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

enter image description here

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?

Sovereign Inquiry
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    I believe Camp Bastion ran at 25 beds, surgable to 50, for a peak of 10000 UK troops served. UK has 2.4 beds per 1000 population, including long term patients. Starfleet ratio doesn't seem out of proportion, providing they have reserve equipment to expand in to other areas for mass casualty situations. – Michael Nov 01 '23 at 21:57
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    From what I can find, an aircraft carrier might have 12 beds for 5000 crew, so also not dissimilar. – Michael Nov 01 '23 at 22:01
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    According to wikipedia modern US aircraft carriers have 40-50 beds https://en.wikipedia.org/wiki/Hospital_ship – Organic Marble Nov 01 '23 at 23:36
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    @Michael On a couple of occasions, the Enterprise-D's cargo bay(s) were repurposed for medical use for mass casualties, such as "Ethics" (the one where Worf gets paralyzed). A temporary solution to be sure, but certainly workable until they can get to a starbase. – Cadence Nov 02 '23 at 00:15
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    @Cadence wouldnt also surprise me if the holodecks could be used here for overflow if the power supply was stable - instantly equipped room for another 25+ beds depending on the physical size of the room. – Moo Nov 02 '23 at 02:03
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    @OrganicMarble I stand corrected - but it also notes that they provide the hospital service for their strike group, so well over 5000 people served. – Michael Nov 02 '23 at 06:08
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    There's some artistic licence to this - it's part of the overall unspoken agreement between the creators of the show and the viewers - common on TV shows of the time - that The Enterprise isn't expecting too much trouble (e.g. with children on board in TNG, laxish security, etc.) and the only reason it encounters so many emergencies is that something interesting needs to happen every week because they're on telly. Despite being armed, and the many comparisons to the military, The Enterprise is not a warship. – komodosp Nov 02 '23 at 12:53
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    Star Treks transporters, which can be used to change peoples' age, should also be able to cure or heal disease and injury. – Stanley Webb Nov 02 '23 at 13:41
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    Was the ship designed for changeling infiltrations? – user253751 Nov 02 '23 at 15:45
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    @StanleyWebb It does have some basic cleaning-up for known pathogens, removing the need for quarantining returning crew. M'Benga uses the pattern buffer to hold critically injured patients, and centuries later in Discovery there's enough capacity to temporarily hold the entire crew, so it should be fine to hold the injured while slowly going through the queue. – Martheen Nov 02 '23 at 16:52
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    Holodecks easily make up the difference. Even 10 Forward on 1701-D can be quickly converted. –  Nov 02 '23 at 17:35
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    @StanleyWebb Transporters just disassemble and reassemble people's bodies exactly as they were. They're not used as instant-surgery facilities. If they do use transporters to fix problems, it requires lots of adjustments, programming, and time, which in emergencies, nobody has. – Sovereign Inquiry Nov 02 '23 at 21:36
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    I think it makes sense for a exploratory vessel of a highly advanced civilization to include facilities for rescue missions. If they encounter a dire situation on a Planet, they should be able to safe a lot more injured civilians than a military craft usually would. – Falco Nov 03 '23 at 08:53
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    Off the top of my head, the movie-era Enterprise Technical Manual (exact name escapes me) said that the refitted Enterprise had seven beds in the regular sickbay ward. – Codes with Hammer Nov 03 '23 at 13:53
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    @frеdsbend So how much "actual" space does a holodeck take up? – Mark Morgan Lloyd Nov 03 '23 at 16:39
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    @frеdsbend - It's a small room about the size of a Doctor's surgery, but the walls can be made to look much farther away, and it can use forcefields, optics and moving floors to create the illusion of being much much larger. It has the benefit though, of being able to instantly create beds, medical equipment and even qualified doctors; – Valorum Nov 04 '23 at 11:37

4 Answers4

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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.

enter image description here

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.

enter image description here

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

enter image description here

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.

enter image description here

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

enter image description here

Valorum
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    i guess we find out about rank having its privileges if the ship gets hit by a big rock and you end up being treated in a shuttle bay. – releseabe Nov 02 '23 at 07:50
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    @releseabe - Or treated by Tom Paris – Valorum Nov 02 '23 at 10:47
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    I’m assuming larger facilities are not available without converting anything because space is a premium inside a starship? – Todd Wilcox Nov 02 '23 at 11:40
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    This is a good list. It may be worth mentioning that they used the holodeck for triage at least once in VOY Deadlock. – Engineer Toast Nov 02 '23 at 12:07
  • @EngineerToast - That's a good find. See edit – Valorum Nov 02 '23 at 12:27
  • @ToddWilcox Not necessarily a premium, but just not expected to be needed. Ships like the Enterprise D have a ridiculous amount of space available. Perhaps mess halls and shuttle bays are just more conveniently located and easier to make use of than a larger dedicated medbay in a less conveniently located location. Though transporter tech makes that unlikely. – Michael Richardson Nov 02 '23 at 15:39
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    @ToddWilcox: At least going by the STTNG Blueprints, the sickbay that we typically get to see is just a small ICU in a much larger complex. Check out the excerpt that is shown in the article on Forgotten Trek for a glimpse at the larger facility. This doesn't mean the sickbay is arranged exactly like that (with the blueprints being not quite canon), but it illustrates that there is plenty of space for such facilities. – O. R. Mapper Nov 02 '23 at 17:55
  • @ToddWilcox - Quite the opposite. They've got lots of space on boards; https://scifi.stackexchange.com/a/77531/20774 – Valorum Nov 02 '23 at 19:35
  • @O.R.Mapper - That's a good find. See edit – Valorum Nov 02 '23 at 19:35
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    Real life capital ships, such as the U.S. New Jersey (BB-62) also have relatively small dedicated, full-time facilities for medical care, but are similarly able to convert other spaces to triage/treatment areas. Mess decks are one such space. – Wayne Conrad Nov 02 '23 at 21:46
  • I wonder where all the shuttles go – Azor Ahai -him- Nov 02 '23 at 22:32
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    Great overview. Just another point: if the majority of a ship's crew is injured, once triage has been taken care of the least injured ones can use the beds in their quarters and/or be treated without needing bed rest. Someone with a broken rib and sprained ankle doesn't need to stay in sickbay or overflow facilities. You generally only NEED the sickbay beds/wards/overflow locations during triage and for critical/unstable patients. The only exception to this is a virus, where you'd want to keep infected personnel away from healthy ones. – Robotnik Nov 03 '23 at 01:35
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    @AzorAhai-him- Outside. – Valorum Nov 03 '23 at 06:18
  • It is interesting that the shuttle bays are the best equipped to convert, and yet the one scenario where you are most likely to need the shuttles is to receive the injured/infected beings in the advent of an evacuation. Granted, these are likely the largest spaces and would already have internal bulkheads capable of maintaining atmospheric pressures... but still this is the primary biohazard risk that you would want to protect the reset of the crew from. – Chris Schaller Nov 05 '23 at 10:51
  • @ChrisSchaller - It's a big open space that you can near-instantly clear. It's the same reason we use football fields and carparks in the real world – Valorum Nov 05 '23 at 11:28
  • @ChrisSchaller: "would already have internal bulkheads capable of maintaining atmospheric pressures" - what for? In the 24th century, shuttle bays are consistently shown to have atmospheric forcefields, so the air stays in, but solid objects like shuttles can pass through, while the shuttle bay's space doors are open. – O. R. Mapper Nov 05 '23 at 11:29
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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.

Valorum
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computercarguy
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    "where they gather information on interstellar occurrences remotely with sensors" - except when awful dialogs like in TNG: "Where Silence has Lease" occur. Cue "Captain, based on where the probes disappeared I have been able to plot the outer boundaries. I could move in closer." ;) – O. R. Mapper Nov 02 '23 at 17:50
  • @O.R.Mapper, well, sure, but the idea there is still to get readings from sensors. Getting closer to a phenomena will be to have stronger readings from sensors and maybe stronger communications with the probes to overcome interference. And yes, people will still make "bad" decisions to get into bad situations. We're still talking about biological entities that don't have 100% perfect logic. Even Vulcans don't have that. Nor does anyone have the ability to 100% predict how something is going to happen, not even Troy or other Betazoids. And that's also usually why it's a TV episode. :-) – computercarguy Nov 02 '23 at 17:59
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    Too short for me to edit, but I believe you mean ‘imminent destruction’, not ‘eminent destruction’. The destruction in question is indeed almost always immediately impending (‘imminent’), but not usually remarkable or distinguished (‘eminent’). – Austin Hemmelgarn Nov 02 '23 at 18:05
  • @AustinHemmelgarn, good call. Fixed. Thanks! – computercarguy Nov 02 '23 at 18:06
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    @AustinHemmelgarn welllllll ... The destruction of the enterprise is usually remarkable, isn't it? – DonQuiKong Nov 02 '23 at 18:29
  • Also too short for me to edit, but “Start Trek” -> “Star Trek” – fyrepenguin Nov 02 '23 at 18:34
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    I disagree that they aren't (or shouldn't be) expecting mass casualty events. It may not be likely for the crew to suffer that many recoverable injuries all at once, but it's not at all uncommon for the Enterprise to be dispatched to a ship or colony in distress where there might be many wounded. – Cadence Nov 02 '23 at 21:07
  • Depending on what you mean by "a large section of the hull," the crew may or may not be killed. If we're talking about situations like Wolf 359 or Sector 001 where Starfleet ships were literally losing a quarter or a half of their hulls, then yes, we know the crew has a low chance of survival. But there are other cases where the hull gets battered continually and the crew receive cliché Trek injuries from shrapnel, burst EPS conduits, minor hull breaches, etc. The Enterprise-C, for example, lost lots of its crew before crossing through the temporal rift. – Sovereign Inquiry Nov 02 '23 at 21:22
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    @Cadence, I can definitely see the logic there. It's definitely a common theme in the TV series, yet in-universe that's not the main goal or use of the ships. I can remember episodes starting with someone talking about the months long scientific mission, only to be interrupted with an emergency mission because they happen to be the closest ship. The instances where the Enterprise and other Federation ships need to respond to major medical emergencies should be the rare case, not the norm. We just see it as the norm because it's a TV show that focuses on the action. – computercarguy Nov 02 '23 at 21:25
  • Also, patients get evacuated, too, if possible--uninjured ones or medical personnel might carry them into escape pods. You mentioned "rescue ships"--and this is an important function of Starfleet vessels as well. Medical facilities need to be able to handle not just their own crews, but also patients in need of rescue (such as colonists), as Valorum mentioned. Starfleet's main goal, as you said, is peaceful exploration, but they clearly know that they have to prepare for the worst (such as wars). That's why they still equip their ships with powerful weaponry and extensive medical facilities. – Sovereign Inquiry Nov 02 '23 at 21:30
  • @SovereignInquiry, as much as I love how realistic Star Trek tries to be, and EPS conduits rupturing would more likely kill someone than burn them, if we were actually being realistic about it. It wouldn't be much of a family show if people got completely fried to a crisp during every battle or meteorite shower. Even in a submarine, certain compressed air lines will kill you if you happen to walk by as they rupture, and plasma is way worse. – computercarguy Nov 02 '23 at 21:30
  • @computercarguy That's a great point. But that's why they supposedly have such extensive med facilities. The EPS conduits always decide to hold back a little and give the doctors more work to do. – Sovereign Inquiry Nov 02 '23 at 21:33
  • @SovereignInquiry, yes, and that's why the shuttle bays and other rooms can be extended to be medical facilities in emergencies, but they also realize that they don't need extensive med bays on the regular. It's a waste of space to dedicate room for 200-500+ beds when the ship may only need it 1% of the time. That was in Valorums answer. – computercarguy Nov 02 '23 at 21:33
  • @computercarguy I was actually surprised to learn that they had extra sickbays. I know these things aren't needed on a regular basis, but I was wondering whether or not they had the capacity to treat large numbers of people in an emergency. Clearly, they do. – Sovereign Inquiry Nov 02 '23 at 21:39
  • @SovereignInquiry, well, it's not that the ships have extra sickbays, it's that they can convert other areas into sickbays in an emergency. I know that's a pedantic difference, but the ship designers did know/understand that there would be a need for more medical facilities in an emergency, as well as knowing that a small med bay would work perfectly the vast majority of the time. I also didn't know that the cargo bays were designed with medical facilities in them, I just thought that was part of the story and that the equipment was taken out of storage, or something. – computercarguy Nov 02 '23 at 21:46
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    @computercarguy From Valorum's answer: "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.'" – Sovereign Inquiry Nov 02 '23 at 22:14
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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.

TomMelly
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    Hi, welcome to SF&F. While this does make sense out-of-universe, we do strongly prefer answers to be in universe. – DavidW Nov 02 '23 at 12:23
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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.

Janspeed
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