MEDICAL OFFICERS GUIDE
Commander William Patton
Chief Medical Officer
This document is intended to give the player basic information to fill a medical position in our Star Trek sim. Whether the player is Chief Medical Officer, Medical Officer, Nurse, or Counselor a certain amount of medical knowledge is necessary to properly 'play the part'. I will attempt to give a brief overview of the Medical Officer's duties, his role aboard a starship, and resources available to assist the player.
Much of the information regarding diseases, equipment, procedures, and physiology are not unique to this document. The information is readily available on various web sites and in the 'Star Trek Encyclopedia'. I have used all of these as resources in preparing this document. No copyright infringement is intended. I believe that use of this information constitutes fair use. If the holders of these copyrights disagree, please contact me at firstname.lastname@example.org and I will remove the questionable material.
The Holoworld Fleet, Cocoon Fleet and myself are not associated with Paramount Pictures or VIACOM in any way. No copyright infringement is intended. Star Trek, Star Fleet, and the Star Fleet Logo are copyrighted by Paramount Pictures, a VIACOM company.
II. MEDICAL DEPARTMENT ORGANIZATION
The size of the Medical Department, both physically and in personnel, depends upon its location. A Starbase, Space Station, or Colony will have larger facilities, more personnel, and more resources available. Larger starships will likewise have larger Medical Departments than smaller vessels. For the present, I will deal with the medical facilities aboard a typical starship.
The Sickbay is generally located in a protected area of the ship. Only the Battle-Bridge is probably better protected. The Sickbay is capable of continued life support function for a period of time should it become isolated from the ship's systems. The Sickbay usually consists of a out-patient care area, surgery suites, intensive care and isolation wards, physical therapy areas, variable environment treatment areas for treatment of aliens requiring special environments, a biohazard containment area, laboratories and diagnostic areas, a dental facility, a Counseling area, medical offices, and a nursery. The actual facilities present depends a great deal on the size of the ship.
All other areas of the ship - shuttle and cargo bays, holodecks, mess halls, guest and crew quarters can be quickly converted into triage/trauma centers in the event of an emergency.
The Chief Medical Officer (CMO) oversees the Medical Department and its staff. He or She is responsible for all administrative details of the department. He or she ensures that the department meets its mission requirements and is ready to handle any medical situation that arises. He is responsible for the safety of any food, biological substances, and alien visitors brought aboard. He is responsible for the physical and mental health of the crew. Periodically he will perform routine physical exams on all crew members. The Chief Medical Officer, or a Medical Officer designated by him, will accompany all Away Teams to provide emergency medical treatment.
In addition the Chief Medical Officer can remove anyone, even the Commanding Officer, from active duty status. Removing the Commanding Officer from active duty because of medical reasons is not a step to be taken lightly. If this is done, be prepared to back up your actions at the subsequent formal hearing and be prepared to face the consequences if it is found you acted in undue haste.
The Assistant Chief Medical Officer (asstCMO) fills the same slot that the Executive Officer does in relation to the Commanding Officer. He or She works with the CMO to ensure the Medical Department is performing at a high level of efficiency. He or She fills in for the CMO when the CMO is absent.
The Chief Nurse/Chief Medic (male or female) is the right arm of the CMO. He or She is responsible for direct patient care on an hour-to-hour basis. Any patients in Sickbay will see much more of the nurses that they will of the doctors. A good Chief Nurse will readily agree that he or she really runs the Medical Department. A nurse or medic can perform most medical procedures except surgery and other complicated treatments. Before she does so, however, he should obtain an order from the CMO or asstCMO to do so.
Further medical assistance is available through use of the Emergency Medical Hologram (EMH). The EMH is a holographic representation of a physician. It is fully functional and capable of performing all medical diagnostic and treatment procedures present in the Star Fleet Medical Database.
The Medical Department will also include a varying number of physicians, nurses/medics, technologists, physiotherapists, etc. Who and how many will depend on the size of the ship and the imagination of the CMO player.
III. DIAGNOSIS AND TREATMENT
Here is where the imagination of the CMO player comes into its own. There are many diseases listed in the Star Trek canon (see below), but you can come up with medical problems on your own. Toss in a little technobabble, diagnose a problem, search for a treatment. But you have to know a little bit about what you're doing or you will dig yourself a deep, deep hole.
For instance, don't diagnosis Denebian Encephalitis (a brain infection) and then proceed to treat it by amputation of the leg. You have to know some anatomy; where the spleen is and what it does, what's the clavicle, does you patient use iron or copper in his hemoglobin, what is hemoglobin and what does it do. Such basic knowledge can be obtained from almost any high school biology book, encyclopedia, from searching on the web, etc. You don't have to get very detailed, just enough so you sound like you know what you're talking about.
EMERGENCY SITUATIONS: In an emergency situation, where the patient is unconscious and unresponsive, there is a set procedure to follow that will make you look knowledgeable. It's as simple as A-B-C. When first arriving to evaluate the patient, after determining that the patient is indeed unresponsive, use the following sequence:
A - Airway: Is the patient's airway open and free of obstruction? If not free the airway from any obstruction.
B - Breathing. Is the patient breathing on his own. Listen for air flow at nostrils and mouth. Is the chest rising and falling as he breathes? If the patient is not breathing then administer five quick breaths, mouth-to-mouth or with a respiratory stimulating device (this is Star Trek after all, they have a machine for almost everything).
C - Cardiac. What is the patient's cardiac status? Can you feel a pulse or heart beat? Is the skin its normal color or is it pale or cyanotic (indicating low blood flow or low oxygen level)? Is the skin cool and sweaty (indicating shock and low blood flow)? If the cardiac function is absent or depressed immediately begin the old-fashioned -- in the 24th Century -- chest compressions or apply a cardiac stimulator and administer drugs to stimulate the patient's system.
IV. SOME THOUGHTS ON STAR TREK MEDICINE:
The Star Trek universe has many wonderful scientific and technological advances, when compared to the Twentieth Century. FTL travel, Photon and Energy weapons, Replicators, and Matter Transporters to name just a few. The stories involved in the series (STOS, STNG, ST- DS9, ST-Voyager) all make use of these advances and in some cases carry the advances to a logical conclusion. However, it as always seemed to me that there is one area where the advances in one area were not carried to their logical use in another field. The field of medicine and medical therapy seems to me to have been vastly under-rated. Advances in other fields do not seem to have a logical concurrent advance in medicine.
Teleportation via the Transporter Beam & Replicator Technology: How does it work? (Really it does not) They never do tell us on the series, except to say that it breaks down the body's structure and re-assembles it at the receiving point. You step on the transporter pad, your body in destroyed, information is recorded and broadcast to the receiving point where it is reassembled. It is still the same "you" after this process is complete. The same you in mind, memory, and body.
How does this work? I have no idea. But a few fundamental steps should be self-evident
in the process. During destruction, the body's "information" would
have to be recorded down to the molecular level; perhaps down to the sub-atomic
level (in the range of mesons and quarks in all their flavors and strangeness).
During reconstruction, this information must be exactly duplicated. It would
not do to reassemble, say, the heart in the lower abdomen or a neural junction
of the feel of a baseball in the area of the brain which usually deals with smell. The process has to be very, very exact.
Dr. McCoy seems to make use of the technology at times, i.e. During Star Trek-The Voyage Home when he uses a small medical instrument to repair the ruptured cerebral artery inside Chekov's head. Is this an example of use of Teleportation and Replicator technology? It is never explicitly stated as such, but I think so. I postulate that this repair was accomplished through use of the replicator to make a new section of the artery and use of the transporter technology to "beam" it to the correct section of the artery, while beaming out the damaged area. Carrying this process further it is evident that any injury can be so treated. Third degree burns treated with replicated skin replacing the burned areas, internal injuries treated by beaming out the damage area and beaming in a replicated new organ, etc. Even the brain could be replaced as long as the body could be kept alive. This would entail a routine biological-transporter scan of each crew member updated at regular intervals. Such a process could be used to "bring the dead back to life", as the STNG crew did for Captain Picard during one episode.
Why is this technology not more widely used in the Star Trek Universe? Perhaps the writers did not think of it. Perhaps it was just too dull to show during the series production runs. Perhaps there are legal prohibitions against such use. One legal prohibition that comes to mind immediately would prohibit duplicate-selves existing at the same time. Another would to prohibit replicating the dead.
Just some ideas to put out there for general thought and consideration of use. It could open new avenues of adventure or add enormous complications to the game. I am sure that other players can conceive of other logical extensions of Star Trek technology, that would have a surprising impact on the gaming process. Some uses would enhance the game, others would simply make the game too easy.
V. PLAYING THE PART
The first and most important bit of advice I can give the prospective CMO is to get out of Sickbay! You're a doctor, but don't spend all your time working. Give your character some character. What does he do off duty? What does he do to unwind from the stress? Give the character some quirk or problem. Conflict always makes the character more interesting to write and to read.
You should develop a good supporting cast of NPCs (non-player characters) in the Medical Department to interact with your character. This will solidify the Medical Departments supporting staff and give the other players in the game someone else to call on for help.
How do you want to play your character, the Chief Medical Officer? Like the kindly family physician that everyone wishes was taking care of his family (also know as the Marcus Welby Syndrome for those of you in the USA and of a certain generation). Or like a prima-donna surgeon, who is always right and will brook no interference with his medical opinion. Or somewhere in between. It is totally up to you.
The CMO is usually thought of as the 'moral focus of the ship'. He usually
the one who speaks for life in all its diversity. A good CMO is openly accessible
to any of the crew, no matter their problem. He or she does not pass moral judgements
on his patient's beliefs or lifestyles. Losing a patient, no matter the circumstance,
heart-rendering experience to him. A good CMO is the confidant of the Senior Officers, especially the Commanding Officer.
VI. Medical Terms
MEDICAL TERMS: Every Profession has its own language. Medicine is no different. Below are some terms that will help you sound like you know what you are doing.
ABG: Arterial Blood Gases; blood is measured for O2 content; indications: asthma, COPD, chest trauma
Adenosine: Stabilize heart rhythm; for heart arrhythmia
Altered LOC: Altered Level Of Consciousness, possibly from concussion or internal brain hemorrhage
Altered Mental State: Mental disorientation, such as in a drug overdose
Anterior: The forward plane of the body
Apgar Scores: Taken at one minute and five minutes of life, reflect the general status of a newborn, including how well the baby is moving and breathing and other parameters. Perfect score is 10; many healthy babies score 9.
Atropine: A drug used to speed up heart rate, or to treat cardiac arrest
Bilateral Tib-Fib Fractures: Broken tibia and fibula on both legs
Bleeding Out: Very severe hemorrhaging, could be fatal
Blood Culture: Blood is drawn and cultured for bacteria; indications high fever
Blood Gas: Blood sample from artery used to compute the blood level of O2, CO2, and pH
Blown Pupil: Abnormal pupil dilation; dilation following a blow to the head could mean increased intracranial pressure, usually caused by brain hemorrhage
BOA: Birth Out of Asepsis (non-sterile conditions)
Cardiac Enzymes: Enzymes released by damaged heart muscles
CBC: Complete Blood Count
CC: Chief Complaint
cc: cubic centimeters, a liquid unit of measurement equal to one milliliter
Chem 7:;Measures basic electrolytes in blood: Na, Cl, K, CO2, blood urea N2 (BUN), creatinine, and glucose
CHF: Congestive Heart Failure
Coag Panel: Assess blood coagulation
COPD: Chronic Obstructive Pulmonary Disease
Crack the Chest: Make a foot-long incision between two ribs on the left side to gain access to the heart, used in emergency conditions only
Crash Cart: Medical supply cart for cardiac and respiratory arrest
CSF: Cerebrospinal Fluid
D 50: 50% Dextrose (for low blood sugar); one ampule via IV
Decubitus Ulcer: A bedsore, an open sore caused by pressure and lack of circulation, malnutrition may contribute to these ulcers associated with immobility
Diaphoresis: Sweaty skin associated with myocaridal infarction
Dopamine: Makes heart pump strongly
Epinephrine: Drug to treat cardiac arrest
Failure to progress: Baby is not dropping or the woman's cervix is not dilating; depending on the stage of labor, do C-section or administer Pitocin
FUO: Fever of undetermined origin
Hematocrit ("Crit"): Measure number of RBC; decrease means hemorrhage or anemia
in extremis: at the point of death
IV Push (intravenous push): Put in drug directly into IV all at once
Large-bore IV: to transfuse fluids very quickly
Lavage: Washing out
LGFD: Looks Good From Doorway (patient who complains but looks fine)
MI: Myocardial Infarction
MUDPILES: Mnemonic device for anion gap (Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Iron, Lactic acidosis, Ethanol, Salicylate starvation)..an anion gap will indicate one of of these conditions.
Narcan: Antidote for heroin and other narcotics; 0.8 mg via IV
Normal Saline: Saline solution that has the same balance as fluids in the body -- the first type of fluid administered intravenously (IV) in emergencies
NPO: nil per os, "nothing by mouth" ("Put this patient NPO.")
Perf: Perforate; to burst
PERTL: Pupils equally responsive to light...a neurologic test
Pitocin: Hormone given intravenously to stimulate uterine contractions
Platelets: Blood factors that cause clotting
Pneumothorax: Collapsed lung
Posterior: The rear plane of the body
Pressure: Blood pressures at arteries, veins, and within the chambers
PROM: Premature Rupture Of Membranes (water broke too early and the
unborn baby is at risk for infection)
PW: Phaser wound
Ruptured Aortic Aneurism: Ruptured main artery
Send Him Redline: Send him directly and urgently
Sinus Rhythm: Normal heartbeat
STD: Sexually transmitted disease
Tachycardia: Fast heart rate; normal heart rate is 60-100 beats per minute
Tension Pneumothorax: Collapsed lung where air escapes into chest; increases pressure on heart
Throat Culture: Test for Streptococcus
Tox Screen: Drug Test
TPR Temperature/pulse/respiration, the basic diagnostic values for most carbon-based life forms
Type and Cross: Draw blood, type it match with same type for transfusion
V-Tach: Heart Rate abnormally high
Vitamin H: Haldol, a very powerful sedating agent for combative people
WADAO: Weak And Dizzy All Over
Walking Time Bomb: Someone with a disease that cold be fatal any minute
White Coun/WBC: increased count usually indicates infection
WNL: Within Normal Limits
VII. Medical Equipment, Procedures, Medications, Diseases
Much of the information I would like to impart here is available from many sources, many of them copyrighted. Therefore I will content myself with listing a few sources (books, web sites, etc) and leave it up to the reader to search them. After all a good Doc does his own research and workup.
Books: (a search at http://www.amazon.com will yield a price and purchase information)
"The Star Trek Encyclopedia", Michael Okuda and Densie Okuda, Pocket Books, 1999.
"Star Trek: The Next Generation, Technical Manual", Rick Sternbach and Michael Okuda, Pocket Books, 1991.
"Star Trek Role Playing Game: Player's Guide", Matthew Colville, et al; Decipher Inc., 2002.
"Star Trek Role Playing Game: Narrator's Guide", Matthew Colville, et al; Decipher Inc, 2002
http://www.startrek.com/library/medical.asp - This is the medical information page of the Official' Star Trek site.
http://www.ditl.org - This is the Daystrom Institute Technical Library web site. The information here is much better organized that the offical' site, easier to find, and much more detailed. And they've got some great pics, too.
Copyright 2002, Holoworld Fleet (http://www.geocities.com/holoworldfleet) and Don Ratliff (email@example.com)