How one ED mobilized his department during a mass casualty incident (2017)

Medical slang: “crump” vs “crash”

• Multiple medical commenters say “crump” means rapid deterioration, usually less abrupt than “crash.”
• “Crashing” implies immediate, dramatic decline needing instant action; “crumping” can be a more gradual but serious worsening over hours.
• Some use the terms interchangeably; nuance and severity are somewhat debated.

Flow vs procedure, and crisis leadership

• Central theme: “flow is king” in mass casualty events—reducing bottlenecks (CT, meds, triage) to maximize lives saved.
• Commenters stress that many safety procedures (double checks, radiologist reads, strict narcotics control) are optimal in normal operations but harmful when volume makes catastrophe the default outcome.
• Key leadership behaviors highlighted: anticipating chokepoints, rapidly descoping roles, trusting professionals’ judgment, constantly scanning the big picture, and being willing to deviate from protocol.
• Some worry about over-glorifying “move fast and break things”; they emphasize that in normal times, meticulous procedures prevent errors and are preferable.

Procedure vs results tension (including in tech/aviation)

• Extended discussion on when it is acceptable to break rules.
• Some argue that rules exist precisely because not everyone judges risk well; others note that all procedures are written for typical cases and must bend in true emergencies.
• Aviation is cited: pilots may violate rules in emergencies by design.
• In software, anecdotes show both successful and disastrous rule-breaking; distinguishing justified exceptions from overconfidence is hard.

CT/X-ray and throughput optimization

• Several commenters dissect how pairing radiologists with techs and bypassing EMR/billing can vastly improve throughput and latency.
• Trade-off noted: skipping proper labeling and integration creates downstream chaos, but in an MCI, immediate care outweighs future documentation burdens.

Mass casualty planning, triage, and ambulance distribution

• Some systems (e.g., in Europe, U.S. trauma networks) have explicit plans for hospital load balancing and MCI workflows, though improvisation is always needed.
• Triage tags, simple identifiers (even marker-on-forehead), and predesignated roles are discussed as crucial tools.

Other themes

• Interest in disaster psychology/planning books and “swarm leadership” concepts.
• Brief debate on using AI to second-guess doctors; some see empowerment, others see serious risk.