Standard Unit of Healthcare

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Standard Unit of Healthcare

Postby nitePhyyre » Thu Dec 23, 2010 10:46 pm UTC

I don't know if this is the best place for this topic, but it has more to do with logistics than medicine.

So I was trying to design a colony ship. My first step was trying to decide how many people would be on it. I think that number depends on these questions:

What is the smallest amount of people and equipment needed to run a sickbay that could cover 95%+ of all cases. Not 95%+ of all medical cases that exist, but 95%+ that are most likely to walk through the door. It would have to have enough specialists, doctors, nurses, and support staff to keep the sickbay running 24/7. What size community would that healthcare unit accommodate before it starts to overload the system? How would I even look up what I need to know to figure this out?
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Re: Standard Unit of Healthcare

Postby Zcorp » Thu Dec 23, 2010 10:49 pm UTC

nitePhyyre wrote:I don't know if this is the best place for this topic, but it has more to do with logistics than medicine.

So I was trying to design a colony ship. My first step was trying to decide how many people would be on it. I think that number depends on these questions:

What is the smallest amount of people and equipment needed to run a sickbay that could cover 95%+ of all cases. Not 95%+ of all medical cases that exist, but 95%+ that are most likely to walk through the door. It would have to have enough specialists, doctors, nurses, and support staff to keep the sickbay running 24/7. What size community would that healthcare unit accommodate before it starts to overload the system? How would I even look up what I need to know to figure this out?

I'd talk to someone who has experience designing or working as a medical profession on large ships. Cruise ships, air craft carriers etc.
While the scope of time isn't nearly as big the population size is probably pretty close.

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Re: Standard Unit of Healthcare

Postby Diadem » Fri Dec 24, 2010 2:00 am UTC

I thought you only needed a single doctor, or a hologram if no doctor is around :P

In all seriousness though, the answer probably depends on your technology. I can imagine a future where most medical procedures are highly automated. Also, do you also want to do medical R&D, or just treating known problems? Do you want to capacity to train new staff, or do you just need active staff with no worry about what happens in a few decades?

I'd imagine several tens of thousands of people would be realistic. If 1% then went into medicine you'd have several hundred people. That seems enough to cover most disciplines as well as nurses and people to train new doctors.
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Re: Standard Unit of Healthcare

Postby Iulus Cofield » Fri Dec 24, 2010 3:57 am UTC

A lot of questions need to be answered before this can, such as, how long will the colony ship be in operation?

A (relatively) short term flight would probably be okay with your 95% readiness standard, but with a ship that would be in flight for over a century, you have to consider whether you want to risk (more than) 5% of your crew potentially dying.

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Re: Standard Unit of Healthcare

Postby osiris32 » Fri Dec 24, 2010 4:34 am UTC

nitePhyyre wrote:I don't know if this is the best place for this topic, but it has more to do with logistics than medicine.

So I was trying to design a colony ship. My first step was trying to decide how many people would be on it. I think that number depends on these questions:

What is the smallest amount of people and equipment needed to run a sickbay that could cover 95%+ of all cases. Not 95%+ of all medical cases that exist, but 95%+ that are most likely to walk through the door. It would have to have enough specialists, doctors, nurses, and support staff to keep the sickbay running 24/7. What size community would that healthcare unit accommodate before it starts to overload the system? How would I even look up what I need to know to figure this out?


Several questions need to be asked:

How many people are you needing to be able to service?
How much in the way of supplies CAN you bring?
How long will you be en-route to your destination?
What kind of resources will be available upon arrival?
What are your contingency plans?

I would suggest looking up what the sickbay aboard an aircraft carrier keeps in stock. That has to serve 5,000+ men and women for long periods of time. From that, you can create a base of what would minimally be needed to stock your sickbay, and work from there, extrapolating for things like genetic diseases, cancer, pregnancy, accidents/injuries, and illness mutations.
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Re: Standard Unit of Healthcare

Postby CorruptUser » Fri Dec 24, 2010 5:33 am UTC

Carriers are not a perfect example; they always have support in the area and can get a temporary boost in medical staff, their crews are made up of people at the peak of their lives, are more prepared for combat surgery, ob/gyn is not a concern, etc.

I'm going to assume a colony ship means deep space.

For a colony ship, well, you need at least 2 of everything. So that's 2 anesthesiologists, surgeons, GPs, OB/GYN, pediatricians, dentists, podiatrists, optomotrists (not doctors, but useful), endocrinologists, radiologists, physiologists, cardiologists, dermatologists, oncologists, pharmacologists, orthopedics, urologists, gastroenterologists, odolaryngologists, neurologists, neurosurgeons, opthamologists, psychiatrists*, etc, not to mention the nurses. Granted that you can cross train them, which would be better (fewer supplies needed), but you are talking a bare minimum of maybe 50 medical professionals regardless of colony size, unless you want only the most basic of care. After about 2000 colonists, I would add maybe 1 doctor/nurse per 100. While this is a much higher ratio than anywhere in the world, the stresses of space travel, with new bacterias (if they can be called that) that may be either incredibly deadly or harmless**, and so forth, your medical staff will be stretched thin regardless.

The bare minimum for a colony is 8 males and 32 females, any less and you end up with too much inbreeding. I also assume you want more females than males; sorry, women are more valuable for the reproductive cycle. In fact, you could forgo men altogether and just bring samples of semen from the best and brightest, or whatever you want. This will double your initial birthrate, and reduce the supplies needed, as women tend to need fewer calories than men. Not to mention women tend to be healthier and live longer. Sorry guys, and I say this as a guy. Of course, this may put extra strain on the psychiatry department...

Anyway, with 1 baby every 2 years, that's .5 childbirths per year per woman in the colony. With 10,000 people, with only half female, that's 2500 births a year. You have an average of just under 7 births a day, but due to randomness, you could easily have days with 30+ births; worse if everyone gets pregnant as soon as they get off the ship. And if your OB/GYNs are also pregnant... I would say at least 1 in 500 people needs to be trained as an OB/GYN, 1 in 250 if all-female crew.

*You will need them on decades long voyages. Lots of them.
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Re: Standard Unit of Healthcare

Postby osiris32 » Fri Dec 24, 2010 7:24 am UTC

CorruptUser wrote:Carriers are not a perfect example; they always have support in the area and can get a temporary boost in medical staff, their crews are made up of people at the peak of their lives, are more prepared for combat surgery, ob/gyn is not a concern, etc.


Ok, maybe a carrier isn't a good example. A carrier GROUP, however, is meant to be self-sustaining (not indefinitely, for sure, but for long periods of time) so look at the equipment for that. And like I said, just use that as a baseline for equipment. Personnel would be a different question all together.

Cold storage or deep sleep would be a much better alternative for transit, as it gets rid of all the issues. With the exception of system failures and such.
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Re: Standard Unit of Healthcare

Postby Soralin » Fri Dec 24, 2010 10:53 am UTC

CorruptUser wrote:The bare minimum for a colony is 8 males and 32 females, any less and you end up with too much inbreeding. I also assume you want more females than males; sorry, women are more valuable for the reproductive cycle. In fact, you could forgo men altogether and just bring samples of semen from the best and brightest, or whatever you want. This will double your initial birthrate, and reduce the supplies needed, as women tend to need fewer calories than men. Not to mention women tend to be healthier and live longer. Sorry guys, and I say this as a guy. Of course, this may put extra strain on the psychiatry department...

If you want to save mass, you could replace the males with a freezer of frozen sperm. :)

Or if you really want to save mass, replace the whole lot of them with frozen embryos, and a means to grow them at their destination: http://en.wikipedia.org/wiki/Embryo_space_colonization

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Re: Standard Unit of Healthcare

Postby Sharlos » Fri Dec 24, 2010 12:56 pm UTC

If you have the technology for a space colony, I think you'll certainly have the technology to automate vast amounts of medical procedures and diagnosis.

Humans would largely only be needed as medical technicians and research and development.

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Re: Standard Unit of Healthcare

Postby PAstrychef » Sun Dec 26, 2010 3:07 am UTC

We have the technology to put together a colony right now, of mostly off the shelf parts and concepts. (L-5in '95!)
A traveling colony ship just needs the means of propulsion added on. So the assumption that medicine would be automated is nice but not too probable. Also, human doctors are just better at all kinds of medical interactions than computers are. (at the moment).
However, as this is, I suppose, going to be fiction, you can feel free to automate as much as you desire.
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Re: Standard Unit of Healthcare

Postby Sharlos » Sun Dec 26, 2010 4:23 am UTC

PAstrychef wrote:We have the technology to put together a colony right now, of mostly off the shelf parts and concepts. (L-5in '95!)
A traveling colony ship just needs the means of propulsion added on. So the assumption that medicine would be automated is nice but not too probable. Also, human doctors are just better at all kinds of medical interactions than computers are. (at the moment).
However, as this is, I suppose, going to be fiction, you can feel free to automate as much as you desire.


Care to elaborate? We do not have a completely (or nearly) 100% efficient life support system as well as a whole slew of other necessary technologies for a permanent space colony.

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Re: Standard Unit of Healthcare

Postby Sero » Sun Dec 26, 2010 8:58 am UTC

No, what we lack is the transportation infrastructure to put such a structure in place. I can't quite call them 'off the shelf' parts, but concepts, certainly. Assuming practical bulk lifting capacity to orbit and sufficient funding, it is entirely within the realm of technical feasibility to put together a permanent habitat in space. There are a significant number of theoretical designs for such floating around. Oh, I'm sure turning them from concept to safe, viable reality would require a lot of work and twerking and development and testing, but that's refinement of existing techniques, not a fundamental breakthrough in theory or design.

What we lack is sufficiently inexpensive lift to orbit. We need cheaper lift or less mass intensive designs. Cheaper lift is probably the easier, from a design perspective, problem to solve.

Even propulsion is a solved problem, under the assumption of solving low efficiencies with increased mass. Use an orion engine.
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Re: Standard Unit of Healthcare

Postby osiris32 » Sun Dec 26, 2010 9:07 am UTC

Sero wrote:What we lack is sufficiently inexpensive lift to orbit. We need cheaper lift or less mass intensive designs. Cheaper lift is probably the easier, from a design perspective, problem to solve.

Even propulsion is a solved problem, under the assumption of solving low efficiencies with increased mass. Use an orion engine.


One solution that I've heard talked about (though now it's a moot point) is not allowing the EFT on the shuttle to return to Earth, but instead keep it on tillthey reach orbit. Then strip it out and use it as a module for part of a station. The interior tanks could also be removed and used for the same thing. Of course, it would take a lot of work in orbit, but it would mean one less lift.

However, now that the shuttle has been canceled, it really doesn't matter.
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Re: Standard Unit of Healthcare

Postby Sero » Sun Dec 26, 2010 9:31 am UTC

Trying to squeeze out the best cost/benefit you can is worthwhile, but ultimately, all lack of progress in space is down to unwillingness to pay the cost. Oh, that's a little unfair, research is still ongoing and being funded, but it'd be a stretch to say it's a major priority for any organization with the funds necessary at the moment. Currently implemented technology is prohibitively expensive. Using Orion engines for earth-to-orbit was considered completely feasible with 60's era technology, if I'm not mistaken. But there are non-pecuniary costs associated with that technology. There are others, but they require significant initial investments, significant further development, or both.
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Re: Standard Unit of Healthcare

Postby Yakk » Tue Jan 18, 2011 12:31 am UTC

You might have to let people die.

I'm serious. Making a colony ship that maintains even a current first-world earth-standard level of care for a journey of, say, centuries, is going to be extremely difficult. With sufficiently advanced technology it would be easy -- but at that point, the standard of care would be ridiculously higher than today, so it still would be "let people die" type situation.

Heck, making it arrive with anyone still alive is going to be extremely difficult.

So you'll probably have to live with the fact that, when you get seriously sick, they treat you with pain killers. Leverage the fact that your population is extremely small so you can eradicate most communal diseases, and possibly break your society up into non-connected parts that can cross-repopulate when one self-destroys (note: this is hard, because you have to be able to prevent a self-destroying sub-civilization from damaging the others, such as people fleeing a plague and infecting another population, or the like) due to an infectious disease breakout, social maladaption, or whatever.

Or just put everyone into "cold sleep", and/or virtual storage, and rebuild/awaken them on the other end.
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Re: Standard Unit of Healthcare

Postby Me321 » Tue Jan 18, 2011 5:57 am UTC

1 docter with some surgical skills and a slightly trained assistant for more complex procedures can handle 95 % of all medical cases that would appear in a group of healty people chosen for space travel, now there is a limit as to how many people 1 doctor can treat, but I say 1 doctor for every 100 people, and an assistant for every 20 people, but you could adjust the skill of the assistant and taper that off (2 well trained assistants per 100 or 20 slightly trained per 100, or some combination).

It might be a good idea to think of this as a draft, the first person you want is a pilot, then an engineer, then a slightly trained medical person with other nesasary skills, then a co-pilot, then a specialist depending on the mission and then a well trained medical person, then about 5 more specialist , then a psychiatrist.... and you can keep building the list and cut it off any time depending on the size/mission specifications.

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Re: Standard Unit of Healthcare

Postby CorruptUser » Wed Jan 19, 2011 12:29 am UTC

You also want 1 backup of each, for any but the shortest of missions. For voyages lasting decades (if not centuries), death will be unavoidable. It would be a shame if only 1 person knew how to maintain your engines properly...

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Re: Standard Unit of Healthcare

Postby ++$_ » Fri Jan 21, 2011 8:55 am UTC

Hmm. Let's say you want to treat diseases with drugs. How big a stockpile would you need, and how long do the drugs actually last in storage? If they don't last for the whole journey, how are you going to make more? Simple things like aspirin and acetaminophen might be possible to make with a small laboratory, but for most drugs you would need some serious equipment and expertise.

If the colony is going to be out in space for, say, a century, you can expect drug resistances to develop and new germs to evolve (think of all the drug-resistant diseases that have arisen since 1911). How are you going to produce drugs to deal with these things? What are you going to do if delicate and complex surgical equipment breaks down?

The point is that the US spends more than 2 trillion dollars (out of a 14 trillion dollar GDP) on health care for a reason -- the industry is huge and requires many different things to be done in order to deliver its product. In a colony that's supposed to last more than a few years, you might need something like 10% or more of the population to do something or other related to health care, whether that's doctoring/nursing, fixing broken surgical equipment, keeping the hospital bays clean, synthesizing drugs and disinfectants, making sure medical records stay in order, or whatever.

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Re: Standard Unit of Healthcare

Postby Jimmigee » Fri Jan 21, 2011 10:33 am UTC

++$_ wrote:If the colony is going to be out in space for, say, a century, you can expect drug resistances to develop and new germs to evolve (think of all the drug-resistant diseases that have arisen since 1911).


Will the problem be on the same scale in such a controlled and limited environment though? I have no idea; it could be worse, it could be better. Thoughts?

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Re: Standard Unit of Healthcare

Postby CorruptUser » Mon Jan 24, 2011 4:43 am UTC

The costs of treating diseases rises exponentially with population, as Earth currently has 7 billion giant petri dishes for diseases to develop, and with the increase in transportation, plagues can spread throughout the entire world in days. The colony would only have a few hundred/thousand places it could form.

At the same time, Earth has thousands or even millions of people capable of researching ways to deal with all the new diseases. The colony might start off with a few dozen, but as anyone who knows regression will tell you, the next few generations of the colony are unlikely to have as many scientists as the colony founders (I'm assuming your colony is made up of the "best" humans Earth can find).

There is no guarantee that a place that a colony establishes itself doesn't have its own parasites that humans have never evolved natural defenses against. Although, at the same time, the diseases and parasites have never evolved to specifically infect a human body. It's a real wild-card.

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Re: Standard Unit of Healthcare

Postby Cleverbeans » Wed Jan 26, 2011 11:46 pm UTC

You may find Table 10 in the following document helpful.

http://www.cdc.gov/nchs/data/nhsr/nhsr026.pdf
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Re: Standard Unit of Healthcare

Postby savanik » Thu Jan 27, 2011 12:37 am UTC

Some other things you might want to consider:

1. Medical research. Pepperoni purportedly develops mold rapidly in microgravity conditions, so pizza delivered to the space shuttle used salami instead. Viruses and bacteria will almost certainly grow differently in space.
2. Population control. If you only have food for X many people, and someone has a kid... who do you murder and how do you pick them? And who would be more qualified to do this than the medical personnel?
3. Alternative medicine portioning. Trying to keep everyone alive may not be a viable strategy. You might simply say, 'We can treat X, Y, and Z, and anything more complicated, we'll breed more to replace.'
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Re: Standard Unit of Healthcare

Postby Capt. Obvious » Fri Feb 04, 2011 11:31 pm UTC

savanik wrote:Some other things you might want to consider:

2. Population control. If you only have food for X many people, and someone has a kid... who do you murder and how do you pick them? And who would be more qualified to do this than the medical personnel?

It's hard to imagine a worse way to choose who had to be sacrificed than by delegating it onto a medical professional. Sure, life expectancy is one axis, but known skills and even popularity/familial connections are also important axes.

Back to the original posters point, I'd say that "95%" of all cases would presumably be eliminated. Assuming most diseases would show during a pre-flight physical, the flu, STDs and a lot of other infections can be avoided. In a zero-gravity environment I would presume that most problems would be stroke/heart attack level or injury from a physical blow. That is, I assume diagnosis would be easy and conditions non-contagious. Figure that end-of-life care would consist of euthanasia once Alzheimers, etc. presented.

So, some meds certainly, but probably well known for specific issues (not even a full doctor needed). A pair of good surgeons, and maybe a couple of assistants.

This post assumes that when this colony ship is built, there isn't much research needing to be done on the long term effect of zero-G.

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Re: Standard Unit of Healthcare

Postby ThePragmatist » Sat Feb 05, 2011 10:53 pm UTC

Sharlos wrote:If you have the technology for a space colony, I think you'll certainly have the technology to automate vast amounts of medical procedures and diagnosis.

Humans would largely only be needed as medical technicians and research and development.


Humans would not be needed at all once we achieve self-conscious AI or brain-uploading, either of which could be accomplished within the near future.

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Re: Standard Unit of Healthcare

Postby lutzj » Tue Feb 08, 2011 2:32 am UTC

What if you could find a way to simply prevent most pathogens from entering the ship? Plenty of contagious diseases could still sneak in people's guts but with high-quality hygiene and vaccinations you could probably eliminate most endemic diseases, smallpox-style. Most STDs or insect-borne diseases could be stopped completely with simple screening.

ThePragmatist wrote:
Sharlos wrote:If you have the technology for a space colony, I think you'll certainly have the technology to automate vast amounts of medical procedures and diagnosis.

Humans would largely only be needed as medical technicians and research and development.


Humans would not be needed at all once we achieve self-conscious AI or brain-uploading, either of which could be accomplished within the near future.


Humans would arguably make much better intergalactic colonists; the ability to reproduce without needing advanced tools or materials is a huge plus. Also, humans have a strong incentive to ensure that humans remain important, so we probably won't turn out lives completely over to intelligent robots if we can help it.
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Re: Standard Unit of Healthcare

Postby GenericAnimeBoy » Tue Feb 08, 2011 3:50 am UTC

lutzj wrote:Also, humans have a strong incentive to ensure that humans remain important, so we probably won't turn out lives completely over to intelligent robots if we can help it.


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Re: Standard Unit of Healthcare

Postby stevenf » Sun Mar 20, 2011 3:08 pm UTC

The problem that this thread is encountering is that many contributors are making the same conceptual errors that early fiction writers and film makers made - assuming that interstellar or intergalactic space travel will be accomplished by recognisable technology.

Healthcare, as currently understood, is evidence of our unsophisticated level of development. Healthcare in space will, eventually, be nothing like MASH or Scrubs or Green Wing or any known SciFi.

Look at early films of space travel - from the 1920-30s. The ship's interiors resemble contemporary steam ship's engine rooms. Look at Star Trek or Star Wars - we see deep vacuum Dreadnoughts with attendant Biggles machines for the twiddly dashing-about-looking-dashing bits. Real space travel beyond our Solar system will require AIs of a sophistication that we can only imagine, robotics and nanotech likewise. We do not even have names for most of the tech involved. Organics will only be along for the ride, if at all, and will have a negligible role in ship's operations. Heaven only knows what the energy sources will be. At that stage of our development, if we are spared, we will be Kardashev level 1+ or even 2, compared with our current estimated position of 0.7.

It has been quipped that we will recognise an advanced civilisation by its technology appearing to us like magic.

We need to let our imaginations soar above contemporary levels of complexity and possibility.

I offer the suggestion that if the AIs have any use for organics at all then they will have the knowledge and ability to extemporaneously manufacture organisms to suit the ecosystem encountered. Human 9.0 might be an ultra high gravity tolerant, methane breathing, photosynthesising - using the local gamma bursters output, millipede.

The relevance of all this to the origin of the thread is that illness and injury of any description will be well within the compass of the AIs. Healthcare will not be a limiting factor in mature, long endurance space travel.

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Re: Standard Unit of Healthcare

Postby savanik » Mon Mar 21, 2011 2:34 pm UTC

stevenf wrote:The problem that this thread is encountering is that many contributors are making the same conceptual errors that early fiction writers and film makers made - assuming that interstellar or intergalactic space travel will be accomplished by recognisable technology.


I believe the point of the exercise is to answer the question in the context of assuming contemporary technology and the political will to perform intergalactic travel. Given our current technology, is a generation ship possible? Yes. What challenges might they face? That's the question here.

Unaddressed are such questions as, 'Should we build generation ships at all' or even 'in the time it takes to reach its destination, will technology have evolved past the need for generation ships?'

If you can shoot a high delta-V seed probe with no organics onboard and then follow it with standard digital transmission to nano-assemble a human being on the far end, are generation ships really necessary at all? Probably not. :) But the point of the exercise is figuring out what we can do right now.
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