WEBVTT 00:10.135 --> 00:11.552 Hey, Jake, it's Robby. 00:11.553 --> 00:15.514 Listen, man, just call me or text me the second that you get this message, OK? 00:15.515 --> 00:16.515 OK. 00:16.516 --> 00:18.350 I can't reach Jake. 00:18.351 --> 00:19.810 I'm sure he's OK. 00:19.811 --> 00:21.645 - Active shooter at PittFest. - We heard. 00:21.646 --> 00:25.733 Code Triage, Emergency Department now. 00:25.734 --> 00:27.276 What's that mean? Has that happened before? 00:27.277 --> 00:28.902 We're locking down the hospital 00:28.903 --> 00:30.779 and setting up a command center in Administration. 00:30.780 --> 00:32.906 We'll coordinate logistics, supplies, communication. 00:32.907 --> 00:34.324 How many casualties? 00:34.325 --> 00:36.535 Unclear, but initial reports are not good. 00:36.536 --> 00:38.078 OK. 00:38.079 --> 00:40.622 The night shift is gonna be here soon, but we are gonna need more help, 00:40.623 --> 00:42.332 especially from Surgery and Anesthesiology. 00:42.333 --> 00:44.376 MCI group text and email went out to everyone, 00:44.377 --> 00:46.545 including Transport and Environmental Services. 00:46.546 --> 00:48.047 OK, good. 00:48.048 --> 00:50.299 Hey, everyone's gonna want to come in to help. 00:50.300 --> 00:51.592 Keep enough in reserve. 00:51.593 --> 00:53.844 Tell them to come in eight hours later to give us a break. 00:53.845 --> 00:55.805 - And can you try and reach Jake? - Of course. 00:56.890 --> 00:58.307 Surgery's got to call in the cavalry. 00:58.308 --> 01:00.309 - We're gonna need all 25 ORs. - Ahead of you. 01:00.310 --> 01:01.935 Four ORs are prepped and staffed, 01:01.936 --> 01:03.771 and we're working on getting the rest up and running. 01:03.772 --> 01:05.523 - What about disaster supplies? - On their way. 01:07.400 --> 01:09.318 Every patient in the ER needs to go up. 01:09.319 --> 01:11.111 Beds or no beds, they'll get better care 01:11.112 --> 01:12.780 in an upstairs hallway than ignored down here. 01:12.781 --> 01:13.865 Agreed. 01:14.616 --> 01:17.326 There's a whole wing that's empty on the eighth floor. 01:17.327 --> 01:20.038 - I don't know if that's-- - But no nurses to staff it. 01:20.830 --> 01:21.997 No comment on that one. 01:21.998 --> 01:24.249 Waiting room and Triage can go to Family Medicine Urgent Care. 01:24.250 --> 01:25.584 And we should turn off the TVs. 01:25.585 --> 01:27.878 - We don't need to cause any extra panic. - Will do. 01:27.879 --> 01:30.130 The cafeteria will handle the family members and survivors. 01:30.131 --> 01:31.382 What else do you need? 01:33.301 --> 01:34.843 Prayers wouldn't hurt. 01:34.844 --> 01:36.345 Amen to that. 01:36.346 --> 01:38.639 - Keep the press out of here. - Gladly. 01:38.640 --> 01:40.349 Call me directly if you need anything else. 01:40.350 --> 01:41.558 OK, will do. Thank you. 01:41.559 --> 01:44.144 - Hey, what's going on? - Mass casualty at PittFest. 01:44.145 --> 01:45.604 How many victims? 01:45.605 --> 01:47.023 We don't know. Expect the worst. 01:47.565 --> 01:49.192 Did the police find David? 01:50.485 --> 01:52.070 OK, everybody listen up. 01:54.572 --> 01:56.907 There is an active shooter at PittFest. 01:56.908 --> 01:58.617 As the nearest trauma center, 01:58.618 --> 02:00.786 we are going to be getting the majority of the victims. 02:00.787 --> 02:02.788 We don't know yet how many we are getting, 02:02.789 --> 02:06.084 but we are instituting hospital-wide emergency protocols. 02:06.626 --> 02:09.628 We need to move every patient out of here. 02:09.629 --> 02:12.799 They either go home, they go upstairs, or they go to Family Medicine. 02:13.883 --> 02:15.801 Call your loved ones now if you need to. 02:15.802 --> 02:19.263 I can guarantee you cell service will soon be overwhelmed. 02:19.264 --> 02:20.681 Eat something. Stay hydrated. 02:20.682 --> 02:22.349 Use the bathroom while there's time 02:22.350 --> 02:24.393 and meet back here for a full briefing in five minutes. 02:24.394 --> 02:27.187 - Brother, I'm so fucking glad to see you. - Heard it on the police scanner. 02:27.188 --> 02:30.732 - How many we expecting? - I don't know, but it doesn't sound good. 02:30.733 --> 02:33.152 Let's go to the back first in order. 02:33.153 --> 02:34.779 Those guys got to get out of there. 02:37.365 --> 02:39.325 How many patients can you take? 02:45.498 --> 02:47.040 Where do we put the disaster bins? 02:47.041 --> 02:49.418 Behavioral Health. That's now our central supply. 02:49.419 --> 02:50.503 Let's go. 02:51.796 --> 02:53.506 We got more bins coming. 02:55.049 --> 02:56.466 OK. 02:56.467 --> 02:57.885 Right side. 02:57.886 --> 02:59.678 Left side. 02:59.679 --> 03:02.055 I'm gonna need you to grab folding tables from facilities 03:02.056 --> 03:03.640 - to organize all this stuff. - Copy that. 03:03.641 --> 03:05.017 Go. Thank you. 03:05.018 --> 03:09.856 Code Triage, Emergency Department now. 03:11.733 --> 03:16.196 Blood Bank, call 7113. 03:18.239 --> 03:20.532 Thank you for your cooperation and understanding 03:20.533 --> 03:23.410 as we prepare for a mass-casualty event. 03:23.411 --> 03:27.122 Your medical records will be available to urgent care and Family Medicine. 03:27.123 --> 03:28.875 They know you're coming. 03:30.710 --> 03:34.004 OK, please make sure to take all your personal belongings with you. 03:34.005 --> 03:35.339 This is stupid. 03:35.340 --> 03:37.841 Sorry for any inconvenience, sir, but this is an emergency. 03:37.842 --> 03:40.719 This is an emergency room. It's fucking stupid. 03:40.720 --> 03:43.680 Olsen, get back here as soon as the waiting room is cleared. 03:43.681 --> 03:44.766 Copy that. 03:45.516 --> 03:46.517 Telemetry. 03:47.393 --> 03:48.810 OB/GYN. 03:48.811 --> 03:50.896 CCU. ICU. 03:50.897 --> 03:53.148 - Ortho. - MCI protocols. 03:53.149 --> 03:55.108 Make sure you bring all these gurneys and wheelchairs back. 03:55.109 --> 03:56.276 They're going to the ambulance bay. 03:56.277 --> 03:57.861 We need as many as we can get our hands on. 03:57.862 --> 03:58.862 What's next, Cap? 03:58.863 --> 04:00.364 Pharmacy needs to come down and open the PDS. 04:00.365 --> 04:01.949 They also need to bring up all the narcotics, 04:01.950 --> 04:03.700 paralytics, and sedatives that they can. 04:03.701 --> 04:05.369 - Consider it done. - Jake? 04:05.370 --> 04:08.038 Not yet, but you know teenagers. I'll keep trying. 04:08.039 --> 04:09.289 OK, maybe try his mom, Janey. 04:09.290 --> 04:11.333 She's in my phone. Tell her what's going on. 04:11.334 --> 04:14.002 And try Collins. See if you can get her to come back. 04:14.003 --> 04:15.295 Will do. 04:15.296 --> 04:16.672 OK, let's go. Let's go. 04:16.673 --> 04:18.298 Bring all these gurneys and wheelchairs back. 04:18.299 --> 04:20.093 They're all going to the ambulance bay. 04:22.011 --> 04:23.512 Hi. Can you just tell my sister, Becca, 04:23.513 --> 04:26.015 that I'm gonna be a little late picking her up? 04:29.394 --> 04:30.852 I don't know. 04:30.853 --> 04:33.939 Hey. Hey, Mom, I need you or Dad to come to the hospital right now 04:33.940 --> 04:36.650 to pick up Harrison, or he's gonna be stuck here for hours. 04:36.651 --> 04:38.652 I know, I'll explain when you get here, OK? 04:38.653 --> 04:39.821 Love you. Bye. 04:40.571 --> 04:41.863 Hey. 04:41.864 --> 04:43.658 Can we leave yet? 04:45.868 --> 04:47.327 I can't, 04:47.328 --> 04:49.955 but Grandma and Grandpa are gonna come pick you up. 04:49.956 --> 04:52.333 And in the meantime, you can play some games. 04:53.042 --> 04:55.086 Can I watch a movie? 04:55.628 --> 04:57.255 Yes, but nothing scary. 04:58.256 --> 04:59.881 I mean it. 04:59.882 --> 05:02.259 And don't leave this room until I come get you, OK? 05:02.260 --> 05:03.427 OK, Mom. 05:03.428 --> 05:04.845 - Love you. - Bye. 05:04.846 --> 05:07.180 We're gonna be putting four gurneys in each of these trauma rooms, 05:07.181 --> 05:09.766 so make sure you stock both rooms to handle the additional patients. 05:09.767 --> 05:10.851 Not a problem. 05:10.852 --> 05:13.520 And let's broom all these WOWs, ultrasounds out of here. 05:13.521 --> 05:15.647 We're not gonna have time or space for anything but gurneys. 05:15.648 --> 05:16.732 OK. 05:16.733 --> 05:19.401 - Any word on what we're expecting? - Not yet. How's it looking upstairs? 05:19.402 --> 05:21.528 Should have all 25 ORs running within the hour. 05:21.529 --> 05:22.904 We could be buried by then. 05:22.905 --> 05:24.906 Everyone's rolling in as fast as they can. 05:24.907 --> 05:27.200 Surgery is ready. We're here. We're ready. 05:27.201 --> 05:29.202 - I am taking Primary ER. - Have at it. 05:29.203 --> 05:31.247 Who's taking Primary Surgery? 05:32.874 --> 05:34.291 Heavy is the head that wears the crown. 05:34.292 --> 05:35.500 Dr. Walsh. 05:35.501 --> 05:37.210 - Anesthesiology? - Gladden will be down. 05:37.211 --> 05:38.962 He's got four in place, more on the way. 05:38.963 --> 05:40.464 OK, this is yours. 05:40.465 --> 05:42.007 Thank you. What you got in there? 05:42.008 --> 05:45.218 A couple of CAT tourniquets, hemostatic dressings, LMAs. 05:45.219 --> 05:46.595 We got plenty of that stuff. 05:46.596 --> 05:49.598 Butterfly ultrasound works off a cell phone. 05:49.599 --> 05:50.682 - That's cool. - Yeah. 05:50.683 --> 05:53.602 But we're gonna send all the unstable chest and belly straight up to the OR. 05:53.603 --> 05:57.022 OK, everybody listen up. This is how it's going to work. 05:57.023 --> 05:59.649 Our ambulance bay is now our Triage. 05:59.650 --> 06:01.610 EMS will be overwhelmed. 06:01.611 --> 06:05.197 Most will probably arrive by car, several victims per vehicle. 06:05.198 --> 06:08.867 For all you newbies that don't know, Dr. Shen is our night shift attending. 06:08.868 --> 06:11.036 - John, I'm gonna put you on Point Triage. - Cool. 06:11.037 --> 06:14.039 Triage will decide who goes where depending on their injury. 06:14.040 --> 06:18.085 Every department will have a designated primary who will oversee their staff. 06:18.086 --> 06:20.253 If you need someone, look for the vest. 06:20.254 --> 06:24.174 We're all gonna have walkies. We can get you whatever you need. 06:24.175 --> 06:27.427 No patient goes into a room unless it's a trauma bay, 06:27.428 --> 06:29.012 and they will have four patients each. 06:29.013 --> 06:32.974 We need to keep everybody out in the open so we can keep an eye on everything, OK? 06:32.975 --> 06:36.436 Triage is gonna assess and assign every patient 06:36.437 --> 06:39.856 to a specific zone with a colored slap band. 06:39.857 --> 06:43.276 Patient who comes in with a red slap band goes to the Red Zone, 06:43.277 --> 06:45.445 which is the trauma rooms, with overflow out here. 06:45.446 --> 06:49.032 These are the most critical patients who will die without immediate attention. 06:49.033 --> 06:50.325 Samira, where are you? 06:50.326 --> 06:52.244 You are here with Dr. Abbot and me. 06:52.245 --> 06:53.912 Jack's gonna run traffic. 06:53.913 --> 06:56.123 We have five minutes to try and stabilize the reds. 06:56.124 --> 06:58.792 After that, it's OR, ICU, or morgue. 06:58.793 --> 07:01.670 The south and central common area over there will be the Pink Zone. 07:01.671 --> 07:04.714 That is for patients who will die in under an hour without treatment. 07:04.715 --> 07:06.758 McKay and Javadi, you are over there, 07:06.759 --> 07:09.428 with help from incoming night shift and surgical staff. 07:09.429 --> 07:11.471 Yellow Zone is the North Corridor. 07:11.472 --> 07:15.100 Those are gonna be mostly extremity wounds--good vitals, talking. 07:15.101 --> 07:18.396 Mel, you're gonna run point there with Santos and Whitaker. 07:19.564 --> 07:22.024 What if there's a pulseless extremity? 07:23.568 --> 07:26.486 If you can't feel a pulse, check for Doppler flow with this. 07:26.487 --> 07:27.904 It's a mini-ultrasound. 07:27.905 --> 07:29.698 Follow the screen prompts. 07:29.699 --> 07:31.700 But a yellow can change to a red if they go south. 07:31.701 --> 07:33.785 You got to stay on top of them, even if they seem stable. 07:33.786 --> 07:35.328 - OK, yeah. - You got this, Dr. King. 07:35.329 --> 07:37.914 Green--minor lacs and sprains. They go to Family Medicine. 07:37.915 --> 07:39.916 Black and white bands are DOA, imminent death. 07:39.917 --> 07:41.668 Pedes is now our morgue. 07:41.669 --> 07:44.337 Let's hope we don't get too many of these. 07:44.338 --> 07:46.047 We're a MASH unit now. 07:46.048 --> 07:50.051 There's no charting, no electronic medical records, no board. 07:50.052 --> 07:52.262 How do we document treatment? 07:52.263 --> 07:53.513 You'll all get Sharpies, 07:53.514 --> 07:56.349 and every patient has a wrist chart to document treatment and procedures. 07:56.350 --> 07:58.894 You run out of room, write on the patient's forehead. 07:58.895 --> 08:00.520 - Really? - Yeah, really. 08:00.521 --> 08:01.771 Each wrist chart has 08:01.772 --> 08:04.858 a unique mass-casualty-incident barcode and patient number. 08:04.859 --> 08:06.610 That's how the patients are gonna get identified. 08:06.611 --> 08:09.988 This is no-frills combat-zone medicine. 08:09.989 --> 08:13.033 No ultrasound, no X-rays, no CT, no labs. 08:13.034 --> 08:16.703 Assess based on mental status and pulse strength. 08:16.704 --> 08:19.873 Every critical patient gets an IO, intubation, 08:19.874 --> 08:22.042 a unit of blood, and chest tube if needed. 08:22.043 --> 08:24.377 Everything you need-- blood, drugs, bandages-- 08:24.378 --> 08:26.546 everything will be in the Behavioral Health rooms. 08:26.547 --> 08:28.424 That's our supply depot. 08:30.051 --> 08:32.677 Keep a couple of 11 blades in your pocket. 08:32.678 --> 08:36.473 Goal is to resuscitate ASAP so they'll make it upstairs for definitive care. 08:36.474 --> 08:38.183 Trauma surgery and neurosurgery 08:38.184 --> 08:40.018 will decide who goes up to the OR immediately 08:40.019 --> 08:43.314 and who goes to the ICU for further treatment and evaluation. 08:45.149 --> 08:46.608 Communicate. 08:46.609 --> 08:48.902 Ask for help if you need it. 08:48.903 --> 08:50.362 Trust your attendings. 08:50.363 --> 08:51.988 We will get through this together. 08:51.989 --> 08:53.406 Damn right we will. 08:53.407 --> 08:54.867 OK, you three, I want to talk to you. 08:57.703 --> 09:00.997 I need you three to raid Central Supply and bring back all the chest tubes, 09:00.998 --> 09:03.416 ET tubes, thora-seals, normal saline-- 09:03.417 --> 09:04.584 I thought that was all in Behavioral Health. 09:04.585 --> 09:06.044 We can burn through all that in the first hour. 09:06.045 --> 09:07.796 West basement, just past nuclear medicine. 09:07.797 --> 09:09.214 - West basement. Got it. - Wait, wait, wait, wait, wait. 09:09.215 --> 09:10.423 Take one of these empty disaster bins 09:10.424 --> 09:12.008 so you can grab everything you get your hands on. 09:12.009 --> 09:14.177 - What's a disaster bin? - Empty plastic boxes right there. 09:14.178 --> 09:16.179 - You can't miss them. - Where's Collins? 09:16.180 --> 09:19.599 She went home, but Dana is calling her now. 09:19.600 --> 09:21.810 Don't worry. It's OK. We got plenty of people coming in. 09:21.811 --> 09:23.688 Just follow Dr. Abbot's lead. 09:24.522 --> 09:26.231 John, I'm gonna help you get started in Triage. 09:26.232 --> 09:27.816 Sounds good. 09:27.817 --> 09:29.776 Dana. What do you need? 09:29.777 --> 09:31.528 Prep the Yellow Zone for extremity wounds. 09:31.529 --> 09:33.446 We need a shitload of bandages, tourniquets, 09:33.447 --> 09:34.948 splint slings, and IV antibiotics. 09:34.949 --> 09:36.325 - I'm on it. - Yep. 09:37.535 --> 09:38.828 Myrna. 09:40.705 --> 09:42.080 Where the hell did Mryna go? 09:42.081 --> 09:43.832 Antoine, did you take the cuffs off Myrna? 09:43.833 --> 09:45.959 Hell, no. That woman scares the shit out of me. 09:45.960 --> 09:47.460 She keeps trying to bite me. 09:47.461 --> 09:49.422 Son of a bitch. 09:55.928 --> 09:57.470 That's a lot of wrist charts. 09:57.471 --> 09:58.639 300. 09:59.473 --> 10:01.099 Let's hope we don't need them all. 10:01.100 --> 10:04.269 Were you at the last mass-casualty faculty meeting? 10:04.270 --> 10:06.731 No. I was still a resident three months ago. 10:08.441 --> 10:09.442 Right. 10:11.694 --> 10:14.821 Well, one patient at a time, right? 10:14.822 --> 10:17.907 The goal is to triage each patient in ten seconds. 10:17.908 --> 10:19.743 Ten seconds, got it. 10:19.744 --> 10:21.036 Mental status is AVPU. 10:21.037 --> 10:24.372 Alert, response to verbal, response to pain, unresponsive. 10:24.373 --> 10:25.582 Yep. 10:25.583 --> 10:27.417 Next, do they have a pulse? 10:27.418 --> 10:30.003 Radial, carotid, or femoral tells you where to send them. 10:30.004 --> 10:31.589 - That's it. - OK. 10:32.798 --> 10:34.174 Cool. 10:34.175 --> 10:36.385 Oh, I heard it might rain today. 10:37.762 --> 10:39.512 - John? - Yeah, man. 10:39.513 --> 10:42.641 Mental status and pulse gives you everything you need. 10:42.642 --> 10:43.975 Cool. 10:43.976 --> 10:46.895 Unresponsive with no pulses, slap a black and white band on them, 10:46.896 --> 10:48.189 send them to the morgue. 10:49.607 --> 10:53.361 Responds to pain with a faint groan, weak femoral pulse, no radial? 10:53.986 --> 10:55.070 - Red. - Right. 10:55.071 --> 10:56.738 Slap a red band on them, send them back. 10:56.739 --> 10:58.783 Awake, alert with strong radial? 10:59.617 --> 11:00.533 Trick question. 11:00.534 --> 11:02.911 Could be green, Family Medicine for scrapes or sprains, 11:02.912 --> 11:05.288 but stable, penetrating extremity wounds go to yellow. 11:05.289 --> 11:07.540 - Perfect. - Dude, relax. 11:07.541 --> 11:09.960 I got the front door. You worry about the back. 11:14.340 --> 11:17.300 Hey, Paolo, everybody, let's put the heads of these gurneys up 30 degrees 11:17.301 --> 11:19.052 so they all roll in the right way. 11:19.053 --> 11:21.304 - Dr. Robby. - Did you talk to your son? 11:21.305 --> 11:23.890 No, but I have the form to put him on a psychiatric hold. 11:23.891 --> 11:25.850 A social worker signed it. 11:25.851 --> 11:27.727 - I just need you. - OK. 11:27.728 --> 11:29.604 You should probably go home, Theresa. 11:29.605 --> 11:31.398 This hospital is essentially closed. 11:31.399 --> 11:33.358 David wouldn't do this. 11:33.359 --> 11:34.943 I really hope you're right. 11:34.944 --> 11:36.570 I got four shooting victims. 11:37.655 --> 11:39.030 What's your name? 11:39.031 --> 11:40.115 Duncan. 11:40.116 --> 11:41.991 Show me. 11:41.992 --> 11:44.703 Right chest, strong radial. Pink. 11:44.704 --> 11:45.954 What's this? 11:45.955 --> 11:48.164 That's priority boarding. You're gonna be OK. 11:48.165 --> 11:50.418 Back wound is red. Shoulder is yellow. Neck wound is red. 11:51.252 --> 11:53.211 OK. Let's check out this van. 11:53.212 --> 11:54.296 Yeah. 11:57.675 --> 11:59.217 Hey. See that woman over there? 11:59.218 --> 12:00.719 - You need to speak to her. - Why? 12:00.720 --> 12:02.345 Her son had something to do with the shooting. 12:02.346 --> 12:04.264 I'm not sure for certain, but you need to talk to her. 12:04.265 --> 12:06.058 Shit. OK. 12:10.229 --> 12:12.147 - What's your name? - I'm Sylvia. 12:12.148 --> 12:13.398 This is my son, Omar. 12:13.399 --> 12:14.983 Omar, can you open your eyes for me? 12:14.984 --> 12:16.234 He's deaf. 12:16.235 --> 12:17.569 Gurney! 12:17.570 --> 12:19.279 Sir, can you hear me? 12:19.280 --> 12:20.865 Black and white, Pedes. 12:23.784 --> 12:24.785 Red zone. 12:25.703 --> 12:27.537 You need to let go now. One, two, three. 12:27.538 --> 12:28.997 I want to stay with my son. 12:28.998 --> 12:31.083 He will be very close by, I promise. 12:32.501 --> 12:33.793 What happened to your leg? 12:33.794 --> 12:35.628 I got hit by a car when we were wheeling him in. 12:35.629 --> 12:37.548 OK, we'll see you inside, too. 12:41.844 --> 12:43.219 You got this? I'll check back in a minute. 12:43.220 --> 12:44.471 No problema. 12:44.472 --> 12:46.014 Dr. Ellis, thanks for coming in early. 12:46.015 --> 12:48.141 - Put me in, Coach. - You're on Triage with Shen. 12:48.142 --> 12:49.642 - Ten seconds a patient, right? - You got it. 12:49.643 --> 12:52.521 - Let me know if you need any help. - Help. 12:56.317 --> 12:58.110 Behind you. Coming through. 13:00.863 --> 13:02.447 I'm in. 13:02.448 --> 13:04.533 - Bag her. - O-neg's pouring in. 13:05.659 --> 13:07.744 Stronger pulse. I'll take her up. 13:07.745 --> 13:10.955 Dr. Mohan, that kid came in with his mom. She says he's deaf. 13:10.956 --> 13:13.249 - Ready to go with the O-neg. - Wait, wait. Stop. 13:13.250 --> 13:15.460 O positive for males over 13, women over 55. 13:15.461 --> 13:16.921 O-neg for everybody else. 13:18.422 --> 13:19.673 Hook me up. 13:23.928 --> 13:25.887 - It's really pouring out. - Squeeze in two units. 13:25.888 --> 13:27.555 1500 out buys him a trip to the OR. 13:27.556 --> 13:30.141 If he stabilizes, surgical ICU instead. 13:30.142 --> 13:31.726 I'm gonna see who needs help. 13:31.727 --> 13:32.812 Yeah. 13:34.730 --> 13:36.482 IO's in. Go with O pos. 13:37.441 --> 13:40.361 When there's no time, bone marrow infusion is as good as an IV. 13:41.570 --> 13:43.405 Robby, stabilize for the flip. 13:46.534 --> 13:47.952 - Go. - OK. 13:48.953 --> 13:51.246 He's got a wound on both sides. He's gonna need two chest tubes. 13:51.247 --> 13:52.497 - Yeah. - Need a hand? 13:52.498 --> 13:53.999 Hell, no. I got two hands. 13:57.086 --> 13:58.087 Roll. 13:58.879 --> 14:01.590 OK, quick IO, Etomidate and sux, prep for the intubation. 14:09.390 --> 14:11.058 Got another one for yellow. 14:12.351 --> 14:13.936 Document the tourniquet time. 14:14.478 --> 14:16.187 Mark the arm. Mark the chart. 14:16.188 --> 14:17.856 Let it down briefly once an hour. 14:17.857 --> 14:20.567 - OK. - Four of morphine. Repeat if needed. 14:20.568 --> 14:22.318 Mel, this is Sylvia. 14:22.319 --> 14:24.113 Hi, Sylvia. I'm Dr. King. 14:26.240 --> 14:28.074 Looks like closed tib-fib fractures. 14:28.075 --> 14:30.869 Strong pedal pulses, great flow with the butterfly. 14:30.870 --> 14:33.788 - Great. - OK, I got separated from my son, Omar. 14:33.789 --> 14:35.665 He got shot in the chest. 14:35.666 --> 14:38.585 OK, I'll let you know as soon as I find out anything. 14:38.586 --> 14:41.170 He is deaf, ASL only. They need to know that. 14:41.171 --> 14:43.548 OK. I'll make sure it's in his chart. 14:43.549 --> 14:45.508 She needs X-rays--AP and lateral. 14:45.509 --> 14:47.760 Well, Radiology's gonna be closed for hours. 14:47.761 --> 14:49.971 Put her in a long CAM boot and pain meds. 14:49.972 --> 14:52.433 - We're just gonna make you comfortable. - Thank you. 14:56.562 --> 14:58.062 Coming in with clamps now. 14:58.063 --> 15:01.941 Environmental service manager to the ER. 15:01.942 --> 15:03.776 OK. Pressure dressing on this. 15:03.777 --> 15:04.862 OK. 15:06.572 --> 15:09.158 - What if he dropped a lung? - Then I'll throw in a pigtail. 15:11.285 --> 15:13.161 - Who needs help? - Everyone. 15:13.162 --> 15:15.163 Pinks are supposed to be stable for the next hour. 15:15.164 --> 15:16.581 If you think they need the OR sooner, 15:16.582 --> 15:18.459 - send them to the red zone. - Will do. 15:19.668 --> 15:22.421 I got this. Go with your mom-- I mean, Dr. Shamsi. 15:27.968 --> 15:29.385 How we doing in here? 15:29.386 --> 15:32.055 So far, so good. Blood's primed and ready. 15:32.056 --> 15:33.848 1500 CCs. Time for the OR now? 15:33.849 --> 15:35.476 Definitely. Move him up. 15:40.064 --> 15:41.856 17-year-old with a right chest wound? 15:41.857 --> 15:43.275 Going up to the OR now. 15:44.276 --> 15:45.486 Hold on one second. 15:46.904 --> 15:48.906 They need to know he's deaf when he wakes up. 15:50.449 --> 15:53.660 - Not a lot of test tube output here. - Looks like this one's renal. 15:53.661 --> 15:55.704 Golden ticket--directly to surgery. 15:58.499 --> 15:59.832 That's 3 out of 4 ORs down. 15:59.833 --> 16:03.252 Another 4 about to open, and all 25 will be ready by the time we need them. 16:03.253 --> 16:05.463 - We could be buried by then. - No, you won't. 16:05.464 --> 16:08.883 We'll blast through these, tying off bleeders and slapping on vacuum dressings. 16:08.884 --> 16:11.095 We'll finish the job in a day or two when the dust settles. 16:12.096 --> 16:14.013 Unresponsive, had a weak femoral, lost it. 16:14.014 --> 16:16.432 Two units of blood. If there's no response, call it. 16:16.433 --> 16:17.934 No pulse, no OR. 16:17.935 --> 16:19.602 Gunshot to the head. 16:19.603 --> 16:21.854 - Through and through? - Yeah, we still got a strong pulse. 16:21.855 --> 16:23.648 This one can make it because the intracranial bleed 16:23.649 --> 16:25.024 can decompress through the bullet holes. 16:25.025 --> 16:26.859 Walsh, neurosurgery in house? 16:26.860 --> 16:29.613 Yes, send him to the neurocrit ICU. They'll triage from there. 16:31.740 --> 16:34.075 - OK, you guys good in here? You got this? - We got this. 16:34.076 --> 16:35.911 Bring me a few more before I get bored. 16:36.996 --> 16:38.538 ER immediately. 16:38.539 --> 16:41.332 All available transport to the ER immediately. 16:41.333 --> 16:42.875 Through and through? 16:42.876 --> 16:44.460 It doesn't look like it. 16:44.461 --> 16:46.338 Getting backed up out there. 16:53.971 --> 16:55.263 Good view of the chords. 16:55.264 --> 16:56.889 Easy peasy, I'm in. 16:56.890 --> 16:58.307 Bag her up. 16:58.308 --> 17:00.059 We have more ambulances coming. 17:00.060 --> 17:01.519 End tidal CO2 looking good. 17:01.520 --> 17:02.979 20 French on a kelly. 17:02.980 --> 17:04.564 What the fuck are you doing? 17:04.565 --> 17:06.315 - I'm saving lives. - You should not be here. 17:06.316 --> 17:07.609 None of these people should be here. 17:09.695 --> 17:10.820 Larry, Larry! 17:10.821 --> 17:12.405 Head wounds don't go to yellow. 17:12.406 --> 17:14.365 - Wait, what? - Triage says yellow. 17:14.366 --> 17:15.908 - Hold on. - Go. 17:15.909 --> 17:18.619 I've got this. Trust me. 17:18.620 --> 17:20.164 Oh, we're a little late for that. 17:21.290 --> 17:25.918 Any available transport to the ER now. 17:25.919 --> 17:28.963 This is Grayson Cooper, 68. Bullet grazed his scalp. 17:28.964 --> 17:30.506 I got lucky. Dude just clipped me. 17:30.507 --> 17:31.758 Let me see. Got a headache? 17:31.759 --> 17:33.342 Not really. A little burning. 17:33.343 --> 17:34.927 - Good for yellow. - Been to a million concerts. 17:34.928 --> 17:36.763 Whatever happened to peace and love, man? 17:36.764 --> 17:38.390 That's a great question. 17:40.267 --> 17:41.267 It should be numb. 17:41.268 --> 17:43.269 Israeli bandage starts with hemostatic gauze 17:43.270 --> 17:45.521 then turns into a pressure dressing. 17:45.522 --> 17:47.899 - Is that arterial? - No, but it's bleeding pretty briskly. 17:47.900 --> 17:50.693 OK, change it to a tourniquet only if it soaks through. 17:50.694 --> 17:52.779 I got a superficial scalp wound. 17:52.780 --> 17:54.697 Wrap it tight with frequent neuro checks. 17:54.698 --> 17:56.532 - I need to assess your injury. - I'm fine. 17:56.533 --> 17:59.118 Help the others first, please. I'm fine. 17:59.119 --> 18:02.330 - Sir, are you taking any medication? - Just medicinal marijuana. 18:02.331 --> 18:04.041 Yeah? What do you take that for? 18:04.625 --> 18:05.833 Everything. 18:05.834 --> 18:08.837 - IVs on everyone. - I need some help over here. 18:09.671 --> 18:10.839 How is my son? 18:11.548 --> 18:14.342 Omar. He was shot in the chest. We were in the plumber van. 18:14.343 --> 18:16.719 He is upstairs with the surgeons in the OR. 18:16.720 --> 18:18.388 I will come and find you when I know more. 18:19.389 --> 18:20.641 Coming through! 18:33.112 --> 18:35.072 Jesse, hang a unit, then right up to the OR. 18:37.282 --> 18:39.784 - She shot? - No, looks like she got trampled. 18:39.785 --> 18:41.870 Unresponsive in the field. Three more in the rig. 18:42.871 --> 18:43.913 Hey, Javadi! 18:43.914 --> 18:46.499 Got a possible blunt head trauma here. 18:46.500 --> 18:47.876 Pupils are good. 18:49.253 --> 18:50.253 Strong pulses. 18:50.254 --> 18:52.088 OK, assess for blunt head, chest, belly. 18:52.089 --> 18:54.048 - With who? - Anybody. 18:54.049 --> 18:56.384 - How are we doing? - Heads above water so far. 18:56.385 --> 18:57.593 Anything about the shooter? 18:57.594 --> 18:59.595 Haven't heard, but I'll try and get an update. 18:59.596 --> 19:01.681 - I see Langdon's back. - Yeah, not by choice. 19:01.682 --> 19:03.391 I'll deal with that when this shift is over. 19:03.392 --> 19:05.060 - Collins? - Not answering. 19:05.686 --> 19:07.728 I told her to turn off her fucking phone. 19:07.729 --> 19:09.480 Keep trying her. Jake? 19:09.481 --> 19:10.648 No. 19:10.649 --> 19:12.024 But I got his mom on the landline. 19:12.025 --> 19:14.026 Told her to call both of us when she reaches him. 19:14.027 --> 19:15.069 - OK. - Yep. 19:15.070 --> 19:17.405 Environmental services manager to the ER. 19:17.406 --> 19:19.031 One for pink and one for green. 19:19.032 --> 19:20.366 - On it. - I'm sorry. 19:20.367 --> 19:22.201 All press needs to stay in the waiting room. 19:22.202 --> 19:24.370 Come on, man, two minutes. The public needs to know what's going on. 19:24.371 --> 19:25.913 Front of the hospital! 19:25.914 --> 19:27.916 Pedestrian entrance. I'm not telling you again. 19:30.669 --> 19:31.919 What's this? 19:31.920 --> 19:33.421 Responds to pain only, thready pulse, 19:33.422 --> 19:35.047 chest wall contusions with boot prints on his shirt. 19:35.048 --> 19:36.924 - Yellow here, a wheelchair. - OK, sounds good. 19:36.925 --> 19:38.217 Do you need anything? 19:38.218 --> 19:41.096 Well, I was hoping for Thanksgiving and Christmas off this year. 19:42.097 --> 19:43.599 But we can talk about it later. 19:45.309 --> 19:47.101 For proper chest tube placement, 19:47.102 --> 19:49.061 keep going until the last fenestration is intrathoracic. 19:49.062 --> 19:51.022 - OK, stop. - What? 19:51.023 --> 19:52.857 I don't need you teaching me right now. 19:52.858 --> 19:55.861 - You're already an expert? - Read the fucking room, Mom! 19:58.280 --> 19:59.363 3-0 silk. 19:59.364 --> 20:02.326 I'm about to place a horizontal mattress, in case you're wondering. 20:05.954 --> 20:07.539 Looks like you've got this. 20:09.583 --> 20:11.543 This one should go to yellow. 20:13.420 --> 20:15.214 Hey, could you help me? 20:17.633 --> 20:19.551 Soaked through his pressure dressing. 20:20.260 --> 20:22.345 OK, yeah, we can fix that with Raney Clips. 20:22.346 --> 20:23.679 What are those? 20:23.680 --> 20:25.514 They use them in neurosurgery to clamp off the scalp 20:25.515 --> 20:27.058 - before opening the skull. - All right. 20:27.059 --> 20:28.684 I'll be right back. Santos, keep pressure. 20:28.685 --> 20:30.686 You guys are swamped. I got this. 20:30.687 --> 20:32.189 It takes a village. 20:34.650 --> 20:36.442 Sylvia. Sylvia? 20:36.443 --> 20:38.277 Whitaker! Sylvia. 20:38.278 --> 20:41.906 Sylvia, can you hear me? 20:41.907 --> 20:44.033 - I lost her radial pulse. - From a broken leg? 20:44.034 --> 20:46.118 - Well, what did we miss? - I don't know. Heart attack? 20:46.119 --> 20:47.536 Another injury from the car crash? 20:47.537 --> 20:49.790 - That's for pulses. - It has an EFAST mode. 20:54.711 --> 20:57.713 Diagnosis made. Blood in Morrison's, liver laceration. 20:57.714 --> 21:00.549 Car hit the belly. Leg was a distracting injury. 21:00.550 --> 21:03.178 Drill in an IO. I'm gonna get some blood, and then we'll move her to pink. 21:07.641 --> 21:09.308 Just sent another up to the OR. 21:09.309 --> 21:11.102 - I got room for one more red. - On it. 21:11.103 --> 21:12.395 Didn't make it. Going to Pedes. 21:12.396 --> 21:13.729 Another red in Trauma One. 21:13.730 --> 21:15.023 Copy that. 21:17.651 --> 21:20.027 - Dana, if I-- - Careful, kid. 21:20.028 --> 21:22.697 I need Raney Clips and a unit of O-neg. 21:22.698 --> 21:24.323 Raneys will have to come down from the OR. 21:24.324 --> 21:25.741 - I need them now. - OK. 21:25.742 --> 21:26.951 OK, I'll get them. 21:26.952 --> 21:28.036 O-neg here. 21:29.913 --> 21:31.580 - There you go. - Thanks. 21:31.581 --> 21:33.374 We need EVS with a mop. 21:33.375 --> 21:35.251 Not much blood, but a big rush of air. 21:35.252 --> 21:37.753 Got trampled. Collapsed his lung. Tension pneumo. 21:37.754 --> 21:39.171 - Who intubated? - I did. 21:39.172 --> 21:40.673 Mohan is on fire. 21:40.674 --> 21:41.966 - Pulse is coming up. - OK, great. 21:41.967 --> 21:43.426 Slide to pink as soon as there's room. 21:43.427 --> 21:44.927 Got it. 21:44.928 --> 21:47.638 Hey, how many ORs available? 21:47.639 --> 21:49.724 One now. Two more in less than five. 21:49.725 --> 21:51.809 Can you take a belly and one more chest in pre? 21:51.810 --> 21:52.893 No problem. 21:52.894 --> 21:55.271 MCI 21 is going to ICU. I'll be back. 21:55.272 --> 21:56.522 Got it. 21:56.523 --> 21:57.857 Red Zone, Red Zone. 21:57.858 --> 21:59.567 Environmental service manager to the ER. 21:59.568 --> 22:01.653 Three West is full. Take them to Two South. 22:02.654 --> 22:05.448 I need Xeroform, cut 4x4s, and elastoplast tape. 22:05.449 --> 22:07.325 You're here! 22:07.326 --> 22:09.328 In the flesh. What do you got? 22:10.078 --> 22:11.245 Auto versus ped. 22:11.246 --> 22:13.122 We thought it was just a tib-fib fracture. 22:13.123 --> 22:15.041 Then we found an occult liver laceration. 22:15.042 --> 22:16.542 Leg is low priority right now. 22:16.543 --> 22:19.086 If she stabilizes with blood, she can wait an hour for the OR. 22:19.087 --> 22:20.755 - And if not? - Front of the line, baby. 22:20.756 --> 22:22.340 Her son's in the OR with a GSW to the chest. 22:22.341 --> 22:24.467 Sweet. Family reunion in post-op. 22:24.468 --> 22:27.803 Whitaker, I'll be right back once this unit's in. 22:27.804 --> 22:28.889 Hey! 22:29.598 --> 22:30.848 Good catch, you two. 22:30.849 --> 22:33.851 Hey, Langdon, we're out of Xeroform. I'll try to find some. 22:33.852 --> 22:35.103 Come on, Sylvia. 22:38.106 --> 22:40.149 Oh, I'm sorry, sir. The ER is closed. 22:40.150 --> 22:41.817 You'll have to exit out the pedestrian entrance. 22:41.818 --> 22:43.027 I'm a patient. 22:43.028 --> 22:44.820 Then you need to go to Family Medicine in Building 8. 22:44.821 --> 22:46.572 No, I'm waiting for surgery on the fourth floor. 22:46.573 --> 22:48.199 OK, well, then go back to your bed. 22:48.200 --> 22:49.784 My son is down here. 22:49.785 --> 22:52.537 I'm sorry, sir, but no one's in and out unless they're on a gurney. 22:54.498 --> 22:59.251 OK, look, my wife is an ER doc, Dr. McKay. 22:59.252 --> 23:01.963 She needs me to get our son home. He's in the staff lounge. 23:04.341 --> 23:06.134 - All right, make it quick. - Thank you. 23:07.844 --> 23:09.845 But, hey... 23:09.846 --> 23:11.514 I am timing you. 23:11.515 --> 23:13.474 If you're not back in five, I'm coming after you. 23:13.475 --> 23:14.725 - Yeah. - Got it? 23:14.726 --> 23:16.353 - Yeah, OK. - Yeah, OK. 23:18.980 --> 23:21.149 - I need a tourniquet now! - Need some help over here. 23:22.526 --> 23:24.443 Back looks good. No exit wounds. 23:24.444 --> 23:26.112 Red Zone! 23:26.113 --> 23:27.948 OK, I'll be right back. 23:30.826 --> 23:32.285 - Javadi, IO. - Yeah. 23:34.162 --> 23:35.246 Here too. 23:35.247 --> 23:36.872 Sux is on board. 23:36.873 --> 23:39.167 - She's not breathing. - I got it. 23:43.380 --> 23:44.548 I'm in. Bag her. 23:46.174 --> 23:47.925 Chad, what are you doing here? 23:47.926 --> 23:50.636 They postponed my surgery. 23:50.637 --> 23:52.096 You can't be in here. 23:52.097 --> 23:54.723 Go sit with Harrison in the staff lounge! 23:54.724 --> 23:56.810 - OK. OK. - Now! 24:02.190 --> 24:03.482 I got it! I'm trying! 24:03.483 --> 24:05.777 Another one for the morgue. Heading to Pedes. 24:20.959 --> 24:22.210 Hey, buddy. 24:23.378 --> 24:25.087 Did you have your surgery? 24:25.088 --> 24:26.798 No, it got delayed. 24:27.799 --> 24:29.300 Ready to go home? 24:29.301 --> 24:31.927 Mom said that Grandma and Grandpa McKay were picking me up. 24:31.928 --> 24:35.139 Yeah, I'm not sure they can get here right now, and neither can Chloe. 24:35.140 --> 24:37.726 But, you know, we can Uber to my place. 24:39.019 --> 24:41.563 I'd rather go home with Mom if that's OK. 24:43.607 --> 24:47.067 Your mom's got her hands full, dude, and I think she's gonna be here pretty late. 24:47.068 --> 24:48.487 I can wait. 24:50.238 --> 24:51.239 OK. 24:52.240 --> 24:53.450 Yeah, OK. 25:03.460 --> 25:05.544 - Should we watch something? - You want to watch a movie? 25:05.545 --> 25:07.087 Yeah, sure. 25:07.088 --> 25:08.797 What do you got on there? 25:08.798 --> 25:10.591 Not much. 25:10.592 --> 25:12.426 That's one unit in. 25:12.427 --> 25:14.386 Her pulse is stronger, but she needs more blood. 25:14.387 --> 25:16.805 Not today. Only one unit if the pulse picks up. 25:16.806 --> 25:18.390 We're already rationing our blood supply. 25:18.391 --> 25:20.518 - What if we run out? - Who wanted Raney Clips? 25:20.519 --> 25:22.144 Oh, me! Thank you. 25:22.145 --> 25:25.105 - I thought you left. - All hands on deck, right? 25:25.106 --> 25:26.524 Is there any word on Omar? 25:26.525 --> 25:29.276 He's this woman's deaf son. Teenage boy shot in the chest? 25:29.277 --> 25:31.904 Kid got lucky. Missed the aorta. He should pull through. 25:31.905 --> 25:33.864 That's amazing. Well, her name is Sylvia. 25:33.865 --> 25:36.283 Would you please tell her about her son when she wakes up? 25:36.284 --> 25:37.661 What are you using to-- 25:39.287 --> 25:42.082 Mateo, MCI-29 goes to the OR... 25:45.085 --> 25:47.419 - What's this? - Unresponsive even to pain. 25:47.420 --> 25:48.504 No GSW. 25:48.505 --> 25:51.006 Strong pulse, but tachycardic and diaphoretic. 25:51.007 --> 25:53.051 Looking for internal hemorrhage. 25:53.927 --> 25:55.719 - FAST negative. - Help me roll her. 25:55.720 --> 25:58.222 All transport to the ER immediately. 25:58.223 --> 25:59.306 - Tim! - Yeah. 25:59.307 --> 26:00.599 - Amp of D50, now. - Got it. 26:00.600 --> 26:02.601 - Seriously? - Look--glucose monitor. 26:02.602 --> 26:04.228 She's diabetic and probably hypoglycemic. 26:04.229 --> 26:06.021 - So check the blood sugar. - No time for that. 26:06.022 --> 26:08.232 Still could be head trauma. If it's DKA, you're making it worse. 26:08.233 --> 26:10.442 My Spidey sense is telling me she took her morning insulin, 26:10.443 --> 26:11.610 but she skipped lunch. 26:11.611 --> 26:13.821 She's in a coma from low blood sugar. 26:13.822 --> 26:16.490 Will you look at that? These are healing hands. 26:16.491 --> 26:18.033 Too bad they're so tiny. 26:18.034 --> 26:19.952 Hello. What's your name? 26:19.953 --> 26:21.245 Dawn. 26:21.246 --> 26:23.831 - Where am I? - Pittsburgh Trauma Medical Center. 26:23.832 --> 26:25.833 You dropped your blood sugar, but you're gonna be OK. 26:25.834 --> 26:28.044 Guess you don't need me here. Don't even say it. 26:29.254 --> 26:30.547 Let's get her to yellow. 26:31.423 --> 26:33.048 What happened? 26:33.049 --> 26:35.050 There was a shooting at PittFest. 26:35.051 --> 26:36.969 But you're safe now. 26:36.970 --> 26:38.846 Whatever you can spare. Thanks. 26:38.847 --> 26:41.725 MCI-33 to yellow for monitoring. 26:42.559 --> 26:43.726 What are you doing? 26:43.727 --> 26:46.061 Ran out of laryngoscopes. No time to autoclave. 26:46.062 --> 26:47.146 Oh, man. 26:47.147 --> 26:50.274 Almost out of chest tubes, too. More coming from Presby. 26:50.275 --> 26:51.692 We're running very low on O-neg. 26:51.693 --> 26:54.195 - Perfect storm. - Yeah. 26:55.947 --> 26:57.991 I got a pink coming in! 26:59.242 --> 27:00.868 Do you feel anything, Grayson? 27:00.869 --> 27:02.161 No pain. 27:02.162 --> 27:04.413 Just a lot of sadness for the world we live in. 27:04.414 --> 27:06.582 - I hear you. - Any room at the inn? 27:06.583 --> 27:07.916 What's her story? 27:07.917 --> 27:11.337 This is Dawn, no trauma, insulin reaction, responded to D50. 27:11.338 --> 27:13.297 - D10 at 100 an hour? - Perfect. 27:13.298 --> 27:15.799 And I borrowed your butterfly. It's on the gurney. 27:15.800 --> 27:17.343 - So just like that. - Yep. 27:17.344 --> 27:19.638 - What are you doing? - Treating the patient. 27:20.597 --> 27:21.805 Raney Clips. 27:21.806 --> 27:24.099 Clamping off a bunch of sub-Q bleeders. 27:24.100 --> 27:26.061 Good work. Keep it up. 27:27.896 --> 27:29.521 Yep, perfect. That's it. 27:29.522 --> 27:31.191 Room for another pink. 27:32.984 --> 27:34.735 - I need suction! - We don't have any. 27:34.736 --> 27:36.612 Too many secretions. I can't see shit. 27:36.613 --> 27:38.113 Here, wipe it out with 4x4s. 27:38.114 --> 27:39.323 Are you kidding me? 27:39.324 --> 27:41.116 You guys have a fiberoptic laryngoscope? 27:41.117 --> 27:43.035 - Nope, just a rigid Glidescope. - That'll do. 27:43.036 --> 27:44.703 Except we don't have any room for it, so just pull out, 27:44.704 --> 27:46.247 and we'll bag for a minute. 27:47.415 --> 27:48.540 When did this guy last eat? 27:48.541 --> 27:50.542 We never know down here. Let me get in there. 27:50.543 --> 27:53.087 I'll keep cricoid pressure. If he vomits, we're fucked. 27:53.088 --> 27:54.296 Doctor. 27:54.297 --> 27:55.589 We may need a surgical airway. 27:55.590 --> 27:56.882 Hold on, hold on, hold on, hold on. 27:56.883 --> 27:58.426 Oh, yeah. This is a tough one. 27:59.135 --> 28:01.387 Oh, yeah, this one looks tough. 28:01.388 --> 28:03.222 - No shit. Prep the neck? - Hold on. 28:03.223 --> 28:04.306 - McKay? - Yeah. 28:04.307 --> 28:06.058 Come over here and just give me a chest compression. 28:06.059 --> 28:07.518 CPR? Did we lose the pulse? 28:07.519 --> 28:09.228 No, just give me one good push. 28:09.229 --> 28:10.729 Yep. OK, two. 28:10.730 --> 28:12.232 And do it again. 28:15.902 --> 28:16.944 OK. 28:16.945 --> 28:18.654 I think I am in. 28:18.655 --> 28:20.448 - Bag him. - Check the end tidal. 28:21.574 --> 28:23.492 - Yellow. We're good. - How'd you do that? 28:23.493 --> 28:24.576 Bubble intubation. 28:24.577 --> 28:26.745 You gave the compression, I followed the air bubbles up. 28:26.746 --> 28:28.372 More than one way to tube a cat. 28:28.373 --> 28:29.623 Coming through. 28:29.624 --> 28:31.083 Robby! 28:31.084 --> 28:32.543 Now, please! 28:32.544 --> 28:33.628 Imagine that. 28:35.255 --> 28:36.588 Anything from Jake? 28:36.589 --> 28:38.215 How much room do we have in pink? 28:38.216 --> 28:41.677 Intubated chest tube, but massive subcutaneous emphysema. 28:41.678 --> 28:43.971 Air from the chest is leaking under the skin. 28:43.972 --> 28:45.681 - Losing the pulse. - What do you think? 28:45.682 --> 28:47.307 Tamponade from pneumomediastinum. 28:47.308 --> 28:49.143 About to cut blowhole incisions to release the air? 28:49.144 --> 28:51.271 Do it. Infraclavicular. 28:52.063 --> 28:53.064 Yep. 29:01.406 --> 29:03.073 Pulse is coming up. Nicely done. 29:03.074 --> 29:05.285 OK, send him to cardiothoracic ICU. 29:11.499 --> 29:14.085 We'll get you pain medicine. A nurse will be by soon. 29:17.589 --> 29:19.548 - Hey, where'd this guy go? - Which patient? 29:19.549 --> 29:22.634 MCI-28, arm injury who refused treatment? 29:22.635 --> 29:24.052 Maybe he left? 29:24.053 --> 29:25.722 With a gunshot wound? 29:30.894 --> 29:32.144 Hey! 29:32.145 --> 29:35.022 - Hey, what the hell are you doing? - I'm fine. Leave me alone. 29:35.023 --> 29:36.733 - You can't do that. - Back off. 29:40.320 --> 29:41.738 I need security in here! 29:43.948 --> 29:45.200 Hey! 29:50.622 --> 29:51.956 Nice move, Slick. 29:52.540 --> 29:53.541 What happened? 29:56.002 --> 29:57.128 Fucker! 29:58.171 --> 30:00.839 I think this guy stole a victim's hoodie and faked an injury to get inside. 30:00.840 --> 30:02.424 He's probably a fucking reporter. 30:02.425 --> 30:03.759 - Asshole. - What? 30:03.760 --> 30:06.137 Hey! Hey, wake up, you faker! 30:07.972 --> 30:09.723 Yep, he responds to pain. 30:09.724 --> 30:11.725 Perlah, blunt head trauma goes to pink. 30:11.726 --> 30:14.145 Soft restraints, six hours observation. 30:14.646 --> 30:16.271 - Gurney to the hub. - Be right back. 30:16.272 --> 30:17.815 I'm fine. 30:17.816 --> 30:19.983 Yeah, great, you can give a statement to the cops. 30:19.984 --> 30:21.068 - Get him out of here. - Yeah. 30:21.069 --> 30:22.529 Where's my phone? 30:24.447 --> 30:25.782 My bad. 30:30.954 --> 30:32.079 Chest tube, please. 30:32.080 --> 30:34.039 - We're out of chest tubes. - What the hell? 30:34.040 --> 30:36.041 You could have told me that before we started. 30:36.042 --> 30:37.501 - Well, I didn't know. - I already made the incision. 30:37.502 --> 30:39.003 Now what am I supposed to do? 30:39.796 --> 30:42.464 - What about this? - An ET tube? 30:42.465 --> 30:43.549 A tube's a tube. 30:43.550 --> 30:45.717 And if you inflate the balloon, it won't pull out. 30:45.718 --> 30:47.177 Fine. Set up a Thoraseal. 30:47.178 --> 30:49.304 - Out of those, too. - For the love of God! 30:49.305 --> 30:50.556 Urine bag? 30:50.557 --> 30:52.015 How am I supposed to connect to that? 30:52.016 --> 30:54.227 Christmas tree adapter. It'll work. 30:55.603 --> 30:57.604 This is all very unconventional. 30:57.605 --> 30:59.816 No. This is genius. 31:03.278 --> 31:05.320 Oh, and four of Ancef. 31:05.321 --> 31:07.197 Sorry, I forgot the Ancef. 31:07.198 --> 31:08.408 Thank you. 31:12.996 --> 31:15.831 Mel! Mel, I need you to reassess, please, now. 31:15.832 --> 31:17.208 Sylvia? 31:19.043 --> 31:20.419 Sylvia. 31:20.420 --> 31:22.087 Her pulse is weak and thready. 31:22.088 --> 31:23.839 She's bleeding out from her liver lac. 31:23.840 --> 31:25.716 - I need O-neg! - O-neg's gone, honey. 31:25.717 --> 31:27.175 Gloria's got more flying in. 31:27.176 --> 31:29.219 Incident Command, what's the ETA on our blood? 31:29.220 --> 31:30.554 Eight to ten minutes. 31:30.555 --> 31:32.764 The patient's gonna have to get by with a liter of saline. 31:32.765 --> 31:35.893 No, no, she needs blood, not crystalloid. Can she go to surgery? 31:35.894 --> 31:38.520 All right, she's next to go, as soon as we get an open OR. 31:38.521 --> 31:40.272 She's not gonna last that long. 31:40.273 --> 31:42.357 Dr. Robby. Dr. Robby! 31:42.358 --> 31:45.152 Dr. Robby, we're out of O-neg, but I'm O-neg. Can I donate? 31:45.153 --> 31:46.570 Gloria's got more blood flying in. 31:46.571 --> 31:49.114 - But I need it now. - What is our blood status? 31:49.115 --> 31:50.949 Just used the last units of O-neg and O-pos. 31:50.950 --> 31:52.159 - More flying in. - ETA? 31:52.160 --> 31:53.243 Less than 10. 31:53.244 --> 31:54.786 Some patients are not gonna last that long. 31:54.787 --> 31:58.373 And I'm sure there are other O-neg donors that probably work here, so... 31:58.374 --> 32:00.375 It would take hours to screen for HIV and hepatitis. 32:00.376 --> 32:02.837 Well, I have neither, and I donate all the time. 32:04.088 --> 32:05.089 Please. 32:06.215 --> 32:07.215 Fuck it. 32:07.216 --> 32:09.217 If the patient's gonna die before they get to the OR, 32:09.218 --> 32:11.386 - then the benefits outweigh the risks. - My man. 32:11.387 --> 32:13.639 All right, kid, roll up your sleeve. I'll meet you in 7. 32:13.640 --> 32:15.223 Listen up. 32:15.224 --> 32:18.185 Central 7, 8, 9 is now the blood donor center. 32:18.186 --> 32:21.521 Anyone who's O-neg or O-pos, we need you to donate now. 32:21.522 --> 32:22.899 Hands where I can see them. 32:24.692 --> 32:27.153 OK, let's do this. 32:30.490 --> 32:32.824 - You two work here, right? - Yes. 32:32.825 --> 32:36.620 Can you tell me how my mom is? Her name is Patricia Gregory--or Trish. 32:36.621 --> 32:38.664 She was shot in her arm. 32:38.665 --> 32:41.501 We're here to help. One second. Bear with us. 32:48.091 --> 32:50.801 Hello? Can I have your attention, please? 32:50.802 --> 32:52.594 My name is Kiara Alfaro. 32:52.595 --> 32:54.972 I'm an emergency-department social worker. 32:54.973 --> 32:58.016 This is Lupe Perez, one of our ward clerks. 32:58.017 --> 33:01.436 I know you all want information about your friends and family. 33:01.437 --> 33:04.231 In order to help you, we have a QR code 33:04.232 --> 33:07.609 you can scan for our patient-identification website. 33:07.610 --> 33:12.197 Cell phones are down, but you can log on to the hospital guest Wi-Fi. 33:12.198 --> 33:15.659 That information is on these papers we'll distribute around the room. 33:15.660 --> 33:18.954 Once you log on, send us the name and birth date 33:18.955 --> 33:20.747 of whomever you're concerned about. 33:20.748 --> 33:22.666 If you could tell us what they were wearing, 33:22.667 --> 33:26.169 upload photos, pictures of tattoos, piercings, 33:26.170 --> 33:28.630 anything to help identify them would be useful. 33:28.631 --> 33:30.424 If we get a match, we'll let you know. 33:30.425 --> 33:34.011 We're setting up phone chargers, water, snacks. 33:34.012 --> 33:37.139 And if anyone needs to change clothes, we've got paper scrubs coming. 33:37.140 --> 33:38.223 Give us some time. 33:38.224 --> 33:42.270 We're doing everything we can to help get you the information you need. 33:52.155 --> 33:53.364 OK, I'm done. 33:54.365 --> 33:56.742 OK, give me the Coban. Come on, come on, come on. 33:56.743 --> 33:58.702 I got this. Here you go. 33:58.703 --> 34:00.245 Here you go. There you go. 34:00.246 --> 34:01.330 Next! 34:02.165 --> 34:04.916 - How's she doing? - We have 500 of saline in. 34:04.917 --> 34:06.501 She's just barely with us, Mel. 34:06.502 --> 34:10.297 OK, well, this unit of whole blood should help. 34:10.298 --> 34:12.591 Yeah, see if you can find a pressure bag. 34:12.592 --> 34:15.178 No, no. Much faster if I just squeeze it in myself. 34:21.392 --> 34:22.977 Need some help with an airway! 34:26.105 --> 34:27.314 What is it? 34:27.315 --> 34:29.149 GSW to the neck with expanding hematoma 34:29.150 --> 34:31.401 and distorted anatomy-- can't intubate him. 34:31.402 --> 34:34.071 - Probably hit the carotid. - OK. I'll do the airway. 34:34.072 --> 34:36.281 Give me a 6.5 and a bougie. 34:36.282 --> 34:37.616 I got the bleeder. 34:37.617 --> 34:40.327 Foley catheter with a 30 cc balloon. 34:40.328 --> 34:42.789 - Are you donating? - O-neg, yeah. 34:45.083 --> 34:46.708 Coming through! 34:46.709 --> 34:48.335 It's too bloody to see a bougie. 34:48.336 --> 34:49.961 Not for this. Three-step process. 34:49.962 --> 34:51.880 Step one, scalpel. 34:51.881 --> 34:55.134 Step two, finger. Step three, bougie. 34:58.846 --> 35:00.598 OK, railroad in the tube. 35:02.308 --> 35:04.309 I'm doing all I can to stop it! 35:04.310 --> 35:06.771 Good, that's far enough. OK, bag him. 35:07.647 --> 35:09.440 Dressing off. 35:10.733 --> 35:13.402 Foley's in. Blow up a balloon. 35:15.655 --> 35:17.364 30 cc's in. 35:17.365 --> 35:18.950 Clamping. 35:19.659 --> 35:20.952 Look at that. 35:21.869 --> 35:24.037 Dry as a bone. 35:24.038 --> 35:25.372 Room for another red. 35:25.373 --> 35:27.749 Dr. Walsh, you have an OR for a head-and-neck case? 35:27.750 --> 35:29.042 MCI-48. 35:29.043 --> 35:32.003 We've got 16 ORs up and running. We've got room for one more. 35:32.004 --> 35:35.090 Liver lac came back after a second unit, needs an ex-lap. 35:35.091 --> 35:37.677 Turning over two ORs now. Send them up. 35:38.469 --> 35:39.678 Where the hell did Mel go? 35:39.679 --> 35:41.847 I don't know, but she needs to get back to yellow. 35:41.848 --> 35:43.598 That's 2 grams of Ancef. 35:43.599 --> 35:44.684 Great. 35:45.893 --> 35:47.478 Let's take a look at your dressing. 35:48.271 --> 35:50.564 All right, that looks good. The bleeding stopped. 35:50.565 --> 35:52.275 Can you wiggle your fingers? 35:53.526 --> 35:56.279 Ma'am? Ma'am, can you move your fingers for me? 35:57.697 --> 36:00.031 OK, does it feel the same on both sides? 36:00.032 --> 36:01.492 Great. How's the pain? 36:06.164 --> 36:09.666 Well, the bullet probably went through the two forearm bones, 36:09.667 --> 36:12.210 but there's no damage to the nerves or arteries, 36:12.211 --> 36:13.713 so that's a good sign. 36:17.133 --> 36:18.259 You're gonna be OK. 36:21.137 --> 36:23.139 I'll find you some tissues. 36:27.727 --> 36:29.352 Robby, blood's arrived. 36:29.353 --> 36:30.521 Oh, right on. 36:31.272 --> 36:34.191 Eviscerated bowel, fresh ABD and saline. 36:34.192 --> 36:35.318 OK, bag for a sec? 36:36.694 --> 36:38.904 3.375 Zosyn and a sterile dressing. 36:38.905 --> 36:42.240 I can't believe I'm saying this-- another Christmas tree and Foley bag. 36:42.241 --> 36:44.160 How did we run out of chest tubes? 36:45.953 --> 36:48.205 Less than 500 cc's out. Surgical ICU can take him. 36:48.206 --> 36:49.664 ET tubes in the chest-- they're gonna wonder 36:49.665 --> 36:51.791 what the hell we're doing down here, but it was a great save. 36:51.792 --> 36:53.501 Hey, Javadi, I need you to find Whitaker 36:53.502 --> 36:55.253 and go up to the helipad-- we got blood flying in. 36:55.254 --> 36:56.463 - OK. - Stay behind the yellow line 36:56.464 --> 36:58.089 between 10:00 and 2:00 so the pilot 36:58.090 --> 36:59.299 - can see you the whole time. - OK. 36:59.300 --> 37:00.508 You got this? 37:00.509 --> 37:02.219 Moving him up as fast as we can. 37:02.220 --> 37:03.678 This one's going to yellow. 37:03.679 --> 37:05.138 More chest tubes, courtesy of Presby. 37:05.139 --> 37:06.848 Awesome. I'm gonna go check on Triage. 37:06.849 --> 37:08.184 Copy that. 37:10.353 --> 37:12.312 - They find the shooter yet? - Not yet, but we'll find him. 37:12.313 --> 37:14.689 - Half the county is looking. - What about with her? 37:14.690 --> 37:16.858 - Waiting for the FBI to get here. - They find her son? 37:16.859 --> 37:19.486 No, but they pinged his cell phone to the area of the shooting. 37:19.487 --> 37:20.695 Fuck. Does she know that yet? 37:20.696 --> 37:22.697 - She's about to find out. - OK. Thanks. 37:22.698 --> 37:24.241 What's with all these bloody handprints? 37:24.242 --> 37:26.117 That's when people were trying to stop us to get a ride in, 37:26.118 --> 37:27.661 but we were already packed. 37:27.662 --> 37:28.995 Chest, belly, arm, and leg. 37:28.996 --> 37:30.747 Red, pink, yellow, and a lucky green. 37:30.748 --> 37:32.625 Two gurneys, two wheelchairs. 37:34.835 --> 37:36.670 - My partner's in bad shape. - What's his name? 37:36.671 --> 37:38.129 Rich. Rich Stefano. 37:38.130 --> 37:39.965 Hey, Rich. How you doing? 37:39.966 --> 37:41.508 Shit. 37:41.509 --> 37:43.051 He got shot in the face? 37:43.052 --> 37:45.929 No, entrance is on the other side-- neck, above his vest. 37:45.930 --> 37:47.347 - Cheek is the exit wound. - OK. 37:47.348 --> 37:49.307 Come on, Red Zone. He needs an airway. 37:49.308 --> 37:51.309 Come with me. Come with me. 37:51.310 --> 37:53.396 I got you. We'll get you fixed up. 37:55.815 --> 37:56.816 Take him. 37:59.360 --> 38:00.986 Hey, what's up with the SWAT team? 38:00.987 --> 38:03.781 It's just a precaution in case the shooter heads this way. 38:04.407 --> 38:06.534 - Is that a possibility? - There was some chatter. 38:07.243 --> 38:09.160 Well, are we gonna be safe out here? 38:09.161 --> 38:10.745 - Should be now. - Focus on the patients. 38:10.746 --> 38:12.247 Focus on the patients. 38:12.248 --> 38:14.124 Only way out is through. 38:14.125 --> 38:15.875 Any idea how many more are coming? 38:15.876 --> 38:18.128 Incident Command is sending all these ambulances 38:18.129 --> 38:19.379 back to the scene for more victims. 38:19.380 --> 38:21.881 We may not even be halfway through yet. 38:21.882 --> 38:23.049 Jesus. 38:23.050 --> 38:24.468 When is this gonna end? 38:31.058 --> 38:32.268 Fuck.