Triage

On Mother's Day, I found out my paternal grandmother's sister passed away, and that her daughter (my aunt) was in the hospital after an accident - oddly enough, within a few hundred feet of a cremation area. I don't know the exact details - understandably the family is in mourning, myself included. 'Baby Mousie' was a spirited lady. And Aunt Vidya used to sneak me hamburgers about 25 years ago.

Funny what one remembers.

But the reason I'm writing this isn't so much about that. A more fitting memorial is due for that; what this is about what apparently happened - and some of the confusion that apparently was associated with it.

Having worked in an ER, been certified (EMT, BLS-I, ACLS, PHTLS... and some other acronyms I can't remember), I listened to a relative describe what he was told by someone who was there. That Baby Mousie, in her 80s, was apparently having an epileptic seizure after the accident. That the ambulance folks (I'm not certain that they are certified in Trinidad and Tobago, perhaps they are) wouldn't touch her, and that despite being asked to take her to the hospital first - they did not¹.

Instead, from what I understand, they performed triage. and in performing triage, they may have saved a life where they could have lost 2. A lot of this is based on what I've been told by different people, but from what I've heard - they made the right decisions at the right time.

And after talking to my own mother a bit (who must be recovering from the shock of hearing my voice), I mentioned this to her. The triage part. Why? Because sometimes you just save what you can. Sometimes you prioritize, sometimes you make the best decisions you can at the time and you live with the results. I'm lucky in that I've almost always been good at this. It isn't like picking a winning horse, it is about reading a scenario and working with that knowledge faster than you could explain it to someone else.

And Triage has so many applications. Medical professionals get away with it almost without question at the time because there is a bit of shock in people around when training usually kicks in for medical professionals. When a medical pro sees a spurting artery, they don't gape - or if they do, they do it while clamping it off somehow. This applies to other things, like technology.

When something breaks, it gets fixed. When something cannot be fixed within a given amount of time, you fix the next thing. You work with streams of data that are supposed to be happening in chronological order. You move quickly and as efficiently as possible. Sometimes explanation takes longer than implementation, and that is a severe liability. What would have happened had the ambulance folks explained everything about triage to people on the scene? What are the odds that they could have lost 2 patients?

If someone has a bit of influenza, you have the option to sit down and talk to them and their family. But in an emergency situation... that time doesn't exist. Decades of experience culminate in the ability of a well trained person to make an informed decision in split seconds.

So you save what you can. If there is one thing I miss from the days in the Emergency Department and treating Marines, it was the clarity of thought that comes between the ticks of a second hand on a clock. It was the ability to do what had to be done without a dissertation on anatomy and physiology. You can explain afterwards.

¹You don't mess with someone who's having a seizure. You try to keep their airway clear, but you can really hurt someone who is having a seizure if you mess with them. It's been a while since I had a stethoscope on, but there are some things you don't forget. As tempting as it may be to hold them still, you can't. If you can, you get them something to bite on so that they don't bite their tongue. But that's about all you can do.