[gizmonty]

I was pretty astonished by this article. I work in the medical field in Australia and I can’t imagine any hospital here responding and coping in this manner. Our trauma is generally from car crashes and only rarely from guns. I think the victims of this incident were very lucky that this guy was running the show that night. What I would like to know is how well they coped with record keeping and infection control. These are the things that I find tend to get deprioritised in a crisis.

[JshWright]

I work in EMS in the US (upstate New York).

Generally there is an "MCI kit", which has a form that can be attached to the patient (an elastic band around the wrist or ankle, generally). That form will contain whatever information we know about the patient, interventions thus far, etc. It stays with them throughout the process (in the triage and treatment areas, to the OR, etc). That being said, documentation is often a tertiary concern at best in large scale events like this.

As far as infection control goes, the OR is obviously using standard sterile procedures. In the ER, infection control is mostly "changing your gloves a lot" (be sure to put on two pairs, any only change the top pair, as your hands are going to get really sweating, and putting a new pair of gloves on your bare hands is going to be impossible).

[js2]

> documentation is often a tertiary concern at best in large scale events like this...

People came in so grievously injured and so many at a time that Fisher, who is the medical head of trauma services for the hospital, and his colleagues used markers, writing directly on patients, to do triage.

When someone arrived, an emergency room physician would mark their wounds. It was quick, simple and impersonal by necessity.

Fisher says in those first few hours, the patients were functionally anonymous to the surgeons trying to save their lives. "There's no paper charts prepared for all those patients," says Fisher. "No documentation, so literally they just write on the patient. Just write where the wounds are."

https://www.npr.org/sections/health-shots/2017/10/04/5555849...

> As far as infection control goes...

How soon do patients get antibiotics administered?

[JshWright]

Yeah, that's another common technique in extreme circumstances. You can sharpie a lot of info onto someone's forehead...

[ryanmarsh]

used markers, writing directly on patients

We did this in the Army.

[pyromine]

Hell, I took an outdoor emergency course (the national ski patrols first responder course) and even we are trained on MCI's and triage.

[karlkatzke]

While I doubt anywhere but the US or a military battlefield will get hundreds of bullet wound patients at once, it's quite possible to get dozens of patients in one go at any hospital. One memorable story I have been told is a tour bus that overturned on a tight hairpin mountain road. Most tour buses do not have seatbelts. The only hospital within reasonable driving distance got 40 elderly patients with head trauma, multiple broken bones, and exposure. Gunshot wounds are not the only Mass Casualty Incidents that can happen. Think about a riot at an Aussie Rules Football game, for instance...

The article doesn't go into detail about your two areas of concern but does mention two items: Infection control was mostly glove changes. Record keeping was on the triage tags from the MCI; cards are attached to patients and travel with the patient. Yes, both of these are a "bare minimum" effort and may not have been used, but when the priority becomes throughput of a system many features of a system can get dropped and picked up again after the crisis is over.

[maxxxxx]

I once hung out for half a day at a hospital in Bakersfield, CA to watch a surgery and they had several gunshot victims come in. So in the US it seems they are highly experienced with this kind of injury unfortunately.

[cperciva]

I don't know if it applies in this case, but US trauma medicine has also benefited tremendously from the experience of doctors who worked in military hospitals.

[burkemw3]

It goes the other way too, with military surgeons getting training in US cities: https://www.cbsnews.com/news/intense-training-for-military-s...

[dba7dba]

Before the War on Terror, US Military trauma surgeons got experience treating bullet wounds by working rotations at hospitals near high crime/gang areas like Compton.

[eric_h]

This is also true of traumatic brain injuries. A number of my doctors after a fairly serious (to me alone) car accident mentioned that they have a lot more information thanks to doctors treating victims of TBIs caused by explosions.

[walshemj]

As where doctors in northen Ireland during the troubles

[will_hughes]

I'd heard stories from those involved responding to the Port Arthur mass shooting.

It's obviously a completely different scale though, and they had some time to prepare before the patients started arriving.