Supply

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SoP: Medical

Duties & Expectations

The Medical Department's duties extend to many facets of the crew function, from direct medical care, mental health support and to preventative measures. As a member of the MD, you are expected to provide and facilitate aid to any crew in need.

• Provide the best possible care to any crew.
• Remain vigilant of any potential harm that may come to crew, through sensors or radio.
• Maintain etiquette and bedside manner. Your duties may extend to sensitive care.
• Ensure the sterility and cleanliness of all medical care facilities.

Dress Code & Presentation

Members of the Medical Department must be identifiable at a glance as to minimize confusion during emergencies, and for any armed conflict conventions to be followed accordingly. Failure to adhere to these standards may impair your ability to fulfill your duties. These policies extend to the Exploration department's medical roles as well.

• All on-duty Medical staff must wear white, pale blue or medical crosses on their person.
  • This extends to accessorised apparel such as satchels, armbands or headwear, such as a medical beret.
  • Medical scrubs and any other apparel originating from Medbay is an exception to this.
• Clothing must practically allow physical motion, given the duties which often fall upon the department.
• Clothing must be clean and sterile. Medical staff should not be covered in grime, oil or bodily fluids, this does not extend to emergent emergencies.
  • This especially extends to handswear (Mainly gloves)
• Anyone fulfilling the duties of a Chemist or a Surgeon must wear Latex or Nitrile gloves.
  • Otherwise, other types of gloves or handswear are up to the individual.

Privacy

The Medical Department is expected to address the needs of all crew with care and confidentiality. Patients should have confidence that their needs will be met effectively and with discretion. A Non-Disclosure Policy thus exists as follows:

• Information in patient records may not be disclosed without a relevant warrant.
  • Exceptions include the existence of prescriptions or scheduled procedures. What they are specifically is privileged, but calling a crewmember to medbay is not a violation.
• The identity of a patient receiving treatment should not be broadcasted.
  • Exceptions can include the location of the patient undergoing treatment (‘they’re in medbay receiving treatment’), but this is up to medbay’s discretion.
• Information gleaned from medical scans should be kept private.

Repeated failure to obey the Non-Disclosure Policy is grounds for termination from the Medical Department.

Suit Sensors

Suit sensors are a core part of Medical’s functions. Misuse of it can lead to a lack of trust, and thus lack of use. This directly impairs Medical’s ability to fulfill their duties efficiently. Keep common sense and good etiquette in mind when dealing with sensors data.

• Inquiring after someone who is taking damage on sensors is acceptable.
  • You should not call out their location on radio unless they are in critical condition.
• Using sensors for non-medical purposes by non-command Medical personnel is not allowed. This extends to relaying specific locations of crewmembers when prompted.
• Heads of Staff have access to the Bridge console for sensor access. Sensor data may not be used by them regardless outside of an active warrant, or threat to life.
  • Tracking an individual must only be done for an active manhunt / warrant, or a threat to safety / security, not personal reasons or as general monitoring.

Threats to the Installation

Privacy is suspended when there is a probable threat to life or the installation as a whole that is discovered by medbay. Examples include but are not limited to:

• Discovery of a xenobiological larvae growing inside someone’s body.
• Discovery of an uncontained virus in a patient.
• Calling out for someone in / near critical condition on sensors.
• Non-accidental deaths.
• Mass afflictions suspected to be from external contamination or internal hazards.

The threat must be probable, not just possible. The discovery of something unexpected does not automatically mean it is hostile to the installation - medical personnel must have clear solid reasoning to enact this clause.

Equipment

Medbay has access to a variety of tools, medicines and substances that are both integral to the department's function and dangerous if misused. Despite the department's accessibility to its workers, there are expectations to be held based on role and specific items.

Surgery

• All Surgery tools are to be kept within the operating theatre, and within the designated surgery containers, if possible.
  • This is due to the fact that the surgery kit containers automatically sterilize the instruments.
  • Any replaced surgical tools (such as by improved versions from Research) should be stored in secure containers anywhere in Medbay.

Chemistry Grenades

• Chemistry grenade manufacture and experimentation can be done by a Chemist or a chemist-fulfilling role within Medbay using the CMO's discretion.
  • Safety standards are to be expected. Live sapient patient testing is not allowed unless volunteered.
  • Chemist grenades cannot be taken or used outside of Medbay without explicit CMO permission.
    • If no able-bodied CMO is present, emergency exception applies according to existing Medbay staff discretion.

Non-Medicine

• Non-medicine is not allowed to be carried around or exploited outside of Medbay by Non-Chemists and Non-CMO personnel without CMO's permission.
  • If no able-bodied CMO is present, emergency exception applies according to existing Medbay staff discretion.
  • No Medbay staff are allowed to utilize Non-medicine for detainment, restraining, incapacitation or harmful purposes outside of Medbay to other crew.
    • An exception to this is when their lives are in direct risk during emergencies.
  • Chemists and the CMO have discretion for distribution of non-medicines to other crew by request. (Examples being fertilizer, space cleaner)
    • If no able-bodied Chemists or CMOs are present, distribution of non-medicines to other crew is not allowed.

Right to Refuse Treatment

In general, every patient has the right to refuse treatment, even if it may result in their death.

• A patient should be informed of the treatment's benefits, risks and potential alternatives.
• A patient's consent should not be coerced.
• Medical Department staff are authorized to refuse treatment if they believe alternative procedures would be even more detrimental to the well being of the patient (such as refusing anesthetics before a major surgery)
• A patient has the right to refuse treatment, even if it may result in their death.
  • This does not extend to treatments meant to mitigate threats to station and staff (Read Biological Hazards below)
  • Such a refusal should be documented and signed by the patient with witnesses present.
  • Do Not Resuscitate (DNR) requests fall under this and should be respected.

Biological Hazards

Crewmembers that are carrying parasites, infections or other hazards that may be a threat to other crew may have their right of treatment waived by the CMO (if one is present).

• A patient who refuses to have such a treatment is to be detained by Security forces and brought to Medbay for treatment.
  • Once in Medbay, MD staff are allowed to ensure their procedure is carried out, even against their wishes. This may include forced restraining, sedatives or any other means of subduing.
  • If such a patient manages to escape Medbay, previous restrictions apply.
• This clause does not apply to hazards that are only a threat to the person themselves.

Procedures

Phoron Spill

Upon announcement of a phoron spill, respond immediately, following these steps:

1. Get a cryobag. Be prepared to deal with a patient who has most likely panicked.
2. Get a toxins first aid kit, or drag the medibot. Preferably a toxins first aid kit. Anti-toxin works faster than tricordazine.
3. Get to the patient immediately and urge them to start making their way toward medbay as far as they can get, using the main corridor. If possible, have a second emergency responder get a biosuit and prepare their emergency oxygen tank and mask in case the patient failed to escape the zone of contamination. Do not under any circumstance attempt to hack any doors or otherwise gain entry to an area that would require actions that pose a risk of fire, such as tampering with wires, or cutting walls with a welder.
4. Administer antitoxin and remove all clothing from the victim as soon as they are found. Continue to administer high doses of antitoxin as you return to medbay.
5. If the victim collapses or is found already collapsed, immediately put the victim into the cryobag and rush to medbay.
6. Use the cryo pods to stabilize the victim if their condition does not respond to antitoxin treatment. If the victim already had to be put inside a cryobag, then they should be put into a cryo pod immediately on arrival to medbay.
7. After successful treatment, scan the patient for any internal injuries caused by the poisoning, such as a damaged liver. Treat if necessary.

Viral Outbreak

• All infected crew to be isolated in Virology or Medbay.
• Sterile masks/Internals and gloves are mandatory for medical personnel and recommended for crew.
• Quarantine must be maintained until outbreak can be contained and disease can be treated.

Autopsy

In the event that a deceased individual is discovered, or an individual perishes while under your care, an autopsy should be performed if one has not been done already.

• Security should be informed any time a corpse is discovered, regardless of whether the cause of death is known or not.
• An autopsy should be performed and recorded in an effort to resolve any questions that may arise later on, or if evidence is needed by Security.
• If you have valid reason to believe the death was a suicide, see Suicide or other voluntary death below for how to proceed.

Suicide or other voluntary death

In all cases of corpses being found that are potential suicides, Security should be contacted to investigate, just in case it's actually murder. If a crewmember is exhibiting suicidal behavior, either verbally or through their actions, Security is obligated to detain the individual. However, after the offending crewmember has been detained, they are meant to be remanded to Medical's custody. The Psychiatric Ward exists specifically to detain any crew at risk of engaging in self-harm or other suicidal behaviors until they can be evaluated.

• When Security alerts Medical that they will be delivering an at-risk patient, prepare a straight jacket and sedatives.
• Meet Security in the Medical foyer with the patient, and escort both the officer and the patient to the Psychiatric Ward's processing airlock.
• Allow Security to remove the patient's personal effects. These must be stored in the corresponding cell's locker.
• Dress the patient in their new attire. Ideally a medical gown and/or white jumpsuit and white shoes.
• Buckle the patient to the bed in their cell and utilize the attached flasher to disorient the patient long enough for their restraints to be removed.
• Provide Yard Access unless the patient is a danger to other patients.
• In the event that a patient continues to attempt to cause themselves or others harm after being checked in to the Psychiatric Ward, call for Security and detain the patient again. Administer sedatives, and then a straight jacket. Transfer the patient to Solitary Confinement.
• The Patient should be held in the Psychiatric Ward until a Psychiatrist is capable of providing an evaluation. If they are determined to be a danger to themselves and others, their status should be upgraded to HuT. Otherwise, begin the process of releasing the patient and returning their possessions.

Psychiatric Ward

Psychiatric Ward Regulations

Medical cannot confine someone in the Psychiatric Ward unless one of the following is true.

• Immediate threat to themselves (someone stabbing themselves, physically preparing to enact self-harm, repeated and probable threats to end one's own life, etc).
  • Security must be contacted if available to notify them of this, and so that they may challenge it if necessary.
• Proof that the individual is under the influence of a mind-controlling influence, and either no Security exists, or Security authorizes the confinement.
  • This is not 'they must be crazy to do this', this is 'we have seen / have sound evidence to indicate there is something directly controlling them'.
• Requested to do so by Security, either due to behavior hostile to life or behavior indicating the individual is not of sound mind.
  • Medical has the right to refuse to confine someone to the Psychiatric Ward if it is determined the person is of sound mind, regardless of what Security has determined.
• Security does not exist, or is otherwise incapacitated, and behavior has been observed indicating a general hostility to life.
  • Examples include: Mutilating bodies for entertainment, setting off uncontrolled fires in the ship for entertainment, attempting to drive the ship into an asteroid field.
  • Security, and available command (if no CMO) must be notified if confining someone to the Psychiatric Ward in this manner.

The psychiatric ward is not just another brig cell. Even if someone is otherwise committing crimes, up to and including violent offenses, it is not Medical's discretion to simply confine them as a mental patient off of that alone. Violations of this protocol will result in the offending doctor(s) charged with Illegal Confinement as part of Corporate Regulations and/or suspended.

Psychiatric Patient Expectations

As a psychiatric patient, you are expected to abide by certain standards. Failure to obey will result in further punishment such as solitary confinement.

• If you are incarcerated, do not attempt escape.
• Further attempts at suicide will be met with solitary confinement. (( Also probably a server ban. ))
• If you feel you have been unjustly incarcerated, contact the Psychiatrist, Chief Medical Officer, Internal Affairs, or Facility Director (in that order of first to last) to appeal your case.

Psychiatric Patient Rights

As a psychiatric patient, you are entitled to certain rights under any circumstance, regardless of the nature of your crimes.

• All patients are entitled to medical examination and aid if requested.
• All patients are entitled to speak to an Internal Affairs Agent for legal council if requested.
• All patientss are entitled to be allowed to send fax to Central Command if requested.
• All patients are entitled to food and water if requested.
• All patients are entitled to be provided with clothing--preferably the standard gown and/or white jumpsuit, and white shoes.
• All patients are entitled to safe and reasonable cell accommodations such as functional lighting, a place to sleep, and access to the brig's communal area if serving a sentence longer than 20 minutes.

Mirrors, Resuscitations and DNRs

• Mirror resleeves should not be the first recovery method unless the patient's condition is too far gone (example being, over 1000 total damage)
• If the patient is lacking a mirror, and does not have a DNR, alternate recovery methods may be followed in spite of excessive damage caused to the body.
  • In such cases, if the time, effort or resources that have to be invested into their non-mirror recovery is deemed too great of a burden, the CMO can waive the body's resuscitation for this shift.
    • The body is then to be transported to the morgue and the shuttle, if possible.
• Attempt resleeving if a mind and body record already exists in database and they are not explicitly listed as "Do Not Revive" (DNR) in their medical records.
  • The lack of Medical Records for a given patient assumes their consent to resuscitation, particularly if a mirror is present.
• If at any time you believe a DNR order has been falsified, or unjustly ordered, you should bring it to the attention of Central Command immediately. Falsifying a DNR order is punishable under the Reformation Act of 2560, and is viewed as attempted murder by Policy/Corporate Regulations.
• A valid DNR is usually:

1. A confirmed desire to not be resleeved. See also Right to Refuse Treatment. An employee may also specify a standing DNR in their medical and/or employment records. These are witnessed by central command's medical departments, and are legally binding.
2. Reasonable order from a station's Chief Medical Officer or CentCom to withhold resleeving for known suicidal^* individuals. Note there must be hard evidence of a suicide for this to be valid, such as announcing the suicide on the radio, or a note left behind, multiple eye witnesses, etc.
3. Reasonable order from a director or CMO where resleeving may cause unnecessary tramua, ex. only on-hand mind record would leave the deceased remembering particularly traumatic experiences, such as a slow and drawn out death. This should only be used if alternative backup memory/mind scans are available off-site, or if the subject requests such before their demise (and meets the requirements of a valid DNR).
4. Legal execution by order of Central Command and/or tribunal of heads as listed under legal code (obtaining copies of suspects body and mind data are encouraged in case of appeal by governing bodies).

^* Note that recreational activities in which someone expects to be possibly killed do not count as suicide. These individuals usually already have a scan on file in advance, and should always be revived.