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kylek044

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Alright - I know this is a stupid question, but I am a student who doesn't know the real answer.

So, on last week's Grey's Anatomy episode (I know, I know... it's not medically accurate a good amount of the time), the interns actually responded to a large-scale emergency in the field. Does this actually happen?

Please refrain from angry and sarcastic posts telling me how stupid I am...I already know.
 

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Alright - I know this is a stupid question, but I am a student who doesn't know the real answer.

So, on last week's Grey's Anatomy episode (I know, I know... it's not medically accurate a good amount of the time), the interns actually responded to a large-scale emergency in the field. Does this actually happen?

Please refrain from angry and sarcastic posts telling me how stupid I am...I already know.

Not stupid at all--how would you know for certain unless you've ever worked in the emergency department and seen it done?

I'm a first-year med student with EMT experience and don't know--so let's hear it from you people out in the field. Does this ever happen?
 

GeneralVeers

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Not stupid at all--how would you know for certain unless you've ever worked in the emergency department and seen it done?

I'm a first-year med student with EMT experience and don't know--so let's hear it from you people out in the field. Does this ever happen?


Doubtful. There wouldn't be much for them to do in the field anyway without equipment. EMTs and Paramedics would do a far more efficient job, and would bring the patients to designated disaster centers. Most large hospitals have disaster drills where people are designated to "respond" and treat mock patients.
 
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ForbiddenComma

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Do most hopsitals have set policies for when people have bombs in their chest?
 

dlung

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Our "go-team" that recently went to construction site accident with 3 major traumas (potential field amps) had 1 surg attg, 1 EM attg, and a senior surg resident.
 

Jeff698

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Physicians and nurses frequently respond directly to the scene of a mass casualty incident. The bigger the incident, the more likely they are to go.

Sadly, they usual go unrequested. They show up on scene and, in general, get in the way.

The appropriate way to handle physican field response is to coordinate it through EMS. If they request physician support, then it's appropriate and useful. Otherwise, not so much.

BTW, interns of any specialty would be in the way.

Take care,
Jeff
 

southerndoc

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Most disaster scenes only have an EMS physician (i.e., the EMS medical director) respond. In New Haven, CT, we have a SHARP physician on call 24/7. SHARP stands for Sponsor Hospital Area Response Physician. The reason he/she responds to MCI's is to clear those that do not need to be sent to the ED to prevent overwhelming the ED any further.

Many hospitals also have a field surgery team, but it's not a bunch of interns and residents running lose.
 

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Immediately after the Atlanta Olympic bombings, Emory sent a senior EM resident out into the field to help with triage and treatment in the field. However, by the time she got there, all the patients had already been transported to the ED.
 

Dr.Evil1

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I think that this episode of Grey's Anatomy as well as past episodes of ER and other programs that show field teams of doctors navigating wreckage in the pursuit of patients is the stupidest thing I have ever heard of. You are telling me that ER or surgery residents would do a better job of extricating patients and transporting to the hospital then the fire and EMS that have been doing it every day for many years? There is a place for physicians in mass casualty but in general physicians belong in the hospital, not searching the wreckage of some ship or plane wreck.
 

dlung

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I am also on a "go-team," consisting of a general surgeon, an anesthesiologist, an ortho surgeon, a scrub tech, and me..an EP. We "go" to Iraq and Afghanistan. Where does your go-team go? (and where are you at that you have actually use a go-team in the city?)

Yeah, this is a local 'go-team' that works with USR (yours sounds like DMAT). I'm not exactly sure of the composition of the team besides the top three MDs (I woke up late for the case presentation at grand rounds, oops). These guys only get called maybe average of once/1-2years for incidents like I described. It'd actually been maybe 2+ years since the last time they went to anything. Several years ago they drove across the Potomoc when a big plane crashed into the side of the Pentagon...
 

c.bear

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I believe this answer is dependent on the EMS Medical Director and how any one city's EMS system is set up. Most of us are in citys where transportation is quick and their are lots of ambulances available at any one time; probably little need for a team on the scene. But for the most part the important aspect in any disaster is triage (with those colored tags) and transport. It was explained to me that MDs on the scene can be helpful with triage questions by paramedics and special procedures. That being said....I do know of one EM attending that had a pger for disasters, but I don't know if he actually would go out to the field or not.

I guess I did not know the answer to the question....and I just did a disaster training class.....
 
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Wackie

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There's a big volunteer organization full of mostly EMS for disasters here. They'll respond nationwide as well.

I guess it depends on the disaster. Doctors, nurses, EMS all went out with hurricane Katrina. But that's different than say a MCI where hospitals nearby are still functioning.
 

trkd

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At the UNM interview, one of the attendings seemed to be big on DMAT and if I understood right, the "go" team did katrina type stuff and other wildfire type stuff if I remember correctly, as well as some international stuff apparently. Sounded like 3rd year residents can get in on it along with some attendings and nurses that go.
 

sphincter tone

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the first rule of triage is not to make any more patients so they failed. :rolleyes:

If you get hurt by falling off a raft while trying to lift a pipe off a patient, not only will you not be able to help anyone else, but you'll be sucking resources because someone will have to come take care of you.

Best and fastest way of creating more causalties is to send a bunch of inexperienced, clueless (as far as scene safety etc.) interns and residents out to the field to run amuck.

To the OP, while local systems have their own disaster plans, FEMA has established the National Incident Management System (NIMS) that dictates standards on how mass causalty incidents should be handled. If you want more info

http://www.fema.gov/emergency/nims/index.shtm
 

Dr. Dukes

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Shock Trauma has a GO-TEAM (http://www.umm.edu/shocktrauma/go_team.html) that responds when requested to MCIs that might/do require field surgery. NYC FDNY EMS fellows are on call to respond to big MCIs in NYC. FDNY sends their medical control MDs to all MCIs with more than 20 patients.
As far as that episode of Grey's Anatomy...so much for a structured triage system consisting of primary and secondary tirage officers. If anything, MDs at a scene that big would serve in the treatment area deciding where to send people...but they certainly wouldn't be off playing like they remember. Remember...at an MCI there should be no ALS outside the treatment area.
 

pushinepi2

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Shock Trauma has a GO-TEAM (http://www.umm.edu/shocktrauma/go_team.html) that responds when requested to MCIs that might/do require field surgery.... Remember...at an MCI there should be no ALS outside the treatment area.

Amen. R Adams Cowley is smiling down on us from his heavenly "death lab."

Seriously, though, physician (and RN, PA) response to disasters should be coordinated via a centralized incident command. No one, not even injured patients, benefits from a throng of doctors that self-dispatch to the scene of an incident. If there's anything we learned from the post 9-11 FDNY response, it is the value of integrated communications between emergency responders. DMAT, USAR, and other teams function best when they are integrated into an ordered, tiered mass disaster response. Advanced life support resources are already strapped, and any meaningful physician-type response to a disaster needs to take into account the availability of resources. It wouldn't make much sense, for example, to send every trauma surgeon to the scene of some building collapse while salvagable patients are arriving at the hospital... with no one to operate on them! Incident command systems aren't perfect, but they are designed to take situations like these into account.

I was fortunate enough to work with an emergency physician who witnessed first hand some of the patient care disasters occuring after the Murrah Federal Building was bombed (Oklahoma City.) Even though he "self dispatched" (along with a paramedic student, no less), he credits the regional fire and EMS agencies with much of the success. Ironically, the arrival of healthcare providers at the scene only contributed to prevailing catastrophe. An unfortunate testament to the hazards implicit in a mass, disorganized healthcare provider response occured when a well-meaning LPN was struck on the head by a piece of falling debris. She became an additional casualty and eventually died from a closed head injury. This is an extreme example, to be sure, but it nevertheless echoes the need for communication and an apporpiate delegation of responsibility. Ideally, RNs/MDs/DOs/PAs, and other non field personnel who wish to provide assistance at the scene of an MCI should do so through existing incident command channels. Field medical directors, GO-TEAMS, DMAT teams, and other units are examples of EMS sanctioned MCI response.

-P
 

Dr. Caveman

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Dude... I saw that episode and that is why I just can't get into Grey's... It totally sucks too :( because I swear the number one question I get asked when a girl finds out I'm in med school is "Have you seen Grey's...etc" What a shame ;) haha
 

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what amused me about this episode was that they took all of the surgeons into the field...in the background you could see ambulances taking off to the hospital - but uhh.. .once the rigs got to the hospital, who will be doing the surgery since all the docs are in the field?

Totally made no sense.
 

greytmedic

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I have been involved in organizing and implementing several mass casualty drills. When the incident only requires a local response that does not involve large amounts of resources the response is by local EMS and Fire agencies responding to a box alarm (MABAS in Illinois). This usually is just surronding towns and cities sending in resources and personell. Our local command structure allows for the one EM physician (usually the PMD or assistant PMD) to respond to the scene. They stay in the command post and their responsibiltiy is to coordinate transfers of patients to the appropriate hospitals. (This hospital can take so many reds, so many yellows, etc). They are not performing procedures or even touching patients, just logistical coordination of resources.

In Illinois, there is the Illinois Medical Emergency Response Team (IMERT). They are the team responsible for responding to massive incidents like Katrina. They have the equipment and facilities to set up and man field hospitals. The doctors that work with IMERT usually stay at the field hospital, which creates a gray area as to if a field hospital is actually "the field." IMERT will respond to smaller incidences with just a team of 4-5 members, they just have to be activated by the Director of Public Health.
 

The Tolf

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what amused me about this episode was that they took all of the surgeons into the field...in the background you could see ambulances taking off to the hospital - but uhh.. .once the rigs got to the hospital, who will be doing the surgery since all the docs are in the field?

Totally made no sense.

What annoyed me most about this show was ER did a similar mass casualty show last fall with a child in shock following the Doc in the field... Come on, cant they come up with better fake MCIs?!?!?!
 
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Dr. Dukes

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The IMERT sounds a lot like a DMAT or the IMSURT out of MGH. They respond to BIG (read: hurricane) disasters that take days/weeks to sort out, not a ferry boat crash that will be all cleaned up in a day. DMATs have an 18hour activation time, which means they're not on scene for at least 1.5 days from the time of the disaster. They are meant to mostly take care of priority 2/3 patients when the physcial hospital in the disaster area is overwhelmed with real sick patients.
Anyone correct me if I'm wrong.
 
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deleted109597

what amused me about this episode was that they took all of the surgeons into the field...in the background you could see ambulances taking off to the hospital - but uhh.. .once the rigs got to the hospital, who will be doing the surgery since all the docs are in the field?

Totally made no sense.

You left out the fact that when one of the surgeons came back to the hospital, his job was to read the list of names they have identified. You know, you need an MD to read that list. Not like they wouldn't have someone with more authority to do that.
 

kylek044

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Did anybody think those were some really WEAK chest compressions being done on Meredith last night???? :)
The compressions sucked.
The breath-compression ratio was wrong.
Not to mention, McDreamy went from diving in FREEZING water (he was probably hyperthermic, himself) to carrying her out of the water and giving her cpr.
 

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probably not the best management of a hypothermic patient. I dont watch that show, but my wife does and it was so stupid I could hardly study. Admittedly, I DO sit around and watch the national geographic channel....
 

Dr. Will

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She will probably survive and it will piss me off considering she was sumberged for sooooo long.
 

FieldDoc

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She will probably survive and it will piss me off considering she was sumberged for sooooo long.

If they really wanted to show some real-ish life, they would show all her savvy friends having to visit her at the local nursing home if she ever regained any function at all following this. Somehow I think that she'll show up next week with nothing more than a limp or something lame. (ha, that was kind of a joke in itself)
 
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Dr. Dukes

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If they really wanted to show some real-ish life, they would show all her savvy friends having to visit her at the local nursing home if she ever regained any function at all following this. Somehow I think that she'll show up next week with nothing more than a limp or something lame. (ha, that was kind of a joke in itself)

She could share a room with her mom...
 

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She will probably survive and it will piss me off considering she was sumberged for sooooo long.



She was underwater for like, a week. :eek: :smuggrin:


I'm getting frustrated with the show. They're dragging this out too much.


And

"She's in asystole"
*everyone backs away from her dramatically, no compressions being done*
"We're losing her!"

Well, derr. Who's got compressions and where'd they go?


Was it me or did it come across as them feeling better about asystole than v-fib?

I wanted Izzy to shut the f- up already with her little monologue.
 

igcgnerd

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I wanted Izzy to shut the f- up already with her little monologue.

Yeah with what she said she really was a witch.
How high will they bring her core temp before they call it?
They just needed an excuse to bring Denny back.
 

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My guess: Meredith dies. Then it turns out everything that happened since Denny's death was actually a dream Denny was having while recovering from the transplant.
 

Orthonut

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what amused me about this episode was that they took all of the surgeons into the field...in the background you could see ambulances taking off to the hospital - but uhh.. .once the rigs got to the hospital, who will be doing the surgery since all the docs are in the field?

Totally made no sense.
McVet!


Wait, have they killed him off yet? I've missed a few episodes lol.
Dakota said:
My guess: Meredith dies. Then it turns out everything that happened since Denny's death was actually a dream Denny was having while recovering from the transplant.
lol. *cries* because that's probably true...
 

emtcsmith

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I called dream/tv reset button about half way into that code...But really when are they going to get through a single year on this show?
 

Dr. Dukes

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but, how freeking hard is it to do real CPR? I've (and everyone else here also has, I would assume) done real CPR on a 20 minute transport, why can't an actor do it for 10 seconds.
Yes, I know Grey's is a TV show, and not actual factual medicine, BUT HONESTLY!
 
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deleted109597

but, how freeking hard is it to do real CPR? I've (and everyone else here also has, I would assume) done real CPR on a 20 minute transport, why can't an actor do it for 10 seconds.
Yes, I know Grey's is a TV show, and not actual factual medicine, BUT HONESTLY!
Cuz it would hurt Ellen Pompeo's chest.
 

IntheDraft6

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Not to take away from this discussion on Grey, but did anyone see the episode of CSI:Miami a week or two ago (I know it is only TV, but still). Delco was shot near the mastoid. He goes into VFib in the ER and they start shocking him. He goes into asystole and they keep working him for a while. Finally they give intracardiac epi and as the syringe is still in his chest, he sits up on the strecher and takes a deep breath. After that he is in a hospital room with a bandage over his head talking and acting fine, except for some memory loss. Never intubated or anything.
 
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