I have a gift for you - the lost Asylumverse planning guide (from 2013!)

So, years ago I actually started writing out a guide of random but mostly useless information about Asylum and Broadhoof after I received permission from folks to write fan-fiction based on my fan-fiction. It was a humbling but invigorating experience. So in my exuberance, I decided that I should craft something that would help provide the reader a more coherent world for their shared narrative. It was filled with schedules and codes and even some history of the hospital.

Why did I include all of this? Because there truly is nothing as thrilling as rules about dress-code.

"Here," I thought, "is perhaps something that might fire the imagination of some eager writer who I had been lucky enough to convince to read my story." It would be something I could share and hand out to foster more stories with a stronger central construct. "Derek," I said to Derek, "This is a wonderful idea and you should feel smug about it."

And I then promptly forgot about it for six years.

Now I posted excerpts from this years ago, but I decided that (after going through it all and getting over my embarrassment) I might as well share the whole thing in all of it's... existence. Saying grandeur would not only be egotistical in the extreme, but it would be a bold faced lie. This is more a glimpse into a younger mind thinking that the readers wanted to know how many minutes were set aside every day to let Twilight take a shower and go to the bathroom. Because hey, who doesn't want to know how the main characters in their stories handle their private business?

^{What was that think about how wizards in Harry Potter used to poop on the floor? Am I remembering that right?}

So I hope you can enjoy and laugh with me a bit at the sort of impetuous things one might make when they're caught up in a mania for writing everything down - and maybe understand how I could forget I had this thing sitting around. The formatting is wonky, I've never had an editor look through this junk, and it's something that, when I found it, I felt a burst of excitement followed by deep embarrassment.

So enjoy a laugh at my expense!

Asylumverse Guide
Updated: June 20, 2013

Note from the Author:
This is a Work In Progress and something I crafted after a request for something similar, so those of you who have been wanting to do a story about your OCs or other characters within the Broadhoof Memorial Psychiatric Hospital will have something to go off of. Now, I created this more as a rough sketch, or a loose set of guidelines, to give you an idea of what might go on within Broadhoof, helping to create some level of consistency between stories. But if you want – or need – to change something, by all means go ahead! This is not firm fact, but just my internal thoughts about the hospital. And if you ever have any thoughts or questions about anything at all, please feel free to PM me!
-Derek (aka Daemon of Decay)

Setting Summary
Broadhoof Memorial Psychiatric Hospital (BMPH), commonly called Broadhoof, is the largest psychiatric and mental hospital within Equestria. Located outside of Ponyville, it serves the needs of Ponyville and the capital of Canterlot. Although mostly dealing with psychiatric and mental patients, the hospital also is a leader in brain surgery. Established in the late 1800s, it has seen frequent updates and renovations over the years, although it has kept its white-stone facade on the front side of the original building, which houses administration and doctors’ offices.
Broadhoof houses a few hundred patients at any one time. Most patients are temporary patients who willingly check themselves into the hospital for short periods of time while dealing with addiction, depression, etc. However, the hospital also houses the criminally insane, patients that are violent, and patients whose mental issues prevent them from succeeding in the outside world in the long-term.

Hospital Staff

• Dr. Valentino Rose: Chief of Medicine.

Description:  Stallion. Unicorn. Tan coat, black mane with grey streaks. Cutie mark: scarlet rose on a blue medical cross. Blue eyes. Mustache, and glasses (gold-rimmed spectacles).
Age: Middle aged (40s-50s)

• Nurse Ratchet: Head Nurse.

Description:  Mare. Unicorn. White coat, Pink/red mane. Cutie mark: pink ratchet with a white heart in the middle of it. Gold eyes.
Age: Late 30s to early 40s.

• Silas Agate: Orderly; Assistant to Nurse Ratchet.

Description: Stallion. Earth pony. Black coat, flat grey/silver mane. Cutie mark: block of grey slate. Light grey eyes.  A physically large stallion. 
Age: Late 20s to early 30s.

• Nurse Coldheart: Senior Nurse (Nurse Practitioner).

Description:  Canon (Link)
Age: Mid 30s.

• Nurse Bonbon: Nurse; In training to become a pharmacist.

Description:  Canon (Link)
Age: Mid 20s.

Patient Categories

• Patient categories are loose groupings for patients with broadly similar needs in regards to security and care. Patients in a group are not homogenous, and are still treated according to their medical needs. For example, it is used to separate patients with a history of violence towards others from those who are prone to self-harm. Thus two Alphas would require the presence of more orderlies during daily activities to prevent violence from occurring, even if both patients have different conditions or disorders.
• It is also worth noting that patient categories are mostly used within official documentation. Patients are rarely referred to by categorization, even amongst staff. The classification, when used, is most often used in regards to patient housing – Alpha’s having their own special section within the High-Security ward, for instance. Staff use classifications for treatment purposes (deciding on what sort of treatments to follow) and sometimes when planning out activities, but the biggest contributing factor is the individual patient and their needs: two Alphas might received wildly different treatments and be handled in completely different ways, thus calling them by the title of Alpha is not as useful except in the loosest sense.

• • Name (Color) Security Level | Risk Level

    • Name is the official name for the classification.
    • Color is used in official paperwork and as an extra identifier for the group (Ex. Alpha being highlighted with red in the patients’ files), but is not used in conversation.
    • Security Level is used to determine the amount of extra security measures that need to be utilized. This is not just in terms of escorts, but also for receiving visitors and access to activities and objects. Some patients are convicts and thus need extra security measures by law. Low-Security is for patients who require nothing more than the measures provided for the general population.

Security Levels: High-Security, Low-Security

• • • Risk Level is the risk of a patient engaging in destructive or harmful behavior. A routinely violent patient and a patient who is on suicide watch are both At Risk, while a patient who is no danger to themselves or others is Low Risk.

Risk Levels: At Risk, Potential Risk, Low Risk

• • Alpha (Red) High-Security | At Risk

Violent patients, the criminally insane, and patients needing constant surveillance due to other circumstances where they pose a threat to others. Is also applied to patients under isolation or punishment on a temporary basis. Alpha patients are also classified as At Risk due to possibilities of self-harm, either indirectly (engaging in violence) or directly (suicide or self-mutilation).
Guidelines: Alpha patients require constant observation and close supervision by staff. Patients are to be confined to secure rooms as necessary, checked daily for contraband, and are to never be left unattended. Straightjackets and restraints are to be utilized as needed. Are always to be escorted by at least two orderlies.

• • Beta (Yellow) High-Security | Potential Risk

Patients convicted of non-violent crimes, patients who are long-term or permanent residents that require more control, and Alpha patients who have exhibited continued good behavior or an improvement in their symptoms.
Guidelines: Beta are closer to general population (Delta) patients than Alpha patients in terms of rules (individual rooms for long-term patients, personal items, greater degrees of freedom, etc.). What separates Beta from Delta classification is that Beta patients are either still serving criminal sentences or denote patients that at one time did possess an Alpha classification, and thus still require slightly elevated levels of observation.
Note: Twilight Sparkle is a Beta.

• • Gamma (Green) Low-Security | At Risk

Patients who are at risk of engaging in self-destructive behavior, but do not pose a threat to others. These include those on suicide watch and those prone to self-mutilation. Gamma can also be applied to patients whose medical conditions pose a risk to their own health, such as those with epilepsy. 
Guidelines: Gamma patients are to be treated as general population (Delta) patients, with additional observation during day and night. Extra therapy as necessary.

• • General Population (Delta) (Blue) Low-Security | Low Risk

Patients who require no extra rules or guidelines. The general population of patients who possess greater degrees of autonomy and self-reliance. Note: normally not referred to as Delta patients but as General Population or GP.
Guidelines: General population (Delta) patients are the baseline patient and fall under standard guidelines for patient care.

• • Zeta (Black) Low-Security | Low Risk

Patients who require extra assistance during daily lives, including catatonic patients, and patients with severe physical or mental disabilities.
Guidelines: Zeta patients require extra assistant as their individual cases necessitate. Generally they require a nurse or orderly to assist them with most basic functions, such as eating or bathing.

• • Foals (Pink) Low-Security | Low Risk

Patients who are not yet adults. Can be applied in addition to above categories as necessary.
Guidelines: Foals require extra care in addition to their other classification. Foals are to be escorted by staff at all times and generally kept separate from the general population. Foals are otherwise to follow their own rules on a case by case basis.

Alert Codes

• There are a number of different Alert Codes utilized in extreme or emergency circumstances. These are normally announced over the speakers, either across the hospital or in the local vicinity. Alert codes are unrelated to the colors used in patient identification, which are used just within paperwork and related data.

• • • Code Red Fire
    • Code Yellow Lockdown
    • Code White Active Violence (Riot) or Hostage Situation
    • Code Blue Cardiac / Respiratory Emergency
    • Code Green Combative Patient
    • Code Purple Missing Patient (Adult)
    • Code Pink Missing Patient (Foal)

Hospital Wards

• Patients are housed in different wards/sections depending on their classification and needs. Generally there are two divisions to the hospital: High-Security and General Population (Low-Security). Within these wards the population is separated according to classifications.
• There is also a separate portion of the hospital which serves as a General Hospital to Ponyville and the surrounding area. Kept partially separated from the psychiatric hospital, although they share surgical facilities.

Outfits

• Patients: patients wear light green patient gowns. They are short sleeved and resemble loose fitting shirts. The reason for why patients wear them at all times is for ease of identification at a distance – patients wear green, the staff wear white.
• Nurses: traditional outfits as seen on the show, with white caps.

(Example) Daily Schedule for a Beta patient

0700 Morning Checks. Patients are woken up by the staff, and the lights are turned on in their rooms to ensure they get up. Patients are given 15 minutes to get dressed and make their beds before assembling out in the hall. Once in the hall they are given the morning medication and inspected before being lead to the baths, making sure they don’t attempt to bath all at once.
0715 Bathing. Patients are escorted to the bathing facilities as Morning Checks are completed, to take care of personal grooming. While the showers are private and separated by gender, staff is always present in the bathroom. During this time, staff conduct random room inspections to search for contraband or anything of note. Generally a patient’s room is searched bi-weekly, although disobedient or At Risk patients are searched more frequently.
0745 Grooming Check. Orderlies inspect patients to ensure proper grooming is taking place. Patients are lined up for inspection. One inspection is complete, patients are lead to the cafeteria for breakfast.
Note: The timetable for Morning Checks, Bathing, and Grooming Checks are not definite beyond the first 15 minutes. Checks are staggered and patients go to the baths as their checks are completed. This means that while some patients are finishing their showers and assembling for grooming checks, others are still being lead to the bathroom for their turn. All patients are to have bathed and been checked before they head to breakfast as a group.
0800 Breakfast. Patients are given a half-hour to eat breakfast. Due to the higher security needs of these patients, they are normally the first to arrive so they can be fed first. Patients who have been rewarded for consistent good behavior and are not at risk are allowed to sit with the general population. Those in the Risk category are confined to the same tables for closer observation by staff.
0830 Morning Group Session. Patients are led off to their respective therapy groups, depending on the patient’s needs and their doctor’s orders. These are small therapy sessions, and the morning meetings are generally short and deal with a single topic: repeating rules that might have been broken, checking on how patients are generally feeling, and allowing them to voice any concerns they may have.
0830 (alt.) Morning Meeting with Doctor. Some patients have their morning group session replaced with a personal meeting with the doctor overseeing their case. This can either be a planned alternative (every other day) or on an ‘as needed’ basis (in the aftermath of an episode). Unlike the group sessions these are more specific to the patient and involve questions about medication, symptoms, and anything the doctor may with to bring up.
Note: This can also be replaced with a meeting with a patient's Case Worker, who is assigned to them from outside the hospital to ensure they are not being mistreated. While all patients have access to them, they are only mandatory in certain cases where the patient might not be capable of evaluating their lives effectively (foals, the elderly, the mentally deficient, etc.).
0900 Morning Free Time. Patients are allowed into the community area to engage in leisure activities. These run the gamut from board games to reading to indoor activities. At Risk patients are directly supervised. This time period also allows patients whose morning sessions run longer to still rejoin the group and avoid missing out on the rest of the day’s activities.
Note: Morning Free Time is nominally allowed. However, this time period is often cut short to allow greater time for the Morning Meetings with Doctors, Groups, or Caseworkers.
1000 Daily Activity #1. Patients are led to their first activity of the day. These can differ for each patient, and are broken up to suit the needs of the patients and their doctor’s orders.
Example Activities:

• • • • • Yard Time. Patients are allowed into the yard for exercise and physical activity. Almost all patients are given an hour a day in the fenced off yard. Patients are encouraged to engage in light activities such as walking, non-physical games, and general socializing. Pegasi with clipped wings (High-Security and At Risk patients) are allowed to hover. Those pegasi who are still fully flight capable are allowed to fly within a specialized gymnasium.
        • Arts and Crafts. Patients are given time with a suitable choice of activity. Generally activities are varied daily to give patients new experiences. Patients with certain talents or desires (musicians, for example) may be given more time with the desired activity as a reward or according to their doctor’s orders.
        • Social Time. Patients are given time to socialize indoors with selected activities, ranging from books to board games to conversation. Patients are encouraged to interact with others, but participation is not enforced as with group meetings.
        • School. Schooling is provided to long-term patients who are not yet adults (foals and teens) and those with special education needs. Some schooling can be done by tutor for students that require/need it, although the costs of such are placed upon the families and not the hospital itself. Education is mandatory for non-adults.

1200 Lunch. Patients are given a half-hour to eat lunch. Patients who have been rewarded for consistent good behavior and are not at risk are allowed to sit with the general population. Those in the Risk category are confined to the same tables for closer observation by staff.
1230 Daily Activity #2. Patients are led to their second activity of the day. These can differ for each patient, and are broken up to suit the needs of the patients and their doctor’s orders. See above for full list.
1430 Afternoon Group Session. Patients are led off to their respective therapy groups, depending on the patient’s needs and their doctor’s orders. These are small therapy sessions, and the afternoon meetings are usually a little longer than the morning ones, but are designed for more social interaction. These often involved a group activity (show and tell, a movie with a theme, etc.). They offer a chance for patients express any concerns with the day so far.
1430 (alt.) Afternoon Meeting with Doctor. Some patients have their afternoon group session replaced with a personal meeting with the doctor overseeing their case. This can either be a planned alternative (every other day) or on an ‘as needed’ basis (in the aftermath of an episode). Often these longer sessions are more involved portions of the patient’s treatment or therapy. Normally, patients don’t have both morning and afternoon meetings with their doctors, unless necessary or a part of their treatment regime.
Note: This can also be replaced with a meeting with a patient's Case Worker, who is assigned to them from outside the hospital to ensure they are not being mistreated. While all patients have access to them, they are only mandatory in certain cases where the patient might not be capable of evaluating their lives effectively (foals, the elderly, the mentally deficient, etc.).
1600 Daily Activity #3. Patients are led to their third activity of the day. These can differ for each patient, and are broken up to suit the needs of the patients and their doctor’s orders. See above for full list.
1800 Dinner. Patients are given a half-hour to eat dinner. Patients who have been rewarded for consistent good behavior and are not At Risk are allowed to sit with the general population. Those in the Risk category are confined to the same tables for closer observation by staff.
1830 Afternoon Free Time. Patients are allowed into the community area to engage in leisure activities. These run the gamut from board games to reading to indoor activities. At Risk patients are directly supervised.
2000 Bathing. Patients are escorted in groups to the bathing facilities to take care of personal grooming. Showers are private, although staff is always present in the bathroom. During this time, staff conduct random room inspections to search for contraband or anything of note. Generally a patient’s room is searched bi-weekly, although disobedient or At Risk patients are searched more frequently.
2030 Personal Time. Patients are allowed an hour of personal time after bathing within their own rooms before lights out. Patients are allowed the freedom to do what they will in this time. This is also normally when the night time medication is administered.
2130 Light’s Out. Patients are instructed to go to bed. Lights are turned out and patients are observed to ensure they have gone to sleep.

Kaidan- adding some medical knowledge and terminology for you all. Feel free to ask your hospital related questions and I’ll do my best. I haven’t killed anyone yet.
Psychiatrist- Doctor who specializes psychiatry, which is the treatment of mental illness. Prescribes the medications.
Psychologist- Does clinical counseling, and not a doctor. Usually they master in Psychology but some states/countries only require a bachelor’s.
(PA)Physician’s Assistant-2-4 years of schooling, must work under supervision of a doctor to have all his orders signed off.
(NP)Nurse Practitioner- Someone with a master’s in nursing, can prescribe some meds and do advanced procedure’s other nurses can’t.
(RN) Registered Nurse- The main type of nurse, bachelor’s in nursing and supervises all patient care according to the doctor’s orders. Administers meds as directed.
(LVN)Limited Vocational Nurse- Depending on state, they can take one year of schooling and don’t require any bachelor’s of nursing. They must be supervised and can only do what the RN tells them too.
Nurse Aide / Assistant - The lucky souls who change bedpans, linens, and restrain crazy patients so the RN/LVN/Doctor doesn’t get bitten/poop flung at them. Training only takes 2-6 weeks, and they can’t do the fun invasive procedures (start an iv.)

Hospital Administration- Most hospitals have a board of directors, with each director heading a department of medicine (surgery, psychiatry, nursing, administration.)

Restraint teams consist of 5 members, one for each limb and one to keep them from bashing their head against something hard. Responds to code greens (though in my experience, it’s just the first 5 people in the room that end up doing the take-down.)
What do they ‘inject’ to take down combative patients? An easy, and well known one, is sodium pentothal. Isn’t that what they use in lethal injections? It sure is. At a proper dose (let’s go with 5mg) it causes unconsciousness for 5-10 minutes within 30 seconds. It can be injected into any muscle, so if a Doctor runs up and stabs the patients, that’s what he’s likely using. (Lethal injection uses a higher dose, and other drugs that actually kill the person.) Someone knocked out by it needs to have their breathing monitored once they recover, to make sure they don’t throw up and choke or stop breathing adequately.

Code Blue- If you have someone go down, here’s some advice courtesy of the AHA. Check responsiveness by shouting/tapping them and check pulse on the neck. If they are unresponsive with no pulse, start chest compressions. 2 breaths after 30 compressions, attach a defibrillator as soon as it comes. If the patient is in V-Tach or V-Fib, or if the defibrillator is automatic, it will tell you to shock. Otherwise they just continue CPR until a Doctor tells them to stop. Adenosine can reverse Atrial Flutter, stopping the heart and hopefully slowing a very-fast heart rate. Epinephrine or Vasopressin are given to all pulseless patients during CPR. Atropine is given when the heart rate is slow and has a pulse, and you want to speed it up. That should be enough to ‘wow’ readers, and keep you from shocking asystole like they do on T.V. (Pro-tip, if they flatline, electricity does nothing.) You can send me a message if you want specific BLS/ACLS details. :)

Comments

[Reese]

Hey, I think I remember this! Neat.

[Georg]

You know, this sounds a lot like personal experience. (which means either a lot of research, or... personal experience)

White or green shirts?

[Replica Knight]

Hot dang. Woah

[Replica Knight]

Ya know, the first time I read this I thought it was gonna be like that game Outlast but this is way better.

[ionn]

Thanks!

[Hap]

So...

When's the next chapter?

(also, goddamn, six years?)