How Does This Go Down In Your Shop

[Old_Mil]

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You're single coverage in your level 2/3 community hospital with a visit volume between 25k-45k.

Around 3am ambulances start arriving in your bay with 25 GSW victims from a local nightclub.

Do your colleagues come in? Do they even live locally and have the ability to come in if they wanted to?

 

[WilcoWorld]

Our hospital has a mass casualty protocol. It would rally the surgeons on call and I could wrassle definitely one (the one on call), maybe a few, other EP's out of bed. We'd start triaging in the original sense of the term.

But no, I would not expect to get my whole group out of bed at 3am. I could ask, but I simply think most wouldn't answer the phone at that hour.

 

[Janders]

We are in a dense enough area that EMS would likely handle spreading the patients out for us, enough nearby EDs and trauma centers.

But if something like that happened, yes I'd call my partners, the general surgeons, the intensivist, the surgical PA, the anesthesiologists, the CMO who is an ED doc... all hands on deck. Most people are a 20-30 min drive away, though a few live down the street.

 

[dotcb]

Every hospital should have a disaster protocol. As a mass casualty incident, this would qualify. This would involve a designated incident commander, a command center (room), and there should be protocoled contacting of surge capacity staff. It should not be you, the front line doc, calling in the surge capacity staff. I would activate the disaster protocol and call the head of my department.

 

[GeneralVeers]

Never had it happen, but I imagine it would be extremely messy. Only 2 hospitals are in my area. Our ED volume is about 38K. At night after 4AM I'm on my own. Most of our doctors travel from other cities in TX so probably couldn't help out. Likely it would be just me and the general surgeon until 6 AM.

 

[Vandalia]

The closest I have come to something like this is a tornado that went through the area years ago. The problem was not too few physicians, but too many showing up.

I don't mean "fun" in the "going to Disney World sense" or anything remotely close to it, but for a lot of physicians, the opportunity to be involved in a mass-casualty scenario is ... if not "fun", then... "intriguing."

 

[Daiphon]

We have a disaster protocol wherein the C-Suite is to work the phones on all angles (doctoring, nursing, etc) with phone cascades built in: CS calls X number, each of them calls another X, exponentially reaching staff.

That said, I'd park one of my lower rung people with my phone & tell them to call everyone in my contacts under 2 cultivated lists... much more likely I'll get an immediate response from my personal number than the hospital showing up on Caller ID. d=)

Semper Brunneis Pallium

 

[Old_Mil]

...and how bad would your press ganeys get from all the waiting room traffic that would be sitting around for 5-6 hours and/or those patients with appointments who had them cancelled? 🙂

I think quite a few of us would be in the same situation as Veers.

 

[AlmostAnMD]

...and how bad would your press ganeys get from all the waiting room traffic that would be sitting around for 5-6 hours and/or those patients with appointments who had them cancelled? 🙂

I think quite a few of us would be in the same situation as Veers.

Yeah nobody ever talks about this but I've tried to imagine what the HA that's been waiting for an hour already to be seen now is placed behind 10 GSW's. I wonder how many of the ED patients just give up and go home.

 

[dchristismi]

Non trauma center here, and there aren't any real "clubs" - unless you mean of the shuffleboard variety.

I sure hope we have a disaster protocol, but I've never seen it. My first call would be to the house super. I might phone a couple local folks, but there really aren't that many locally. So basically, I'd be screwed. But EMS knows this, so unless it was a trauma code or homeboy ambulance dropoff, it wouldn't come to me as we don't have any trauma center designation.

I trained at ORMC, and send mad props for their kickass teamwork. I will say that I have never been so glad to see my (gay) night-working colleague as I was at signout 7 am Sunday morning after hearing about it during my morning drive. It's hit sort of close to home. Hell, it was just up the road.

 

[gutonc]

...and how bad would your press ganeys get from all the waiting room traffic that would be sitting around for 5-6 hours and/or those patients with appointments who had them cancelled? 🙂

I think quite a few of us would be in the same situation as Veers.

A couple of years ago, my (now ex...but that's irrelevant to the discussion) wife had me take her to the ED for persistent vertigo (post-viral labyrinthitis as it turned out). About 30 minutes after we arrived, with IVF and anti-emetics on board (mercifully), 6 ambulances rolled up at once bringing the first wave of survivors of a tour bus crash (there were 2 more waves of another dozen or so patients while we were still in the ED). She wound up getting admitted so we didn't get a PG survey.

But the simple fact of somebody coming in to tell us what was up with the delay (which I already knew about because I had gotten the Mass Casualty page...I worked at that hospital) chilled us both out.

Send a CNA out to the waiting room with Turkey Sammiches in this scenario and all will be forgiven.

 

[WilcoWorld]

A couple of years ago, my (now ex...but that's irrelevant to the discussion) wife had me take her to the ED for persistent vertigo (post-viral labyrinthitis as it turned out). About 30 minutes after we arrived, with IVF and anti-emetics on board (mercifully), 6 ambulances rolled up at once bringing the first wave of survivors of a tour bus crash (there were 2 more waves of another dozen or so patients while we were still in the ED). She wound up getting admitted so we didn't get a PG survey.

But the simple fact of somebody coming in to tell us what was up with the delay (which I already knew about because I had gotten the Mass Casualty page...I worked at that hospital) chilled us both out.

Send a CNA out to the waiting room with Turkey Sammiches in this scenario and all will be forgiven.

You're absolutely right that communication can go a long way in these situations. A white coat walking out to the waiting room and saying "we haven't forgotten about you, and we're working hard to get you seen" will garner a lot of understanding (I do this during surges and get impressed by the humaneness of the general response). But you're wrong to say all will be forgiven. In a busy ED there's usually someone who will say "I don't care. That doesn't fix my problem! (which has usually been going on for 6 months and has not acutely worsened)"

But, whatever. If I live my life trying to make that person happy, than I'm already doomed. So, yeah - what you said.

 

[gutonc]

You're right that communication goes a long way, but you're wrong to say all will be forgiven. In a busy ED there's usually someone who will say "I don't care. That doesn't fix my (6 month, not acutely worsened) problem!"

But, whatever. If I live my life trying to make that person happy, than I'm already doomed.

Touche'. I should have said "much...from rational people...will be forgiven".

Hell, I was 20 minutes late to see a new patient in my clinic (who didn't actually have cancer, which is what I do) because I was busy coding a patient in my infusion unit (who made it to the ED across the street alive, but not to the floor). When I apologized because I was dealing with a critical patient, she replied "I don't care about anybody but myself". The only upside is that my institution is too cheap to pay for PG surveys for everyone and, as a result, I am never surveyed.

 

[wholeheartedly]

When I worked in the blood bank here a few years ago, we had a mass casualty with a bus rollover. Like 50 or more senior citizens on their way back from the casino. Driver had a medical emergency, bus crashed and rolled. We're a Level 1 , but it happened in a more rural area so the closer EDs were facing the potential staffing issues. We were expecting to be slammed as the level 1, but we got two airlifted patients, then a few more bad ones, and then the rest slowly trickled in after being triaged and stabilized elsewhere. We apparently have a pretty strong EMS system in place and some unique program for the region that i'm not too familiar with (just that it is in place because this whole huge corner of the state and bordering states is pretty rural) , so that seemed to help keep the really rural/small shops from being completely overwhelmed.

Interestingly, the ED was being inspected or something that day and the inspectors were supposed to see a demo of how a mass casualty situation would be run. Instead, they got to see it for real.

 

[Raryn]

I'm reminded of the story of what happened at the San Bernadino shooting last year... The victims were being brought in during the Loma Linda EM program's weekly conference, so the entirety of the residents were in house. One of the attendings just walked over to the lecture hall and an extra 41 people showed up to the department.

 

[Tenk]

With all the bad stuff going on: for anyone in this situation, always strip patients down ASAP (preferably before they enter your department). You don't know who you are getting (i.e. Good guy versus bad guy) and what they may be armed or loaded with (i.e. Explosives) collateral damage is something you need to consider and really need to echo to your staff to be on the alert. Stay safe!!!

 

[Perrin]

With all the bad stuff going on: for anyone in this situation, always strip patients down ASAP (preferably before they enter your department). You don't know who you are getting (i.e. Good guy versus bad guy) and what they may be armed or loaded with (i.e. Explosives) collateral damage is something you need to consider and really need to echo to your staff to be on the alert. Stay safe!!!

Yes. I've had to clear 2 handguns that fell out after log rolling patients. Neither had bad intent, just happened to be CC-ing and got in MVCs.