Wednesday, April 17, 2013

Everyday Heroes

Atul Gawande describes the activity at Boston's hospitals on Monday:
Each hospital has an incident commander who coördinates the clearing of emergency bays and hospital beds to open capacity, the mobilization of clinical staff and medical equipment for treatment, and communication with the city’s emergency command center. At my hospital, Stanley Ashley, a general surgeon and our chief medical officer, was that person. I talked to him after the event—I had been out of the city at the time of the explosions—and he told me that no sooner had he set up his command post and begun making phone calls then the first wave of victims arrived. Everything happened too fast for any ritualized plan to accommodate.
So what did you do, I asked him.
“I mostly let people do their jobs,” he said. He never needed to call anyone. Around a hundred nurses, doctors, X-ray staff, transport staff, you name it showed up as soon as they heard the news. They wanted to help, and they knew how. As one colleague put it, they did on a large scale what they knew how to do on a small scale. They broke up into teams of six or so people, one trauma team for each patient. A senior nurse and physician stood at the door to the ambulance bay triaging the patients going to the teams. The operating-room director handled triage to, and communication with, the operating rooms. Another staff member saw the need for a traffic cop and began shooing extra clinicians into the waiting room, where they could stand by to be called upon.
Richard Wolfe, the chief of the emergency department at Beth Israel Deaconess Medical Center, told me he had much the same experience there. Of twenty-one casualties, seventeen were serious and seven required emergency surgery. One patient came in with both legs almost completely amputated already. Another’s leg was too mangled to save. Numerous victims had open, bleeding wounds, with shrapnel and shards of fractured bone. One had a lung injury from the blast. Another was burned on over thirty per cent of the body. One had to have an eye removed. Wolfe arrived in the emergency department expecting to take charge of assigning everyone responsibilities.
“But everybody spontaneously knew the dance moves,” he said. He didn’t have to tell people much of what to do at all.
I spoke to Deb Mulloy, the nurse in charge of our operating rooms that afternoon, and a few of the other nursing leaders to find out how they knew the dance moves. Mulloy began mobilizing as soon as she saw the news flash onto a television screen. Others learned through Twitter, text messages, smartphone news apps. They all began to act before the alarm had been sounded.
“We just knew this was real,” Mulloy said, “and a lot of people could be hurt.”
Change of nursing shift is at three o’clock. So she immediately notified the day shift to stay on. No one wanted to leave, anyway. This doubled the available staff.
All I can say is, "Thank you."

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