SoP: Medical

Standard Operating Procedures
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SoP: Medical

Medical

Medical Oath

The Medical Oath sworn by recognized medical doctors in the employ of NanoTrasen

1. Now, as a new doctor, I solemnly promise that I will, to the best of my ability, serve sentient life-caring for the sick, promoting good health, and alleviating pain and suffering.
2. I recognise that the practice of medicine is a privilege with which comes considerable responsibility and #I will not abuse my position.
3. I will practise medicine with integrity, humility, honesty, and compassion-working with my fellow doctors and other colleagues to meet the needs of my patients.
4. I shall never intentionally do or administer anything to the overall harm of my patients.
5. I will not permit considerations of gender, race, religion, political affiliation, sexual orientation, nationality, or social standing to influence my duty of care.
6. I will oppose policies in breach of human rights and will not participate in them. I will strive to change laws that are contrary to my profession's ethics and will work towards a fairer distribution of health resources.
7. I will assist my patients to make informed decisions that coincide with their own values and beliefs and will uphold patient confidentiality.
8. I will recognise the limits of my knowledge and seek to maintain and increase my understanding and skills throughout my professional life. I will acknowledge and try to remedy my own mistakes and honestly assess and respond to those of others.
9. I will seek to promote the advancement of medical knowledge through teaching and research.
10. I make this declaration solemnly, freely, and upon my honour.

Non-Disclosure Policy

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. If the patient does not have faith that their information will be kept private, they may not disclose all of their concerns, or may otherwise hinder their own treatment. As this ultimately leads to a less healthy work environment overall, NanoTrasen strictly upholds a Non-Disclosure Policy across its Medical Departments:

1. Patient records, medical treatments, behavioral health, prescriptions, etc, are considered privileged information and are not to be disclosed to other members of the station outside of the Medical Department without the permission of all involved parties unless the disclosing physician has a reasonable expectation that disclosing the information will save the life of the patient.
   • For instance, inquiring publicly over communications channels if someone is alright (ex: noticing biometric data decreasing via sensors) is not a violation of the NDP.
   • Although Security requires a Warrant before they may procure otherwise privileged information, some relevant information may be freely disclosed. This includes, but is not limited to, the manner by which a patient was injured, or who delivered them to Medical. Medical practitioners are expected to use discretion and medical judgement when determining what information is relevant and what is privileged.
   • Sensor Locational data is considered privileged information by default, as disincentivizing their use will affect the health of the work environment writ large. The sensor locations of fugitives should not be distributed to Security without the presentation of a warrant. However, the question of Sensor Data is a significant grey area. If it may be demonstrated ex post facto that the disclosure of locational data was provided to Security for means other than the apprehension of the suspect, it may be waived. This is outlined further in the Warrants disambiguation below.
   • Gossiping in any form about patient health (physical or behavioral), records, or status is a violation of the NDP, and is considered a dismissible offense.
2. This NDP extends beyond Medbay to any other party privy to this information by design, including Security, Heads of Staff, the Colony Director, and Central Command.

Warrants

It is in the interests of the Medical Department to protect the privacy of their patients. However, it is also in the interest of the Medical Department to maintain a friendly and cooperative work environment with the Security Department. As such, the issuance of Warrants is an especially vital interaction to understand. Security may access a patient’s privileged information by presenting the Medical Department with a Warrant. The Medical Department may only disclose the information of the specific individual subjected to the Warrant.

Warrants that request details of conversations between a caregiver and patient are only enforceable when there is concrete, physical evidence linking this person to a crime, and then only if the requested information is demonstrably relevant to the crime or will demonstrably aid in the capture of fugitives. Warrants requesting this information should be held to the highest scrutiny possible.

In case of emergency, warrants may be issued ex post facto to legitimize divulged information - like a caregiver providing the sensor locational data of a known and public fugitive to Security. These warrants can be disputed still and, if found to be invalid, may be used to demonstrate that the caregiver broke Non-Disclosure Policy - unless they were demonstrably tricked, lied to, or otherwise coerced by third parties, (ie. Security convincing them that a nonviolent fugitive is an active, dangerous criminal, or if the caregiver is threatened with violence or legal penalty). In these cases, fear of life and freedom, or good faith, may exonerate the caregiver.

• Warrants may be disputed up the Chain of Command if a Practitioner reasonably believes the information demanded is unnecessary for the purposes of - or is outside of the bounds of - that Warrant.
• Disputes progress from Head of Security, to the Colony Director, to Central Command itself.
  • Internal Affairs Agents may assist in the process of determining if a warrant was valid and enforced correctly or not.
• Caregivers do not have to disclose information while a warrant is disputed and cannot be punished for not doing so. Corporate Regulations citing a failure to obey orders only apply after the warrant has been validated by the highest authority - Central Command. Delaying warrant enforcement out of spite, misplaced principle, or because of bias is obstruction of duty.
  • Disputes have to be made in good faith (ie. when it is believed the Security Department is overstepping its authority).

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

Right to Refuse Treatment

As a patient, to consent to or refuse treatment, you must have the capacity to make that decision. Capacity means the ability to use and understand information to make a decision.

Under the terms of the Sol Central Mental Capacity Act of 2550, all adults are presumed to have sufficient capacity to decide on their own medical treatment, unless there is significant evidence to suggest otherwise.

For consent to treatment or refusal of treatment to be valid, the decision must be voluntary and you must be appropriately informed:

• Voluntary: you must make your decision to consent to or refuse treatment alone, and your decision must not be due to pressure by healthcare professionals, friends or family.
• Appropriately informed: you must be given full information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn’t go ahead.

Doctors 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, which could cause the patient bleed out or go into shock or be harmed by moving during aforementioned surgery).

If you have capacity and make a voluntary and appropriately informed decision to refuse a treatment, your decision must be respected. This applies even if your decision would result in your death.

If you are 18 or older, have the capacity to make an advance decision about treatment and know that you have a condition that, in time, may affect your capacity to make decisions, or simply as part of your preparations for growing older, you can arrange an advance decision and have it included in your medical records. This is a decision to refuse particular medical treatments for a time in the future when you may be unable to make such a decision.

The treatments you are deciding to refuse must all be named in the advance decision and you need to be clear about all the circumstances in which you want to refuse this treatment. If the treatment is life-sustaining, your advance decision will need to be in writing, signed in the presence of a witness, and you must include a clear statement that the advance decision is to apply to the specific treatment, even if your life is at risk.

Provided your advance decision is valid and applicable to current circumstances, it has the same effect as a decision that is made by a person with capacity. This means that the healthcare professionals treating you cannot perform specific procedures or treatments against your wishes.

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 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 Colony 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.

Resleeving Policy Regarding DNRs

• Always 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 presence of these records implies they want to be revived.
• If they are missing one of the two records, consult their medical records for any indications that they are DNR, and then mind-scan the victim post-mortem if they are missing the mind record, or use a card-sleeve to consult with them if they are missing a body record, so you can ask how they want their new body to be designed.
• 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.

Paramedic Weapon Permits

It has been ruled that all relevant employees be issued weapon permits to allow for personal protection in the course of carrying out the duties assigned to NanoTrasen’s specialized departments. As such, weaponry and permits have been distributed to those departments affected by this provision. The ownership of a Paramedic weapon permit represents the employee’s entitlement to carry any weapon conducive to maintaining a safe environment when engaged in Hazardous Area recovery activities, or during transit to engage in such activities. The Paramedic weapon permit does not grant its bearer the right to bear or display arms inside a NanoTrasen facility, unless for the purposes of transportation to or from the Research or Security departments. Secure lockers have been provided for the express storage of these weapons. The on-station carrying of assigned melee weaponry, including but not limited to survival knives, outside of the Paramedic Triage Bay is equally unlawful. Failure to properly secure all weaponry within the relevant department may result in penalties, up to and including the revocation of this Departmental weapon permit or the revocation of Departmental certification for an unstated period of time. Under specific circumstances, namely the announcement of Codes: Red or Delta, the restrictions barring the carry or usage of assigned or recovered weaponry may be waived by an acting member of the on-site Command Staff. In the event that no Security crewmembers are available – either by incapacitation or other condition – these restrictions may also be lifted on Code: Yellow.

Transcore (data packet) for Medical evacuations

During the evacuation of the station, it is the CMO's duty to gather all medical information pertaining to personnel sleeves for the current work shift. Located inside their office should be a locker containing a "Transcore" Data packet which is to be inserted into the resleevers monitor for instant back up of this critical information. The CMO and other medical personnel are to guard this packet with their lives if need be, so that it can be transported off the station and given to the proper authorities!

((OOC NOTE: THIS SHOULD ONLY BE INTERACTED WITH IN CODE DELTA OR EVACUATION SCENARIOS. YOU RISK OUT OF CHARACTER PUNISHMENT OTHERWISE.))