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How one ED mobilized his department during a mass casualty incident (2017)

298 点作者 CrispyKerosene9 个月前

19 条评论

biofox9 个月前
The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.
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Bartkusa9 个月前
&gt; <i>Dr. Greg Neyman, a resident a year ahead of me in residency, had done a study on the use of ventilators in a mass casualty situation. What he came up with was that if you have two people who are roughly the same size and tidal volume, you can just double the tidal volume and stick them on Y tubing on one ventilator.</i><p>This technique was later applied during the COVID-19 pandemic, when ventilators were in high demand and short supply.<p><a href="https:&#x2F;&#x2F;www.vice.com&#x2F;en&#x2F;article&#x2F;this-risky-hack-could-double-access-to-ventilators-as-coronavirus-peaks&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.vice.com&#x2F;en&#x2F;article&#x2F;this-risky-hack-could-double...</a>
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dalben9 个月前
Interesting that he had to do so much thinking and improvising. I&#x27;m an EMT in Belgium, and every hospital here has to have plans for mass casualty events. Ambulance bays are built to be transformed into a triage ward, spare beds are kept close, often there&#x27;s a dedicated command room, ...
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FireBeyond9 个月前
Dr Joshua Corso was the Senior Resident on duty the night of the Pulse Nightclub shooting in Orlando, and had a photo of his trainers covered in blood go viral.<p>I saw him do a talk at an EMS conference a few years back that was both profoundly touching and deeply insightful, and talked about all the things you might not think of (at one point, there was a lot of banging from something nearby the ED, that made people think there was more shooting, and so they had locked it down further, which made some of the efforts more difficult (moving people from ED to theater, for example).
bgroat9 个月前
I&#x27;m not an Orson Scott Card fan generally, but I LOVED his Shadow Series (the world of Ender&#x27;s Game from the perspective of Bean).<p>In one of the books in the Shadow Series Bean explains his leadership style as:<p>&quot;I will always explain why something is important, and why we&#x27;re doing it this particular way... The reason for this is that if we ever find ourselves in a situation where I CAN&#x27;T give orders you know what I prioritize and how I might think of something... furthermore, if we&#x27;re in a situation where I CAN give orders but DON&#x27;T explain you will understand that it&#x27;s simply because I do not have time, but presumably have good reasons, and will proceed to immediately execute said orders&quot;<p>It appears this emergency room operated in a similar capacity
lostlogin9 个月前
I’m surprised reports were generated quicker when the radiologist worked with the X-ray tech.<p>Back when I did x-rays, a quick radiologist could report a set of films in about a minute.<p>I could X-ray 6 patients per hour (whilst doing data entry, billing, walking them to the room etc as well). I doubt I’d have been much more than twice as fast if the admin was skipped.
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acedTrex9 个月前
What a great read, i love times where competent people make shit happen. Crisis leadership is a rare skill.
SheinhardtWigCo9 个月前
&gt; For years I had been planning how I would handle a MCI, but I rarely shared it because people might think I was crazy.<p>This is such a huge problem.
rolph9 个月前
triage tags for MCE<p><a href="https:&#x2F;&#x2F;www.ncbi.nlm.nih.gov&#x2F;books&#x2F;NBK459369&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.ncbi.nlm.nih.gov&#x2F;books&#x2F;NBK459369&#x2F;</a><p><a href="https:&#x2F;&#x2F;www.nj.gov&#x2F;health&#x2F;ems&#x2F;documents&#x2F;ems-task-force&#x2F;disaster_tag_presentation.pdf" rel="nofollow">https:&#x2F;&#x2F;www.nj.gov&#x2F;health&#x2F;ems&#x2F;documents&#x2F;ems-task-force&#x2F;disas...</a> [PDF]<p><a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Triage_tag" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Triage_tag</a><p><a href="https:&#x2F;&#x2F;www.boundtree.com&#x2F;triage-tags&#x2F;c&#x2F;269?srsltid=AfmBOoq-EyDCxLql1-yV24AWZo_tk6rptv3xvDojRw_t-_gE-SoT2y2i" rel="nofollow">https:&#x2F;&#x2F;www.boundtree.com&#x2F;triage-tags&#x2F;c&#x2F;269?srsltid=AfmBOoq-...</a> [ARTICLE FOR SALE]
amonon9 个月前
If you are interested in disaster psychology and planning like this, you might also enjoy &quot;The Unthinkable&quot; by Amanda Ripley. It covers several notable disasters and the environment that shaped them. It gives advice on the psychology of victims of a disaster, how to prepare for one as an individual, and how to prepare for one as a community.<p>It was recommended to me by an EMT giving a TECC class. I found the book fascinating and am open to other recommendations in the same vein.
ianso9 个月前
Does anyone else think this should be made into a movie?<p>Massive respect to this ED.
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vasco9 个月前
&gt; I didn’t black tag a single one. We took everybody that came in—I pulled at least 10 people from cars that I knew were dead—and sent them straight back to Station 1 so that another doc could see them. If the two of us ended up thinking that this person was dead, then I knew that it was a legitimate black tag<p>If you don&#x27;t pre-tag them, the second guy will be the only tag on them so there&#x27;s no &quot;double check&quot;. The second doctors opinion wins, since the first one is doing zero triage between black and red. Still commendable but it doesn&#x27;t have the safety property he described.
stuff4ben9 个月前
So I&#x27;m not the only one who thinks about and pre-plans solutions to disaster situations in their head to pass the time. Not coincidentally I like to peruse prepper-type forums&#x2F;subreddits. It&#x27;s for those &quot;you never know&quot; and &quot;someday this might be useful&quot; type of events. FWIW, I&#x27;m not a guns and ammo prepper either (not that they&#x27;re not important, but it&#x27;s way down the list).
bell-cot9 个月前
On HN back in 2017, with 71 comments -<p><a href="https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=15688900">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=15688900</a>
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dinobones9 个月前
Do paramedics&#x2F;ambulances shard across hospitals?<p>It looks like there’s 3 hospitals within 15 minutes of the Las Vegas strip, I’m curious if there’s any attempt to allocate patients equally so that no single hospital becomes overwhelemed.
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rurban9 个月前
And most of our OS&#x27; and stdlib&#x27;s are riddled with blocking IO, where only the OS does the work-stealing.<p>Beam is an incredibly slow VM, but in situations where everybody is waiting on IO, Beam is king.
ro_bit9 个月前
Does &quot;crumped&quot; in this context mean a sudden deterioration? (ie. crumpled)
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more_corn9 个月前
What a fantastic story. I’m humbled by the tireless efforts of the medical workers in this story, even the people working the phones. This is the story of hope, pride and excellence I want to see.
kragen9 个月前
a fictional account by filk star leslie fish, &#x27;the day it fell apart&#x27;<p><a href="https:&#x2F;&#x2F;youtu.be&#x2F;4aYVbt5ZwTc?si=ee4y8BZjgKOf3-5T" rel="nofollow">https:&#x2F;&#x2F;youtu.be&#x2F;4aYVbt5ZwTc?si=ee4y8BZjgKOf3-5T</a><p><pre><code> just a little general hospital in a little factory town the board put me in charge for mainly keeping prices down i hadn&#x27;t touched a patient since 1982 but the day of the explosion i remembered what to do at 11 in the morning we all heard the factory blow the blast took out the windows and the shrapnel fell like snow we could get no help from out of town for half a day or more we had near a thousand casualties and beds for 94. and can you keep your head your backbone or your heart we all found out the answer on the day it fell apart it was worse than combat medicine supplies were draining fast bandages ran out and antiseptics wouldn&#x27;t last i took all the able-bodied i could catch inside the door and made them help the doctors or go scrounge supplies and more i invented laws to tell them saying, &quot;in such emergency forget your usual job and boss; your orders come from me!&quot; i sent the cops to commandeer anything in reach food or disinfectant, cloth or alcohol or bleach and can you keep your head your backbone or your heart we all found out the answer on the day it fell apart the janitor ran cleanup squad; the cook maintained supplies the garbage man removed the ones who died before our eyes the clerks burned all our papers to boil water on the fire</code></pre> ...<p>it gets more engaging from there<p>things like this have happened lots of times in real life, but the people who did them don&#x27;t sing songs about them of course