Freelance Traveller - Active Measures

Medevac 2

by Timothy Collinson

This article originally appeared in the November/December 2023 issue.

The PCs are tasked with extracting a high value target from a hospital’s intensive care ward. The target has recently undergone major surgery, for the purposes of some of the following detail, some form of colorectal bowel surgery is suggested. “The President” may be male, female or, to increase the difficulty of the scenario, an alien with very different medical needs; they may be a world leader, corporation CEO, or recently elected head of the local gentlesophont’s ikebana society. The reason they must be extracted from the hospital is left for the referee and could be by patron or player agency, but could include:

protection from an attempted assassination (which might explain why they’re in hospital in the first place)
protection from an attempted abduction to hold the President hostage for financial gain or to gain valuable information or concessions
protection from a surgical procedure that is deliberately designed to or completely ignorantly going to hurt or kill the President
the closing in of antagonistic forces about to overrun the hospital
an opportunity to access the President and bypass their standard (and tight) security in an environment where there may be more options for subterfuge or direct action than in their usual environment and routine
to prevent discovery, or revelation to the public at large, that the President is in fact an imposter substituted prior to admission to hospital.

Referees may wish to create, if not already present, political, corporate or societal backgrounds which give a richer flavour to the interactions with NPCs and offer choices that must be made in relation to factions and their motivations.

Complication 1

The President isn’t actually in intensive care in a large hospital but in one of the three surgical high care units [SHCUs]1 - The disciplines of the SHCUs may vary according to hospital and their specialities. Other possibilities include cardio, renal and neurology. (in this case colorectal¹), sometimes called high-dependency units, that are tucked away within more standard wards but offer more extensive care than a standard ward.

These SHCUs are one step down from intensive care. Either mistranslation, non-medical ignorance or carelessness, or the improvement of the President’s condition means that they’re not where the patron thinks they are.

In a low-tech setting this may not come to light until the PCs are on site—although there is the possibility of an intercept of messages revealing any change in location, or rumours from staff who know and may be encountered before any planned extraction. In a mid- or high-tech setting, PCs may be able to infiltrate hospital computer systems before the extraction in order to obtain the exact, or rather, correct location.

If caught flat-footed, several SHCUs are in separate locations on entirely different floors to the intensive care unit—the latter is usually situated not far from operating theatre territory.

Further complexity can be provided by the President having been admitted under a false and unknown name.

Plans for the Princess Iphigenia Hospital and details for some of its staff can be found in2 - Freelance Traveller, No, 118, July/August 2023 “Medivac!”². The Surgical High Care Unit on Level E and its immediate environs are detailed below.

Complication 2

Once found, the President needs to have 24-hour care to stay alive. This will be a mixture of technology (although limited in a low-tech setting—but see footnotes regarding the dates of technology introduction – sometimes surprisingly early) and nursing care to carry out day-to-day observations, medicine adjustments, dealing with vomiting and stoma output, and so on along with non 24-hour supervisory care from at least a Medic 3—typically the consultant or surgeon concerned with the case. The PCs will have to either bring this level of care with them—the technology and personnel, plus the means of transporting it, or they will need to extract it from the hospital along with the President. Sophont medical staff may or may not wish to go along with this depending on the greater detail of the scenario and its factions.

To Persuade nursing staff to go along with extraction: Difficult (10+) Persuade check (2D mins, SOC).
Reduce difficulty by 1 step for every Cr5000 offered (or similar inducement).
DM+2 if of the same faction as the President.

To Persuade doctors to go along with extraction:
Very Difficult (12+) Persuade check (2D mins, SOC or INT).
Reduce difficulty by 1 step for every Cr10,000 offered.
DM+2 if of the same faction as the President.

The President will not be very mobile with catheter, nasal/gastric tubes or drains taking output (and ECG tags measuring cardio function), along with feed/fluid/medicine/salts/oxygen/vitamins/antibiotic tubes giving input. The President may have limited mobility despite being hooked up to all this and, with care, may be able to walk short distances accompanied by a portable IV drip stand, or may be entirely bedridden, or may be unconscious. As ever, the needs of the adventure should dictate the situation. In low-tech settings, less will be made of the technology needs although these can still be present to a limited degree (or medical tech a level or two higher than the typical tech level for the world). In high tech settings some of the detail of the above may be ‘reduced’ to simpler scanning and support but remember there are physical limits to what a sophont body will need in connection with supportive technology such as this. [See “Further Reading” for a number of medicine related articles which are worth consulting. -tc]. Invasive monitoring or procedures such as described here would seem most likely at typical Traveller tech levels unlike the near complete absence of such in, say, Star Trek³.

Input/Output Table⁴
	Insertion	Extraction
IV PICC Line⁵	Difficult (Medic, 1D×10 mins, EDU)	Routine (Medic)
Nasal Cannula⁶	Routine (Medic, 1D rounds, EDU)	Easy (unskilled)
Nasal/Gastric (n/g) Tube⁷	Routine (Medic, 1D rounds, EDU)	Easy (unskilled)
Ileostomy	Difficult (Medic, 1D+6 hours, EDU)	Difficult (Medic)
Stoma bag⁸	Easy (Medic) or Average (unskilled)	Routine (unskilled)
Intermittent Sequential Compression Pump	Easy (Medic, 1D rounds, EDU)	Easy (unskilled)
(Urinary) Catheter⁹	Average (Medic, 2D×5 mins, EDU)	Easy (Medic)¹⁰
ECG monitors	Routine (Medic, 1D rounds, INT)	Easy (unskilled)
Drain¹¹	Average (Medic, 1D+10 mins, EDU)	Routine (Medic)
Note: Although the extraction/unplugging of various support technologies listed above may be done safely by unskilled characters, the characters may not know that. Also note, that if things go wrong, competent medical skill should be available to avoid complications. Note: The n/g tube, drain, stoma and catheter drainage bags don’t have to be disconnected from the patient but can simply be moved from the bed frame to the IV drip stand to make the patient semi-mobile. This can be done by the unskilled. The three ECG monitor leads join a connector which can easily be unplugged or reconnected by the unskilled (although ripping off the three pegs and their ‘stickers’ off the chest itself is easy as well).

4 - The author was informed by staff that he had collected the ‘full set’ of possible connections – represented by this list – that might be used in a colorectal unit. Other possibilities may exist in other medical specialities.

5 - Peripherally Inserted Central Catheter – a very thin flexible tube inserted into a vein via the crook of the elbow and running up to the superior vena cava not far from the heart. An ultrasound or chest x-ray is required to confirm the correct placement. May remain in place for several months and usually inserted when a patient needs more than a week or two of intravenous therapy. Two connectors at the elbow joint allow IV drips of TPN (total parenteral nutrition) or antibiotics ,etc., to be fed in or blood samples to be taken out. It should only be accessed within a sterile field (i.e., at a minimum: gloves, alcohol swabs and a small drape (or sheet) to work on). First used on Terra at TL7 or the end of TL6. TPN is a food substitute specially formulated from glucose, salts, amino acids, lipids, vitamins and minerals for the patient’s blood make up and looks like a white milky fluid which must be kept out of direct sunlight. TPN was first developed on Terra at TL6.

6 - or oxygen prong. A lightweight tube which at one end, after hooking around the patient’s ears, splits into two prongs inserted into the nostrils to deliver air/oxygen. The other end may be connected to a portable oxygen generator or a hospital wall connection. Invented on Terra around early TL6.

7 - A tube which runs up the nose, down the throat and into the stomach to drain stomach fluid to a bedside bag and which may be supported at intervals by aspiration (a large syringe sucking out the stomach contents if it’s not draining itself – a vile green bile). Insertion is Routine, but exceedingly unpleasant for the patient who must attempt to swallow the tube. In situ, it is also unpleasant, may cause a (near constant) gag reflex and makes swallowing medication difficult.

8 - Eventually this settles down to a small bag attached to the body which needs emptying 4-6 times a day and changing once a day. However, in the initial stages following surgery, it may be in overdrive and need a larger bedside drainage bag.

9 - Catheters have been used from ancient times but the flexible tube was invented on Terra at TL3.

10 - Not actually painful but distinctly uncomfortable and may leave the patient finding urinating subsequently slightly harder and/or uncomfortable for a time.

11 - Yet another tube inserted through the skin to remove pus, blood or other fluids from a wound. There are various kinds, so the insertion task is just a rough guide.

Complication 3

The President’s condition is about to deteriorate beyond the capacity of any basic nursing skills to deal with. Medic 2 at least will be required to stabilise the President. This can be as a result of the evacuation, or part of the natural course of post-operative events. Or both as the former exacerbates the latter.

Time will be of the essence here and the safest plan might be to return to the High Care unit (or similar) if it is still the closest means of getting immediate support.

To Stabilise a Deteriorating Patient:
Very Difficult (12+) Medic check, (1D days, EDU).

Once the President has been extracted from the immediate situation they may have several weeks of recovery to go through as they’re progressively taken off the various support technologies and medication they may be being given.

The PCs may be rewarded with cash of course, but perhaps some honour from the President or his associates would be more appropriate. Or possibly they’ve shown such competency that they may be offered other jobs…

Suggestions for Factions

Author’s Note: Interflora World Cup

Yes, there is such a thing (I’ve just learned). It pits the “floristry elite” against each other and is “far bigger than a battle of bouquets”. 20 countries are whittled down to 5 over three days. There are some 200,000 flowers at the venue and “many, many egos at stake”. It’s the “Olympics of floristry” and the first time it has taken place in the UK since it started in 1972.

The global flower industry is worth some £28 billion so “there is pressure, of course” and it does get quite fierce apparently. “To be honest it can get, I wouldn’t say nasty, but it can be quite fierce, there’s a lot of emotion, a lot of drama behind the scenes”. The judges looking for four areas: ideas, colour, workmanship (technique), and composition, and there is £15,000 prize money at stake.

So my idle attempt at humour with the ‘ikebana society’ at the beginning of this adventure wasn’t quite so outrageous as I'd imagined! (Quotes are from the BBC news item and various interviews with participants.)

A long-established and well-loved government but without an obvious successor needs the President extracted before it’s discovered that they’ve only got months to live. The President’s supporters want to sequester the President somewhere where they can control the narrative and media output, even in the event of their death, until they have a successor in place. It will be very difficult to find staff who don’t think the President isn’t in the best place possible already.

A corporation wants to extract the President of a rival corporation while security is not as established. They aim to ‘persuade’ the President, who is a charismatic and successful CEO, that they should stand down. Roll 2D6 for hospital staff allegiance. 2-3 they’re very anti the corporation, 4-10 they have no opinion about the corporations, 11-12 they’re very pro the corporation.

The corporation the President leads has got wind of the previous plot and wants to extract their CEO to a safer location. See previous for hospital staff allegiances.

Formal flower arranging is a popular and cut-throat hobby on the world of the Princess Iphigenia Hospital. So much so that virtually anything goes in the conflict between various societies. Two of the most prestigious are vying to win as many trophies as possible at a large annual festival and one knows that ensuring the President of the opposing society is out of the picture will ensure their side’s prevalence.

NPC

Prof Jamz Kaan, 697DDA, Age 46, Cr60,000
Rank 5: Scholar: Physician
Characteristics: STR 6 (+0), DEX 9 (+1), END 7 (+0), INT 13 (+2), EDU 13 (+2), SOC 10 (+1)
Skills: Electronics (remote operations) 4, Medic 4, Investigate 3, Science (biology) 2, Admin 1, Art (writing) 1, Diplomat 1, Language 1, Drive 0, Mechanic 0, Profession (biologicals) 0, Science (robotics) 0
Equipment: Lab Ship, Scientific Equipment
Relationships: Ally, Enemy×2

Professor Kaan is of middling height, well-proportioned and has the typical confidence of a surgeon at the top of his game. He specialises in robotic colorectal surgery and publishes widely on the subject in the university teaching hospital he works in. His lectures can be dry and erudite but his name is well-known and his classes popular.

Equipment

Colorectal Surgery Robot:

A surgical robot in three parts: the patient cart (the actual robot performing the keyhole surgery with four arms – one of which is a camera), the surgeon console (from which the surgeon responsible remotely operates the robot) and the vision cart (which provides power generation, image processing and information systems).

Ileustim:

Small handheld device which soothes and stimulates a paralytic ileus.

To stimulate a paralytic ileus with an ileustim:
Average (8+) Medic check (1D mins, EDU).
Alternatively, wait 2D days with the patient unable to eat or drink and in considerable discomfort.

IV drip stand:

a 2m stand on five castors capable of carrying a load of up to 4kg of hanging infusion bags. Two or three IV infusion pumps may be located on the stand below the infusion bags.

IV infusion pump:

A volumetric pump (about the size of a hardback book) through which IV lines are passed and which calculates volume over time and delivery rates in conjunction with the desired dose rate (e.g., mg/kg/min). Alarms indicate various conditions requiring attention.

Medical bed:

An adjustable bed on (lockable) wheels. Height can be adjusted as well as head angle and knee angle. The sides and end panels can be flipped down to allow easier ingress/egress of the bed or for support staff to make the bed. Patients may be wheeled to scanning units without having to be mobile. Control panels at the foot of the bed are accessible for staff and another panel near the head give the patient the ability to adjust position.

Sequential Compression Pump:

A toaster size unit placed at the foot of the patient’s bed which every 20 seconds or so inflates cuffs around the patient’s calves to avoid deep vein thrombosis or pulmonary embolism (or both: a venous thromboembolism).