Triage is the key…..

We were on emergency call duty for a full 72 hours over the weekend…Patients had poured in with appendicitis, perforated duodenal ulcer, head injuries, stab wounds, the entire gamut of emergency patients…I was into my third house post and emergency call duties were no more intimidating, but exciting….Emergency call duties meant that you got to do appendectomies, suturing of duodenal perfs and other assorted operations….It was exhausting but at the same time deeply satisfying….It was a Monday afternoon. I had finished my post emergency rounds,  had lunch and dropped off to a well deserved siesta…..

Someone was shaking me….”Guru, wake up! we have a multiple casualty situation…The Prof wants all residents ASAP at the trauma ward”….It was “Tatya” Joshi, one of the surgical registrars….I swam into consciousness and turned to ask Joshi the details, but he was gone…..I threw on some clothes and hurries to the trauma ward….It was six in the evening…..

The scene that greeted me was straight from  Dante’s hell…There were injured persons in the trauma ward, in the corridor and finally in the cavernous indoor badminton court….There was chaos. Groans, moans and cries of pain filled the air….There had been a major railway accident at Raoli camp station, around one kilometer from Sion Hospital…The driver of a local train had suffered a massive heart attack and had died…His body continued to lean against the throttle, the train speeding and crashing into another train at the station…It was the rush hour with people returning home from work and the people were packed like sardines…..More than 150 people had been brought to the Sion hospital in half an hour. Nearly a third of them had serious injuries….

I did not know what to do…..Then Prof spotted me….”Shirahatti” he bellowed, “Join Prof Vilas. He will tell you what to do”….Prof Vilas looked cool and dapper as ever with not a hair out of place….He seemed to be lazing through the patients….”Guru, over here”…I joined him…

By this time the badminton hall was full of doctors and nurses….Everyone including the internists, dermatologists, even psychiatry residents had come down to help…Off duty nurses had poured out of the nurses quarters and were busy helping out…We had run out of stands to hang the IV bottles….Bandages were strung across the pillars and used for hanging the IV bottles…Prof had formed teams, each headed by a consultant….Residents and nurses were assigned to each consultant…

“Triage Guru…That is the mantra in multiple casualties…We should prioritize patients in need of urgent management” Prof Vilas told me…The first patient was a young man…He breathed in irregular gasps….Prof Vilas felt for his pulse…Shone a torch into his eyes…Both pupils dilated and fixed….”Nothing to do here..Lets move on”…Prof Vilas moved to the next patient. “But sir, I protested…He needs attention” “Guru, he is brain dead…Pupils dilated and fixed..Pulse not felt..Don’t waste your time and resources on him..Conserve your energy for a patient with salvageable injuries. Nurse, put a black tag on him”

Next was a middle aged woman…She was crying with pain and shock…There was a wound on her forehead with a little blood around it…She cried out to us “Am I seriously injured doctor? please save me”…Prof Vilas ignored her and moved to the man next to her…He seemed to be sleeping…Looked comfortable….”Nurse”  snapped Dr Vilas…”18 gauge  needle and a twenty ml syringe….fast” “Guru, Do you see the cyanosis around his lips? He has labored breathing..neck veins are dilated…trachea deviated to the right….This is tension pneumothorax….He will die in minutes if don’t decompress it”…He thrust the needle into the man’s chest…There was an audible hiss of escaping air….His cyanosis disappeared…His breathing improved….We shifted him to the trauma OR and put in a chest tube. His condition stabilized dramatically…

It went on and on.. Triage patients….Identify the life threatening injuries, do urgent bedside procedures…Shift to OR if needed surgery…Go to the next patient…I did chest tube insertions, tracheostomies, ligated spurting blood vessels..I had never done so many procedures in a single evening….The badminton hall was slowly emptying with stable patients being shifted up to the wards…I looked at my watch…It was 2 AM!! We had been continuously on our feet for eight hours….I hadn’t realized how time flew…I sank into to a chair to take a breather….I must have dozed off…

“Beta” a soft voice woke me with a start….There was a elderly Sikh woman standing next to me….She had a plate heaped with sandwiches and hot samosas in one had and a bottle of ice cold coke in the other….”I have been watching you for the last many hours. You haven’t eaten or drunk. Don’t sleep on an empty stomach. Have these.” I suddenly realized that I was famished…I wolfed down the food and chugged down the coke…I felt totally refreshed…

I realized that there were no more patients but the hall was full of Sikhs with blue turbans…They had huge containers of food and drink and were going from doctor to doctor urging them to rest, eat and drink…These men and women were from Koliwada, home for the Sikh refugees who had settled there after the partition of the country…They believed in service to mankind and would be the first persons to help out in disasters….The Prof and Dr Vilas were chatting with an elderly Sikh gentleman and joking with him…

The last patient was transferred to the ward..The hall was eerily quiet..Dawn was just breaking….I yawned and dozed off….

“Hey sleeping beauty! rise and shine” This was Prof Vilas looking as dapper as ever. Prof was next to him…”Shirahatti, you had a weekender right?” Prof asked…Yes I admitted….Go to your room and sleep…I will call you in the evening. We will see our patients together….”

I slept for straight 12 hours…..


Author: drshirahatti

I am a surgeon, specializing in Gastrointestinal Surgery...I have headed the Departments of GI surgery, General Surgery and Medical Education.....I also was the Dean of two large government hospitals in Mumbai.....I like reading about cultures and like to travel....

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