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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)

#101

Post by andrei-akopian »

anamexis wrote: post #40
CrispyKerosene wrote: post #37

Earlier quoted context omitted.

Thanks. How do you check if something will be a repost? Edit: Plugged the article URL into the search bar at the bottom of HN and it worked surprisingly well. Im not sure why, but i had no confidence in that actually working.

You can also just click "past" under the post header.

That doesn't work. It plugs the title into hn.algolia.com which only returns the same thread.

Shouldn't it search for the URL instead?

Am I missing something?

Also, I noticed the tracking parameters are in the URL of the old thread. Shouldn't the mods remove them using https://linkcleaner.app/ or something? I know the parameters are sometimes relevant but still...

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

#102

Post by FireBeyond »

lostlogin wrote: post #65
kotaKat wrote: post #53

Earlier quoted context omitted.

Digital x-ray has changed everything so much. Slap the Wi-Fi enabled plate under someone, click click, image already up on the screen and doc's reading it. I (almost) broke my ankle and had to go to the ER to have it looked at and it was during a system downtime -- the doc did just that alongside the radiology tech from the machine's console instead of from a PACS workstation. In a masscal event on one of these syste…

It does get better when digital, but there is more to it than one might think when a good tech does it all in a few seconds and a couple of clicks. Positioning and adapting exposures isn’t always straightforward. In terms of tracking imaging, you have to be able to track images back to a patient, and something identifying images needs to relate back. It’s a disaster otherwise and a complete waste of time. That ‘emerg…

> In terms of tracking imaging, you have to be able to track images back to a patient, and something identifying images needs to relate back

The worst incident I have been on as a paramedic involved transporting 73 people from a train derailment. One of the simpler, but crude, methods we had as a fallback, was a sharpie and writing a number on foreheads, etc...

But we had MCI tags, which all have a unique number, would serve as a pseudo-MRN.

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

#103

Post by ghufran_syed »

tptacek wrote: post #12
RandomCitizen12 wrote: post #6

Earlier quoted context omitted.

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.

I often use them interchangeably, but “crashing” implies it’s a bit faster (and therefore more obvious), whereas “crump” implies it can be a bit slower. So a “crashing” patient implies you have to run in the room and do something immediately, but a patient who “crumps” might gradually get worse over several hours, have to be put on a ventilator, require pressors, but with much less drama maybe?

I think “crash” gets used more in the past tense, whereas “crump” gets used maybe equally in both future and past tense? e.g “that patient you signed out to me crumped a couple of hours later” , but also, say when leaving a shift, in the future tense, “the guy in bed 6 is admitted to medicine, but let me tell about him in case he crumps”.

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

#104

Post by kayodelycaon »

pas wrote: post #94
eapressoandcats wrote: post #86

Earlier quoted context omitted.

There’s not really a clear tension though. Procedures exist with an intent to get results. Airlines have lots of procedures that are carefully followed and the result is “the plane always arrives safely”. If you asked a pilot the question to “make a choice between procedures and results” they’d think you were crazy. Obviously there can be misguided procedures, but any decision made or operation done can be misguided.

What's the result of the completely useless flight safety mantra? People will not leave their belongings! The mantra should tell them that they will be compensated if they make it out alive but they will be put down like a mad dog if they hinder others with their packing and packages... Also people do charge all the fucking time, and don't put their phone into airplane mode. :|

I would say it works incredibly well. Everyone knows what it is. Everyone knows what they are supposed to do in an emergency. Everyone knows there are emergency exits. Everyone knows there are life jackets. Everyone knows they are supposed to wear a seatbelt. At least some people will get it right.

Do not underestimate how even minimal training can be extremely effective at scale. I know from experience that I am a person who does not freeze, I focus. When shit happens, I act but I can act without thinking. Because of that mantra, I have a plan to follow and I will act correctly.

Also don't underestimate the effect of priming. It reminds you there is a plan. When pilots prepare for takeoff, they briefly review how to handle emergencies during takeoff. Not because they don't know, but to bring those procedures to attention and have them ready in their mind.

For the mantra to work, all it has to do is remind you those procedures you vaguely know exist.

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

#106

Post by amonon »

If you are interested in disaster psychology and planning like this, you might also enjoy "The Unthinkable" 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.

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.

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

#107

Post by stuff4ben »

So I'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/subreddits. It's for those "you never know" and "someday this might be useful" type of events. FWIW, I'm not a guns and ammo prepper either (not that they're not important, but it's way down the list).

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

#108

Post by ted_dunning »

treflop wrote: post #82
at_a_remove wrote: post #79

Earlier quoted context omitted.

An irritatingly overlooked issue is the tension between procedure and results . Obviously, a well-refined procedure learns from past issues and evolves, growing ever more adaptable and useful, the way that aircraft rules are "writ in blood." Still, every one of the adaptations was prompted by an event that was Not in the Script. I think, for my next job, one of those questions I will ask when the time comes to ask if…

I believe this is not a question that can be asked. Recently I pushed a change straight to production by myself with no approval and violated many rules but it saved us and carried us for weeks. Worse case if it broke, rollback would happen under in under 30 seconds. I did it because not only did I triple check, I’ve kept mental track of the number of regressions and issues that have been logged against all of my wor…

I once had an engineer push changes directly to production because they were confident that they would do it correctly.

In fact, they were completely misguided about their own accuracy because they had systematically ignored or not understood the errors that they had made in the past.

The challenge as a tech lead or manager is telling the difference between you and them. Or even telling whether you are them. My own tendency would be to fire both of you.

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

#109

Post by ted_dunning »

somat wrote: post #76
AtlasBarfed wrote: post #34

Earlier quoted context omitted.

The CT scan reminds me of someone that was trying to optimize welders. They said they were at their maximum, but welders would move parts and plates and then weld. Efficiency expert realize that welding was maximized if the welders were welding the entire time. Other people could bring them the metal parts that needed to be welded. So the normal process where the CT person wouldn't move the person in and out of the C…

Makes me think of the apocryphal story that the genius behind Sears Roebuck & co, the thing that enabled them to change from being "just another mail order company" to "The mail order company" was to invert the fulfillment process. this changed the cost of assembling an order from n to log(n) I don't think it was Mr Sears or Mr Roebuck that came up with the idea, One of their warehouse managers I expect. I always sor…

What do you mean by "invert the fulfillment process"?

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

#110

Post by ryandrake »

Retric wrote: post #99
pas wrote: post #93

Earlier quoted context omitted.

How would you know? How would they know? Okay, sure you will have a hunch based on the answer, but it seems something that only experience can tell. (Okay, you can ask them about their experience.. and who know how forthcoming and honest and relevant their answer will be, right?)

Pilots aren’t limited by experience, they know a great deal about aircraft systems and the mechanics of flight. Procedure is incapable of handling every single edge case because the possibilities are endless. So when do you deviate from procedure? When the edge case you’re in is well outside the scope of exit procedures which requires detailed understanding of the procedures and their justifications.

Pilots are also allowed to deviate from any procedure and even violate federal regs in the event of an emergency.

14 CFR § 91.3(b) In an in-flight emergency requiring immediate action, the pilot in command may deviate from any rule of this part to the extent required to meet that emergency.

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