Does "crumped" in this context mean a sudden deterioration? (ie. crumpled)
My understanding is that it's deterioration to the point where your patient is, in a figurative sense, actively trying to die.
How one ED mobilized his department during a mass casualty incident (2017)
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Re: How one ED mobilized his department during a mass casualty incident (2017)
#12Does "crumped" in this context mean a sudden deterioration? (ie. crumpled)
Wiktionary says crump means "(intransitive, US, medical slang) (of one's health) to decline rapidly (but not as rapidly as crash)."
There are several doctors here, one of them could pop in and tell us if crumping and crashing are interchangeable. I actually thought "crumping" was the more severe thing to say.
Re: How one ED mobilized his department during a mass casualty incident (2017)
#13The 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.
I don't think giving nurses unrestricted access to narcotics is giving them 'freedom to do their job' because a valid part of a nurse's job is controlling access to narcotics. It's not a medical need, but it's an operational and societal need. Same with whatever a CT tech would do away from the controls. I think this is more accurately a descoping of the job to improve throughput.
Re: How one ED mobilized his department during a mass casualty incident (2017)
#14Do paramedics/ambulances shard across hospitals?
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.
Re: How one ED mobilized his department during a mass casualty incident (2017)
#15Interesting that he had to do so much thinking and improvising. I'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's a dedicated command room, ...
Re: How one ED mobilized his department during a mass casualty incident (2017)
#16Do paramedics/ambulances shard across hospitals? 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.
Can't say for Las Vegas, but we do here (in Belgium). There's a dedicated responsibility during mass casualties to distribute leaving ambulances over hospitals, also taking into account hospital specialties and facilities, such as a burn unit. The closest hospital is usually skipped because victims who self-transport will usually go there.
Re: How one ED mobilized his department during a mass casualty incident (2017)
#17The 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.
What struck me was how the author was able to identify choke points and make decisions to deviate from procedure to fix them. In many organizations, adherence to procedure is more important than getting good results. It is interesting to see that at least in this hospital at this time, that wasn't true.
Re: How one ED mobilized his department during a mass casualty incident (2017)
#18I’m surprised reports were generated quicker when the radiologist worked with the X-ray tech. Back when I did x-rays, a quick radiologist could report a set of films in about a minute. 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.
Could you do more than one patient in ten minutes if they were lined up outside your door and shuffled on and off the machine by spare staff?
Re: How one ED mobilized his department during a mass casualty incident (2017)
#19I’m surprised reports were generated quicker when the radiologist worked with the X-ray tech. Back when I did x-rays, a quick radiologist could report a set of films in about a minute. 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.
I read this to suggest that it was a flow thing more than a quantity thing.
By doing the readout on the spot, they could decide what was next for the patient before they even made it out of the machine, and the patient would roll directly off to get whatever attention the scan indicated.
I also thought I picked up an insinuation that they saved time by short circuiting all the convoluted EMR and billing kinds of systems, too. He mentions the radiologist reading the images directly off the “small screen” on the machine itself.
Re: How one ED mobilized his department during a mass casualty incident (2017)
#20What a great read, i love times where competent people make shit happen. Crisis leadership is a rare skill.