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⚡ EP 12: The pressure reaches new heights as everything begins to collapse. 😨 Hidden truths come dangerously close to being exposed.
⚡ EP 12: The pressure reaches new heights as everything begins to collapse. 😨 Hidden truths come dangerously close to being exposed.
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TVTranscript
00:10Hey, Jake.
00:11Your home, stay home.
00:12Listen, ma'am.
00:12Just call me or text me the second that you get this message, okay?
00:15I can't reach Jake.
00:18I'm sure it's okay.
00:20I had to shoot her a pit fast.
00:21We heard.
00:25What's that mean?
00:26Has that happened before?
00:27We're locking down the hospital and setting up a command center and administration.
00:30We'll coordinate logistics, supplies, communication.
00:33How many casualties?
00:34Unclear, but initial reports are not good.
00:37Okay.
00:38The night shift is going to be here soon, but we are going to need more help,
00:40especially from surgery and anesthesiology.
00:42MCI group text and email went out to everyone, including transport and environmental services.
00:46Okay, good.
00:49Hey, everyone's going to want to come in to help.
00:50Keep enough in reserve.
00:52Tell them to come in eight hours later to give us a break.
00:54And can you try and reach Jake?
00:55Of course.
00:57Surgery's got to call in the cavalry.
00:58We're going to need all 25 ORs.
01:00Ahead of you.
01:00Four ORs are prepped and staffed, and we're working on getting the rest up and running.
01:03What about disaster supplies?
01:05On their way.
01:07Every patient in the ER needs to go up, beds or no beds.
01:10They'll get better care in an upstairs hallway than ignored down here.
01:13Agreed.
01:14There's a whole wing that's empty on the eighth floor.
01:17I don't know if that's...
01:18But no nurses to staff it.
01:20No comment on that one.
01:22Waiting room in triage can go to family medicine urgent care, and we should turn off the TVs.
01:25We don't need to cause any extra panic.
01:27We'll do.
01:27The cafeteria will handle the family members and survivors.
01:30What else do you need?
01:33Prayers wouldn't hurt.
01:35I'm into that.
01:36Keep the press out of here.
01:38Gladly.
01:38Call me directly if you need anything else.
01:40Okay.
01:40Will do.
01:41Hey, what's going on?
01:42Mass casualty at Pit Fest.
01:44How many victims?
01:45We don't know.
01:46Expect the worst.
01:47Did the police find David?
01:50Okay, everybody, listen up.
01:54There is an active shooter at Pit Fest.
01:57As the nearest trauma center, we are going to be getting the majority of the victims.
02:00We don't know yet how many we are getting, but we are instituting hospital-wide emergency protocols.
02:06We need to move every patient out of here.
02:09They either go home, they go upstairs, or they go to family medicine.
02:13Call your loved ones now if you need to.
02:16I can guarantee you cell service will soon be overwhelmed.
02:19Eat something, stay hydrated, use the bathroom while there's time, and meet back here for a full briefing in five
02:24minutes.
02:24Brother, I'm so fucking glad to see you.
02:26I heard it on the police scanner.
02:27How many we expected?
02:28I don't know, but it doesn't sound good.
02:31Let's go to the back first.
02:32This guy's got to get out of there.
02:45Where do we put the disaster bins?
02:47Behavioral health.
02:47That's now our central supply.
02:49Let's go.
02:51We got more bins coming.
02:54Okay.
02:56Right side.
02:58Left side.
02:59I need you to grab folding tables from the facilities to organize all this stuff.
03:03Copy that.
03:03Go.
03:18Your medical records will be available to urgent care and family medicine.
03:27They know you're coming.
03:30Okay.
03:31Please make sure to take all your personal belongings with you.
03:34This is stupid.
03:35Sorry for any inconvenience, sir, but this is an emergency.
03:37This is an emergency room.
03:39It's fucking stupid.
03:40Bullshit.
03:41Get back here as soon as the way room is clear.
03:43Copy that.
03:46Telemetry.
03:46Got it.
03:47OB-GYN, CCU, ICU, ortho.
03:52MTI protocols.
03:53Make sure you bring all these gurneys and wheelchairs back.
03:55They're going to the ambulance bay.
03:56We need as many as we can get our hands on.
03:58What's next, Cap?
03:58Pharmacy needs to come down and open PDS.
04:00They also need to bring up all the narcotics, paralytics, and sedatives that they can.
04:03Consider it done.
04:05Jake?
04:05Not yet, but you know teenagers.
04:07I'll keep trying.
04:07Okay, maybe try his mom, Janie, she's in my phone, tell her what's going on.
04:11And try Collins.
04:13See if you can get her to come back.
04:14Will do.
04:15Okay, let's go.
04:16Let's go.
04:16Bring all these gurneys and wheelchairs back.
04:18They're all going to the ambulance bay.
04:21Um, hi.
04:22Can you just tell my sister, Becca, that I'm going to be a little late picking her up?
04:27Um, uh, I don't, I don't know.
04:31Hey, hey, Mom.
04:32I need you or Dad to come to the hospital right now to pick up hair centers.
04:35We're going to be stuck here for hours.
04:36I know, I'll explain when you get here, okay?
04:38Love you, bye.
04:40Hey!
04:41Can we leave yet?
04:46I can't, but Grandma and Grandpa are going to come pick you up.
04:49And in the meantime, you can play some games.
04:52Can I watch a movie?
04:55Yes, but nothing scary.
04:58I mean it.
04:59Don't leave this room until I come get you, okay?
05:02Okay.
05:03I love you.
05:04Bye.
05:05We're going to be putting four gurneys in each of these trauma rooms, so make sure you
05:07stock both rooms to handle the additional patients.
05:10Not a problem.
05:10And let's room all these wows, ultrasounds, out of here.
05:13We're not going to have time or space for anything but gurneys.
05:16Okay.
05:16Any word on what we're expecting?
05:18Not yet.
05:18How's it looking upstairs?
05:19Should have all 25 ORs running within the hour.
05:21We could be buried by then.
05:23Everyone's rolling as fast as they can.
05:24Surgery's ready.
05:25We're here.
05:26We're ready.
05:27I'm taking primary ER.
05:29Have at it.
05:29Who's taking primary surgery?
05:33Heavy is the head that wears the crown.
05:34Dr. Walsh.
05:36Anesthesiology.
05:36Glad it won't be down.
05:37He's got four and pace.
05:38More on the way.
05:39Okay.
05:39This is yours.
05:41What you got in there?
05:42A couple of cat tourniquets, hemostatic pressings, LMAs.
05:45Oh, yeah.
05:46That's good.
05:47Butterfly ultrasound works off a cell phone.
05:49Ooh, that's cool.
05:50Yeah.
05:50We're going to send all the unstable chest and belly straight up to the OR.
05:53Okay, everybody, listen up.
05:55This is how it's going to work.
05:57Our ambulance bay is now our triage.
06:00EMS will be overwhelmed.
06:01Most will probably arrive by car, several victims per vehicle.
06:05For all you newbies that don't know, Dr. Shen is our night shift attendant.
06:09John, I'm going to put you on point triage.
06:10Cool.
06:11Triage will decide who goes where depending on their injury.
06:14Every department will have a designated primary who will oversee their staff.
06:18If you need someone, look for the vest.
06:20We're all going to have walkies.
06:21We can get you whatever you need.
06:24No patient goes into a room unless it's a trauma bay, and they will have four patients each.
06:29We need to keep everybody out in the open so we can keep an eye on everything.
06:33Okay?
06:33Triage is going to assess and assign every patient to a specific zone with the colored slap band.
06:39Patient who comes in with a red slap band goes to the red zone, which is the trauma rooms with
06:44overflow out here.
06:45These are the most critical patients who will die without immediate attention.
06:49Samira, where are you?
06:50You are here with Dr. Abbott and me.
06:52Jack's going to run traffic.
06:53We have five minutes to try and stabilize the reds.
06:56After that, it's OR, ICU, or morgue.
06:58The south and central common area over there will be the pink zone.
07:01That is for patients who will die in under an hour without treatment.
07:05McKay and Javadi, you are over there with help from incoming night shift and surgical staff.
07:09Yellow zone is the north corridor.
07:11Those are going to be mostly extremity wounds.
07:13Good vitals, talking.
07:15Mel, you're going to run point there with Santos and Whittaker.
07:18Uh, what if there's a pulseless extremity?
07:22Oh, if you can't feel a pulse, check for Doppler flow with this.
07:26It's a mini ultrasound.
07:28Follow the screen prompts.
07:30But a yellow can change to a red if they go south.
07:32You've got to stay on top of them, even if they seem stable.
07:34Okay, yeah.
07:34You got this, Dr. King.
07:35Green, minor lax and sprains as they go to family medicine.
07:38Black and white bands are DOA, imminent death.
07:40Peds is now our morgue.
07:41Let's hope we don't get too many of these.
07:44We're a mass unit now.
07:46There's no charting, no electronic medical records, no board.
07:50How do we document treatment?
07:52Oh, you'll all get Sharpies, and every patient has a wrist chart to document treatment and procedures.
07:56We're not a room, right on the patient's forehead.
07:59Really?
08:00Yeah, really.
08:00Each wrist chart has a unique mass casualty incident, barcode, and patient number.
08:05That's how the patients are going to get identified.
08:06This is no frills, combat zone medicine.
08:10No ultrasound, no x-rays, no CT, no labs.
08:13Assess based on mental status and pulse strength.
08:16Every critical patient gets an IO, intubation, a unit of blood, and chest tube if needed.
08:22Everything you need, blood, drugs, bandages, everything will be in the behavioral health rooms.
08:26That's our supply depot.
08:28So, um, oh, keep a couple of 11 blades in your pocket.
08:32Goal is to resuscitate ASAP so they'll make it upstairs for definitive care.
08:36Trauma surgery and neurosurgery will decide who goes up to the OR immediately and who goes to the ICU for
08:41further treatment and evaluation.
08:45Communicate.
08:46Ask for help if you need it.
08:49Trust your attendings.
08:50We will get through this together.
08:52Damn right we will.
08:53Okay, you three, I want to talk to you.
08:57I need you three to raid Central Supply and bring back all the chest tubes, ET tubes, thoracels, normal saline.
09:03I thought that was our own behavior.
09:04We can burn through all that in the first hour.
09:06West Basement just passed nuclear medicine.
09:08West Basement, got it.
09:08Wait, wait, wait, wait, wait.
09:09Take one of these empty disaster bins so you can grab everything and get your hands on.
09:12It's a disaster bin?
09:12Empty plastic boxes right there.
09:14You can't miss them.
09:15Where's Collins?
09:16She went home.
09:17But Dana is calling her now.
09:19Don't worry.
09:20It's okay.
09:20We got plenty of people coming in.
09:22Just follow Dr. Abbott's lead.
09:24John, I'm going to help you get started in triage.
09:26Sounds good.
09:28Dana, what do you need?
09:29Oh, up the yellow zone for extremity wounds.
09:31We need a shitload of bandages, tourniquins, split slings, and IV antibiotics.
09:35Come on.
09:37Myrna.
09:41Where the hell did Myrna go?
09:42Antoine, did you take the cuffs off Myrna?
09:43Hell no.
09:44That woman scares the shit out of me.
09:45She keeps trying to bite me.
09:47Son of a bitch.
09:55Oh, that's a lot of risk charts.
09:57300.
09:59Let's hope we don't need them all.
10:01Were you at the last mass casualty faculty meeting?
10:04Oh, no.
10:05I was still a resident three months ago.
10:08Right.
10:09Oh.
10:10Wow.
10:11Well, one patient at a time, right?
10:14The goal is to triage each patient in ten seconds.
10:18Ten seconds.
10:19Got it.
10:19Mental status is AVPU.
10:21Alert, responsive.
10:22Verbal, responsive.
10:23Pain, unresponsive.
10:24Yeah.
10:25Next, do the evapulse.
10:27Radial carotid ephemeral.
10:29Tells you where to send them.
10:30That's it.
10:31Okay.
10:32Pull.
10:34Oh, I heard it might rain today.
10:37John.
10:38Yeah, man.
10:39Mental status and pulse.
10:41You do everything you need.
10:43Cool.
10:44Unresponsive with no pulses.
10:45Slap a black and white band on them.
10:47Send them to work.
10:49Responsive pain with a faint groan.
10:51Weak femoral pulse.
10:52No radial.
10:53Uh, red.
10:54Right.
10:55Slap a red band on them.
10:56Send them back.
10:57Awake, alert with strong radial.
10:59That's your question.
11:00Could be green.
11:01Family medicine for scrapes or sprains.
11:03If, uh, it's stable, penetrating,
11:04your ceremony wounds go to yellow.
11:05Perfect.
11:06Dude.
11:07Relax.
11:07I got the front door.
11:08You worry about the back.
11:11You got a C-call.
11:12Let's go take them.
11:13Guys, keep moving.
11:14Hey, Paolo, everybody,
11:15let's put the heads of these gurneys up 30 degrees
11:17so they all roll in the right way.
11:19Dr. Robbie.
11:20You talking to your son?
11:21No, but I have the form to put him on a psychiatric hold.
11:24The social worker signed it.
11:26I just need you.
11:27Okay.
11:27You should probably go home, Teresa.
11:29This hospital is essentially closed.
11:31David wouldn't do this.
11:33I really hope you're right.
11:35I got four shooting victims.
11:37What's your name?
11:39Duncan.
11:40Show me.
11:42Right chest, strong radial, pink.
11:45What's this?
11:46That's priority boarding.
11:46You're going to be okay.
11:48Back when he's red, shoulder is yellow,
11:49neck when he's red.
11:51Okay.
11:52Let's check out this van.
11:53Yeah.
11:58Hey, see that woman over there?
11:59You need to speak to her.
12:00What?
12:00Your son has something to do with the shooting.
12:02I'm not sure for certain,
12:03but you need to talk to her.
12:04Okay.
12:04Okay.
12:10What's your name?
12:11I'm Sylvia.
12:12This is my son, Omar.
12:13Omar, can you open your eyes for me?
12:15He's deaf.
12:16Gurney!
12:17Sir, can you hear me?
12:19Black and white, peds.
12:24Red zone.
12:25Need to let go now.
12:26Oh, I want to stay with my son.
12:28You will be very close by, I promise.
12:32What happened to your leg?
12:33I got hit by a car when we were wheeling me.
12:35Okay, we'll see you inside, too.
12:41You got this?
12:42I'll check back in a minute.
12:43No problemo.
12:44Dr. Ellis, thanks for coming in early.
12:45With me and coach.
12:46You're on triage with Shen.
12:4810 seconds of the patient, right?
12:49You got it.
12:49Let me know if you need any help.
12:51Help.
13:00I'm in.
13:02Bag her.
13:03Oneg's pouring in.
13:05Stronger pulse.
13:06I'll take her up.
13:07Dr. Mohan, that kid came in with his mom.
13:09She says he's deaf.
13:10Ready to go with the Oneg.
13:12Wait, wait, stop.
13:13O positive for males over 13, women over 55.
13:15Oneg for everybody else.
13:18Hook me up.
13:23It's really pouring out.
13:25Squeeze in two units.
13:261,500 out, visome a trip to the OR.
13:27If he stabilizes, surgical eyes to you instead.
13:30I'm going to see who needs help.
13:33Yeah.
13:35IOS in.
13:35Go with O-Paz.
13:37When there's no time, bone marrow infusion's as good as an IV.
13:41Robbie, stabilize for the flip.
13:46Oh.
13:47Shit.
13:47Ooh.
13:49He's got a wound on both sides.
13:50He's going to need two chest tubes.
13:51Yeah.
13:51Need a hand?
13:52Hell no.
13:53I got two hands.
13:57Parole?
13:59Okay, quick, IO.
14:00Tom and eight, it sucks.
14:00We're up with the innovation.
14:12Document the tourniquet time.
14:14Mark the arm.
14:15Mark the chart.
14:16Let it down briefly once an hour.
14:18Okay?
14:18Four more scenes repeat if needed.
14:20No, this is Sylvia.
14:22Hi, Sylvia.
14:23I'm Dr. King.
14:25Oh.
14:25Oh.
14:26Looks like closed-tip did fractures.
14:28Strong pedal pulses.
14:29Great flow with the butterfly.
14:31Okay.
14:31I got separated from my son, Omar.
14:34He got shot in the chest.
14:35Okay, um, I'll let you know as soon as I find out anything.
14:38He is deaf.
14:39ASO only.
14:40They need to know that.
14:41Okay, um, I'll make sure it's in his chart.
14:43She needs x-rays, AP, and lateral.
14:45Well, um, radiologist's going to be closed for hours.
14:47Uh, put her in a long cam boot and pain meds.
14:50We're just going to make you comfortable.
15:01Okay, pressure dressing on this.
15:03Okay.
15:06But what if he dropped a lung?
15:08Then I'll throw in a pigtail.
15:11Who needs help?
15:12Everyone.
15:13Pigs are supposed to be stable for the next hour.
15:15If you think they need the OR sooner, send them to the red zone.
15:18Will do.
15:19If I got this, go with your mom.
15:21I mean, Dr. Shamsi.
15:27How we doing in here?
15:29So far, so good.
15:30Blood's primed and ready.
15:321,500 cc.
15:33It's time for the OR now?
15:34Definitely.
15:34Move him up.
15:39Um, uh, 17-year-old with the right chest wound?
15:42Going up to the OR now.
15:44Hold on one second.
15:47They need to know he's deaf when he wakes up.
15:50Not all the chest do what I put here.
15:52Looks like this one's renal.
15:53Golden ticket directly to surgery.
15:58That's three out of four ORs down.
16:00Another four about to open and all 25 will be ready by the time we need them.
16:03We could be buried by then.
16:05No, you won't.
16:05We'll blast through these, tying off bleeders and slapping on vacuum dressings.
16:09We'll finish the job in a day or two when the dust settles.
16:12Unresponsive, had a weak femoral, lost it.
16:14Two units of blood, there's no response, call it.
16:16No pulse of the OR.
16:18Gun shot to the head.
16:20It's running through.
16:21You still got a strong pulse.
16:22This one can make it because the intracranial bleed can decompress through the bullet holes.
16:25Walsh, neurosurgery in the house?
16:27Yes, send them to the neurocrit ICU.
16:28The trailer's from there.
16:31Okay, you guys good in here?
16:32You got this?
16:33Got this.
16:34Bring me a few more before I get bored.
16:41Throw it through?
16:43Doesn't look like it.
16:44Back up out there.
16:55Easy peasy, I'm in.
16:57Back her up.
17:00Entitled CO2 looking good.
17:0120 French on a Kelly.
17:02What the fuck are you doing?
17:04I'm staying alive.
17:05You should not be here.
17:06None of these people should be here.
17:09Larry, Larry!
17:11Edwards, don't go to yellow!
17:12Wait, what?
17:13TRIOS has yellow!
17:14Hold on.
17:15Go.
17:16I've got this.
17:18Trust me.
17:18Oh, we're a little late for that.
17:26This is Grayson Cooper, 68.
17:28Will it graze his scalp?
17:29I got lucky.
17:29Dude just clipped me.
17:31Let's see.
17:31You got a headache?
17:32Not really.
17:32A little burning.
17:33Good for yellow.
17:34In a million concerts.
17:35Whatever happened to a piece of love, man?
17:36That's a great question.
17:40Should be numb.
17:41He's really bad.
17:41He starts with hemostatic gauze,
17:43then turns into a pressure dressing.
17:45Is that arterial?
17:46No, but it's bleeding pretty briskly.
17:48Okay, change it to a turning kit
17:49only if it soaks through.
17:50I got a superficial scalp wound.
17:52Grab it tight with frequent neurochecks.
17:54I need to assess your injury.
17:56I'm fine.
17:56Help the others first.
17:57Please, I'm fine.
17:59Um, sir, are you taking any medication?
18:01Just medicinal marijuana.
18:02Yeah, what do you take that for?
18:04Everything.
18:06Ivy's on everyone.
18:07Help over here.
18:09How is my son?
18:11Omar.
18:12He was shot in a chest.
18:13We were putting a plumber van.
18:14He is upstairs with the surgeons in the OR.
18:17I will come and find you when I know more.
18:19Coming through.
18:21Wait, right here.
18:23Go.
18:23Oh, shit.
18:33Jesse, hang your unit, then right up to the OR.
18:37She shot?
18:38No.
18:39Looks like she got trampled.
18:40Unresponsive in the field.
18:41Three more in the rig.
18:43Hey, Javadi.
18:44Got a possible bloodhead trauma here.
18:46Peoples are good.
18:49Strong pulses.
18:50Okay.
18:50Assess for bloodhead, chest, belly.
18:52With who?
18:52Anybody.
18:54How we doing?
18:55Heads above water so far.
18:56Anything about the shooter?
18:57Haven't heard, but I'll try and get an update.
19:00See, Langdon's back.
19:01Yeah, not by choice.
19:02I'll deal with that when the shift is over.
19:03Comments?
19:04Not answering.
19:05I told her to turn off her fucking phone.
19:08Keep trying her.
19:09Jake?
19:10No.
19:10Probably got his mom on the landmine.
19:12Tell her to call both of us when she reaches.
19:13Okay.
19:14Yeah.
19:17One for pink and one for green.
19:19On it.
19:20I'm sorry.
19:20All press need to stay in the waiting room.
19:22We have two minutes.
19:23The public needs to know.
19:24Front of the hospital.
19:25But there's your interest.
19:26I'm not telling you again.
19:30What's this?
19:32Responsive pain only.
19:33Thready pulse.
19:33Chest wall contusions with boot prints on a shirt.
19:35Yellow hair wheelchair.
19:36Okay.
19:36Sounds good.
19:37Do you need anything?
19:38Well, I was hoping for Thanksgiving and Christmas off this year.
19:42We can talk about it later.
19:45Will proper chest tube placement keep going until the last ministration is intra-tharacic?
19:50What?
19:50I don't need you teaching me right now.
19:52You're already an expert.
19:54I mean, the fucking room, mom.
19:55There's nobody free.
19:56All right.
19:56Then, then, put the place right back, right here.
19:58Through your silk.
19:59About to place a horizontal mattress, in case you're wondering.
20:06Looks like you've got this.
20:17Soap through his pressure dressing.
20:20Okay, yeah.
20:21We can, uh, fix that with rainy clips.
20:22What are those?
20:23I need them in neurosurgery to clamp off the scalp before opening the skull.
20:27All right.
20:27I'll be right back.
20:27Santa's keep pressure.
20:28You guys are swamped.
20:29I got this.
20:31Jake's a village.
20:36Sylvia?
20:36Whitaker?
20:37Sylvia.
20:38Sylvia, can you hear me?
20:40Sylvia.
20:41Can you hear me?
20:42I lost a radio pulse.
20:43From a broken leg?
20:44Well, what did we miss?
20:45I don't know.
20:45Heart attack?
20:46Another injury from the car crash?
20:47That's for pulses.
20:48It has an E-fast mode.
20:55Diagnosis made.
20:56Blood and Morrison's.
20:56Liver laceration.
20:58Car hit the belly.
20:58Legos are distracting the drink.
21:00Um, drill in an IO.
21:01I'm gonna get some blood, and then we'll move her to pink.
21:08Just sends another up to the OR.
21:09I got room for one more red.
21:10On it.
21:11Didn't make it.
21:11Going to Pete's.
21:12Another red and trauma one.
21:13Copy that.
21:17Pete, right?
21:19Careful, kid.
21:20Um, I need Rainy Clips and a unit of O-Neg.
21:23Rainy's left to come down from the OR.
21:24I need them now.
21:25Okay.
21:25Okay, I'll get them.
21:26O-Neg here.
21:29Here you go.
21:30Thanks.
21:31We need EVS with the mop.
21:33Not much blood, but a big rush of air.
21:35Got trampled.
21:36Collapsed as long.
21:37Tension pneumo.
21:37Who went to bed?
21:38I did.
21:39Moher is on fire.
21:40Hustle's coming up.
21:41Okay, great.
21:42Slide the pink as soon as there's room.
21:43Got it.
21:45Hey, uh, how many ORs available?
21:47One now.
21:48Two more in less than five.
21:49Can you take a belly and one more chest in pre?
21:52No problem.
21:53MCI-21's going to ICU.
21:54I'll be back.
21:55Got it.
21:56Red zone.
21:57Red zone.
21:59Three less is full.
22:00Take them to two staff.
22:02I need zero for them, cut four by fours, and elastoplast tape.
22:05You're here.
22:06Got a pink coming in.
22:07In the flesh.
22:08What do you got?
22:10Uh, auto versus ped.
22:11We thought it was just a tid-fib fracture.
22:13Then we found an occult liver laceration.
22:15Leg is low priority right now.
22:16If she stabilizes with blood, she can wait an hour for the OR.
22:19And if not?
22:19Throw in the line, baby.
22:20Your son's in the OR with the GSW to the chest.
22:22Sweet.
22:23Family reading and post-op.
22:24Whitaker?
22:25I'll be right back once this unit's in.
22:27Uh-huh.
22:28Hey!
22:29Good catch, you two.
22:42Hey, Lane.
22:43We need to go to family medicine and building in.
22:44No, I'm waiting for surgery on the fourth floor.
22:46Okay, well then go back to your bed.
22:48My son is down here?
22:49I'm sorry, sir, but no one's in and out unless they're on a gurney.
22:54Okay, look, um, my wife is an ER doc, Dr. McKay.
22:59She needs me to get our son home.
23:00He's in the staff lounge.
23:04All right, make it quick.
23:07But hey, I am timing you.
23:11If you're not back in five, I'm coming after you.
23:13Got it?
23:14Yeah, okay.
23:15Yeah, okay.
23:18I need some help over here.
23:22Back looks good.
23:23New exit now.
23:26Okay, I'll be right back.
23:30Javadi, I.O.?
23:34Here, too.
23:35Socks is on board.
23:37I got it.
23:43I'm in, beggar.
23:46Chad, what are you doing here?
23:47They, uh, they postponed my surgery.
23:50You can't be in here.
23:52Go sit with Harrison in the staff lounge.
23:54Okay.
23:55Now!
23:56Okay.
24:01I got it!
24:03Another one for the morgue.
24:04I need to repeat.
24:07I fell on my left side.
24:10Yeah!
24:10Yeah!
24:11Yeah!
24:14Yeah!
24:15Yeah!
24:16Yeah!
24:16Yeah!
24:16It looks like I just wanted some shrapnel.
24:20Hey, buddy.
24:23Did you have your surgery?
24:25No, it got delayed.
24:26Yeah.
24:27Ready to go home?
24:29Mom said that Grandma and Grandpa McCain were picking me up.
24:32Yeah, I'm not sure they can get here right now, and neither can Chloe, but, you know, we can Uber
24:36to my place.
24:39I'd rather go home with Mom, if that's okay.
24:42Uh, your mom's got her hands full, dude, and I think she's gonna be here pretty late.
24:46I can wait.
24:50Okay.
24:52Yeah, okay.
24:54Okay.
25:03Should we watch something?
25:04You want to watch a movie?
25:06You want to watch a movie?
25:06Yeah, sure.
25:07What do you got on there?
25:09Not much.
25:10That's one unit in.
25:12That's one unit in.
25:12Her pulse is stronger, but she needs more blood.
25:14Not today.
25:15Only one unit if the pulse picks up.
25:17We're already rationing our blood supply.
25:18What if we run out?
25:19Who wanted rainy clips?
25:20Oh, me.
25:21This guy's all good.
25:22I thought you left.
25:23All hands on deck, right?
25:25Is there any word on Omar?
25:26He's this woman's deaf son.
25:28Teenage boy, shot in the chest.
25:29Kid got lucky.
25:30Missed the aorta.
25:31He should pull through.
25:31Oh, that's amazing.
25:33Um, well, her name is Sylvia.
25:34Would you please tell her about her son when she wakes up?
25:36What are you using the...
25:39Mateo, MTI 29.
25:45What's this?
25:46Unresponsive, even to pain.
25:47No GSW.
25:49Strong pulse, but tachycardic and diaphoretic.
25:51Looking for internal hemorrhage.
25:54Fast negative.
25:55Help me, Ruler.
25:58Tim!
25:59Yeah?
25:59Ampity 50 now.
26:00Got it.
26:00Seriously?
26:01Look, glucose monitor.
26:02She's diabetic and probably hypoglycemia.
26:04So check a blood sugar.
26:05No time for that.
26:06Still could be hedgehog.
26:07If it's decay, you're making it worse.
26:08My spidey sis is telling me she took her morning insulin,
26:10but she skipped lunch.
26:11She's in a coma from low blood sugar.
26:14Wait, look at that.
26:15These are healing hands.
26:16Too bad they're so tiny.
26:18Hello, what's your name?
26:20Dawn?
26:21Where am I?
26:22Pittsburgh Trauma Medical Center.
26:24You dropped your blood sugar, but you're going to be okay.
26:26You see you don't need me here?
26:27Don't even say it.
26:29Let's get her to yellow.
26:31What happened?
26:32Uh, there was a shooting at Pitt Fest, but you're safe now.
26:37Whatever you can spare.
26:38Thanks.
26:39MCI 33 to yellow for monitoring.
26:43What are you doing?
26:44Ran out of laryngoscopes.
26:45No time to autoclave.
26:46Oh, man.
26:47Almost had a chest tube, too.
26:48More coming from Presby.
26:50Run a berry low and no nag.
26:51Perfect storm.
26:58Do you feel anything, Grayson?
27:00No pain.
27:02Just a lot of sadness for the world we live in.
27:04I hear you.
27:05Any room at the inn?
27:06Uh, what's her story?
27:07This is Dawn.
27:08No trauma.
27:09Insulin reaction.
27:10Responding to D50.
27:11D10 at 100 an hour?
27:12Perfect.
27:13Oh, and I borrowed your butterflies on the gurney.
27:16So just like that?
27:17Yep.
27:17What are you doing?
27:18Treating the patient.
27:20Rainy clips.
27:22Clamping off a bunch of subcube leaders.
27:24Good work.
27:25Keep it up.
27:27Yeah, perfect.
27:28That's it.
27:29Room for another pain.
27:32I need suction.
27:34We don't have any.
27:34Too many secretions.
27:35I can't see shit.
27:36Here, wipe it out with 4x4s.
27:37Are you kidding me?
27:39You guys have a fiber optic laryngoscope?
27:41Yep, just a rigid glidescope.
27:42Damn.
27:42I accept we don't have any room for it, so just pull out one bag for a minute.
27:47When did this guy last eat?
27:48We never know down here.
27:49He leaked in there.
27:50Team Crackley, pressure a few vomits.
27:52We're fucked.
27:52Doctor?
27:55Hold on, hold on, hold on.
27:57Oh, yeah, this is a tough one.
27:59Oh, yeah, this one looks tough.
28:01No shit.
28:02Prep the neck.
28:02Hold on, okay?
28:04Yeah.
28:04Come over here.
28:05Just give me a chest compression.
28:06CPR?
28:07Did we lose the pulse?
28:08Just give me one good push.
28:09Yep.
28:09Okay, give me two.
28:11And do it again.
28:16Okay.
28:17I think I am in.
28:18Bag him.
28:19Check the end title.
28:20Uh, yellow.
28:22We're good.
28:22How did you do that?
28:23Bubble intubation.
28:24You gave the compression off all the air bubbles up.
28:26More than one way to tube a cat.
28:28Coming through.
28:30Robbie?
28:31Now, please.
28:32Wow.
28:32How's that?
28:35Anything from Jake?
28:36Hey, how much room do we have in peace?
28:38Intubated chest tube, but massive subcutaneous emphysema.
28:41Air from the chest is leaking under the skin.
28:44Loosen the pulse.
28:45What do you think?
28:45Tampon off from pneumomedia steinum.
28:47About to cut blowhole incisions to release the air.
28:49Do it.
28:50In for clavicular.
28:51Yeah.
28:52Yeah.
29:01Pulse is coming up.
29:02Nicely done.
29:03Okay, send him to cardiothoracic ICU.
29:11We'll get you pain medicine.
29:12A nurse will be by soon.
29:17Hey, where'd this guy go?
29:18Uh, which patient?
29:20LCI 28 arm injury who refused treatment.
29:22Uh, maybe he left?
29:24There's a gunshot wound?
29:31Hey.
29:32Hey, what the hell are you doing?
29:33I'm fine.
29:34Leave me alone.
29:35You can't do that.
29:35Back off.
29:36Give me that clap.
29:37All right.
29:40We need security in here.
29:43Hey.
29:43Hey.
29:44He's hypotensive.
29:46Oh, my God.
29:48Oh.
29:50Nice move, Suck.
29:52What happened?
29:56Fucker.
29:57Yeah, go ahead.
29:58I think this guy stole a victim's hoodie and faked an injury to get inside.
30:01He's probably fucking the whore.
30:02Asshole.
30:03Hey.
30:04Hey, wake up, you faker.
30:07Yeah, response to pain.
30:10Her low-blown head trauma goes to pink.
30:11Soft restraints, six hours observation.
30:14Going to the hub.
30:15Be right back.
30:16I'm fine.
30:18Great.
30:18You can give a statement to the cops.
30:20Get them out of here.
30:21Where's my phone?
30:22Oops.
30:24My bad.
30:31Chest tube, please.
30:32We're out of chest tubes.
30:33What the hell?
30:34You could have told me that before we started.
30:36I didn't know.
30:36I already made the incision.
30:37Now, what am I supposed to do?
30:39How about this?
30:41An ET tube.
30:42A tube's a tube, and if you inflate the balloon, it won't pull out.
30:46Fine.
30:46Set up a thoracil.
30:47Out of those two.
30:48Oh, for the love of God.
30:49Hearing bag?
30:50How am I supposed to connect to that?
30:52Christmas tree adapter.
30:53It'll work.
30:55This is all very unconventional.
30:58No.
30:58This is genius.
31:03Oh, um, and four of ANSEF.
31:05Sorry, I forgot the ANSEF.
31:13Mel.
31:13Mel, I need you to reassess, please, now.
31:16Still here?
31:20Her pulse is weak and thready.
31:22She's bleeding out from her liver lack.
31:24I need Oneg.
31:25Oneg's gone, honey.
31:26Glory's got more flying in.
31:27Incident command.
31:28What's the ETA on our blood?
31:29Okay, okay, okay, okay.
31:30The patient's gonna have to get by with the leader of ceiling.
31:32No, no, she needs blood, not crystalloid.
31:34Um, can she go to surgery?
31:36All right, she's next to go.
31:37As soon as we get an open OR.
31:39It's time to last that long.
31:40Dr. Robbie.
31:41Dr. Robbie?
31:42Dr. Robbie.
31:43We're out of Oneg, but I'm Oneg.
31:44Can I donate?
31:45Glory's got more blood flying in.
31:46But I need it now.
31:48What is our blood status?
31:49Just use the last units of Oneg and Opaz more flying in.
31:51ETA?
31:52Less than 10.
31:53Some patients are not gonna last that long,
31:54and I'm sure there are other Oneg donors that probably work here.
31:58It would take hours to screen for HIV and hepatitis.
32:00I have neither, and I donate all the time.
32:04Please.
32:06Fuck it.
32:07If the patient's gonna die before they get to the OR,
32:09then the benefits outweigh the risks.
32:10My man.
32:11All right, kid, roll up your sleeve.
32:12I'll meet you in seven.
32:14Listen up.
32:15Central 789 is now the blood donor center.
32:18Anyone who's Oneg or Opaz, we need you to donate now.
32:21Hands where I can see them.
32:30You two work here, right?
32:32Yes.
32:33Can you tell me how my mom is?
32:34Her name's Patricia Gregory, or Trish.
32:36She was shot in her arm.
32:38We're here to help.
32:39One second.
32:40Bear with us.
32:48Hello.
32:48Can I have your attention, please?
32:50My name is Kiara Alfaro.
32:52I'm an emergency department social worker.
32:55This is Lupe Perez, one of our ward clerks.
32:58I know you all want information about your friends and family.
33:01In order to help you, we have a QR code you can scan for our patient identification website.
33:07Cell phones are down, but you can log on to the hospital guest Wi-Fi.
33:12That information is on these papers we'll distribute around the room.
33:15Once you log on, send us the name and birth date of whomever you're concerned about.
33:20If you could tell us what they were wearing, upload photos, pictures of tattoos, piercings,
33:26anything to help identify them would be useful.
33:28If we get a match, we'll let you know.
33:31We're setting up phone chargers, water, snacks, and if anyone needs to change clothes, we've
33:35got paper scrubs coming.
33:37Give us some time.
33:38We're doing everything we can to help get you the information you need.
33:52Okay, I'm done.
33:54Give me the coat.
33:55Come on, go, go, go.
33:58There you go.
33:59There you go.
34:00Next!
34:02How's she doing?
34:03Yeah, 500 of saline in.
34:05She's barely with us, no.
34:06Okay, well, this unit of whole blood should help.
34:10Yeah, see if you can find a pressure bag.
34:12No, no, much faster if I just squeeze it in myself.
34:21Need some help with an airway?
34:26What is it?
34:27GSTL beats the neck with an expanding hematoma and distorted anatomy.
34:30Can't intubate him, probably hit the carotid.
34:32Okay, I'll do the airway.
34:33Give me a 6.5 and a bougie.
34:36I got the bleeder.
34:38Foley catheter with a 30cc balloon.
34:40Are you donating?
34:41Oneg, yeah.
34:46It's too bloody to see a bougie.
34:48Not for this.
34:49Three-step process.
34:50Step one, scalpel.
34:52Step two, finger.
34:53Step three, bougie.
34:59Okay, railroad in the tube.
35:04Good, that's far enough.
35:06Okay, bag him.
35:08Dressing off.
35:11Pulleys in.
35:12Blow, blow, blow.
35:1630cc's in.
35:17Clamping.
35:19Look at that.
35:22Pry as a bone.
35:23Room for another red.
35:25Dr. Walsh, you have an OR for a head and neck case.
35:28MCI 48.
35:29We've got 16 ORs up and running.
35:31We've got room for one more.
35:32Liverlight came back after a second unit.
35:34Needs an XLAP.
35:35Turning over two ORs now.
35:36Send them up.
35:38Where the hell did Mel go?
35:39I don't know, but she needs to get back to yellow.
35:42That's two grams of ANSAF.
35:43Great.
35:46Let's take a look for dressing.
35:48That looks good.
35:49The bleeding stopped.
35:50Can you hold it your fingers?
35:53Ma'am.
35:54Ma'am, can you move your fingers for me?
35:57Okay, does it feel the same on both sides?
36:00Great, how's the pain?
36:06Well, the bullet probably went through the two forearm bones,
36:09but there's no damage to the nerves or arteries,
36:12so that's a good sign.
36:17You're going to be okay.
36:21I'll find you some tissues.
36:27Robert, let's arrive.
36:29All right on.
36:31Eviscerated bowel.
36:33Fresh ABD and saline.
36:34Get back for a sec.
36:363.375 Zosin and a sterile dressing.
36:39I can't believe I'm saying this.
36:40Another Christmas tree and Foley bag.
36:42How did we run out of chest tubes?
36:46Less than 500 cc's at surgical ICU.
36:48You can take him.
36:4850 tubes in the chest.
36:49They're going to wonder what the hell we're doing down here,
36:50but it was a great save.
36:51Hey, Jabadi, I need you to find Whitaker.
36:53Go up to the hill pad.
36:54We got blood flying in.
36:55Okay.
36:55Stay behind the yellow line between 10 o'clock and 2 o'clock
36:57so the pilot can see you the whole time.
36:59Okay.
36:59You got this?
37:00Moving them up as fast as we can.
37:02There's one to go to yellow.
37:03More chest tubes.
37:04Got to see a press bee.
37:05Awesome.
37:05I'm going to go check out triage.
37:07Copy that.
37:10They find the shooter yet?
37:11Not yet, but we'll find him.
37:12Half the county's looking.
37:13What about with her?
37:14Waiting for the FBI to get here.
37:16Did they find her son?
37:17No, but they pinged his cell phone to the area to shoot him.
37:19Did she know that?
37:20She's about to find out.
37:22What's with all these bloody handprints?
37:24That's when people were trying to stop us to get a ride in,
37:26but we were already packed.
37:27Chest, belly, arm and leg, red, pink, yellow, and a lucky green.
37:30Two guardians of the load here.
37:34Okay, I got it.
37:34I got it.
37:35The fodder's in bad shape.
37:36What's his name?
37:37Rich.
37:37Where's Stefano?
37:38Hey, Rich.
37:38How you doing?
37:41You got shot in the face?
37:43No, I entered on the other side.
37:44Neck.
37:45Above his vest.
37:46She can see the exit wound.
37:47Okay.
37:47Come on, Red Zone.
37:48He needs an airway.
37:49Come with me.
37:50Come with me.
37:51I got you.
37:52We'll get you fixed now.
37:56Take him.
37:59Hey, what's up with the SWAT team?
38:01This is a precaution in case the shooter heads this way.
38:04Is that a possibility?
38:05There was some chatter.
38:07Are we going to be safe out here?
38:09Should be now.
38:10Focus on the patients.
38:10Focus on the patients.
38:12The only way out is through.
38:14Any idea how many more come?
38:16Incident command is sending all these ambulances back to the sea.
38:18I need for more victims.
38:19We may not even be halfway through yet.
38:22Jesus.
38:23When is this going to end?
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