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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)

#41

Post by ooterness »

dalben wrote: post #15

Interesting 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, ...

As Eisenhower put it: "Peace-time plans are of no particular value, but peace-time planning is indispensable."

In other words, the act of planning means you're better prepared for specific contingencies, so you'll hopefully be better prepared for whatever actually happens, but some improvisation will always be necessary.

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

#42

Post by stereo »

mewse-hn wrote: post #32
dalben wrote: post #15

Interesting 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, ...

With respect from Canada, I doubt you are seeing many incidents with 200+ gunshot victims in Belgium

https://en.wikipedia.org/wiki/2016_Brussels_bombings

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

#43

Post by bb611 »

dinobones wrote: post #14

Do 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.

Yes to the extent they're able.

This article is a pretty good overview of the situation across Las Vegas that night: https://www.facs.org/for-medical-professionals/news-publicat...

In short, every hospital was overwhelmed, but Sunrise was the closest to the shooting so got the most overflow.

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

#44

Post by alwa »

lukan wrote: post #29
alwa wrote: post #26

Earlier quoted context omitted.

While that’s true, I worry about glorifying too much the desperation of the whole situation. If the same patients had arrived at a pace consistent with normal operations, wouldn’t you expect the outcomes to have been better? Normally cross-checking medications and dosages saves lives by reducing medical errors. Normally I’d rather not be operated on by a surgeon so strung out that, like the author describes, his mind…

"Normally I’d rather not be operated on by a surgeon so strung out that" Normally no one wants to be part of a "mass casualty event" but if one ends up in one, I would be glad if competent people do the best they can and not stop on arbitary regulations meant for normal times.

Absolutely, and I hope that I didn’t give the impression otherwise. In times of crisis I’m immensely grateful that most everyone will step up beyond their normal responsibilities.

I’m even more grateful that leaders like the author have spent their careers developing the experience, instinct, discernment, credibility, and fortitude to make the right adaptations under pressure.

I’d even agree with the original comment that a good leader trusts their people and gets out of their way. I just think that manifests differently in steady-state operations than during crisis.

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

#45

Post by kragen »

a fictional account by filk star leslie fish, 'the day it fell apart'

https://youtu.be/4aYVbt5ZwTc?si=ee4y8BZjgKOf3-5T

  just a little general hospital in a little factory town
  the board put me in charge for mainly keeping prices down
  i hadn'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'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, "in such emergency
  forget your usual job and boss; your orders come from me!"
  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
...

it gets more engaging from there

things like this have happened lots of times in real life, but the people who did them don't sing songs about them of course

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

#46

Post by ericmcer »

biofox wrote: post #5

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.

This could be a really cool use for AI. We have so many rules and systems in place to protect normal people from professionals that we have to blindly trust. If I had a reliable AI in my pocket I could be in charge of my own safety again.

I did this a month or so ago when a Dr. recommended a cortisone injection behind my ankle. I asked GPT about it, it said consensus recommends against it because it can weaken the Achilles. The doctor hated it but I am really glad I didn’t just blindly trust him.

I guess I like it because it is enabling instead of replacing humans.

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

#47

Post by mewse-hn »

stereo wrote: post #42
mewse-hn wrote: post #32

Earlier quoted context omitted.

With respect from Canada, I doubt you are seeing many incidents with 200+ gunshot victims in Belgium

https://en.wikipedia.org/wiki/2016_Brussels_bombings

I stand corrected

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

#49

Post by alwa »

aftbit wrote: post #17
biofox wrote: post #5

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.

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.

This struck me too—especially the way he seems to have kept one eye on the big picture even while he was facing a flood of individual patients depending urgently on his task-level attention.

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

#50

Post by hinkley »

aftbit wrote: post #17
biofox wrote: post #5

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.

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.

Having people bleed out in the waiting room is quite an unpopular outcome. When you have the luxury of time it's less excusable to make a misdiagnosis or to rush a treatment.
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