How one ED mobilized his department during a mass casualty incident (2017)
An emergency physician’s account of managing the Las Vegas mass shooting becomes a case study in how hospitals cope when patient volume vastly exceeds capacity. Commenters focus on the primacy of “flow” in mass-casualty care, the trade-offs between strict procedures and improvisation, and how temporarily expanding staff responsibilities—such as nurses accessing medications or radiologists reading images at the scanner—can save lives despite increased risk. The thread also touches on formal disaster planning, ambulance load balancing across hospitals, and whether tools like AI could someday help patients better evaluate medical decisions.
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.