[Proto-Traveller] Starship Design

[aramis]

McPerth;
There is a general trend here in the US civilian sector that is gradually transferring the routine care of patients to Nurse Practitioners and Physician's Assistants. In the US, CRNAs (Certified Registered Nurse Anesthetists) are now required by the national certifying agency to have a doctoral degree in anesthesia; in many respects CRNAs becoming certified over the next few years will have more education - and almost certainly more applied experience - than a newly graduated anesthesiologist.

Not just Nurse Practitioners...

In Alaska, for example, the following are all "physicians" for purposes of medical care:

• Medical Doctors (MD)
• Osteopathic Doctors (DO)
• Chiropractic Doctors (DC)
• Physicians' Assistants (PA), Surgical PAs (PA-S) and Clinical (PA-C)
• Advanced Nurse Practitioners (ANP) and Field Nurse Practitioners (FNP)

Of these, only DC's and some FNP's can't write prescriptions. But they have same authority to sign off-work slips, write referrals to specialists, and are governed by the State Medical Board the same as all the others. (Some FNP's have authority to write 'scripts; it's issued upon completion of the credits.)

PA's and Nurse Practitioners need an MD "supervising" them. He has to review their charts on a weekly basis, and may observe any patient at their discretion. (My primary care physician is a PA-C, supervised by an MD. Also iin the same practice are two ANP's and a part time DO.)

Dentists (DD, DDS) and Optometrists (OD) are allowed to write prescriptions, as well, but can only write off-work notes for items in specialty, and can't normally file Workman's Comp paperwork nor disability.

Aside from Nurse Practitioners, who may hold specialties (My neurologist is an ANP-Neurologist, for example) either by sitting the state boards or by national certification.

Plus, there are RNs with BS, MS, and PhD degrees, and LPN's with AAS and BS degrees. According to my RN friends, there's little that LPNs can't do that they do; the big difference is in autonomy. RN's have authority to issue drugs based upon standing orders, LPN's don't

Also, Certified Nurse Assistants fill the same role as military corpsmen. They have more training that the average E2 or E3 corpsman - it's a 12-18 month program (depending on ability to complete the credits and whether they take the 3 months off for the summer)

Phlebotomists and radiology technicians hold related certifications.

Non-certified orderlies also work in the hospitals... and sometimes interact with patients.

In Classic traveller terms, tho', Medical 3 is some form of physician. Could be a PA, FNP, ANP, MD, DO, or some other item...

But there should be a Medical 3, Dex 8 person per surgical bed, and probably should be a medical 2 or better doing anesthesia per two surgical beds. There should be a medical 1 per 5 beds, IMO. Let the specific specialties be specified in other ways...

 

[Mithras]

What would you advise? Let's say I push the number of staterooms to be split between patients and medical staff up to a maximum of 39 (with 5 others in use by the ship's non-medical crew)

Of those 39, what would the patient-staff split look like? 18 staff and 40 patients (all double occupancy)? What would they be?

As this is a small ship universe, I see it as a full hospital ship (albeit a small one), where the personnel recovers from light (and medium) wounds and illness (never forget the non combat related casualties).

As such, I'll even suggest to make a stateroom as OR and one as Post Suergery Recovery Unit . In real world they will both need more space that a room, but they don't need as much 'out room space', as the patient has another bed assigned even when there, and he/she will not move anyway when on them.

I'd convert most cargo space to more staterooms, both for inmates and personnel, even if you must add some staff, the ratio staff-inmate decreases as the hospital grows (as explained on the previous post)

 

[dean]

Family Nurse Practioners (FNP) can write non-narcotic scripts here in AZ. It all depends on what each state nursing board (and perhaps medical board) says about it.

I did not go into the depth you did because it seemed even more off-topic (starhip design).

Perhaps you should use your magic mod powers to split these medical posts off to a different thread?

 

[dean]

What would you advise? Let's say I push the number of staterooms to be split between patients and medical staff up to a maximum of 39 (with 5 others in use by the ship's non-medical crew)

Of those 39, what would the patient-staff split look like? 18 staff and 40 patients (all double occupancy)? What would they be?

Well, personally, I still think you nee to address the seriously wounded/basket cases issue and have a good chunk of low berths. In addition, while the rules require staterooms for and crew to have certain minimum accommodations, people who are sick or hurt don't do much outside their beds. An old-school "hospital ward" would probably be the most efficient thing to allow the staff access to the patients to provide care. There might be some small private rooms for officer casualties or patients requiring isolation. Along with necessary medical devices/equipment, each bed would not really need more than 1 dton each, in a ward layout. Add 2-4 dtons per 8-12 patients for the staff desk/station.

However, if you are thinking these folks might be staying weeks, until full recovery, then you would need additional facilities for rehabilitation and recreation, reconditioning and retraining. Say 10-20 dtons total.

If the ship receives acute cases, one or more surgical suites are needed, and a recovery area. I'd think 4-6 dtons per suite, and 4 dtons + 1 dton per patient capacity in recovery (staff station plus beds). You'd also want to allocate for a triage area; say 4 dtons plus one dton per patient space, probably big enough to serve 4-6 or 10% of the total beds, whichever is greater.

And, of course, you still need to allocate space to lavatories for the ambulatory cases, kitchens for food prep, and storage and supply spaces.

Insofar as staff is concerned, that would depend entirely on the number of patients you have designed the ship to serve.
Minimal staffing would be no less than 2 docs, one nurse for 10 patients per shift, one orderly/medic for 10 patients per shift, an imaging technician per shift, a pharmacist, and a couple non medical support staff.

If you take acute cases and have one or more surgical suite, then at least one surgeon (goes back and forth between two suites (one is used, gets prepped and the patient brought in while he works on another patient in the other suite), with 2-3 assistants for each surgeon (anesthesia, assistant (nurse) and support (could be nurse or tech)), at least one triage nurse or doc, at least one triage orderly (both of these depending on the size of the triage area).

If you have the idea that full recovery will be in the ship and it could be 2-4 weeks, then the rehab and reconditioning spaces mentioned above would need staff; typically one physical therapist can work with 4-6 patients at a time; they'd also have a PT assistant.

Add cooks, housekeepers/cleaning orderlies, and support staff (secretaries to handle the paper work, clerks to manage and reorder supplies) for flavor.

My .02 Cr.

 

[McPerth]

What would you advise? Let's say I push the number of staterooms to be split between patients and medical staff up to a maximum of 39 (with 5 others in use by the ship's non-medical crew)

Of those 39, what would the patient-staff split look like? 18 staff and 40 patients (all double occupancy)? What would they be?

You have 30 staterooms in your ship. Cargo space sould be converted to 30 more, but let's say 25 more starerooms an leave 20 dton cargo for spares, supplies, etc..

So we would have 55 staterooms.

From those, 5 should be for ship crew (engineers, as th only enlisted, taking double occupancy), so we're down to 50 staterooms.

Let's say one of them is OR, one as POIC, one as radilogy room and one as a small lab, so we have 46 staterooms.

We's need at least two surgeons (one trauma specialist, one generalist), one anesthesiologist, an internist, a radiologist (most patients would need it) and an ER/reanimation specialist, each with a single stateroom and one more single stateroom for pharmacist. Down to 39 rooms (78 places if double occupancy).

We need about 2-4 people (minimum) as 'service crew' (food is bad enough in hospitals as not to have a cooker or two), probaly 2-4 more for maintenance work (medical/surgical instruments are delicate) and a lab tech. Let's say 6 in total, 72 places left.

Let's say 4 nurses for OR/POIC, 68 places left.

2 person ambulance crew, down to 66 places

We need (minimum again, 8 hour shifts, no spare days for R&R) about 3 nurses per 15 inmates, so we must divide places left by 18, leaving us 3 groups 12 spares. I'd give those spares to 3 nurses and the rest inmates (lowering the ratio a little), so we'd need 12 nurses and 54 inmates. Working in 3 shifts we have 4 nursery units with 13-14 inmates each, for a 54 places hospital.

You'd see I don't put a ICU on this hospital. Any patient needing it should be frozen and waiting for the ship to arrive to friendly territory.

I'd also give the hardpoints sandcasters and train the service crew in its use just in case (although if some kind of Geneva Convention is in force, no offensive weapory should be allowed).

NOTE: every time in this post I say nurse, I meant anyone doing nursery work, regardless of its actual studies.

 

[McPerth]

Aramis:

In Spain, nurses have no specialization to talk about. A nurse specialization law was passes on late 80's (1987, IIRC), but was never implemented. As nurseing studies were changed lately (part of the Bologna plan all across the EU). another was pased a few years ago, but it is still implementing (or so they say) and, in truth, only midwifery is more or less an specialty (i'm not sure if it's a spacialty or a side career), but I don't think we must take this specialty into account in this case...

About anesthesiologists, they need to be doctors (6 years university) and then course a 5 year residency.

Also, only MDs may make prescriptions (this includ dentists, that are MDs in Spain), though the issue of prescribing nurses is arged (to no avail) since I ended my studies (back on 1988).

As you say, there's much role preservation back stabbing (of course disguised as seccuriry issues) in all this matter.

 

[Otto Harkaman]

I don't know why you don't have some medical robots to fix some of your staffing problems it is like the 300th century isn't it? Ling Standard Products is selling expert medical bots.

 

[McPerth]

Well, personally, I still think you nee to address the seriously wounded/basket cases issue and have a good chunk of low berths.

This ship must exist too, of course, but I see the one we're now discussing as a mobile hospital to try to keep loss of personnel and replacements at minimal, either when working in unfriendly space (and so unable to replace losses) or to keep unit cohesion, as told before.

In addition, while the rules require staterooms for and crew to have certain minimum accommodations, people who are sick or hurt don't do much outside their beds. An old-school "hospital ward" would probably be the most efficient thing to allow the staff access to the patients to provide care. There might be some small private rooms for officer casualties or patients requiring isolation. Along with necessary medical devices/equipment, each bed would not really need more than 1 dton each, in a ward layout. Add 2-4 dtons per 8-12 patients for the staff desk/station.

That's a good idea. if you need only (according to my former numbers) about a 3 nurses team (with small or shared staterooms) for 15 inmates, and each inmate just needs 1 dton, we can have one such unit every 24 dtons (giving 3 for station), instead of one unit per 36 dton as my numbers showed, so multipling the capacity by 1.5 (up to 81 inmates), as most doctor/support crew won't change too much.

However, if you are thinking these folks might be staying weeks, until full recovery, then you would need additional facilities for rehabilitation and recreation, reconditioning and retraining. Say 10-20 dtons total.

I assume this space was already given in the 4 dton per staterom, but if we apply what you said above, that may be in order.

Another possibility is to leave this to the ship they crew, and reahab being performed by the ship's medical staff, keepong the hospital ship for patients who really need to be hospitalized.

This last possibility could make the ship a little crowded for those inmates who could be sent 'home' (to their ships) in the middle of a jump...

If the ship receives acute cases, one or more surgical suites are needed, and a recovery area. I'd think 4-6 dtons per suite, and 4 dtons + 1 dton per patient capacity in recovery (staff station plus beds). You'd also want to allocate for a triage area; say 4 dtons plus one dton per patient space, probably big enough to serve 4-6 or 10% of the total beds, whichever is greater.

I assume triage and first aid is made on their 'home' ships by their medical staff. About surgical suites and recovery area, as they need less corridor/R&R/etc. space, I assumed the same tonnage (each) as a full stateroom that needs it (4 dton, with a 3 metter floor-to-floor height, means 18 square metters)

And, of course, you still need to allocate space to lavatories for the ambulatory cases, kitchens for food prep, and storage and supply spaces.

Again I assume they're featured in the 4 dton/stateroom

Insofar as staff is concerned, that would depend entirely on the number of patients you have designed the ship to serve.
Minimal staffing would be no less than 2 docs, one nurse for 10 patients per shift, one orderly/medic for 10 patients per shift, an imaging technician per shift, a pharmacist, and a couple non medical support staff.

If you take acute cases and have one or more surgical suite, then at least one surgeon (goes back and forth between two suites (one is used, gets prepped and the patient brought in while he works on another patient in the other suite), with 2-3 assistants for each surgeon (anesthesia, assistant (nurse) and support (could be nurse or tech)), at least one triage nurse or doc, at least one triage orderly (both of these depending on the size of the triage area).

Just 2 doctors for the full hospital may be not enough, due to lack of needed specialists (only 2 specializations).

About a surgen with more than one surgical suite, he will not endure it too much, I guess it won't be efficient (remember I assume most patients are already treated for first aid-stabilization on their ships)

Add cooks, housekeepers/cleaning orderlies, and support staff (secretaries to handle the paper work, clerks to manage and reorder supplies) for flavor.

Some of this work (cleaning, etc) might be done by robots, as most administrative work by computers (remember, TL is quite higher than ours).

EDIT:I also assume most of the ambulatory work is done by the medical personnel on other ships, so I don't care about it

 

[McPerth]

I don't know why you don't have some medical robots to fix some of your staffing problems it is like the 300th century isn't it? Ling Standard Products is selling expert medical bots.

I count on them, but the recovery hospital time, once you're conscient, is better spent with people than bots. I relly on them mostly for support roles (as said in the previous post).

 

[rancke]

I don't know why you don't have some medical robots to fix some of your staffing problems it is like the 300th century isn't it? Ling Standard Products is selling expert medical bots.

Or at least an Emergency Medical Hologram.


Hans

 

[aramis]

Aramis:

In Spain, nurses have no specialization to talk about. A nurse specialization law was passes on late 80's (1987, IIRC), but was never implemented. As nursery studies were changed lately (part of the Bologna plan all across the EU). another was pased a few years ago, but it is still implementing (or so they say) and, i ntruth, only mindwifery is more or less an specialty (i'm not sure if it's a spacialty or a side career), but I don't think we must take this specialty into account in this case...

About anestesiologists, they need to be doctors (6 years university) and then course a 5 year residency.

Also, only MDs may make prescriptions (this includ dentists, that are MDs in Spain), though the issue of prescribing nurses is arged (to no avail) since I ended my studies (back on 1988).

As you say, there's much role preservation back stabbing (of course disguised as seccuriry issues) in all this matter.

As an FYI, in normal american english, Nursery is the room where infants and toddlers are cared for and/or bedded. Nursing is the medical subfield.

Nursing one of those areas where Traveller absolutely lacks the granularity under CT, MT, and T4 to be of much use in modeling.

For a medical ship, the important numbers are overall staffing ratios for surgery and patients; I think we both agree 2:30 is about right for medical staff for patient care, counting orderlies and nurses (but ignoring housekeeping - that's ships' maintenance crew)

So the question is surgery... the local 7 bed surgical center has 0 doctors - doctors hire the center, not the center hiring them. It has 4 prep nurses, 3 recovery nurses, and as many medical techs & orderlies. If all ORs are full, each typically has an 1/2 anesthesiologist, and has an MD and either a DO or PA-S. Anesthesiologists typically work 2 rooms, sometimes bringing a nurse assistant. The

So each surgery is 5 staff per OR, only one of which must be med-3.

And that's about the high end, locally.


@Dean I'm not splitting it yet -

 

[McPerth]

As an FYI, in normal american english, Nursery is the room where infants and toddlers are cared for and/or bedded. Nursing is the medical subfield.

Fixed. TY for your correction (as you sure have guessed, english is not my native language).

Nursing one of those areas where Traveller absolutely lacks the granularity under CT, MT, and T4 to be of much use in modeling.

As the fact that medical 3 (2 in MGT) is a full MD is one of the few clear as to skill use in CT/MT, I've always assumed that medical 2 is a graded nurse and medical 1 is a corpsman, paramedic, nursing auxiliar. Needless to say, that has been my interpretation, far from canon.

EDIT: the problem with my assumption is when that same nurse/corpsman gains experience as to raise its skill, leading to what would be a legal matter in our RW, as his studies would not have changed, but his skill would give him another place... (I guess my medical skill would be at least 3 in any medical emergency, but I'm not a doctor, cannot prescribe and God helps anyone I had to operate even the simplest surgery, and I don't believe for lack of dexterity, but lack of skill). END EDIT

For a medical ship, the important numbers are overall staffing ratios for surgery and patients; I think we both agree 2:30 is about right for medical staff for patient care, counting orderlies and nurses (but ignoring housekeeping - that's ships' maintenance crew)

2:30 per shift, not as total ratio (remember the ship would be out of any help, nor can dend off time staff to home).

So the question is surgery... the local 7 bed surgical center has 0 doctors - doctors hire the center, not the center hiring them. It has 4 prep nurses, 3 recovery nurses, and as many medical techs & orderlies. If all ORs are full, each typically has an 1/2 anesthesiologist, and has an MD and either a DO or PA-S. Anesthesiologists typically work 2 rooms, sometimes bringing a nurse assistant. The

So each surgery is 5 staff per OR, only one of which must be med-3.

And that's about the high end, locally.

Most hospitals here have medical staff hired. Only in private medicine (minoritary) do doctors hire hospitals, instead of hospital hiring doctors.

I don't think (not sure) it would be legal in Spain to have the same anesthesiologist for 2 OR at once (except for emergencies, off course).

As told before, here the minimum staff for an OR (except very small surgery) includes 3 MD: surgeon, assistent and anesthesiologist.

Anyway those are quite often leagal matters, not real needs. I guess in Spain, where most of health is a public issue, costs are less priority, leading to higher ratios (and some times to wasting ressources).

 

[rancke]

As the fact that medical 3 (2 in MGT) is a full MD is one of the few clear as to skill use in CT/MT, I've always assumed that medical 2 is a graded nurse and medical 1 is a corpsman, paramedic, nursing auxiliar. Needless to say, that has been my interpretation, far from canon.

EDIT: the problem with my assumption is when that same nurse/corpsman gains experience as to raise its skill, leading to what would be a legal matter in our RW, as his studies would not have changed, but his skill would give him another place... (I guess my medical skill would be at least 3 in any medical emergency, but I'm not a doctor, cannot prescribe and God helps anyone I had to operate even the simplest surgery, and I don't believe for lack of dexterity, but lack of skill).

Having Medical-3 does not make you an MD. It corresponds to the (minimum) skill an MD is supposed to have. You can have a skill of 2 and still be an MD (through some sort of mistake or shenanigans) and you can have a skill of 3 (or more) and not be an MD.

Think of a highly skilled medical practitioner who emigrates to another country. If the medical authorities there don't recognize the institution that granted him his degree and refuse to give him a license to practice, he could end up as a corpsman with Medical-5. OTOH, the son of someone who paid for a new ward might get a degree and a license with a medical skill of 1.


Hans

 

[McPerth]

Having Medical-3 does not make you an MD. It corresponds to the (minimum) skill an MD is supposed to have. You can have a skill of 2 and still be an MD (through some sort of mistake or shenanigans) and you can have a skill of 3 (or more) and not be an MD.

Think of a highly skilled medical practitioner who emigrates to another country. If the medical authorities there don't recognize the institution that granted him his degree and refuse to give him a license to practice, he could end up as a corpsman with Medical-5. OTOH, the son of someone who paid for a new ward might get a degree and a license with a medical skill of 1.

While I agree with you:

CT:Bk1, page 20, under Medical skill:

Medical 3 is suficient for a character to be called doctor, and assumes a license to parctice medicine, including writing prescriptions, handling most ailmemnts, and dealing with othre doctors on a profesional level. A dexterity 8+ is required for a doctor to also be a surgeon.

 

[aramis]

Having Medical-3 does not make you an MD. It corresponds to the (minimum) skill an MD is supposed to have. You can have a skill of 2 and still be an MD (through some sort of mistake or shenanigans) and you can have a skill of 3 (or more) and not be an MD.

Think of a highly skilled medical practitioner who emigrates to another country. If the medical authorities there don't recognize the institution that granted him his degree and refuse to give him a license to practice, he could end up as a corpsman with Medical-5. OTOH, the son of someone who paid for a new ward might get a degree and a license with a medical skill of 1.


Hans

Under CT, yes, it does make one a Doctor.

Medical-3 is sufficient for a character to be called
doctor, and assumes a license to practice medicine, including
writing prescriptions, handling most ailments, and
dealing with other doctors on a professional level. A dexterity
of 8+ is required for a doctor to also be a surgeon.
(TTB, p.26, entry Medical [skill]:, ¶3)​

 

[rancke]

Under CT, yes, it does make one a Doctor.

Medical-3 is sufficient for a character to be called
doctor, and assumes a license to practice medicine, including
writing prescriptions, handling most ailments, and
dealing with other doctors on a professional level. A dexterity
of 8+ is required for a doctor to also be a surgeon.
(TTB, p.26, entry Medical [skill]:, ¶3)​

That's a simplistic interpretation and one based on the assumption that one paragraph is sufficient to cover everything there is to know about the practice of medicine on every world in the Imperium. That is not an assumption that I consider sound.

My interpretation is that assuming no complicating circumstances, Medical-3 is sufficient to pass the exams that lets a character be called doctor and get a license to practice. The rule assumes that a character with with Medical-3 has a title and a license. Not a bad assumption, but one that is unlikely to be correct in every single instance in the universe. I do not subscribe to the notion that the skill in itself magically confers title and permission to practice. I most certainly would not expect a Traveller editor to reject an NPC writeup of a character with Medical-3 who did not have a license to practice.


Hans

 

[dean]

All of the numbers I expressed in my post were rock-bottom absolute minimums.

American Casualty Clearing Stations in Korea and Viet Nam were staffed by one doctor and several corpsmen who worked as long as the casualties came in, or until they fell over from exhaustion.

The MASH units were better, and had more support staff (nurses) but the doctors were still primarily there to do quick-and-dirty surgery to get the patients stable for transport to clearing hospitals.

The Clearing Hospitals did additional surgery and stabilized the patients; casualties that would be able to return to combat within a week or so were kept there. Otherwise they were shipped behind the lines to larger base hospitals where they would convalesce for 2-4 weeks.

People who were more injured than that were either put on a hospital ship (Korea), or flown (Viet Nam) back to Guam, Hawaii, or the US. Most of these men would not likely be returning to combat, at least not anytime soon.

Today, soldiers hurt to any real degree in Iraq were in a large base hospital in country within 6-8 hours. Most seriously wounded were in Ramstein in less than 24.

However, the 1 week jump time of Traveller makes these comparisons difficult at best.

Now, ObTrav:

However, in my opinion, so long as there is a friendly base within one jump, it makes more sense that any casualty that cannot be immediately patched up and returned to duty would be cold berthed and taken to that base for treatment and recovery.

A hospital ship would not normally be deep in enemy territory, and I think that a much more efficient ship would be one that brings replacements in in cold sleep, and takes the casualties out in cold sleep. The logistics of getting wounded to a hospital ship would be complex, and anyone that could not be returned to duty inside the two-week jump window is better served to be placed in cold berth after being stabilized, and get the proper attention at a facility where all the specialty services are available and the patient will be fully returned to active service.

To me, the above scenario makes even more sense when talking a small ship universe. In a big ship 'verse, the biggest ships would have their own hospitals right on board, like today's aircraft carriers do, and they would also receive the worst of the casualties from the smaller ships of the fleet.

An unarmed J3 with half the cargo space devoted to low berths for replacements outbound, and wounded inbound, sounds a lot more efficient to me than a dedicated hospital ship.

 

[McPerth]

All of the numbers I expressed in my post were rock-bottom absolute minimums.

American Casualty Clearing Stations in Korea and Viet Nam were staffed by one doctor and several corpsmen who worked as long as the casualties came in, or until they fell over from exhaustion.

The MASH units were better, and had more support staff (nurses) but the doctors were still primarily there to do quick-and-dirty surgery to get the patients stable for transport to clearing hospitals.

The Clearing Hospitals did additional surgery and stabilized the patients; casualties that would be able to return to combat within a week or so were kept there. Otherwise they were shipped behind the lines to larger base hospitals where they would convalesce for 2-4 weeks.

People who were more injured than that were either put on a hospital ship (Korea), or flown (Viet Nam) back to Guam, Hawaii, or the US. Most of these men would not likely be returning to combat, at least not anytime soon.

Today, soldiers hurt to any real degree in Iraq were in a large base hospital in country within 6-8 hours. Most seriously wounded were in Ramstein in less than 24.

However, the 1 week jump time of Traveller makes these comparisons difficult at best.

Now, ObTrav:

However, in my opinion, so long as there is a friendly base within one jump, it makes more sense that any casualty that cannot be immediately patched up and returned to duty would be cold berthed and taken to that base for treatment and recovery.

Sure time comparisons are difficult at best, but the rest of this entry is quite interesting. I gues one of the points we disagree is which place in the scale you talk about sould those hospital ships take, and that may be a matter of doctrine more than just a matter of capability.

Personally I see those ships as somwhere between the MASH and the Clearing Hospitals. Even if you're just one jump away from home, the time added to any hospitalization taken to rearguard is raised by more than 2 weeks (go and return), and jump time doesn't count as healing time in this case, while if inmated in the hospital ship it will. I'd keep the patients with les than 4 weeks foreseen stay at the hospital ship, and only send rearguard those that more time is predicted (and most non combat casualities that cannot be treated on their ships).

A hospital ship would not normally be deep in enemy territory, and I think that a much more efficient ship would be one that brings replacements in in cold sleep, and takes the casualties out in cold sleep. The logistics of getting wounded to a hospital ship would be complex, and anyone that could not be returned to duty inside the two-week jump window is better served to be placed in cold berth after being stabilized, and get the proper attention at a facility where all the specialty services are available and the patient will be fully returned to active service.

To me, the above scenario makes even more sense when talking a small ship universe. In a big ship 'verse, the biggest ships would have their own hospitals right on board, like today's aircraft carriers do, and they would also receive the worst of the casualties from the smaller ships of the fleet.

I fully disagree at this point. Precisely the fact that is a small ship universe (and so no hopitals on tenders) makes those ships necessary, and if you don't take some of them in your thrust on enemy territory (along with supply ships, and so on), you're leaving your offensive forces without medical support, taking every wounded (even if lightly, but in need of surgery) out of commision for all the campaign.

In a big ship universe, as you say, the Tenders (if BR/BT combo is used) or BBs act as mobile bases, having full hospital, repair shops, etc and probably you don't even need a hospital ship.

An unarmed J3 with half the cargo space devoted to low berths for replacements outbound, and wounded inbound, sounds a lot more efficient to me than a dedicated hospital ship.

As I said before, I also see the need of such a ship, just I believe they cover different niches. As I said above, probably a matter of doctrine.

 

[aramis]

Types of Medical Ships...
The needs of a medical ship are dependent upon what the medical ship does.

There should be casualty transport ships. A couple OR's, a dozen beds for those not able to be safely frozen but likely to be revivable, and a whole lot of low berths.

A local-support-in-crisis ship (of limited use, save for epidemics) would be several OR's, recovery beds, and a bunch of small staterooms for short duration.

Traveling Frontier Circuit Medical Center: 2-3 OR's, disease lab, and 2-3 exam rooms, and a disease lab and radiology lab.

Ship-mounted MASH units... for marine ops, mostly, but probably also capable of being part of the support/auxiliary ships...

How to build them into ships

OR's should be labs, and should be about the size of a stateroom; we have stats for labs from the CT errata... 0.2 per ton. An OR should be about the same size as a stateroom. MGT states that it's 4Td per researcher for labs.

So, if we presume an OR needs a crew of 3 (I'd argue 2.5, but I'll use McPerths' three... that makes the OR 12 Td. If we include Preop in that, and scrub station, I think it's about right, or just a hair big.

We should treat ICU and Post-op as labs as well. I'd say 2 Td per patient, and if we take 2 nurses per 5 patients as a minimum, that's a good 8Td per 5 patients; 3 nurses per 5 gives us 12 Td... so, 2td station + 2td per bed, maximum 5 beds per station. For a full-up meatball, with 12 hours per patient in post-op, and freeze if not able to go to a stateroom, we need 12 per OR.

Wards- a ward bed should be half a stateroom, plus a 4 Td "Lab" Station for each 12 such rooms? (this gives 2 nurses per 48 patients - low, but not uncommon in military field hospitals in Korea and Nam... as the OR staff pulled the extra shifts to help keep numbers manageable.)

We need an imaging lab. One tech, 30 minutes per scan, thus supporting 2 OR's per 4Td. Let's pretend, for now, that it's an "advanced imager" combining multiple types of scanner into an imager unit of 2Td and a 1 td workstation, plus 1 td of access space and such...

For the following, presume the following
Surgeon = Medical 3 Dex 8
Doctor = Medical 3, dex may be under 8
Nurse = medical 2
Medic = Medical 1
Orderly = Medical 0

So, for our meatball unit... a MASH in a hull

6x OR: 72 Td MCr14.4 - 6 Surgeons, 6 doctors, 6 nurses
Post-Op/ICU 75 beds (12 per surgery, rounding up to a multiple of 5) = 15x12=180 Td, MCr36, 30 nurses, 15 medics
Wards: 96 beds (48 SR, 184Td, MCr24), 2 stations (8Td, MCr1.6), 2 Nurses. 4 medics for full staffing.
Imaging Labs x3: 12 Td, MCr2.4, 3x Techs
Drug Synthesis: 4Td, MCr0.8, 1x Chemist

Total Tonnage 352Td
Total Cost: MCr79.2
Staffing
• Surgeons x6
• Doctors x6
• Nurses x38
• Medics x21
• Imaging Techs x3
• Chemist x1
Meaning another 75 staterooms (300 Td, MCr 37.5)
For a grand total of 652Td, MCr116.7

Plus, add some G-Carriers for ambulances, plus their crews... total 24 Td and MCr3.5 per ambulance...

The GCarriers at 8Td, MCr1 each. 4 patients each, plus driver, a pair of orderlies, and 2 medics. This uses the metric of 1 person under medical care takes 2x the space of a passenger.
5 SR for each; 20Td plus MCr2.5 per ambulance.​

If we want to be able to grab half an OR shift per unit-sortie... 6x6=36 meaning 9 ambulances... 216 Td, MCr31.5, 9 drivers, 18 orderlies, 18 medics.

So combining it, 868Td, MCr148.2 for the MASH...

Then add 100 Td of low berths... 200 of them, MCr100. I think there are enough nurses aboard already, but just for good measure, 4 more nurses (1 per 50) for 16Td and a MCr2 more.

Plus 16 Td supplies.
Bringing it to 1000Td, MCr250.2

 

[far-trader]

Not to throw a huge multispanner into the medical discussion but I'm not sure I see a salient point being addressed. Touched on maybe, especially in aramis' latest just above. This might be part of the difference of opinion in a couple posts, and partly overlooked.

Different paradigms will mean different levels of staffing/crewing. Perhaps very different, even in some types of personnel.

Military will be the shortest staffed, with many functions covered by 'conscripted' crew. See above for notes on corpsmen and such.

Civilian will have the widest variety of both type and numbers, even of quality. Everything from philanthropic units ala Doctors Without Borders to posh luxury hospitals for the rich. Starships of course, the first going where needed, the second providing a combination cruise and specialty treatments.

Just a thought