Doctors and Hospitals

[Icosahedron]

I've been thinking for a while about Medics, skills and facilities. IMTU, I figure Level 1 is about first-aider/paramedic standard, Level 2 is about full nurse/trainee doctor standard, Level 3 is a qualified GP/surgeon, and Level 4+ is various levels of consultants of repute.
This may differ IYTU of course, but I'm more interested in the effects of hospital facilities.

Picture a Level 4 consultant surgeon treating someone at a roadside accident with only his LBB (little black bag) to help. How much of his skill could he actually apply? How would the patient's chances compare if he were treated by a paramedic at the roadside, or the surgeon in a fully equipped hospital? How good is the sick bay on a ship (I know this has been covered to some extent elsewhere) What happens if a TL15 surgeon finds himself using TL8 or TL2 facilities? Cryo revival depends on medic skill, but what about facilities? How do you compare revival from a capsule in a shipwreck to revival in a Starport hospital?
Thoughts, anyone?

 

[ravells]

I think it's one of those things I would just chuck modifiers at on the fly depending on the situation. I can see too many variations for it to be worth drawing up tables for.

 

[flykiller]

a lot of medical skill depends on the equipment available. if a skill level 4 medic is outfitted like a level 1, I'd say treat him like level 1, + 1 for extra knowledge. if the medic is in a situation very different from what he normally deals with, e.g. heart surgeon attempting to deal with a car wreck victim, then drop the +1.

 

[aramis]

Icosahedron: I have a similar idea of competence; due to using MT, I put level 5 as "Specialist of Note" rather than 4. 4 would be noted GP or Surgeon, or average specialist.

 

[Sifu Blackirish]

Icos...

I would treat this doctor situation just as you would a pilot with different TL equipment. Can't remember where I saw it, but basically you get increasing negative DMs as you move away from your base TL. Imagine a current electrical engineer either dealing with a Marconi-era radio or a TL-15 synaptic datanet...

Remember that short story by C. M. Kornbluth..."The Little Black Bag"?
Basically, people were so dumb in this future that the medical instruments operated themselves. Could (pre-Virus) TRAVELLER assume that level of sophistication? Might make a difference if you were empathic or had 'people' skills (think McCoy from Star Trek TOS), too.

One also has to consider the level of specialization. A psychiatrist might have a PhD but would you want him setting a broken leg? What would a neurologist know about performing an emergency appendectomy? Etc...

 

[Icosahedron]

Originally posted by Dominion Loyalty Officer:
Icos...

Can't remember where I saw it, but basically you get increasing negative DMs as you move away from your base TL. Imagine a current electrical engineer either dealing with a Marconi-era radio or a TL-15 synaptic datanet...

Yes, I use a house rule called Personal TL that works for all skills, but what I'm mostly stuggling with, I suppose, is rating hospital facilities and assigning DMs for them, from first aid kit up to Sector Capital Hospital.

 

[far-trader]

T20 has that, in the Technology and Equipment section (p211, 212, and 217) and the vehicle Sickbay (p243) and ship/craft Sickbay (278) as DC mods to treatment. Though it does all seem to me a bit disjointed. For MTU I break it down as:

</font><blockquote>code:</font><hr /><pre style="font-size:x-small; font-family: monospace;"> TL 1-3 4-6 7-9 10-12 13-15

Large Hospital +5 -0 -5 -10 -15

Small Hospital +10 +5 -0 -5 -10

Small Hospital includes MASH units and Ship/Craft Sickbay units.

Medical Kitbag +15 +10 -0 -2 -4

Medical Kitbag includes Vehicle Sickbay units and First Aid Kits.</pre>[/QUOTE]The breakdown of the various treatment facilites is cost and capacity. A large hospital is very expensive and can treat a large number of patients. A small hospital is expensive but limited in the number of patients it can treat. Medical Kitbags come in a variety of sizes and costs but are very limited in the number of patients they can treat before being exhausted, typically only one for a First Aid Kit, perhaps a few for a full Medical Kit, to possibly several for the Vehicle Sickbay.

 

[Black Globe Generator]

Nice work, far-trader, as usual - *YOINK!*

 

[far-trader]

You're welcome BGG

That'll be Cr8,650 for the checkup, please pay at reception

 

[far-trader]

Oh, and for CT you could just divide the DMs by 3 or so.

 

[Ken Barns]

Originally posted by Icosahedron:
Picture a Level 4 consultant surgeon treating someone at a roadside accident with only his LBB (little black bag) to help. How much of his skill could he actually apply?

Does he have an anaesthetist with him or not?

Working as the single emergency doctor in a small town, and having been "by the roadside" before, the best thing I can do is let the emergency service workers do their thing while I get back to the hospital to prepare the other staff and equipment. Ambos have their own gear and know how to use it - in most cases I'd just be getting in the way (assuming well-skilled ambos).

How would the patient's chances compare if he were treated by a paramedic at the roadside, or the surgeon in a fully equipped hospital?

They are two different points on the pathway of care - often with the emergency department in between. If there is no decent pre-hospital system of care, then the patient isn't going to survive until theatre; and if there is no surgeon then (assuming surgery is needed) things begin to look pretty dire as well.

How good is the sick bay on a ship (I know this has been covered to some extent elsewhere)

It depends upon the size of the ship. A 100-ton scout would have similar facilities to a small ocean-going yacht - maybe a first aid kit. A large liner would have the same facilities (or more) compared to a town of similar population.

What happens if a TL15 surgeon finds himself using TL8 or TL2 facilities?

The two big steps forward in surgery (both made at about the same time 150-ish years ago) were anaesthesia and antisepsis. I'm sure a TL15 surgeon could rig up adequate TL8 or TL2 antisepsis. I'm not sure I'd want him coming at me with only TL2 anaesthesia (ie. "Hold the patient down please nurse, and get him to bite on this bullet.") TL8 anaesthesia should be fine.

Much of this issue depends on the ease and safety of cryogenics/fast drug. If these bradymetabolic technologies are easy and safe, then most sick bays from TL10 upwards will consist of low berths - keep the patients safe until they can get to a place where they will receive the best possible care.

 

[aramis]

Originally posted by Dominion Loyalty Officer:
Icos...

I would treat this doctor situation just as you would a pilot with different TL equipment. Can't remember where I saw it, but basically you get increasing negative DMs as you move away from your base TL. Imagine a current electrical engineer either dealing with a Marconi-era radio or a TL-15 synaptic datanet...

MT (And, IIRC, TNE) use the tech stages, not the TL's directly. DM-1 per each, IIRC. (Either that or DiffMod of 1 level per tech band.)

I do use it.

 

[Icosahedron]

Thanks for the replies, guys, some useful food for thought here.

 

[Liam Devlin]

Originally posted by far-trader:
T20 has that, in the Technology and Equipment section (p211, 212, and 217) and the vehicle Sickbay (p243) and ship/craft Sickbay (278) as DC mods to treatment. Though it does all seem to me a bit disjointed. For MTU I break it down as:

</font><blockquote>code:</font><hr /><pre style="font-size:x-small; font-family: monospace;"> TL 1-3 4-6 7-9 10-12 13-15

Large Hospital +5 -0 -5 -10 -15

Small Hospital +10 +5 -0 -5 -10

Small Hospital includes MASH units and Ship/Craft Sickbay units.

Medical Kitbag +15 +10 -0 -2 -4

Medical Kitbag includes Vehicle Sickbay units and First Aid Kits.</pre>

The breakdown of the various treatment facilites is cost and capacity. A large hospital is very expensive and can treat a large number of patients. A small hospital is expensive but limited in the number of patients it can treat. Medical Kitbags come in a variety of sizes and costs but are very limited in the number of patients they can treat before being exhausted, typically only one for a First Aid Kit, perhaps a few for a full Medical Kit, to possibly several for the Vehicle Sickbay. [/quote]Great stuff again Far Trader!

Two suggestions:

How about a population modifier to this (Chances of finding the size facility(ies) on planet/ insystem listed above;

How about listing Clinics as well--they aren't small hospitals per se, but should be included as well.

Last note, for Icosahedron, the T20 technology page also lists the TL-13 autodoc & TL-14 autodoc devices. These make a starship's small med bay much more automated, & require a power source.

Lowberths, and emergency (4-person)lowberths for emergency trauma rooms also should be considered for mass casualty holding areas until a low populated world's medical folks can get to them, or better medical aide arrives.

For those with a lower tech flavor, heisting traveller medical equipment from the TNE Handbook
the automed (1 person)--requires medic's assistance, not fully automated (like Autodoc), and must be instructed what to do.

TL 10-11-adds +1 to T/Medical checks
TL 12-13-adds +2 " "/ " "
TL 14-15-adds +3 " "/ " "