Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

epmonthly.com

Post reply on HN
Print view View original

61–70 of 116 posts

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

#61

Post by rootusrootus »

dalben wrote: post #16
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.

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.

This is common in the US, and I would assume in every other modern healthcare system.

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

#62

Post by romwell »

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…

> 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.

Taking medical advice from ChatGPT over what your doctor says, what could go wrong?

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

#63

Post by sfilmeyer »

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, there was lots of sharding across hospitals (although it wasn't executed perfectly). Wikipedia has some good info. About 60 people died and almost 900 were injured, over 400 of whom had gunshot or shrapnel wounds.

https://en.wikipedia.org/wiki/2017_Las_Vegas_shooting#Victim...

> Approximately 867 people were injured, at least 413 of them with gunshot wounds or shrapnel injuries. In the aftermath, many victims were transported to area hospitals, which included University Medical Center of Southern Nevada, Sunrise Hospital & Medical Center, and at least one of the six hospitals of Valley Health System. Sunrise Hospital treated the largest portion of the wounded: 199 patients, 150 of whom arrived within about 40 minutes.[80] University Medical Center treated 104 patients. Additionally, six victims sought medical treatment in Southern California; UC Irvine Medical Center treated four and Loma Linda University Medical Center treated two. Many victims of the shooting required blood transfusions, which totaled 499 components in the first 24 hours of treatment. This blood was rapidly replaced by available blood from local and national blood banks.

>University Medical Center, the Level I trauma center in Las Vegas, was difficult to access for the more than 50 percent of patients transported by private vehicles because Interstate 15, the most direct route from the shooting location, was closed to the public. Also, an erroneous emergency services announcement made one hour after the shooting reported UMC had reached capacity and was on diversion. This confusion persisted for several hours and led to most patients being transported to Sunrise, a Level II trauma center.

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

#64

Post by lostlogin »

amluto wrote: post #24
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.

I recently accompanied a patient through an imaging lab. It was a room full of maybe 10 pieces of expensive equipment, and there was a big line of patients in a waiting room. There was one single technician, who handled one patient at a time, kept disappearing, and even when the technician was there, they spent more time convincing the machines to send the images to EMR than actually taking images. I estimated that t…

>I can easily imagine that skipping all the EMR integration and paperwork and just taking the pictures and having someone stand in the room and read the images would have gotten that 4x throughput improvement

Yes. But 45 minutes later when someone wants to see the images ‘on that guy with the broken leg’ it becomes a nightmare. You need some labelling and a documentation system, and a unique identifier for each patient is a bare minimum. Using the RIS and creating an order isn’t that slow, and quickly becomes a time saver once you’ve got several patients.

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

#65

Post by lostlogin »

kotaKat wrote: post #53
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 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 ‘emergency patient’ function isn’t that helpful when it’s completely anonymous and there are several cases.

I’ve been a PACS admin for a brief time, and have seen enough to get twitchy.

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

#66

Post by lostlogin »

aftbit wrote: post #18
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.

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?

For sure.

And the most critical stuff is quick. I’m sure most techs could knock off a chest X-ray in 2 minutes, repeatedly.

As a student and doing all the paperwork correctly, I did 125 chest X-rays in a dedicated chest room in an 8 hour shift. That’s a 4 minute turn around.

However, all the patients were walking and talking. This makes a massive difference.

I failed the module on chest x-rays on first submission. I was supposed to log 120 over 3 years, showing progression.

Not enter 120+ from a single day. Resubmission was just paperwork, so not a big deal.

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

#67

Post by hatthew »

RandomCitizen12 wrote: post #13
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.

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.

Depends how you define the job. A different interpretation is that the job of a medical professional is to improve the health of their patients as much as they can. Normally this is done by frequently having someone/something more specialized ensure perfect care for the task at hand, but on this night that might take too long, so the best way to improve the health of the patients was to abandon protocol and do the best they can as fast as they can.

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

#69

Post by btach »

RandomCitizen12 wrote: post #13
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.

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.

Unrestricted access doesn't mean unmonitored access. Narcs are counted at every single access and records of who pulled what are kept and audited.
Post reply on HN