Why are sickbays so ridiculously ill-equipped for large-scale medical situations?

Question

I was looking at pictures for the Titan filming sets, and I came upon a photo of their sickbay.

As far as I could see, it only had three biobeds and one surgery bed, and one extra reclining bed. That only makes five total. Now, I know not everyone on the ship will be having life-threatening incidents on a daily basis, but the point is that people do get critically injured, with large portions of the crew needing serious medical care. Just think about how many crew members were killed/injured when

the changelings infiltrated the ship,

and more still when

the Borg temporarily took control of the younger crew members.

The number of people needing medical attention would have quickly surpassed the number of beds and amount of space available in sickbay. And this is not the first time. I don't have to list all the times huge portions of the crew on the Enterprise, Enterprise-D, Enterprise-E, or Voyager suffered injuries from an intrusion or got dangerously sick with some unknown alien virus. Another great example from Voyager would be "Year of Hell," when the ship was continually battered and the crew repeatedly suffered casualties. I doubt that their measly four or so biobeds would have supported the crew during times of such duress. You would need a lot of space on these starships. They are occupied by hundreds of people, or in the case of Galaxy class starships, 1000 or more. I know that their medical technology is highly advanced and the worst-case scenario isn't the norm, but why wouldn't they design sickbays to handle more patients if the worst-case scenario did happen? Why didn't they prepare for potential overflows, instead of just deciding to lay patients on the ground wherever there was space?

Some of the more recent shows have been more reasonable, with Star Trek: Discovery adding a sizable sickbay and Star Trek: Strange New Worlds essentially recreating an entirely new and surprisingly well-equipped sickbay for the Enterprise, but was there some reason that no one thought to make them bigger?

Answer 1

This is extensively addressed in the Star Trek: The Next Generation Technical Manual. In brief, Starfleet vessels typically have plans to convert void spaces (like shuttlebays and cargo holds) into 'triage' facilities when significant medical emergencies are encountered.

Large numbers of patients can be handled by emergency conversion of one or more shuttlebays into triage and treatment centers. The main shuttlebay is equipped with five portable emergency hospital modules, which can be set up in the flight deck area, providing up to five triage and surgery wards. Three additional emergency patient care modules can provide up to seventy-five intensive-care beds and 530 medium-care beds.

Shuttlebays 2 and 3 are each equipped with one hospital and one emergency patient care module. These emergency care facilities are equipped for full biohazard protocol, minimizing exposure risk to Enterprise personnel.

Additionally, Shuttlebay 3 includes hardware for short-term conversion to Class H, K, or L environmental conditions, intended for nonhumanoid populations. Note that the use of shuttlebay facilities for medical service will necessarily impact shuttlecraft launch and recovery operations, a factor that can be significant during evacuation scenarios. For this reason, large-scale evacuation involving shuttlecraft support will generally make use of sickbay and other facilities first, before shuttlebay conversion procedures are invoked. Fewer numbers of patients can be handled by conversion of other facilities. Guest quarters on Decks 5 and 6 are convertible to medical intensive-care use, and utility hookups

They give a scenario where overflow facilities (including additional areas of the ship and cross-trained personnel) are used to deal with a catastrophic emergency involving more than a hundred injuries. Triage is performed at the site of the accident, then again on the ship to determine which of the injured require immediate surgical intervention. The walking wounded and not-immediately-dying are then shuffled off to various treatment teams around the ship.

Using all personnel transporters aboard the Enterprise, a maximum of approximately one thousand individuals per hour can be evacuated to the ship. If the number of casualties is relatively small, site-to-site transport can be used to beam the patients directly to the on-board treatment area. Otherwise, patients are beamed only to the transporter rooms and then shuttled to the treatment area by gurney. This is because site-to-site transport effectively halves the capacity of the trans- porter system. While on-site triage is underway, conversion of secondary treatment areas would be prepared, using medical conversion Kits. For major disasters, hospital and emergency patient care modules can be deployed, providing full-scale surgical and intensive-care facilities. If necessary, these conversions can include complete biohazard protocols. Once patients are received onboard, treatment teams would include all available medical staff. The medical staff would be supplemented as needed by additional cross-trained personnel from other departments.

We see this happening in TNG: Ethics (with shuttlebays converted into triage zones).

DATA: The Denver's standard crew complement is twenty three, but they were transporting five hundred seventeen colonists to the Beloti sector.

CRUSHER: I'll need to convert all three shuttlebays to emergency triage centres. I also want all civilians with medical training to report for duty.

And TNG: Disaster (where they use Ten Forward as their emergency medical locale).

DATA: I have surveyed all the turbolifts and service crawlways on this deck. Access to the Bridge has been completely severed by emergency bulkheads.

WORF: Sickbay?

DATA: Heavy damage to section twenty three A has cut off access to Sickbay. I have ordered a security team to bring casualties here until further notice.

A similar set of circumstances occurs on the Voyager where they tend to use the largest available space (the mess hall) in medical emergencies.

JANEWAY: Casualties?

TUVOK: Reports are coming in. Twelve wounded, many of them critically. The Doctor is setting up a triage facility in the mess hall. Two crew members were killed in the breach.

_{^{VOY: Year of Hell}}

On Voyager they also use the holodecks for triage.

TUVOK: Fifteen crew members have been seriously wounded with plasma burns, twenty seven experienced other injuries. The Doctor is setting up triage facilities in Sickbay and Holodeck two.

_{^{VOY: Deadlock}}

---

It's also worth mentioning that there are medical facilities on the Enterprise-D that we just don't get to see often, including a whole 'secondary sickbay'.

The Medical department, under the direction of the Chief Medical Officer, is principally located in two sickbay facilities on Deck 12. The primary facility, located on the port side of the ship, consists of two medical intensive-care wards, an attached laboratory, the CMO's office, and a small nursery. The second facility, located on the starboard side of Deck 12, is similar to the primary sickbay but features two dedicated surgery suites, a physical therapy facility, a nursery, and a null-grav therapy ward. Adjacent to the second facility is a dental care office and a full biohazard isolation unit.

The Star Trek: The Next Generation USS Enterprise NCC-1701-D Blueprints highlights that what we think of as 'the sickbay' is actually just the reception area for a much bigger (and largely unseen) facility that takes up a big chunk of Deck 12.

On a related note, we also have on-screen mentions of wards, treatment centres, recovery rooms, etc that we only see fleetingly or just in conversation. While this doesn't necessarily answer your question (e.g. what happens in an emergency?) it does help us to build a picture of a much larger set of facilities that aren't always visible to audiences.

CRUSHER: Tell Doctor Selar she can use ward three for the ambulatory cases, and I'll stay here.

_{^{TNG: Tapestry}}

and

INT. WORF'S SICKBAY ROOM

Worf has been moved to a private room just off main sickbay. There are several monitors, some medical equipment, and a diagnostic bed. Worf is sitting up in bed and has swung his legs over the side. His face is a mask of determination as he carefully grips the side of the bed and moves his feet down to the floor.

_{^{Script - TNG: Ethics}}

Answer 2

Valorum has a great answer, so I won't rehash any of that, but they miss one aspect that is pretty significant: mass casualty incidents aren't expected to have survivors.

This is space we're talking about. If a large section of the ship is significantly damaged, there's an extreme likelihood that the atmosphere will be evacuated, leaving no survivors.

If the ship suffers enough damage, the ship explodes, also leaving no survivors. Rescue ships looking for escape pods will likely find uninjured or mildly injured crew, or dead crew who succumbed to their injuries before they could be found. Either way, the majority of crew found in pods won't really need much for a medical bay, and the Federation has dedicated hospital/medical and rescue ships that can be brought in to handle those situations, anyway.

There's another aspect that Valorum misses. The vast majority of ships are exploration ships, where they gather information on interstellar occurrences remotely with sensors. Even when they go to a planet's surface, they have sensor readings so they know it's either reasonably safe or know to take appropriate protective gear, and all that before they even leave the ship. So they should be doing science most of the time, rather than them being dedicated warships which might/should/would expect more casualties than a science vessel. Yes, we see Enterprise and other ships engage in violent encounters, but that's not really their intended purpose.

Out of universe, we usually see episodes start with Data, LaForge, or another high ranking officer talking about the science mission they were on, only to be interrupted by a Klingon, Romulan, etc. attack, or a ship needing rescue from a super nova, or something else that's exciting. Because pure science isn't really that interesting for most people and won't bring in the ratings like a fast paced space battle or rescue from imminent destruction. But that's also the beauty of Star Trek. We, as the general public, get a glimpse into pure sciences like stellar cartography, the chemistry of the Oort Cloud, issues with terraforming, and more, and then before we get bored with it, something exciting happens. It's a bit of a trick, but we get trained to think of space exploration and other sciences as continually exciting.

That last bit is somewhat off topic, but it also leads back to the fact that medical bays are small because the real mission of Federation ships is boring science, not warfare. These medical bays are more than enough for the usual carpal tunnel, sprained ankle, bruise from hitting a low hanging structural girder, and other routine mishap. You aren't even going to find too many diseases, since it's a contained ship with few outside contacts. If you do get something like the flu or a cold, crew can handle that in their own quarters. Something like an STD can get a shot and warned not to spread it. And so on.

So really, the med bays don't need to be large. Any problem big enough to cause mass casualties will probably not leave survivors, and anything smaller than that will not likely need more than what the med bay has.

Answer 3

Irrespective of the SF, in-universe, reason, from the creator's perspective, a large ward would be a distracting expense that would take up a lot of studio-space.

Answer 4

Since the ship has a somewhat limited amount of medical personel they wouldn't need a larger sickbay other than for non medical personel to help assist with what they can do like maybe sort out the most urgent cases and fix minor injuries.

But that doesn't need to be done in the actual sickbay. They can do that somewhere else with more space like a temporarily refitted cargo bay. Also you do not know which parts of the ship that could be affected by an incident so this also allows for a more adaptable solution depending on the situation.

This frees up space in the sickbay and since they can just transport people from that temporarily extended sickbay directly to the real sickbay the transport issue becomes nonexistant. Unless transporters are down of course but then I'm pretty sure they have emergency transporters for use within the ship.