Medical Officer Simming Guide
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From Leonard H. "Bones" McCoy, to Beverly Crusher, Katherine Pulaski, Julian Bashir, Voyager's EMH "The Doctor," and Phlox, the Chief Medical Officer is a well-respected and well-represented member of the Star Trek starship crew. In McCoy's and Crusher's cases, to mention only the first two, the CMO has been not only the chief of medical operations on the ship, but also one of the Captain's closest, most important and most influential advisors. Of course, we can't all be CMOs, but even those of us just starting out in medical - or those of us playing ACMOs - would seem to have big shoes to fill.
Medical does not have a bridge station, and likely never will, and as such some creativity is required when trying to work with the rest of the ship and crew. Sickbay is, for medical reasons, usually on its own deck, and is usually isolated from the other departments on the ship. The CMO typically has an office in sickbay, and the turbolifts typically stop just outside sickbay (or else patients are transported directly to a biobed therein). This does not leave much room for interaction with other characters of the "on-my-way-to-the-office" variety. Not everyone bumps their head or gets a plasma burn, and so the medical officer may find her- or himself SIMming alone, at least while the officer is on duty.
Doctors who serve in Starfleet are generally referred to by their title of "doctor" instead of "sir" or their rank.
Before the Mission
The potential for this isolation to lead to the boredom (and total isolation) of the medical officers, however, is easily turned into a strength - especially just before a new mission, when the CMO and whatever other medical officers there might be must ready a rather large and relatively important section of the ship for launch. Some of these are general: Are the ship's medical stores fully stocked? You don't want to have to replicate everything while on the mission, after all, as time is of the essence in most medical emergencies. Have all new officers and crewmembers received their obligatory physical examinations? Has the Captain had a physical any time in the past year? Is the medical staff (doctors, nurses, and medics - something like EMTs) knowledgeable of the technologies being used in your ship's sickbay? Have there been recent refits that would improve or extend sickbay's technological capabilities? These are the sorts of questions that the CMO, at least, will have to answer before the mission begins and the ship launches.
But there are other, mission-specific questions to answer, too. Where is the ship going? With what species will you be interacting? Are there diseases or injuries you can prefigure before the mission begins -- a special virus that only affects Cardassians, when you are traveling into Cardassian space, for example? Thinking about these things before the mission starts is a great way of getting the medical department involved in the plotline well before away teams are formed and phasers are drawn. Also, if continuing on the same ship, are there any crewmembers who were injured or ill on the last mission? How are they now? Will their previous illness/injury have any effect on their performance in this new mission? Here, the medical officer can help to bring some continuity to the ship's plotline from mission to mission, and can interact with other members of the crew before anything more directly mission-related starts happening.
During the Mission
Once the mission gets underway, the medical officer is bound to work with the plot, just like everyone else. The medical officer's primary duty is to preserve the health of the crew. If someone falls ill, they go to sickbay to be made well. If someone gets injured, they go to sickbay to be made whole again. Away teams typically include one medical officer, either the CMO or a more junior officer, depending upon the away team's purpose and needs. But whether in sickbay, on an alien ship, or the planet surface, this is where the medical officer really gets to shine. No one else on the ship can do what the medical officer can do. Anyone can wrestle with a Klingon. But, once the first heart has stopped, only the medical officer can get the Klingon's second heart pumping pink blood through the Klingon again.
The standard tool for diagnosis is the medical tricorder, and the medical officer should almost always SIM her- or himself with one in her or his hand. The tricorder cannot do everything, however, and it does not grant omniscience to the doctor who wields it. Sometimes, the doctor is not going to know what is wrong with the patient, and this is, I think, one of the best sources for creativity in the medical officer's posts. Is it something new? Or something old, and well-known? Are medical resources and facilities limited, as on an away mission? Or will the medical officer have all the benefits of twenty-fourth century medical technology in treating the patient?
Of course, sometimes there is not time for an extended examination. Emergencies are common in Starfleet, and when they occur, and people are hurt and in danger of dying, the medical department becomes the center of the ship's activity. I try in these instances to instill some urgency into my posts, clipping dialogue very short, and trying to avoid lengthy descriptions between words or actions. Fast-paced medical posts can be as dramatic, as exciting, and as fun to write as anything else that goes on in a SIM. In any event, one might rely to a greater or lesser extent on canon Star Trek medical technologies and drugs. It depends entirely upon the situation and the medical officer's discretion. A mix of canon and creativity seems to me to be characteristic of the SIM as a whole, and thus probably ought to be characteristic of the medical officer's posts, as well.
After the Misison
Aside from filing reports, continuing medical treatments and therapies, and so on, the medical officer has a wide range of activities or duties she or he can pursue between missions, or in the down-time that comes with many missions. Is there a new article in the Journal of the Starfleet Medical Academy that demands reading? Have new discoveries been made, or new technologies developed, with which the medical officer would like to become familiar? Or, perhaps more interesting to those with OOC interests in science or medicine, is the medical officer engaged in any independent, scholarly or clinical research? Are there experiments to conduct in the medical or science labs? Articles to write for scholarly publications? Working through these kinds of things IC can be a bit tiresome if done poorly, leaving the rest of the crew with posts that read more like textbooks than Star Trek, but, if done well, I think it is important to give the medical officer a career that extends beyond the routine treatment of patients and emergency medical services. Often, these kinds of off-duty or off-mission activities can be incorporated nicely into the next mission.
In addition to everything already said, which applies to all medical officers, there are of course duties specific to the Chief Medical Officer aboard any starship. Chief among these is insuring that all of the above mentioned responsibilities are fulfilled, whether by the CMO her- or himself, other PC medical officers, or NPC nurses, medics, and doctors of the CMO's invention. From her or his office, the CMO organizes the operations of sickbay. Without that organization, sickbay is infinitely less effective than it might otherwise be, and so the administrative side of the CMO's task should not be overlooked IC.
Additionally, as the ranking medical officer, the CMO is ultimately responsible for all treatments and therapies conducted in sickbay. As such, the CMO should observe and supervise in the treatments she or he assigns to lower-ranking doctors, and comment or criticize when appropriate. That said, a CMO who fails to give the other medical officers on the ship any leeway with which to explore possible new treatments or research strange new diseases is not much of a leader, and, in addition to being an administrator, the CMO is nothing if not a leader. One way of doing this, I have found, is to establish a medical specialization for your character, and to encourage your medical officers to do the same. With a variety of illnesses and injuries coming into sickbay, different medical officers are thus thrown into the spotlight at different times, taking some of the burden off of the CMO and giving the lower-ranking medical officers regular chances to direct the medical show. Keep in mind that all medical officers are competent generalists, and each is capable of treating any injury or illness well.
The gravest responsibility that falls to the CMO is to remove those officers from duty whose physical or mental health prevents them from fulfilling their duties aboard the ship. (In the latter case, this responsibility ought to fall at least partly to the ship's Counselor.) According to Starfleet Regulation 121, Section A (a restatement of the much older Starfleet Order 104, Section C), the CMO's power to remove officers from duty can extend, when warranted, to the First Officer and Commanding Officer. This responsibilty ought not be taken lightly by the player SIMming a CMO, as it is altogether too easy for this power to be misconstrued as mutiny. If an occasion for exercising this power ever occurs in a SIM, it is strongly advised that the CMO consult with other senior officers aboard the vessel - the CO or FO, if possible - before taking any official actions. In these cases, and particularly where the CO is concerned, it is necessary that the CMO compile detailed evidence supporting her or his decision. Such evidence ought to indicate that the CO is incapable of commanding the vessel, either due to physical incapacitation or mental disease. When the CO is removed from duty, command of the vessel falls immediately to the next officer in the chain of command until the CMO or another similarly qualified medical authority (never lower-ranking MOs on the vessel) deems the CO fit to resume command. No other officer aboard the vessel, other than the CO and the Counselor, has the authority to suspend an officer from duty. (Note: There is some debate as to whether the CMO can act alone in these matters or, as detailed in the UFOP's General Order 28, command officers can be removed only by the agreement of at least three senior officers. The position of canon, as detailed in TOS, "The Doomsday Machine," and VOY, "Year of Hell, Part 2," is that the CMO can act independently in these matters.)
Finally, and perhaps most importantly, the CMO is the liaison between the medical department and the Captain. Whether that relationship is direct, or is mediated by the First Officer, will depend entirely upon the dynamics of the particular ship in question. But the CMO should not absent her- or himself from high-level decision-making processes aboard the ship simply because her or his uniform is not red, but teal. To do this well, the CMO needs to get out of sickbay every once in awhile. Don't file all of your reports electronically, or conduct all of your communications by commbadge, but go to see the Captain or the FO personally. The CMO holds one of the most respected positions on the ship, and will not be turned away by anyone, unless it is absolutely necessary.
The most interesting aspect of this role for the CMO, I think, is to be an advocate for non-violence. This can be a crucial element in any meeting at which the CMO is in attendance, but if such a meeting is not possible, then the CMO ought to visit the Captain or FO privately and give voice to her or his concerns. While security and tactical officers have to think in terms of conflict, medical officers are intimately familiar with the results of such conflict in human (or Vulcan, or Cardassian, or Romulan, or ...) terms. Try to be a strong voice for diplomacy, for caution, for peace whenever possible. Not only does it represent the medical department well, I think it provides a good forum IC for characters to debate the nature of the actions they wish to understake. More diplomatic Captains may find this quite welcome, and encourage it IC; more militaristic Captains may engage the CMO in open and heated debate. There is fun to be had in both, and that, I think, is what makes all of this so interesting.
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