Triage

“Getting out of the hospital is a lot like resigning from a book club. You're not out of it until the computer says you're out of it.”
- Erma Bombeck

Since hospitals are private companies in the business of making money, it makes little sense for them to have empty beds or unused capacity. That’s just wasteful and unprofitable as a business. And yet that “efficiency” means hospitals can quickly become overwhelmed with the smallest of disasters.

Normally, one should not consider a rock concert a “disaster scene”. (Unless you really, really hate rock music :-) But last year, in Kansas City, Rockfest2008, exceeded the capacity of St. Luke’s Hospital, a major institution and winner of frequent quality awards. A concert of 50,000 fans created 22 ambulance calls over a couple of hours with cases ranging from heat exhaustion to a broken spine. This is an incident rate of just 0.044% but “The surge was so great the hospital had to place some patients on mattresses on the floor and tell ambulances that it had reached its limit for all but trauma patients.” Just imagine what would happen if the incident rate were higher like a biological agent or dirty bomb exploded in a sport stadium or other crowded event.

With mass care events, triage is activated (with a twist). Normally, with hospital emergency room triage, the most serious cases go first. Mr. Gunshot wound goes to the head of the line; Little Runny Nose Kid gets to wait (and wait). But with mass care, with overwhelming number of patients, the most serious patients are allowed to die. The goal is to save the highest total number of lives. A first responder or medical practitioner could spend 30 minutes trying to revive one person with CPR or save 6 seriously wounded from bleeding to death in the same time period. When forced to choose, would you save the one or the six?

When I was a “victim” in a Sarin gas attack drill, it took hours for medical rescuers to arrive. The fireman who arrived first became victims. Then guys in “space suits” showed up to take air samples. Then a bio-unit set up decontamination tents and finally bio-suited teams brought in stretchers or escorted the wounded to the tents for processing. All “victims” had a card stating the severity of our “wounds”. We noticed the rescuers were NOT saving those with “black” tags, the most seriously wounded. When we asked, they explained, these people were already dead after so long a wait or soon would be. They had to remain focused on the lives that could still be saved.

Bottom Line

Most of the time the American health system is a marvel with speedy service. But come flu season, a rock concert or a real disaster, there will be too few doctors and too few beds. This is one of the real fears behind a viral pandemic – hospitals will not be able to cope with the patient load. For this reason it is vital to know First Aid and be able to care for the health of yourself and your family as much as you can.

P.S. New Scientist magazine notes that Health workers may flee in pandemic panic. A survey in the UK revealed that only 15% of hospital workers would go to work during a pandemic. Even the Nurses and Doctors would stay home.