Oh fucks face, Malloy IT IS THAT KIND OF TRIAGE

[nadinbrzezinski]

in a pandemic your resources go down to the point of non-workable!

Been there, done that, yep, played god! And in a pandemic you really have no clue how bad it will get

[DS1]

1. What's he talking about now?

[nadinbrzezinski]

2. Federal Directives for Mass Casualty Triage in case of a flu Pandemic

I remember those directives when taking and later teaching Triage to my medics

Nope if you are over 80 you are not treated before the twenty year old

It is that kind of triage

And yes... in one case I let go of a two year old (agonal breathing, brain mass coming out of ears and nose), and instead worked on her grandfather, in his sixties, with a bad femur fracture

Oh and yes, by the time we were done sending cris to the hospital we did put kid in a swath... She died, while I started the second IV on grand dad.

[benddem]

3. someone has to make decisions

you can't waste all your resources caring for someone who is going to die or someone who will require more man power than you can afford.

[nadinbrzezinski]

6. IC Medical more than once

I still live and wake up in the middle of the night over those decisions....

[Fovea]

4. Hyatt Regency Skywalk collapse

Charlie Foxtrot of emergency management.

Any sort of massive casualties can bring the system to
a halt. But infection takes a higher toll on healthcare providers.

[nadinbrzezinski]

5. Tell me about it

I know that he does a good job usually exposing the usual suspects, but them federal directives ARE standard triage

Granted, there are many other things we could be doing to prepare that we are not doing... but that is another kettle of fish

[Ilsa]

7. I'm with you ndbzzk. I don't understand why Kathy

didn't go over that with him better. She should have a good idea about that kind of triage.

[nadinbrzezinski]

8. Hell under the standards if we have a pandemic

I'll stay home and die, I am in one of the groups to be triaged black... so well, been a good ride

I am surprised he didn't mention the two year olds and younger who are also in the WHO guidelines... I mean that should horrify most folks... but Triage ain;t for the faint of heart... I take it you've done it

[Ilsa]

9. I understand it. I'm a "nonworking" nurse now, but I have a good head

for emergency and planning. I may have to go back to work later.

The thought of anyone having to make such monumental decisions in triage is a real stressor. But it has to be done. The Big Plan has to be done. And the guidelines and rationale behind them has to be abided by. But yes, I understand about who falls to the margins and why for the saving of humanity.

Just got through assisting mother-in-law on her rotator cuff surgery. I gave her unsolicited advice: BE sure to ask the doc for your post-op scripts ahead of time; ask about how immobilized you are going to be, for how long, how much pain, etc. She didn't do that or she didn't listen and he didn't offer much information about what she was to expect. Consequently, I ended up doing the bulk of the post-op planning for her to keep her safe while on pain meds, dressed vs topless, and fed. I have to be careful not to overstep my bounds, but jeebus, it's a time-consuming pain to try to fix up stuff after the fact.

[nadinbrzezinski]

10. After dad fell and broke hip it fell on me to do a lot of the heavy lifting

including the buying of the wheelchair and other stuff they needed. Since I used to buy equipment I sort of knew where and how to look,

Hugs about mother in law

And here is what I sent Mike

Mike this may not be nice, but what you described is CLASSIC TRIAGE. I used to first train in it, then train my people and was designated Medical Incident Commander more than once... yep I got to play god.

As a former Medic... who's been there done that... I realize that if we have a massive pandemic the ability to treat mass amounts of people will go down to zilch, zero... nada

This is standard triage

I have, as a medic, let go of a young child who under any other circumstance I'd treat... and later watch die at the hospital. Why? Agonal breathing and brain mass coming out of her nose and ears... as well as some blood... most of those patients don't do well... and yes seeing her die wasn't easy either.

I treated her grand dad.. who was salvageable.

Not only do I still question myself for that decision, but I KNOW in my heart that grand dad had a hell of a survivor guilt... and at times I still see her deep blue eyes... and large, I mean this LARGE pupils... as in blown out pupils.

Now that was a train wreck.... small by any standard when it comes to triage conditions

I could also tell you of the young bride I sent to the hospital with a broken hip, while her younger brother was never treated, since he was not breathing when we arrived... I made the decision to tag him black... we had twenty others who were serious to critical and I only had five ambulances.

In a mass event these two will be a walk in the park. and yes the guidelines are clear. If we have one of these, I will stay home and not even bother trying to get that attention

Two reasons

1.- I will be triaged black... and yes I accept it

2.- No use in crowding ERs and sent home to spread it... or for that matter your local football field

Now, there is much we as a nation could do to avoid this situation, but if we have a 1918 situation again, yes... this is standard triage and yes, you have to get medical teams in the same page. By the way, in case you wonder... their death rate will be the highest, comes with the job.

But here are the list of pieces of equipment that will be in short supply very fast

Respirators

EKG machines

Suction machines....

And those will be in short supply within hours of the pandemic breaking locally... so yes, they will need to use those resources for the people who might survive...

[Ilsa]

12. Excellent explanation! Good on you! (Life takes alot of courage.) nt

[nadinbrzezinski]

14. Thanks and if Kathy used to be a nurse she should brief him

this is standard... hell so standard it is not even funny

[Warpy]

11. Non medical people always shirek about that stuff

but when the system is strained to the point that it can't function any more, tough choices have to be made.

The people they cited are the right ones to be allowed to drift off in a morphine haze. The best medicine in the world doesn't work well for those groups under the best circumstances.

[nadinbrzezinski]

13. I know.... problem is in what he described we will not even have enough

Opiates, so make sure to save some for me

:-)

[NuttyFluffers]

15. pandemics literally strain societies to their breaking; triage must exist

if there is any hope of even the most remote survival of social normalcy in the aftermath such painful decisions will have to be made. yes, pandemics are really that apocalyptic, and yes, innocent people all around will be condemned to die. tough, welcome to earth, do your best, hope for a painless exit -- for you have no one else to save you.

oh, and cataclysmic epidemic levels start at 10% mortality rates in the population. 1 in 10 dying around you stresses the entire fragile fabric of our precious little worlds. if, heaven forbid, it got any higher than that -- and it has, many a time -- all bets are off socially. you'll be lucky for the post-apocalyptic dystopias of movies; it'll likely be far worse with death everywhere, as far as the eye can see. all preparation, even triage, in such epic cases are like band-aids on arterial spray; be prepared to die, and likely in agony.

ooh, reality TV is now on! :)

[nadinbrzezinski]

16. I still remember when the first write-ups on Bird Flu came from the WHO

oh back in 1997-98

They spoke of LD 10 on a light side

All the way to LD 50 with some age groups and close to LD 100 with the extremes, babies and old folk.

Most folks do not realize the WHO has been tracking this for now a decade or so... and is expecting this to happen within my lifetime

If and when it breaks out... I don't expect to make it... but I also realize triage needs to exist

And if we have this happen what emerges on the other side may very well be before bird flu and after bird flu

It will change the society, in a way like the Black Death did