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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)

#51

Post by biofox »

ericmcer wrote: post #46
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 Ac…

Someday, but I think we're still a way off.

Regarding your interaction with the doctor, I completely understand both sides, and I can guarantee he was well aware of the small risk of tendon weakening.

People usually want their physician to do "something", otherwise what's the point of going? This puts them in a no-win scenario. A single cortisone injection provides immediate relief, with a very small chance of side effects. If he doesn't offer it, people will complain about him being useless. If he does, some patients will think he's incompetent.

I'd find it exhausting having to second guess every interaction.

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

#52

Post by ThrowawayR2 »

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.

Giving people freedom to do their jobs is how we got the Crowdstrike incident. Those rules and restrictions at a hospital are in place precisely because there are enough people who cannot be trusted with the freedom to do their jobs to make them unavoidable.

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

#53

Post by kotaKat »

lostlogin wrote: post #10

I’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.

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 systems there's typically an 'emergency entry' option that lets you just input patients manually into the system and start shooting, so instead of the normal paperwork process they'll just image first and reconcile later.

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

#54

Post by dotancohen »

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.

  > The author's key takeaway is "flow is king"
Which usually doesn't exactly happen with ED.

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

#55

Post by DowagerDave »

ThrowawayR2 wrote: post #52
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.

Giving people freedom to do their jobs is how we got the Crowdstrike incident. Those rules and restrictions at a hospital are in place precisely because there are enough people who cannot be trusted with the freedom to do their jobs to make them unavoidable.

Your premise is highly debatable; I don't know anyone who determined Crowdstrike was the result of "freedom to do your job", but regardless the hospital rules are for regular operation, not black swan events like this.

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

#56

Post by DowagerDave »

AtlasBarfed wrote: post #34
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.

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…

The balance here is what I think is really impressive. They both built assembly lines AND rely on deep, adhoc experience & skill in applicable places. Efficiency in narrower, skill-specialized areas and an "artisanal" approach to initial triage.

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

#57

Post by DowagerDave »

ericmcer wrote: post #46
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 Ac…

>> If I had a reliable AI in my pocket

that's both a big "If" and a very ambiguous ask - what's does a "reliable AI" mean?

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

#58

Post by DowagerDave »

Bartkusa wrote: post #36

> 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. This technique was later applied during the COVID-19 pandemic, when ventilators were in high demand…

yeah - I recognized that too. Seems like such an obvious thing in hindsight but real genius.

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

#59

Post by DowagerDave »

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.

my understanding is "crump" as in crumple, fast but not immediate deterioration. I believe you can crash at the end of your crump.

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

#60

Post by rootusrootus »

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, ...

> I'm an EMT in Belgium

It always happens eventually in discussions like this. "I'm from and I don't get why y'all are so stupid, unlike us."

The US healthcare system is worthy of critique for many things, most of all cost, but the quality of care is just as good as every other western nation. Doctors are quite skilled, just like they are in Belgium I assume. And of course hospitals plan for mass casualty events. All of them, I bet, if they have an ER.

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