Hey, Jake, it's Robby.
Listen, man, just call me or text me the second that you get this message, OK?
OK.
I can't reach Jake.
I'm sure he's OK.
- Active shooter at PittFest. - We heard.
Code Triage, Emergency Department now.
What's that mean? Has that happened before?
We're locking down the hospital
and setting up a command center in Administration.
We'll coordinate logistics, supplies, communication.
How many casualties?
Unclear, but initial reports are not good.
OK.
The night shift is gonna be here soon, but we are gonna need more help,
especially from Surgery and Anesthesiology.
MCI group text and email went out to everyone,
including Transport and Environmental Services.
OK, good.
Hey, everyone's gonna want to come in to help.
Keep enough in reserve.
Tell them to come in eight hours later to give us a break.
- And can you try and reach Jake? - Of course.
Surgery's got to call in the cavalry.
- We're gonna need all 25 ORs. - Ahead of you.
Four ORs are prepped and staffed,
and we're working on getting the rest up and running.
- What about disaster supplies? - On their way.
Every patient in the ER needs to go up.
Beds or no beds, they'll get better care
in an upstairs hallway than ignored down here.
Agreed.
There's a whole wing that's empty on the eighth floor.
- I don't know if that's-- - But no nurses to staff it.
No comment on that one.
Waiting room and Triage can go to Family Medicine Urgent Care.
And we should turn off the TVs.
- We don't need to cause any extra panic. - Will do.
The cafeteria will handle the family members and survivors.
What else do you need?
Prayers wouldn't hurt.
Amen to that.
- Keep the press out of here. - Gladly.
Call me directly if you need anything else.
OK, will do. Thank you.
- Hey, what's going on? - Mass casualty at PittFest.
How many victims?
We don't know. Expect the worst.
Did the police find David?
OK, everybody listen up.
There is an active shooter at PittFest.
As the nearest trauma center,
we are going to be getting the majority of the victims.
We don't know yet how many we are getting,
but we are instituting hospital-wide emergency protocols.
We need to move every patient out of here.
They either go home, they go upstairs, or they go to Family Medicine.
Call your loved ones now if you need to.
I can guarantee you cell service will soon be overwhelmed.
Eat something. Stay hydrated.
Use the bathroom while there's time
and meet back here for a full briefing in five minutes.
- Brother, I'm so fucking glad to see you. - Heard it on the police scanner.
- How many we expecting? - I don't know, but it doesn't sound good.
Let's go to the back first in order.
Those guys got to get out of there.
How many patients can you take?
Where do we put the disaster bins?
Behavioral Health. That's now our central supply.
Let's go.
We got more bins coming.
OK.
Right side.
Left side.
I'm gonna need you to grab folding tables from facilities
- to organize all this stuff. - Copy that.
Go. Thank you.
Code Triage, Emergency Department now.
Blood Bank, call 7113.
Thank you for your cooperation and understanding
as we prepare for a mass-casualty event.
Your medical records will be available to urgent care and Family Medicine.
They know you're coming.
OK, please make sure to take all your personal belongings with you.
This is stupid.
Sorry for any inconvenience, sir, but this is an emergency.
This is an emergency room. It's fucking stupid.
Olsen, get back here as soon as the waiting room is cleared.
Copy that.
Telemetry.
OB/GYN.
CCU. ICU.
- Ortho. - MCI protocols.
Make sure you bring all these gurneys and wheelchairs back.
They're going to the ambulance bay.
We need as many as we can get our hands on.
What's next, Cap?
Pharmacy needs to come down and open the PDS.
They also need to bring up all the narcotics,
paralytics, and sedatives that they can.
- Consider it done. - Jake?
Not yet, but you know teenagers. I'll keep trying.
OK, maybe try his mom, Janey.
She's in my phone. Tell her what's going on.
And try Collins. See if you can get her to come back.
Will do.
OK, let's go. Let's go.
Bring all these gurneys and wheelchairs back.
They're all going to the ambulance bay.
Hi. Can you just tell my sister, Becca,
that I'm gonna be a little late picking her up?
I don't know.
Hey. Hey, Mom, I need you or Dad to come to the hospital right now
to pick up Harrison, or he's gonna be stuck here for hours.
I know, I'll explain when you get here, OK?
Love you. Bye.
Hey.
Can we leave yet?
I can't,
but Grandma and Grandpa are gonna come pick you up.
And in the meantime, you can play some games.
Can I watch a movie?
Yes, but nothing scary.
I mean it.
And don't leave this room until I come get you, OK?
OK, Mom.
- Love you. - Bye.
We're gonna be putting four gurneys in each of these trauma rooms,
so make sure you stock both rooms to handle the additional patients.
Not a problem.
And let's broom all these WOWs, ultrasounds out of here.
We're not gonna have time or space for anything but gurneys.
OK.
- Any word on what we're expecting? - Not yet. How's it looking upstairs?
Should have all 25 ORs running within the hour.
We could be buried by then.
Everyone's rolling in as fast as they can.
Surgery is ready. We're here. We're ready.
- I am taking Primary ER. - Have at it.
Who's taking Primary Surgery?
Heavy is the head that wears the crown.
Dr. Walsh.
- Anesthesiology? - Gladden will be down.
He's got four in place, more on the way.
OK, this is yours.
Thank you. What you got in there?
A couple of CAT tourniquets, hemostatic dressings, LMAs.
We got plenty of that stuff.
Butterfly ultrasound works off a cell phone.
- That's cool. - Yeah.
But we're gonna send all the unstable chest and belly straight up to the OR.
OK, everybody listen up. This is how it's going to work.
Our ambulance bay is now our Triage.
EMS will be overwhelmed.
Most will probably arrive by car, several victims per vehicle.
For all you newbies that don't know, Dr. Shen is our night shift attending.
- John, I'm gonna put you on Point Triage. - Cool.
Triage will decide who goes where depending on their injury.
Every department will have a designated primary who will oversee their staff.
If you need someone, look for the vest.
We're all gonna have walkies. We can get you whatever you need.
No patient goes into a room unless it's a trauma bay,
and they will have four patients each.
We need to keep everybody out in the open so we can keep an eye on everything, OK?
Triage is gonna assess and assign every patient
to a specific zone with a colored slap band.
Patient who comes in with a red slap band goes to the Red Zone,
which is the trauma rooms, with overflow out here.
These are the most critical patients who will die without immediate attention.
Samira, where are you?
You are here with Dr. Abbot and me.
Jack's gonna run traffic.
We have five minutes to try and stabilize the reds.
After that, it's OR, ICU, or morgue.
The south and central common area over there will be the Pink Zone.
That is for patients who will die in under an hour without treatment.
McKay and Javadi, you are over there,
with help from incoming night shift and surgical staff.
Yellow Zone is the North Corridor.
Those are gonna be mostly extremity wounds--good vitals, talking.
Mel, you're gonna run point there with Santos and Whitaker.
What if there's a pulseless extremity?
If you can't feel a pulse, check for Doppler flow with this.
It's a mini-ultrasound.
Follow the screen prompts.
But a yellow can change to a red if they go south.
You got to stay on top of them, even if they seem stable.
- OK, yeah. - You got this, Dr. King.
Green--minor lacs and sprains. They go to Family Medicine.
Black and white bands are DOA, imminent death.
Pedes is now our morgue.
Let's hope we don't get too many of these.
We're a MASH unit now.
There's no charting, no electronic medical records, no board.
How do we document treatment?
You'll all get Sharpies,
and every patient has a wrist chart to document treatment and procedures.
You run out of room, write on the patient's forehead.
- Really? - Yeah, really.
Each wrist chart has
a unique mass-casualty-incident barcode and patient number.
That's how the patients are gonna get identified.
This is no-frills combat-zone medicine.
No ultrasound, no X-rays, no CT, no labs.
Assess based on mental status and pulse strength.
Every critical patient gets an IO, intubation,
a unit of blood, and chest tube if needed.
Everything you need-- blood, drugs, bandages--
everything will be in the Behavioral Health rooms.
That's our supply depot.
Keep a couple of 11 blades in your pocket.
Goal is to resuscitate ASAP so they'll make it upstairs for definitive care.
Trauma surgery and neurosurgery
will decide who goes up to the OR immediately
and who goes to the ICU for further treatment and evaluation.
Communicate.
Ask for help if you need it.
Trust your attendings.
We will get through this together.
Damn right we will.
OK, you three, I want to talk to you.
I need you three to raid Central Supply and bring back all the chest tubes,
ET tubes, thora-seals, normal saline--
I thought that was all in Behavioral Health.
We can burn through all that in the first hour.
West basement, just past nuclear medicine.
- West basement. Got it. - Wait, wait, wait, wait, wait.
Take one of these empty disaster bins
so you can grab everything you get your hands on.
- What's a disaster bin? - Empty plastic boxes right there.
- You can't miss them. - Where's Collins?
She went home, but Dana is calling her now.
Don't worry. It's OK. We got plenty of people coming in.
Just follow Dr. Abbot's lead.
John, I'm gonna help you get started in Triage.
Sounds good.
Dana. What do you need?
Prep the Yellow Zone for extremity wounds.
We need a shitload of bandages, tourniquets,
splint slings, and IV antibiotics.
- I'm on it. - Yep.
Myrna.
Where the hell did Mryna go?
Antoine, did you take the cuffs off Myrna?
Hell, no. That woman scares the shit out of me.
She keeps trying to bite me.
Son of a bitch.
That's a lot of wrist charts.
300.
Let's hope we don't need them all.
Were you at the last mass-casualty faculty meeting?
No. I was still a resident three months ago.
Right.
Well, one patient at a time, right?
The goal is to triage each patient in ten seconds.
Ten seconds, got it.
Mental status is AVPU.
Alert, response to verbal, response to pain, unresponsive.
Yep.
Next, do they have a pulse?
Radial, carotid, or femoral tells you where to send them.
- That's it. - OK.
Cool.
Oh, I heard it might rain today.
- John? - Yeah, man.
Mental status and pulse gives you everything you need.
Cool.
Unresponsive with no pulses, slap a black and white band on them,
send them to the morgue.
Responds to pain with a faint groan, weak femoral pulse, no radial?
- Red. - Right.
Slap a red band on them, send them back.
Awake, alert with strong radial?
Trick question.
Could be green, Family Medicine for scrapes or sprains,
but stable, penetrating extremity wounds go to yellow.
- Perfect. - Dude, relax.
I got the front door. You worry about the back.
Hey, Paolo, everybody, let's put the heads of these gurneys up 30 degrees
so they all roll in the right way.
- Dr. Robby. - Did you talk to your son?
No, but I have the form to put him on a psychiatric hold.
A social worker signed it.
- I just need you. - OK.
You should probably go home, Theresa.
This hospital is essentially closed.
David wouldn't do this.
I really hope you're right.
I got four shooting victims.
What's your name?
Duncan.
Show me.
Right chest, strong radial. Pink.
What's this?
That's priority boarding. You're gonna be OK.
Back wound is red. Shoulder is yellow. Neck wound is red.
OK. Let's check out this van.
Yeah.
Hey. See that woman over there?
- You need to speak to her. - Why?
Her son had something to do with the shooting.
I'm not sure for certain, but you need to talk to her.
Shit. OK.
- What's your name? - I'm Sylvia.
This is my son, Omar.
Omar, can you open your eyes for me?
He's deaf.
Gurney!
Sir, can you hear me?
Black and white, Pedes.
Red zone.
You need to let go now. One, two, three.
I want to stay with my son.
He will be very close by, I promise.
What happened to your leg?
I got hit by a car when we were wheeling him in.
OK, we'll see you inside, too.
You got this? I'll check back in a minute.
No problema.
Dr. Ellis, thanks for coming in early.
- Put me in, Coach. - You're on Triage with Shen.
- Ten seconds a patient, right? - You got it.
- Let me know if you need any help. - Help.
Behind you. Coming through.
I'm in.
- Bag her. - O-neg's pouring in.
Stronger pulse. I'll take her up.
Dr. Mohan, that kid came in with his mom. She says he's deaf.
- Ready to go with the O-neg. - Wait, wait. Stop.
O positive for males over 13, women over 55.
O-neg for everybody else.
Hook me up.
- It's really pouring out. - Squeeze in two units.
1500 out buys him a trip to the OR.
If he stabilizes, surgical ICU instead.
I'm gonna see who needs help.
Yeah.
IO's in. Go with O pos.
When there's no time, bone marrow infusion is as good as an IV.
Robby, stabilize for the flip.
- Go. - OK.
He's got a wound on both sides. He's gonna need two chest tubes.
- Yeah. - Need a hand?
Hell, no. I got two hands.
Roll.
OK, quick IO, Etomidate and sux, prep for the intubation.
Got another one for yellow.
Document the tourniquet time.
Mark the arm. Mark the chart.
Let it down briefly once an hour.
- OK. - Four of morphine. Repeat if needed.
Mel, this is Sylvia.
Hi, Sylvia. I'm Dr. King.
Looks like closed tib-fib fractures.
Strong pedal pulses, great flow with the butterfly.
- Great. - OK, I got separated from my son, Omar.
He got shot in the chest.
OK, I'll let you know as soon as I find out anything.
He is deaf, ASL only. They need to know that.
OK. I'll make sure it's in his chart.
She needs X-rays--AP and lateral.
Well, Radiology's gonna be closed for hours.
Put her in a long CAM boot and pain meds.
- We're just gonna make you comfortable. - Thank you.
Coming in with clamps now.
Environmental service manager to the ER.
OK. Pressure dressing on this.
OK.
- What if he dropped a lung? - Then I'll throw in a pigtail.
- Who needs help? - Everyone.
Pinks are supposed to be stable for the next hour.
If you think they need the OR sooner,
- send them to the red zone. - Will do.
I got this. Go with your mom-- I mean, Dr. Shamsi.
How we doing in here?
So far, so good. Blood's primed and ready.
1500 CCs. Time for the OR now?
Definitely. Move him up.
17-year-old with a right chest wound?
Going up to the OR now.
Hold on one second.
They need to know he's deaf when he wakes up.
- Not a lot of test tube output here. - Looks like this one's renal.
Golden ticket--directly to surgery.
That's 3 out of 4 ORs down.
Another 4 about to open, and all 25 will be ready by the time we need them.
- We could be buried by then. - No, you won't.
We'll blast through these, tying off bleeders and slapping on vacuum dressings.
We'll finish the job in a day or two when the dust settles.
Unresponsive, had a weak femoral, lost it.
Two units of blood. If there's no response, call it.
No pulse, no OR.
Gunshot to the head.
- Through and through? - Yeah, we still got a strong pulse.
This one can make it because the intracranial bleed
can decompress through the bullet holes.
Walsh, neurosurgery in house?
Yes, send him to the neurocrit ICU. They'll triage from there.
- OK, you guys good in here? You got this? - We got this.
Bring me a few more before I get bored.
ER immediately.
All available transport to the ER immediately.
Through and through?
It doesn't look like it.
Getting backed up out there.
Good view of the chords.
Easy peasy, I'm in.
Bag her up.
We have more ambulances coming.
End tidal CO2 looking good.
20 French on a kelly.
What the fuck are you doing?
- I'm saving lives. - You should not be here.
None of these people should be here.
Larry, Larry!
Head wounds don't go to yellow.
- Wait, what? - Triage says yellow.
- Hold on. - Go.
I've got this. Trust me.
Oh, we're a little late for that.
Any available transport to the ER now.
This is Grayson Cooper, 68. Bullet grazed his scalp.
I got lucky. Dude just clipped me.
Let me see. Got a headache?
Not really. A little burning.
- Good for yellow. - Been to a million concerts.
Whatever happened to peace and love, man?
That's a great question.
It should be numb.
Israeli bandage starts with hemostatic gauze
then turns into a pressure dressing.
- Is that arterial? - No, but it's bleeding pretty briskly.
OK, change it to a tourniquet only if it soaks through.
I got a superficial scalp wound.
Wrap it tight with frequent neuro checks.
- I need to assess your injury. - I'm fine.
Help the others first, please. I'm fine.
- Sir, are you taking any medication? - Just medicinal marijuana.
Yeah? What do you take that for?
Everything.
- IVs on everyone. - I need some help over here.
How is my son?
Omar. He was shot in the chest. We were in the plumber van.
He is upstairs with the surgeons in the OR.
I will come and find you when I know more.
Coming through!
Jesse, hang a unit, then right up to the OR.
- She shot? - No, looks like she got trampled.
Unresponsive in the field. Three more in the rig.
Hey, Javadi!
Got a possible blunt head trauma here.
Pupils are good.
Strong pulses.
OK, assess for blunt head, chest, belly.
- With who? - Anybody.
- How are we doing? - Heads above water so far.
Anything about the shooter?
Haven't heard, but I'll try and get an update.
- I see Langdon's back. - Yeah, not by choice.
I'll deal with that when this shift is over.
- Collins? - Not answering.
I told her to turn off her fucking phone.
Keep trying her. Jake?
No.
But I got his mom on the landline.
Told her to call both of us when she reaches him.
- OK. - Yep.
Environmental services manager to the ER.
One for pink and one for green.
- On it. - I'm sorry.
All press needs to stay in the waiting room.
Come on, man, two minutes. The public needs to know what's going on.
Front of the hospital!
Pedestrian entrance. I'm not telling you again.
What's this?
Responds to pain only, thready pulse,
chest wall contusions with boot prints on his shirt.
- Yellow here, a wheelchair. - OK, sounds good.
Do you need anything?
Well, I was hoping for Thanksgiving and Christmas off this year.
But we can talk about it later.
For proper chest tube placement,
keep going until the last fenestration is intrathoracic.
- OK, stop. - What?
I don't need you teaching me right now.
- You're already an expert? - Read the fucking room, Mom!
3-0 silk.
I'm about to place a horizontal mattress, in case you're wondering.
Looks like you've got this.
This one should go to yellow.
Hey, could you help me?
Soaked through his pressure dressing.
OK, yeah, we can fix that with Raney Clips.
What are those?
They use them in neurosurgery to clamp off the scalp
- before opening the skull. - All right.
I'll be right back. Santos, keep pressure.
You guys are swamped. I got this.
It takes a village.
Sylvia. Sylvia?
Whitaker! Sylvia.
Sylvia, can you hear me?
- I lost her radial pulse. - From a broken leg?
- Well, what did we miss? - I don't know. Heart attack?
Another injury from the car crash?
- That's for pulses. - It has an EFAST mode.
Diagnosis made. Blood in Morrison's, liver laceration.
Car hit the belly. Leg was a distracting injury.
Drill in an IO. I'm gonna get some blood, and then we'll move her to pink.
Just sent another up to the OR.
- I got room for one more red. - On it.
Didn't make it. Going to Pedes.
Another red in Trauma One.
Copy that.
- Dana, if I-- - Careful, kid.
I need Raney Clips and a unit of O-neg.
Raneys will have to come down from the OR.
- I need them now. - OK.
OK, I'll get them.
O-neg here.
- There you go. - Thanks.
We need EVS with a mop.
Not much blood, but a big rush of air.
Got trampled. Collapsed his lung. Tension pneumo.
- Who intubated? - I did.
Mohan is on fire.
- Pulse is coming up. - OK, great.
Slide to pink as soon as there's room.
Got it.
Hey, how many ORs available?
One now. Two more in less than five.
Can you take a belly and one more chest in pre?
No problem.
MCI 21 is going to ICU. I'll be back.
Got it.
Red Zone, Red Zone.
Environmental service manager to the ER.
Three West is full. Take them to Two South.
I need Xeroform, cut 4x4s, and elastoplast tape.
You're here!
In the flesh. What do you got?
Auto versus ped.
We thought it was just a tib-fib fracture.
Then we found an occult liver laceration.
Leg is low priority right now.
If she stabilizes with blood, she can wait an hour for the OR.
- And if not? - Front of the line, baby.
Her son's in the OR with a GSW to the chest.
Sweet. Family reunion in post-op.
Whitaker, I'll be right back once this unit's in.
Hey!
Good catch, you two.
Hey, Langdon, we're out of Xeroform. I'll try to find some.
Come on, Sylvia.
Oh, I'm sorry, sir. The ER is closed.
You'll have to exit out the pedestrian entrance.
I'm a patient.
Then you need to go to Family Medicine in Building 8.
No, I'm waiting for surgery on the fourth floor.
OK, well, then go back to your bed.
My son is down here.
I'm sorry, sir, but no one's in and out unless they're on a gurney.
OK, look, my wife is an ER doc, Dr. McKay.
She needs me to get our son home. He's in the staff lounge.
- All right, make it quick. - Thank you.
But, hey...
I am timing you.
If you're not back in five, I'm coming after you.
- Yeah. - Got it?
- Yeah, OK. - Yeah, OK.
- I need a tourniquet now! - Need some help over here.
Back looks good. No exit wounds.
Red Zone!
OK, I'll be right back.
- Javadi, IO. - Yeah.
Here too.
Sux is on board.
- She's not breathing. - I got it.
I'm in. Bag her.
Chad, what are you doing here?
They postponed my surgery.
You can't be in here.
Go sit with Harrison in the staff lounge!
- OK. OK. - Now!
I got it! I'm trying!
Another one for the morgue. Heading to Pedes.
Hey, buddy.
Did you have your surgery?
No, it got delayed.
Ready to go home?
Mom said that Grandma and Grandpa McKay were picking me up.
Yeah, I'm not sure they can get here right now, and neither can Chloe.
But, you know, we can Uber to my place.
I'd rather go home with Mom if that's OK.
Your mom's got her hands full, dude, and I think she's gonna be here pretty late.
I can wait.
OK.
Yeah, OK.
- Should we watch something? - You want to watch a movie?
Yeah, sure.
What do you got on there?
Not much.
That's one unit in.
Her pulse is stronger, but she needs more blood.
Not today. Only one unit if the pulse picks up.
We're already rationing our blood supply.
- What if we run out? - Who wanted Raney Clips?
Oh, me! Thank you.
- I thought you left. - All hands on deck, right?
Is there any word on Omar?
He's this woman's deaf son. Teenage boy shot in the chest?
Kid got lucky. Missed the aorta. He should pull through.
That's amazing. Well, her name is Sylvia.
Would you please tell her about her son when she wakes up?
What are you using to--
Mateo, MCI-29 goes to the OR...
- What's this? - Unresponsive even to pain.
No GSW.
Strong pulse, but tachycardic and diaphoretic.
Looking for internal hemorrhage.
- FAST negative. - Help me roll her.
All transport to the ER immediately.
- Tim! - Yeah.
- Amp of D50, now. - Got it.
- Seriously? - Look--glucose monitor.
She's diabetic and probably hypoglycemic.
- So check the blood sugar. - No time for that.
Still could be head trauma. If it's DKA, you're making it worse.
My Spidey sense is telling me she took her morning insulin,
but she skipped lunch.
She's in a coma from low blood sugar.
Will you look at that? These are healing hands.
Too bad they're so tiny.
Hello. What's your name?
Dawn.
- Where am I? - Pittsburgh Trauma Medical Center.
You dropped your blood sugar, but you're gonna be OK.
Guess you don't need me here. Don't even say it.
Let's get her to yellow.
What happened?
There was a shooting at PittFest.
But you're safe now.
Whatever you can spare. Thanks.
MCI-33 to yellow for monitoring.
What are you doing?
Ran out of laryngoscopes. No time to autoclave.
Oh, man.
Almost out of chest tubes, too. More coming from Presby.
We're running very low on O-neg.
- Perfect storm. - Yeah.
I got a pink coming in!
Do you feel anything, Grayson?
No pain.
Just a lot of sadness for the world we live in.
- I hear you. - Any room at the inn?
What's her story?
This is Dawn, no trauma, insulin reaction, responded to D50.
- D10 at 100 an hour? - Perfect.
And I borrowed your butterfly. It's on the gurney.
- So just like that. - Yep.
- What are you doing? - Treating the patient.
Raney Clips.
Clamping off a bunch of sub-Q bleeders.
Good work. Keep it up.
Yep, perfect. That's it.
Room for another pink.
- I need suction! - We don't have any.
Too many secretions. I can't see shit.
Here, wipe it out with 4x4s.
Are you kidding me?
You guys have a fiberoptic laryngoscope?
- Nope, just a rigid Glidescope. - That'll do.
Except we don't have any room for it, so just pull out,
and we'll bag for a minute.
When did this guy last eat?
We never know down here. Let me get in there.
I'll keep cricoid pressure. If he vomits, we're fucked.
Doctor.
We may need a surgical airway.
Hold on, hold on, hold on, hold on.
Oh, yeah. This is a tough one.
Oh, yeah, this one looks tough.
- No shit. Prep the neck? - Hold on.
- McKay? - Yeah.
Come over here and just give me a chest compression.
CPR? Did we lose the pulse?
No, just give me one good push.
Yep. OK, two.
And do it again.
OK.
I think I am in.
- Bag him. - Check the end tidal.
- Yellow. We're good. - How'd you do that?
Bubble intubation.
You gave the compression, I followed the air bubbles up.
More than one way to tube a cat.
Coming through.
Robby!
Now, please!
Imagine that.
Anything from Jake?
How much room do we have in pink?
Intubated chest tube, but massive subcutaneous emphysema.
Air from the chest is leaking under the skin.
- Losing the pulse. - What do you think?
Tamponade from pneumomediastinum.
About to cut blowhole incisions to release the air?
Do it. Infraclavicular.
Yep.
Pulse is coming up. Nicely done.
OK, send him to cardiothoracic ICU.
We'll get you pain medicine. A nurse will be by soon.
- Hey, where'd this guy go? - Which patient?
MCI-28, arm injury who refused treatment?
Maybe he left?
With a gunshot wound?
Hey!
- Hey, what the hell are you doing? - I'm fine. Leave me alone.
- You can't do that. - Back off.
I need security in here!
Hey!
Nice move, Slick.
What happened?
Fucker!
I think this guy stole a victim's hoodie and faked an injury to get inside.
He's probably a fucking reporter.
- Asshole. - What?
Hey! Hey, wake up, you faker!
Yep, he responds to pain.
Perlah, blunt head trauma goes to pink.
Soft restraints, six hours observation.
- Gurney to the hub. - Be right back.
I'm fine.
Yeah, great, you can give a statement to the cops.
- Get him out of here. - Yeah.
Where's my phone?
My bad.
Chest tube, please.
- We're out of chest tubes. - What the hell?
You could have told me that before we started.
- Well, I didn't know. - I already made the incision.
Now what am I supposed to do?
- What about this? - An ET tube?
A tube's a tube.
And if you inflate the balloon, it won't pull out.
Fine. Set up a Thoraseal.
- Out of those, too. - For the love of God!
Urine bag?
How am I supposed to connect to that?
Christmas tree adapter. It'll work.
This is all very unconventional.
No. This is genius.
Oh, and four of Ancef.
Sorry, I forgot the Ancef.
Thank you.
Mel! Mel, I need you to reassess, please, now.
Sylvia?
Sylvia.
Her pulse is weak and thready.
She's bleeding out from her liver lac.
- I need O-neg! - O-neg's gone, honey.
Gloria's got more flying in.
Incident Command, what's the ETA on our blood?
Eight to ten minutes.
The patient's gonna have to get by with a liter of saline.
No, no, she needs blood, not crystalloid. Can she go to surgery?
All right, she's next to go, as soon as we get an open OR.
She's not gonna last that long.
Dr. Robby. Dr. Robby!
Dr. Robby, we're out of O-neg, but I'm O-neg. Can I donate?
Gloria's got more blood flying in.
- But I need it now. - What is our blood status?
Just used the last units of O-neg and O-pos.
- More flying in. - ETA?
Less than 10.
Some patients are not gonna last that long.
And I'm sure there are other O-neg donors that probably work here, so...
It would take hours to screen for HIV and hepatitis.
Well, I have neither, and I donate all the time.
Please.
Fuck it.
If the patient's gonna die before they get to the OR,
- then the benefits outweigh the risks. - My man.
All right, kid, roll up your sleeve. I'll meet you in 7.
Listen up.
Central 7, 8, 9 is now the blood donor center.
Anyone who's O-neg or O-pos, we need you to donate now.
Hands where I can see them.
OK, let's do this.
- You two work here, right? - Yes.
Can you tell me how my mom is? Her name is Patricia Gregory--or Trish.
She was shot in her arm.
We're here to help. One second. Bear with us.
Hello? Can I have your attention, please?
My name is Kiara Alfaro.
I'm an emergency-department social worker.
This is Lupe Perez, one of our ward clerks.
I know you all want information about your friends and family.
In order to help you, we have a QR code
you can scan for our patient-identification website.
Cell phones are down, but you can log on to the hospital guest Wi-Fi.
That information is on these papers we'll distribute around the room.
Once you log on, send us the name and birth date
of whomever you're concerned about.
If you could tell us what they were wearing,
upload photos, pictures of tattoos, piercings,
anything to help identify them would be useful.
If we get a match, we'll let you know.
We're setting up phone chargers, water, snacks.
And if anyone needs to change clothes, we've got paper scrubs coming.
Give us some time.
We're doing everything we can to help get you the information you need.
OK, I'm done.
OK, give me the Coban. Come on, come on, come on.
I got this. Here you go.
Here you go. There you go.
Next!
- How's she doing? - We have 500 of saline in.
She's just barely with us, Mel.
OK, well, this unit of whole blood should help.
Yeah, see if you can find a pressure bag.
No, no. Much faster if I just squeeze it in myself.
Need some help with an airway!
What is it?
GSW to the neck with expanding hematoma
and distorted anatomy-- can't intubate him.
- Probably hit the carotid. - OK. I'll do the airway.
Give me a 6.5 and a bougie.
I got the bleeder.
Foley catheter with a 30 cc balloon.
- Are you donating? - O-neg, yeah.
Coming through!
It's too bloody to see a bougie.
Not for this. Three-step process.
Step one, scalpel.
Step two, finger. Step three, bougie.
OK, railroad in the tube.
I'm doing all I can to stop it!
Good, that's far enough. OK, bag him.
Dressing off.
Foley's in. Blow up a balloon.
30 cc's in.
Clamping.
Look at that.
Dry as a bone.
Room for another red.
Dr. Walsh, you have an OR for a head-and-neck case?
MCI-48.
We've got 16 ORs up and running. We've got room for one more.
Liver lac came back after a second unit, needs an ex-lap.
Turning over two ORs now. Send them up.
Where the hell did Mel go?
I don't know, but she needs to get back to yellow.
That's 2 grams of Ancef.
Great.
Let's take a look at your dressing.
All right, that looks good. The bleeding stopped.
Can you wiggle your fingers?
Ma'am? Ma'am, can you move your fingers for me?
OK, does it feel the same on both sides?
Great. How's the pain?
Well, the bullet probably went through the two forearm bones,
but there's no damage to the nerves or arteries,
so that's a good sign.
You're gonna be OK.
I'll find you some tissues.
Robby, blood's arrived.
Oh, right on.
Eviscerated bowel, fresh ABD and saline.
OK, bag for a sec?
3.375 Zosyn and a sterile dressing.
I can't believe I'm saying this-- another Christmas tree and Foley bag.
How did we run out of chest tubes?
Less than 500 cc's out. Surgical ICU can take him.
ET tubes in the chest-- they're gonna wonder
what the hell we're doing down here, but it was a great save.
Hey, Javadi, I need you to find Whitaker
and go up to the helipad-- we got blood flying in.
- OK. - Stay behind the yellow line
between 10:00 and 2:00 so the pilot
- can see you the whole time. - OK.
You got this?
Moving him up as fast as we can.
This one's going to yellow.
More chest tubes, courtesy of Presby.
Awesome. I'm gonna go check on Triage.
Copy that.
- They find the shooter yet? - Not yet, but we'll find him.
- Half the county is looking. - What about with her?
- Waiting for the FBI to get here. - They find her son?
No, but they pinged his cell phone to the area of the shooting.
Fuck. Does she know that yet?
- She's about to find out. - OK. Thanks.
What's with all these bloody handprints?
That's when people were trying to stop us to get a ride in,
but we were already packed.
Chest, belly, arm, and leg.
Red, pink, yellow, and a lucky green.
Two gurneys, two wheelchairs.
- My partner's in bad shape. - What's his name?
Rich. Rich Stefano.
Hey, Rich. How you doing?
Shit.
He got shot in the face?
No, entrance is on the other side-- neck, above his vest.
- Cheek is the exit wound. - OK.
Come on, Red Zone. He needs an airway.
Come with me. Come with me.
I got you. We'll get you fixed up.
Take him.
Hey, what's up with the SWAT team?
It's just a precaution in case the shooter heads this way.
- Is that a possibility? - There was some chatter.
Well, are we gonna be safe out here?
- Should be now. - Focus on the patients.
Focus on the patients.
Only way out is through.
Any idea how many more are coming?
Incident Command is sending all these ambulances
back to the scene for more victims.
We may not even be halfway through yet.
Jesus.
When is this gonna end?
Fuck.