Speaker A
This week on Challenge Accepted, I'm going to see what it's like to be a triage officer in an emergency room during a mass casualty incident.
Michelle Khare experiences a realistic emergency room mass casualty simulation, learning triage and life-saving decision-making.
Key Takeaways
- Triage during mass casualty incidents requires rapid, systematic patient assessment to prioritize care effectively.
- The START triage system uses simple criteria to categorize patients by severity: walking ability, breathing, perfusion, and mental status.
- Simulations with actors and real medical staff provide valuable hands-on training for emergency responders.
- Emotional resilience is crucial for healthcare workers managing high-stress, life-or-death situations.
- Effective triage can save more lives by allocating limited resources to those most likely to benefit.
Summary
- Michelle Khare participates in a 1-hour live-action mass casualty incident (MCI) simulation in an emergency room setting.
- The simulation involves over 30 actors as patients and real medical professionals guiding Michelle through triage procedures.
- Michelle learns to categorize patients by injury severity using the START triage algorithm: green, yellow, red, and black tags.
- She receives crash-course training from Dr. Mike and other experts to prepare for rapid, life-or-death decisions.
- The simulation replicates chaos from a major earthquake with continuous patient influx and complex scenarios.
- Michelle performs triage assessments, including evaluating walking ability, breathing, perfusion, and mental status.
- She experiences the emotional difficulty of tagging patients, especially those categorized as black (deceased or unsalvageable).
- The video highlights the importance of quick, accurate triage to maximize survival and resource allocation during MCIs.
- Michelle also performs emergency procedures on critical patients under expert supervision.
- The simulation concludes with feedback on Michelle’s triage performance and reflections on the emotional toll of emergency care.
Chapters
- 00:00Introduction to the Mass Casualty Simulation
- 01:35Role and Importance of Triage Officer
- 03:18Training on START Triage Algorithm
- 04:44Simulation Begins: First Patient Assessments
- 07:22Handling Complex and Emotional Cases
- 09:48Performing Emergency Procedures
- 20:25Emotional Challenges in Emergency Care
- 29:30Feedback and Reflection on Performance
Full Transcript — Download SRT & Markdown
Speaker A
The catch is I'm not a doctor, and this entire hospital, it's not real. We're putting Michelle [music] through a real-life simulation of a 1-hour mass casualty incident. This is where real doctors, nurses learn. We've essentially designed a live-action hospital video game. Over
Speaker A
30 actors playing patients, real nurses [music] and doctors where Michelle will have to make split-second life or death decisions.
Speaker A
50 microgram spin. I'm worried about her, her close enough to make a vertical incision.
Speaker A
How do you tell someone that someone has died? We've seen it a million times on TV, but how close is it to the real thing?
Speaker A
Everyone [music] needs a tag. Everyone needs a tag. Find out on this week's episode of Challenge Accepted.
Speaker A
Simulation starts in 3, 2, 1. [music] We want to get to Southern California on alert this morning after getting hit by the largest earthquake there in two decades, sparking more than 160 aftershocks.
Speaker A
You can see the damage, over 500 people. [music] All right, there's an earthquake. So, we're going to get people coming in left, right, and center. Ambulances, people walking in, crawling in, personal cars. Do we know how many are coming?
Speaker A
We have no [music] idea. So, we have to be prepared for anything. And that's where your triage skills are really going to be essential, that you need to sort all these patients that are coming in.
Speaker A
My role as a triage [music] officer is to quickly assess the patients arriving at the emergency department and assign them a color based on [music] their injury severity level with the hope of saving as many lives as possible. So, if
Speaker A
you've seen The Pit, what Michelle is going to be experiencing today during an MCI is very similar with one [music] big distinction. They're actors. They have lines. Michelle does not know what she's walking into. She has to rely on this
Speaker A
one day quick education that we presented to her. So, I don't envy her. Dr. Mike, good to see you again.
Speaker A
Good to see you. Yes. I'm Dr. Dr. Mike Varovski, board-certified family medicine physician and content creator online, especially on YouTube, one of the most influential medical educators online, 25 million followers, the legendary Dr. [music] Mike Marshky.
Speaker A
Dr. Mike is in our video. So, Dr. Dr. Mike has the incredible experience of not only being a healthcare and science [music] communicator, but also practicing every single week in the field on real patients. So, I asked Dr. Mike to come
Speaker A
in and make this simulation as real as possible. In one day, we're going to try and simulate 4 years of medical school to teach Michelle what [music] to do during the MCI.
Speaker A
What you're going to be going through tomorrow is very similar to what we train all our emergency department staff on.
Speaker A
Yes, I'm a doctor. I'm [music] a family medicine physician. So the training I have doesn't really prepare me fully for an MCI. It's the experts like Ryan, [music] like Brett. They're the ones who have the experience to not just practice
Speaker A
it in real life, but also to teach it on a very high level to doctors like myself. So I'll be getting a lot of value today, too.
Speaker A
So we're going to teach you how to sort patients so that we make sure that we can do the most good for the greatest number of patients possible.
Speaker A
How do I do that? [laughter] So there will be four categories I can sort patients into.
Speaker A
Whoa. What the? So we have a simulated patient here. I can I can do [laughter] Fortunately, there's a tool available.
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Uh, it's called Start Triage. And uh, we have a flowchart here that will direct you through [music] the algorithm.
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I love flowcharts. The start triage flowchart gives medical professionals a starting guideline [music] to quickly assess patients as they are brought into the emergency room. Starting with the green, we have the patients that are going to be your most minimally injured.
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The first question is, is the patient able to walk? If yes, they're immediately [music] assigned to green. Please walk towards me.
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Yes, [music] that's already green. Easy. We're done. [laughter] Going on to yellow. This is called delayed. So, the patients that are definitely going to need care, but they don't need it right away. Yellow means the patient cannot walk but might still
Speaker A
have stable vitals and mental status. [music] Breathing. They are breathing. Respiratory rate is less than 30. Okay.
Speaker A
Perfusion. When you check for perfusion, you push down on [music] their nail. And when you let go, if it goes from white to normal color in less [music] than 2 seconds, we move on to check their mental status. Can you wave your hand?
Speaker A
Okay. So, yellow, final answer. The red patients are going to be your most critical patients, the ones that need immediate medical care. They have something that you're detecting as abnormal in either their breathing rate, their perfusion, or the way that they're
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responding to you and following commands. They're not walking. Heavy breathing. Uh, respiratory rate is 40.
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High respiratory rate, that's a red. These are the patients that have the most emergent needs. The black category are the patients that are either deceased or unfortunately there's not a lot that can be done to save them. It
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doesn't mean that we ignore them. We're still going to provide palliative care, but unfortunately just there aren't the resources available like there might be on a daily basis. He is not walking.
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Okay. Are they breathing [music] able to? No. Can we position their airway? So you would go over there, do a head tilt, chin lift.
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This does not include CPR. Unfortunately, again, because we only have one minute and we don't have the resources to devote that many people and that many [music] resources to a single patient at this point, but I like where you're going. I like I
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like that you're thinking about it. Okay. So, unfortunately, we're going to have to tag [music] this patient into the black category.
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That sucks. I hesitate to put the black wristband on a patient. It can be extremely challenging and this algorithm helps you do a calculated evaluation on them that takes the emotion out of it. After the [music] incident, people start to break down.
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They have big emotional outbursts because they were putting away their emotions for so long. So, [music] expect after your simulation tomorrow to feel quite stressed out.
Speaker A
Simulation starts in three, two [music] one. Let's get started with our first set here.
Speaker A
My first challenge is to perform triage on an incoming wave of patients who were injured in a collapsed apartment building during the earthquake.
Speaker A
Ma'am, are you injured? She's walking, so it's green. I'm just going to put this here, but if you're able to walk, go ahead and head this way.
Speaker A
Excuse me. Where do you feel pain, sir? My knees are all cut up.
Speaker A
Okay. Hi. Are you able to walk towards my bus? Yeah, I'm okay. You could probably help somebody else while you help me.
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Okay. Okay. Well, I'm just going to tag you here. This is going to tell us how to um treat you in the hospital. Please head in this way.
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Pull this thing out. No, do not touch it. So, the first couple of people I see, they're walking, [music] they're breathing, they're talking, they're responding. I'm great.
Speaker A
Are you able to walk towards my voice? There's confusion here. There's confusion. Airways. Why are we She's breathing. She She has airways.
Speaker A
Yeah, she's talking, but there's confusion. I don't know what to tag her because she can walk, but her mental status I'm going to say yellow.
Speaker A
You have another patient. You have to be quickly. Get your staff out. Michelle, your patient is leaving. Oh my god.
Speaker A
But [music] then the cases start to become trickier and a little more complex. Like a patient who appears and they're able to walk, they're able to talk, but they don't seem all there mentally. Trying to triage this patient
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is sort of like trying to have a conversation with someone while also doing a math.
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looks like and how I'm [music] supposed to assign them. Ma'am, you have lots of cuts. We need to take care of cuts. Yeah. On your forehead.
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Cuts. These are humans, so they're going to give you imperfect answers at times. So, when you're trying to evaluate someone's mental status, you say, "Give me a thumbs up." They don't give you a thumbs up. You can miscategorize them.
Speaker A
Hi. Um, what are you working with here? Okay. Can you hear my voice? Their guts are coming out of their mouth.
Speaker A
Yeah. Yeah. That not important. Okay. What's important? They can't walk. Okay. I'm going to put a red on this.
Speaker A
Okay. Based on what? What do you mean? Based on short of breath. What are we getting breaths wise here? He's breathing really slow. Actually, he is breathing really slow.
Speaker A
Okay. Okay. So, you're going red. Okay. Okay. I'm just That's okay. Patriage isn't my only responsibility.
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It is also my job to perform procedures on the [music] patients that are most high-risisk that I categorized as red.
Speaker A
When you're in front of the hospital, you're triaging. When you're inside the hospital, you're treating.
Speaker A
So, this guy's done an evvisceration. [music] He's full-blown on oxygen. Still able to wake up a little bit. Sir, are you still with us?
Speaker A
What do you think of the vitals so far here? His heart rate is somewhat elevated.
Speaker A
Yes, it's tacoc cardic. But what is the issue right here? We need to cover and address the room and call surgery immedately.
Speaker A
So, we're going to take a look at a patient that has an evisceration. And an evisceration happens when you cut to your abdominal wall and some of your bowel comes out. Yeah. So, it's a really bad day.
Speaker A
It is a bad day. You do not want to ever push the abdominal contents back in cuz forcing them back in is actually not the correct move. So, this patient is going to have to go to the O and see a surgeon to get
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it put back in. But what you're going to do is you're going to try to preserve the bowel.
Speaker A
All of the medical professionals in this simulation are actual doctors and nurses who have been instructed to carry out my commands. [music] Even if I'm wrong, what you want to get first is a big trauma dress. This is sterile saline.
Speaker A
And you're just going to pour some in there. Now go ahead and pull it out and cover the bowel [music] with that.
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We are just going to cover the wound for now and prepare you to go into surgery.
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And now this is like an olusive type dressing that's going to help keep that moisture in so we can [music] has a very strong smell.
Speaker A
Yeah, there we go. Let's put one there. We now want you to grab that roll of tape.
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Perfect. [music] Okay. Yeah, there you go. Thank you for the assist. Okay. Okay. Hey, do we call the O? Can we call him?
Speaker A
Yep, I'll call the O. Okay, we'll get the O prepped. Okay, we'll move on right away.
Speaker A
How are we doing in here? We We're done here. The real Dr. K is actually not me.
Speaker A
It is my dad. Growing up, I was actually on a course to become a physician just like my dad. Instead, I became a YouTuber. So, doing this episode is my one opportunity to hopefully make him proud. Also, my dad says to subscribe.
Speaker A
[music] So, doctor's orders, you better subscribe. The biggest issue that I'm seeing in Michelle right now is that she's making mistakes triaging patients.
Speaker A
Sir, can you hear my voice? Yes. Okay, Brad. I'm starting to see emotions creep up.
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Panic set in. She's freezing. Can you walk towards my voice? Can you walk on his own?
Speaker A
Yeah. Yeah. Okay. Okay. Okay. That's a green. Yeah. Okay. He has a chest injury.
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You see that? Okay. Chest injury. Um, he's walking but he's not walking by himself.
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Does anyone know what they're red? Okay. I'm just going to do red on that. Once you miscatategorize a patient, you're starting to give resources to that patient they didn't need, you could be losing resources for people who [music]
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can be help. This is the domino effect that if you make a mistake early, it can cause you a lot of harm down the line.
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Hey, hey, can we get some help? Walk towards my voice. My wife cannot walk.
Speaker A
Okay. Okay, they can walk. So, they're both somebody over here, please. Okay. Where? Okay. Um, my name is Dr. K and we're going to treat you inside. Keep going inside. After I assign a color to each patient, they will be put into a room
Speaker A
based on [music] that color. Now, each of these rooms have limited beds, staff, and resources. And the problem is if you miscatategorize someone, it creates a chain reaction of problems in the future. For example, [music] if a patient is overcatategorized, green,
Speaker A
red green red idiot that patient will end up taking resources from someone who needs them more. And a patient who is undercatategorized will ultimately not receive the resources they need and thus be at risk of death. So this is kind of
Speaker A
like a resource allocation challenge. It it sure is. Okay. How do you feel? That was so overwhelming.
Speaker A
Remember you have secondary triage always after the fact. Okay. I'm going to be more confident.
Speaker A
Okay. While mistakes are bound to happen cuz patients are going to be changing their severity level. Usually [music] that severity only gets worse. That's why there's always a consideration made for secondary triage where we can adjust for that and catch those mistakes early.
Speaker A
We're just sort of wondering when we can be seen. Get her on some vitals.
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See if any of those guys down there might went inside. Try not to run. Very easy with sharps to get hurt.
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Remember, take care of yourself first. All right. Sorry. Vomiting with head trauma. Can you tell me [music] what happened?
Speaker A
Something fell like a beam. ABC. You have patience. I'm going to teach you this like this basic trauma assessment. It's called the primary assessment. So, first thing you want to know is just do I have an airway. So,
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that's a airway clear. I'm going to check breathing. The next one is B. It's breathing. Now, we're seeing if they're breathing is effective.
Speaker A
Breathing is okay. You hear good breath sounds on both sides? Yeah. I mean, do you want me to double check?
Speaker A
Yeah. Yeah. And then after that, we're going to move to circulation. There's two big things you want to know about circulation. One, you want to know if they have a pulse.
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Then the second thing we're going to check is we're going to look for any major bleeds. Good. So, now we've done airway, breathing, circulation. Most of our problems are going to happen in those three areas, and we'll have to
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address them to save that person's life. Is there a reason why you classified her as red?
Speaker A
We could secondary triage her and change her. We need to move her down to yellow. We only have so many beds.
Speaker A
Yeah. So, I just wasted two gurnies. Yep. Make more room. If you put [snorts] someone into the red zone where they should be in the yellow zone, just switching them could cause people to lose their lives. you're using staff to
Speaker A
mobilize those patients and that can be really difficult. Can be this female right here. So, she's been complaining of blindness in her left eye and some pain and I just have a lot of pain and also my my right ankle I can't
Speaker A
she cannot walk. She's she's blind in one of her eyes. She's got glass sticking out of it.
Speaker A
I think it's really starting to kick in like is this going to be a [music] like forever thing? Am I not ever going to be able to see out of my eye? I'm just freaking out a little bit.
Speaker A
Okay. Yeah. Yeah, I understand. Can we get some care? Like, so right now, are you okay if I just put an IV in here and give her some pain medication, some of morphine again?
Speaker A
Yeah. Okay, great. I will make and it'll help with the pain. Okay. It's going to be I try not to lie to patients, right? I don't say you're going to be okay. But I do try to I think reassurance is very
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important during this stuff. It's going to be it's uh we're doing the best we can.
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Okay. Thank you so much. Okay. This gentleman here has some abdominal trauma. He had a problem.
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I'm fine. Just find my okay. I need pain medications and a CT scan. Okay, that sound good. I agree with that.
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4 milligram sounds good. We're just waiting. What are you doing here? Nothing. Literally nothing.
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[panting and gasps] Katon Everett. He was the lead in the construction site. He's concerned about his men.
Speaker A
Okay. Uh we'll just give him something for the anxiety for anxiety. Why did you order for pain?
Speaker A
4 millig morphine. Okay. I'm fine. Is he allergic to morphine? Are you allergic to morphine? No, I'm Did I? That's I I think we need to prioritize other patients. Then we can do it.
Speaker A
Oh my god. Okay. Okay. What are you doing? What are you doing? Ask questions. Ask questions.
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She's unresponsive. If you need to manage your airway on on the EMS journey, feel free to do it.
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You want to listen? You want to listen first? Yeah. Listen. Get some vitals. So, there's a lot [music] of things that can be happening that are disruptive that you can't even plan for. Being pulled in one direction, then another direction is
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really difficult. How much should they be squeezing? Okay. Every every six seconds, right? Okay. And then we should prep an IV for intubation [music] so that we can give her medication so we can intubate.
Speaker A
Okay. I'll get an IV started. Okay. We're going to work on intubation. And that's where we're [music] going to secure somebody's airway. We would have to put a tube down their throat to help them maintain their airway. But the
Speaker A
other thing it could be used for is breathing, too. Cuz if somebody's not breathing, we could breathe for them.
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Your vital signs are coming up. Her sats are terrible. Okay. Can I get IV quickly?
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Non-dominant hands. There we go. Cuz you want to control the tube with your dominant hand. And this has to be in a place that you can see it, not where the nurses can see it.
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I am ready. Yes. Okay. 120 sucks in. Okay. You have your monitor. What are you looking for? What do you see? [music] I'm looking for the epiglatus.
Speaker A
And then just slide that in there. Nice. You see that's the epiglot. There you try to hit in the middle of the epiglatus. Back up.
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Oh, her teeth. Oh, I just broke someone's tooth. Mal practice. Okay. Oh my god.
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And you're going to take that and then this is the twisting thing once it's in the neck.
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Twist it. There you go. Push it just a little bit further. Boom. Okay. Good. Now then pop this out your thumb [music] out towards the stomach. Out towards the stomach. Out.
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Then bring it forward. Grab it with your other hand. Yes. Good. So then I will come up here and bagging it means assist ventilations.
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Attach. Put on your stethoscope. Put on your stethoscope quick. [music] Check the stomach first.
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Okay. It's not on the stomach. Okay. Chest rise is present. Good. On the right.
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O2 sets coming up to 94. Okay, that's good. Okay. Do you want them to secure the tube?
Speaker A
Yes, secure the tube. She's stable. What do you want to do? Ah, now we need to push uh 50 micrograms fentanyl, 2 millig, and a propal drip, please.
Speaker A
Okay. Can someone repeat that back to me? Okay. 50 of fentanyl, uh, two of propal drip.
Speaker A
Yes. [music] Thank you. Okay. During an earthquake, you're having all sorts of scenarios happen at the same time. But then you're also having really surprising incidents, seeing a young child, someone you feel bad for.
Speaker A
Hi, can you hear me? Can you come towards me? Okay, she's able to move.
Speaker A
Let's see if she can walk. I can't walk. You can't walk. Um, let me feel her pulse.
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Let me see your wrist. Does that hurt? Okay. You got multiple patients. Got it.
Speaker A
There's lots of different people speaking lots of different languages. Sophia loi uh she doesn't know where she is.
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What do you think about that fracture? Uh but she can breathe. She has a pulse. I think it's yellow. I think it's yellow.
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Okay, fair. Tell your staff. Tell your staff. [music] And that's why during an MCI like this, you have to be prepared for absolutely anything.
Speaker A
My water broke about 20 minutes ago. Okay, Michelle, can we get a stretcher for her? Her water just broke.
Speaker A
Michelle, there's two people. We're still going to have patients that are coming to the hospital for other things that were not related to this specific incident.
Speaker A
We should still triage them because we're overflow. Correct. It's for [music] everyone because it is balancing the resources that are available for everyone with the number of people that are coming in.
Speaker A
Hi, can you talk to me? Yes. Tell me what your name is. Genevie Frink.
Speaker A
Okay. What's going on? Uh, my water broke 20 minutes ago. 20 minutes ago. Oh, are you having contractions right now?
Speaker A
Yeah, I started this morning. How far apart are they? 2 minutes. 2 minutes. Okay. Yeah, let's proceed with green.
Speaker A
Lady's like going to deliver a baby, I think. Do we have room? I've called. You want to put her in a room called and any response?
Speaker A
No, we need to escalate. Why did you change to red? Because she's about to deliver a baby.
Speaker A
Okay, that's not on the algorithm. I don't know what to do about that. So, this patient is about to give birth, but because of all of the mistakes [music] I've made over categorizing people, all of the operating rooms are now full.
Speaker A
See, her contractions are getting closer and closer. Like, if she starts to deliver, I told her we're going to have to cut her pants off. I just We're out in the open. So, meaning I now need to perform a
Speaker A
procedure on one of the red tagged [music] patients so that I can create space.
Speaker A
Okay. the scene. I got another coworker. I still haven't been told what's going on with him.
Speaker A
This is not going well. I'm worried about her. She's her airway's closing up. Her need to get to the airway. We need to do rapid incubation.
Speaker A
Yeah. I mean, we could try a lot of swelling and she's like, can we go through a cry?
Speaker A
I would. That would that would make sense. Then we need to prepare for a cry.
Speaker A
Okay. Okay. We're waiting for you. When you're ready, he's ready. You ready? Great. Great. Great. I need the scalpel.
Speaker A
There you go. Yes. Uh, right now I am going to be feeling for the thyroid cartilage. Good.
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And I'm going to make the vertical incision between thyroid cartilage and the cryo ring. Okay. I'm cutting due [music] to skin now.
Speaker A
Okay. It just seems like after the pain medicine, she started to feel really dizzy.
Speaker A
Sorry, my dear. We're going to get her into the yellow. We need to work on her lying down.
Speaker A
I think this is right. How far are you going to push this in? Just a few inches so that we don't go down into the lines.
Speaker A
Correct. Is that the direction? Thank you. Can someone Can somebody pay attention [music] to me, please, for for a moment?
Speaker A
Hey, you're last in line, bro. Dude, I got here before you. I don't care. He can't feel his legs.
Speaker A
He can't see. Hey, can we uh prepare the syringe so I so I can inflate it?
Speaker A
Tube up on the tube. No. Can we just have you sit down now? Now this comes out. Now this comes out.
Speaker A
Now this comes out. and switch the CO2 onto that and I promise I will call them and we'll make sure that you will call them and they have not been called.
Speaker A
The longer that I speak to you, I can't get on the can you take a seat and I will call.
Speaker A
How have you not called when we we talked about like 20 minutes ago? Yo, dude. Dude, dude, get back in.
Speaker A
Oh my god. [laughter] The baby's coming. Get back in bed. So, hey, what's going on here? Get back in bed. Hey, real quick. I got Okay, gold is good. Let me listen to see if it's working.
Speaker A
Okay, what are you listening for? I'm listening to make sure that it's both lungs and not just one.
Speaker A
Wait a minute. I know you. I know. Okay, my dear. This is an emergency.
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Repeat back. I think I think it's working. Okay. Okay. Do you feel good? Uh, yeah. I'll I'll check it out.
Speaker A
Okay. Okay. So, I see. Hey, can we get the OB kit? We have got to get her jeans off cuz that baby's gonna Yeah, I think she's gonna deliver any second. What do you think? Should we cut our jeans off?
Speaker A
Where's my doctor? Get the scissors. All right, come on. Okay. Okay. Um, we did a video on how to deliver a baby 2 years ago, but that was 2 years ago. I don't remember anything on how to do this. Um,
Speaker A
do your best. Open the kit. Start the process. Ma'am, Dr. Cari's here. She's going to do a great job. Oh, my back hurts so bad. She's going to cut your jeans. Okay. Set this up. Set this up.
Speaker A
I uh This is This is crazy. This is actually crazy. So, we should cut her clothes off.
Speaker A
Yes. Hey, listen real quick. Obie just called. They are upstairs. The doc said he much rather deliver this baby upstairs.
Speaker A
I would much rather that, too. Are you okay? Is she stable enough for that or do you want to deliver here?
Speaker A
I think she's got to go. Yeah. The doc says it's much better upstairs for this.
Speaker A
Tell the patient. Tell the We're headed up now. Give us 5 minutes. We'll be there in 5 minutes. Okay. Okay. Thanks.
Speaker A
Oh, thank God. Easy breaths. Easy breaths. You're doing well. But the chaos still isn't over. While I was treating my patients, my staff was triaging even more patients who are now flooding into the hospital.
Speaker A
Mom. Mom. This is mom. Hey, mom. What's mom's name? It's Ruth. Hi, Ruth. It's Jackie. Hey. The hospital is quickly approaching critical mass [music] with every room at full capacity.
Speaker A
My wife goes blind and sue you guys. Like I I I don't know what to tell you.
Speaker A
You're the most important. We pay you four times longer. I just checked in on this. We You're still in line.
Speaker A
What position? When when How do I know if we're moving closer or farther? And all these people are coming. We just get bumped down again and again. My wife's going to go blind. I just checked. Michelle, this patient doesn't look good. Do you
Speaker A
want to check vitals? That's the best you could do. It's the best we can do. There are tons of people here.
Speaker A
Yeah, I I see that. We've been here longer than all of them. I think what's really difficult to grapple [music] with is that on a normal day in the emergency room, many of these debilitating injuries could be resolved.
Speaker A
But because it is a mass casualty [music] incident, you have to pick and choose and ultimately try to save the most number of lives possible. This means making really difficult decisions like choosing to allow a patient to go
Speaker A
blind because those resources need to be used to save the life of someone else.
Speaker A
This is a patient that I miscatategorize. Maybe she could have gotten treatment sooner if I hadn't messed that up.
Speaker A
I'm leaving. [music] I have scratches on my legs and I have a dog that's lost.
Speaker A
These are all her current vitals. She got 2 millig of morphine and she has an ID in place. Meaning still looking for a child. Yeah. Did we call What about the young child that came in earlier? Could that be her child?
Speaker A
Michelle, please. Michelle, they want a CT scan. Ma'am, it's very easy to freeze, to feel overwhelmed.
Speaker A
And I'm worried about Michelle feeling that emotion in the midst of all of the drama that's ongoing. Patients screaming, family members [music] getting angry about time. Hello.
Speaker A
I didn't close it. Sir, if you continue to raise your voice, I'm going to have to ask you to leave. Please, please, please [music] cooperate with Come on. Squeeze, squeeze, squeeze, squeeze.
Speaker A
You need to be able to snap yourself out of it quickly in order to respond to the call. That is your patience.
Speaker A
Can you talk to us? Start a baby. Can you wake up? Can we just move him down a couple more inches? Get her out and then we can I want to take a look at her. You called him Red, but he's agonally breathing. He
Speaker A
hasn't been responsive since you've seen him. Then I think we have to move into black.
Speaker A
Okay. Make make choices. Make choices. Due to my mistakes, every red room is completely full. There was a chance that if I had been more efficient with my resource allocation, there would have been space available and we could have
Speaker A
saved this patient, but I didn't. And so [music] I have to make a really difficult choice to give him a black tag.
Speaker A
Having to be so objective about black tag is horrible, [music] especially in a situation where if it wasn't an MCI, we could have done chest compressions to try and save them.
Speaker A
But to like actively have to say we have to walk away from this person, that's so hard.
Speaker A
So, we will have to get the name, which I'll go get with the ENTs just for the toe tag.
Speaker A
I feel so overloaded with stimuli [music] and decision-m fatigue that I feel like I just need to sit in a quiet room [music] and look at a wall for [laughter] for a few hours.
Speaker A
Yeah. [music] [music] I have no good news for anyone and like emotionally not being able to provide closure is very [music] difficult for me and in in general Brett.
Speaker A
Yes. The the [music] black tag patient that came in. Yeah. Was he at the construction site with the other two?
Speaker A
They they are they that is part of the construction crew with HIPPA. Are we [music] allowed to tell them? Just making sure call on this.
Speaker A
[music] Sir, can you hear my voice? They did recover Brunson. He came to the hospital, but when he arrived, he was unresponsive.
Speaker A
He's unfortunately passed. I just wanted to tell you cuz you were asking about him.
Speaker A
Oh, thank you. I'm I'm very sorry to tell you this news. What we're going to experience and show the general public with this MCI is happening at scale with our healthcare system. We are facing a tremendous shortage, stress, difficulties trying to
Speaker A
give them care with limited resources. So if you don't want this MCI style of health care, we need to make changes.
Speaker A
And I'm hoping that it starts with being kind to healthcare frontline workers, being gracious when you're going in and understanding that they too are humans first and are under tremendous amount of stress. Second, understanding how beautiful and limited life is. That it
Speaker A
can be pulled away from you at any [music] moment and you need to be grateful for it.
Speaker A
You ready for your grade? [laughter] Okay. If we had to break up the categories for which we grade Michelle, if we start [music] with triage, so we're going to have to give her an F on that one because there were times where
Speaker A
she was a bit panicked. [music] She was starting to get caught up. Treatment, I'll give her a B minus. She didn't know exactly what to do in a lot of the [music] scenarios, not surprisingly so.
Speaker A
But then where she really was shining is in communication. Just being able to work with your team and to move people around and to prioritize and to keep checking in. That is really what would save lives in a situation [music] like
Speaker A
this. For a human being to have to be the decision maker. [music] Even just today having like the microscopic taste of what that means and what that [music] feels like. I have infinite love and admiration for anyone who does this
Speaker A
confession. Most people at any [music] given moment are not sick. But I can say with 100% certainty there will be a moment where they will be sick, where they need care. Think about habits that you can change in your life that you can
Speaker A
improve your health to perhaps have a better quality of life for longer. This [music] episode is dedicated to health care professionals everywhere who save lives every single day in real life. If you enjoy this episode, please consider [music] subscribing. And you
Speaker A
can check out this other episode I did where I worked a real 24-hour paramedic [music] shift in a real ambulance. If you enjoyed this episode, I think you're going to love that one. Till then, I'll see you in the next challenge.
Topics:Michelle Khareemergency roommass casualty incidenttriageSTART triagemedical simulationemergency medicinedisaster responseDr. MikeChallenge Accepted
