Standard Operating Procedure (Soteria Medical)

The Soteria Institute Biological Laboratory, or Biolab, is a medical facility established on the surface outpost of Nadezhda, and is part of the Soteria Institute’s Medical and Biological Division. It is tasked primarily with providing medical care and services to the surface outpost’s inhabitants, including keeping the Marshals and Blackshield healthy and operational. Secondarily, the Biolab may also engage in scientific medical studies, including chemical testing, tissue modification, and psionic research. The Biolab is also expected to work hand-in-hand with the Soteria Institute Research and Development Facility, which is located in a joint facility with the Biolab.

Personnel

Soteria Lifeline Technician

Lifeline Technicians, also called SLTs, or LTs, have a broad range of tasks which can be boiled down to acting as both in-house muscle and as paramedical staff. A Lifeline Technician’s first and foremost duty is simple: obey the (legal) orders of the Chief Biolab Overseer. When an SLT is not performing that primary duty, they are also tasked with ensuring the safety of Soteria facilities and personnel, as well as retrieving, stabilizing, and moving injured or dead colonists within the walls to the Biolab, or acting as an extra pair of hands for any on-duty doctors, performing triage and first aid.

They are not required to retrieve dead or injured colonists who are outside the gate or who are in Deep Maintenance; those are Blackshield’s areas, and SLTs are expected to defer to Blackshield for such cases.

SLTs are not expected to perform surgery. If an SLT is certified for basic surgeries in their employment records, they may perform those surgeries when no other surgically-trained staff are available or present. SLTs should not be performing surgeries if a doctor is active just because that doctor is busy with a surgery of their own, unless assistance is requested by the doctor.

Job Competency Requirements:

• Moderate Proficiency in Medical SOP
• Moderate Proficiency with firearms, combat, and first aid treatment
• Familiarity with Authorized Use of Force laws
• Basic Familiarity with the surface outpost's layout, including maintenance tunnels, and reading coordinates
• Basic Proficiency with privacy regulations in General SOP
• Basic Proficiency with chemicals and medicines

Soteria Doctor

The on-staff doctors for the Biolab may have a range of specialties, from nurses to trauma surgeons to your everyday physicians. All employed MD-level doctors are expected to have the same core skillset, however. These are the individuals who are expected to perform surgeries and general medical treatment beyond simple first aid. All doctors are expected to understand surgery, basic chemistry, and how to operate the organ printer in the surgical theater. The method a doctor uses to treat a patient is left to the attending doctor, though patient consent and desires should be taken into account.

Soteria Medical Students are typically individuals who have completed their higher education learning, but who have not yet attained real-world experience in the medical field. They are not held to the same standards as professional doctors, and may not be sanctioned when their lack of knowledge or competence causes minor issues. If their lack of experience causes serious issues, they may still be found criminally liable or sanctioned, and they are expected to obey any senior doctoral staff.

Job Competency Requirements:

• Moderate Proficiency in Medical SOP
• Moderate Proficiency with Medical devices and machinery
• Moderate Proficiency with the uses of chemicals and medicines
• Moderate Proficiency in surgical techniques OR non-invasive chemical treatments
• Moderate Proficiency in first aid and triage
• Moderate Proficiency with privacy regulations in General SOP

Soteria Psychologist

As with doctors, Psychologists come in many flavors; many still specialize in classical psychology and psychiatry, but a growing number of Soteria mental health employees have begun favoring psycho-neurological methodology, after the discovery and the ongoing research into the psionic organ. Many of Soteria’s foremost psionic researchers are also Empaths, as the specialization has come to be known.

Whatever the specialization, psychologists are mental health professionals, not trauma doctors; they are not expected to assist the Biolab’s SLTs or physicians in any direct capacity, though they are not barred from doing so if they possess the requisite knowledge, skills, and abilities. Rather, the psychologist’s primary duty is to see to the mental health and stability of the colony’s inhabitants, as well as assisting any ongoing psychological, psychiatric, or psionic research projects. It is to a psychologist that an unstable colonist will be delivered for mental evaluations, and besides the CBO, the psychologist is the only individual who can sign off on unfitness for work forms, when the cause is psychological.

Job Competency Requirements:

• Moderate Proficiency in Medical SOP
• High Proficiency with privacy regulations in General SOP
• Moderate Proficiency in psychological, psychiatric, or psionic techniques

Chief Biolab Overseer

Chief Overseers are the Institute’s primary hands in the field; on the surface colony, the Chief Biolab Overseer is in charge of the affairs of the Biolab, as their title would suggest. Their primary duty is not tending to patients, performing chemistry, or even handling surgeries, though they may need to do these things when their staff are unavailable. The CBO is expected to be competent and capable, first and foremost, in managing their team and representing the Soteria Institute's interests and providing a public face to the surface outpost's inhabitants. The CBO holds a seat on the Low Council, though it is a joint seat with the CRO. Overseers are reminded that if they cannot agree on a vote, they lose Soteria's vote for a given council decision.

While a CBO may have a variety of backgrounds, they are all expected to have significant knowledge of the human body, and to a lesser degree the bodies of other sapients, too, and together with the Psychologist are the only other individual capable of signing off on unfitness to work forms, when the cause is psychological.

Job Competency Requirements:

• High Proficiency in Medical SOP
• High Proficiency with Medical and Chemistry machinery
• High Proficiency in surgical techniques
• High Proficiency in first aid and triage
• Moderate Proficiency with chemicals and medicines
• High Familiarity with confidentiality laws and regulations
• Basic Proficiency in psychological, psychiatric, or psionic techniques

In addition to:

• Fulfilling all criteria for Command personnel as outlined in the Command SOP, including familiarity requirements there
• The ability to speak, read, and write fluently in English Common

Workplace Structure

The Chief Biolab overseer is the highest authority in the Biolab. Medical Doctors and the Psychiatrist are considered to be of equal rank, but cannot overrule each other in their respective fields, and are permitted to give orders to SLTs, where such orders do not conflict with a CBO’s orders. SLTs are the lowest rank in the Biolab, but are generally expected to be able to handle their own duties without direct supervision.

Procedures

All individuals, regardless of background, inclination, or status, are bound by these procedures whenever they perform the following services under Soteria’s name. This includes cyborgs utilizing Medical modules or machinery.

Medical Oaths

While the Soteria Institute recognizes and respects professionals who take such oaths as the Hippocratic Oath or the Tesselate Oath, employees are reminded that these oaths are not considered legally binding, nor are they a valid exception to following legal orders from superiors or SOP. Overseers are encouraged to exercise discretion when ordering staff to perform antithetical operations, but the decision is ultimately the Overseer’s.

Patient Protection

The following primarily applies to SLTs performing their standard duties, but additionally applies to anyone retrieving patients in the field.

A patient in the field is considered “claimed” when the responding personnel lay hands on the person. Typically, this should be accompanied by a verbal statement as well, but this is not required. Thereafter, if any non-SI personnel attempt to touch or move the patient without the responder’s permission, the responder may take any non-lethal actions necessary to ensure they retain and protect their patient, according to the Authorized Use of Force legal clause. Appropriate use of force is still required, and responders found to use excessive force may face sanctions or criminal charges.

The following applies to patients and SI personnel within the Biolab premises. Once a patient has been brought to the Biolab, they are to be handed off to any on-duty doctors or psychiatrists as needed by their injuries, if available. Otherwise, any existing, capable staff may take over treatment.

While a patient is undergoing treatment within Biolab premises, no non-SI personnel are permitted to interfere, including Marshals or Councilors, and all non-SI personnel should be informed that they must wait in the public lobby. Marshals with a valid warrant, or an order from the Warrant Officer, may remain within the Biolab, but may not interfere with treatment or touch the patient beyond ensuring they are securely restrained unless otherwise specified by the warrant, such as in cases where the patient has been declared DNR after treatment has begun.

Individuals with no valid reason to remain on Biolab premises who refuse to comply with a request to leave may be removed with force.

Payment for Treatment

While the Biolab’s primary purpose isn’t to turn a profit, supplies still have associated costs. The Soteria Institute REQUIRES all personnel in the Medical division to charge for products and treatment according to the chart below, with a handful of exceptions. Personnel from the Marshals and from Blackshield are not to be charged if their injuries are a result of their work protecting the colony (though they may be charged for treatment rendered as a result of, for example, criminal behavior on their part). All colonists who are injured combating a colony-wide threat, such as the Class Seven Biohazard, the Class Eight Biomechanical Infestation, or some external threat, are guaranteed the same free treatment as Blackshield and Marshal colonists.

If a Biolab Overseer is available during a given shift, they may change the following prices as they see fit, or waive them entirely. Moreover, payment for medical treatment may be reasonably delayed for up to two hours based on the availability of doctors or other Biolab staff to handle processing invoices, or if the patient has insufficient funds to pay. This deferred payment may be overruled at any time by a CBO, who may then require payment as immediately as is reasonable. Payment may NOT be deferred in any way for visitors, outsiders, or other non-colonists.

All patients should be informed before treatment that treatment will incur a cost, such as with a public notice in the Biolab lobby, or by individually informing each patient.

Soteria personnel are guaranteed free treatment as part of their employment contract while they are on duty, though frivolous overuse of medical supplies or personnel time may warrant a reprimand.

The following is the price chart for Medical treatment and services, not including elective procedures, which will be covered later. Unless otherwise noted, these charges are to be allocated according to whether or not the indicated service happened at all, not on a per-unit or per-instance format.

• Sleeper Usage: 40 credits
• Cryopod Usage: 60 credits
• Blood Transfusion: 25 credits/bag
• Unbranded Gauze or Ointment: 5 credits/body part
• Advanced Kits: 10 credits/body part
• Soteria Branded Gauze or Ointment: 25 credits/body part
• Chemicals and Medication: 20-40cr for every 30u (rounded up if below) of unique medicine administered
• Defibrillation: 75 credits

Surgery should be charged at a rate of 80 credits per body part operated on, such as arms, legs, head, chest, and so on. This cost includes any necessary organs printed for replacement.

Revival procedures, that is, any usage of Medical supplies performed in the process of resuscitating a dead person, should be charged either a flat 350 credits, or the cost of all procedures performed in the course of resuscitation, whichever is cheaper. This includes any and all surgeries, organ replacements, superficial repair (ATK/ABK/gauze/ointment), cryopod usage, sleeper usage, or any other potential procedures needed for revival.

Emergency procedures, which are procedures performed in an attempt to save a patient in critical condition, but who has not yet died, are charged only for sleeper usage, cryopod usage, surgery, and blood transfusions.

Payment for Medical treatment may be rendered either as credits, or as other tangible or intangible bargains -- assistance, supplies, and so on. Non-monetary payment should be duly recorded in the notes section of any invoices which are written. Monetary payments may be deferred, but cannot be waived except by a CBO, in accordance with the guidelines described at the beginning of the section.

Treatment Procedures

The following procedure is REQUIRED.

To ensure appropriate documentation and record-keeping for payment and other purposes, all patients who are admitted for treatment are to receive a prior and post-treatment body scan, which must be printed and placed securely in a folder or file cabinet after the treatment is completed. Any additional scans taken during a patient’s treatment should be securely stored with the prior and post scans as well.

Body scans should NOT be left out on tables after a patient has been treated and discharged.

Nonpayment and Debtors

Individuals who refuse or are incapable of paying medical fees once they are due are to be blacklisted from Biolab treatment and reported to the Marshals so the debt can be reclaimed. Revival procedures should still be performed, even on blacklisted personnel -- they cannot pay their debts if they are dead, after all.

Marshals and Blackshield cannot be blacklisted from treatment, but they should still be reported to the Marshals for the appropriate legal repercussions.

Elective Procedures and Other Sales

Elective procedures are defined as any procedure which aims to improve a patient’s quality of life, or which is requested by a patient and does not directly relate to an injury. In other words, these are procedures which are not necessary for restoring a person to a full, healthy status, such as providing biological augmentation.

Elective procedures, such as organ modifications, are to be charged according to the following chart. These charges may not be deferred by standard Medical staff as in the case of lifesaving or otherwise health-oriented medical treatment, as these procedures are undergone voluntarily upon the patient’s request. Payment must be decided upon and rendered up-front, and the patient should be informed of the side-effects of the procedure in full before payment is rendered or the procedure is performed. As is the case with the treatment price chart, this chart may be edited or ignored by a CBO as they wish.

• Modification of existing tissues or organs: 75 credits/body part
• Printing of new tissues, including modification of the printed tissues: 150 credits/organ

Any other elective procedures undergone which are not included in the above cases may be priced by the Soteria Medical staff member who performs the procedure, unless a Biolab Overseer is present, in which case they should set the price. Bargains and nonfinancial payment are acceptable for elective procedures, according to the guidelines set forth in the Payment for Treatment section, with the addition of “voluntary experimentation” being an acceptable method of payment for elective procedures only. Any voluntary sapient experimentation must be accompanied by the appropriate paperwork as indicated in the Soteria Research SOP’s Waiver Clause. If a CBO is present, they may offer and dispense payment to individuals who voluntarily submit to experimentation.

Any injuries or complications which arise as a result of elective procedures are to be treated immediately without cost to the patient. The Biolab staff who botched the procedure should be charged the full amount for any incurred costs.

Selling Chemicals, Stimulants, and Other Supplies

Legal medicines, chemicals, and stimulants may be manufactured by Chemistry for sale to the general populace. Chemical sales should be priced at between 1 and 30 credits per unit of chemical, according to the difficulty of production and demand of the chemical; the scale of this difficulty is left to the staff member’s discretion to determine. An exception is made to this pricing scheme for chemicals when they can be exported for a greater amount than otherwise allowed.

Similarly, the sale of other medical supplies -- such as treatment kits -- may be performed at Medical staff’s discretion. Pricing should defer to the Biolab Overseer if one is available, but may otherwise be set by the Medical staff member who sets up the sale or vendor. Medical staff are forbidden from setting out “charitable” or free supplies, unless given express permission by the resident CBO. Marshals and Blackshield may receive a small amount of free supplies per colonist, at Biolab staff's discretion.

Consent to Treatment / Right to Refuse Treatment

For any given procedure, including potentially lifesaving procedures, patients must be given the opportunity to provide consent to treatment or refuse treatment. All adult colonists are presumed to be sound of mind and capable of granting or withdrawing consent at will by default.

If an individual is determined to have a limited capacity for decision-making, this right may be overruled by Medical staff. If this right is overruled, any treatment performed should be considered emergency treatment by Medical staff. Note that overruling this right does not permit Medical staff to force a patient to come into the Biolab if they are actively resisting Medical personnel; in such cases, what treatment is possible may be rendered on the scene. Such cases may warrant an intervention by the Marshals if the patient is a danger to others or themselves.

This overruling is possible in the following situations:

• The patient is unconscious and clearly injured, poisoned, or otherwise unhealthy.
• The patient is in critical condition according to professional Medical knowledge and scanning devices and is unable to provide consent.
• The patient is clearly mentally unsound and is unable to understand either the condition to be treated or the nature of the treatment, such as patients who have been dosed with hallucinogens. Note: If this mental instability does not have a clear physiological cause, i.e. drugs, alcohol, severe infection, etc., the patient must be assessed by a psychiatrist or Biolab Overseer if one is available. A fax should be sent requesting one if neither is present.

In all of the above cases, a judgment call may be made by Medical personnel on the spot to determine whether an individual is capable of providing consent for treatment or not.

Patients who were unconscious upon being admitted for treatment, but who regain consciousness during treatment, are presumed to consent to continued treatment unless otherwise stated.

In any such case wherein this right to refuse treatment is overruled, all treatment performed is to be considered as emergency treatment according to the Payment for Treatment section; only if the patient withdraws consent, then changes their mind later should they be charged for further treatment normally.

Unfitness for Work

In some cases, colonists may suffer from mental or physical conditions which may be physiological or psychological in nature that prevent them from performing their work, or make performing their work a hazard. In such cases, a Chief Biolab Overseer may formally declare them unfit for work. A Doctor or Psychiatrist, depending on the nature of the condition, may initiate this process without a CBO present, but must fax for a CBO in order to complete the process.

Once the declaration is made, the CBO must write a formal letter indicating the declaration and present it to the Low Council, detailing the nature and reasoning behind the declaration. The Council shall then vote on whether this declaration is valid, as outlined under the Command SOP’s Voting Procedures section. If an individual is found to be unfit for work, they must accept either a suspension as if they had been demoted by the Council, or receive treatment for their condition as soon as possible.

What defines “unfit” may vary from condition to condition. However, conditions which simply lessen a colonist’s capacities are not grounds for a declaration of unfitness for work. Conditions which totally inhibit their ability to perform their job, or which inhibit them from performing their duties in a timely and reasonable manner, may qualify. The nature of the colonist’s job should be taken into account: a Scientist who is wheelchair-bound cannot be assessed as unfit for work simply because they take longer to navigate the labs, but a Marshal Officer who cannot chase criminals cannot perform their duty.

Hygiene and Disease Control

These policies remain in place as precautionary measures and against infections, and in the rare cases of pathological disease. Medical staff are required to wear sterile, non-allergenic clothing while they are treating patients. In this respect, the equipment provided in Medical personnel’s lockers is considered sterile, though SLTs and Doctors are encouraged to keep gloves, boots, and jumpsuits or scrubs washed and clean where available.

The Biolab should be kept as clean and neat as is reasonably possible; debris, shattered glass, blood, vomit, and other messes should be cleaned as soon as possible.

Smoking is strictly disallowed within the Biolab, with the exception of the public lobby and the break room, due to the health and flammability risks. Soteria personnel are required to extinguish their own cigarettes before treating patients, and must request that patients extinguish theirs before entering the Biolab.

Quarantine procedures exist in the case of a disease outbreak. In such a case, all Biolab personnel are required to wear medical-grade masks, sterile gloves, and to regularly sanitize their hands. Any Biolab personnel actively treating patients are required to wear biohazard suits, and the CBO is encouraged to analyze disease vectors to ensure personnel equipment is capable of counteracting any infectious agents.

Additionally, all infected personnel are to be quarantined within the Biolab for their safety and the safety of the colony. Anyone attempting to breach quarantine, in or out, without permission from the CBO or the Low Council, may be removed from the Biolab, by force if needed. Quarantine procedures are to remain in effect until a vaccine or cure can be produced to counteract the disease.

Death

For the purposes of Medical SOP, “death” refers to the indefinite cessation of nervous activity and vital biological processes. If a patient is recognized as ‘dead’ by medical scanning equipment, they are medically dead. This state is not necessarily permanent. Patients can often be recovered if their body is intact, provided with the correct treatments, and then defibrillated according to Soteria Medical training materials.

If a defibrillator displays a ‘mental interface error’, the device is unable to restore brain function. If three interface errors are experienced in a row, the cadaver is to be placed in the Morgue for secure storage until they can be transported to the lower colonies for a more intensive revival process.

Any cadavers that are recovered are to be transported via body bags to avoid the potential trauma caused by such a sight on other colonists. Staff are not exempt from this simply because they did not have body bags on their person at the time.

In the event of the total death (wherein an individual cannot be revived, such as by total bodily destruction) of a colonist, the relevant Head of Staff must be informed. Postmortem instructions are to be followed, and the death should not be revealed to other colonists unless consent is given in the deceased’s medical records, or a funeral is requested. A fax is to be sent to the High Council with an autopsy report attached regarding the deceased.

Post-Mortem instructions are to be obeyed whenever possible and reasonable. Unreasonable or unfeasible Post-Mortem instructions need not be obeyed.

Do Not Revive

A “Do Not Revive” order, or DNR, forbids the revival of the specified patient. This order must be documented in the patient's medical files, either by stating “Do Not Revive” or using the abbreviation “DNR.” It can be limited by conditions, such as when the patient's death is caused by a specific medical condition.

Medical personnel is required to check patient records for DNR orders prior to revival. If medical staff has reason to believe that the DNR order was not issued correctly or legally, the Colony's High Council must be contacted via fax. The patient is not to be revived, and the body must be preserved (cryo tube, stasis bag or morgue tray) until a response from the High Council is received. Failure to check medical records for DNR orders where possible may lead to negligence charges. Furthermore, if the patient is a criminal offender, reviving them despite a DNR order in their medical records can be considered aiding in the crime. According to colony law, this can result in similar charges being applied to the person reviving the patient.

Any patient capable of refusing treatment may also request that medical staff add a DNR order to their file. Assessment by a psychiatrist, or if none is available, the Chief Biolab Overseer (CBO), is required. For the DNR order to remain in effect beyond the current shift, the records must be updated in the Soteria main offices in the lower colony. The patient can make this request personally. If the patient requests the change through Upper Colony medical staff, a DNR ratification must be faxed to Soteria's offices in the lower colony, and the CBO’s signature is required. In this case, the DNR order in the medical records will also include the date of application and the signing CBO’s name. Every patient has the right to have their voluntary DNR order to be removed, following the same workflow.

When medical staff are informed of a lawful execution, a DNR order must be added to the criminal's medical records.

Medical staff may also be ordered to add a DNR order to a colonist's record by a Warrant Officer (per Marshals Standard Operating Procedures) or the Lower Council. If no Warrant Officer is present, medical staff may also be ordered by Marshal Officers (including higher-ranking specializations) to add a DNR order to a patient's file if the patient is an infiltrator, outsider, or a known enemy of the colony. If there is uncertainty about whether one or more of these conditions apply, High Council has to be contacted, following the same procedure as described above.