Thread by @tarunds

Health System Collapsed!
This is what we are hearing all day
What does this even mean for us?
Should we panic?
Let's try to understand what happens at the front-line.

To understand the front-line situation.
You need to understand #triage
To understand Triage we need to visit the most dreaded section of any hospital
The Casualty/Emergency.

It’s perhaps the single metric to check the quality of health services around you.
What is the quality of the emergency services available in ur nearby hospital.

Now what do doctors in the Emergency Room do?
Emergency medicine is highly active branch where we see patients ranging from an itch, to a dog bite to a fatal head injury.
So how can a doctor see all of this together?

Well in OPD’s we register and queue up and are seen by a doctor gradually, but thats not how it works in the casualty. How can a pt with head injury stand in a queue?

We Triage.
Now Whats this?
The basic principle of triage states “to save as many in as little time as possible.
Can we elaborate this?

Basically it is the process of rapidly and accurately evaluating patients to determine the extent of their concerns and the appropriate level of medical care required.
what's the goal?

The goal is to match all seriously injured/sick patients to medical facilities capable of providing appropriate care, while avoiding unnecessary transport of patients without critical injuries or problems.

I always feel medicine is part science and part art.
Science because we all have basic similarities in physiology and anatomy but yet each patient is different and requires a nuanced care.
But is this system possible in ER?

No. Good Emergencies are highly efficient and protocolise-d (if that’s a word.) they work in teams and quickly manoeuvre patients based on algorithms and scoring systems to segregate patients.
It's like an orchestra at play.

Most scoring systems incorporate several types of criteria to differentiate major from minor trauma, including:
●Physiologic (eg,blood pressure,level of consciousness)
●Anatomic (eg, bone fracture, surface area of burn)
●Mechanistic (eg, height of fall)
●Age and comorbidities

So a patient with a heart attack is prioritised over a patient moaning due to abdominal pain.
Triage also uses a color code:
Red: Urgent intervention eg airway obstruction
Yellow: Admitted, Stabilised but intervention can wait eg fracture
Green: a pt with minor wound eg a bruise

A usual day at ER with say 5 doctors works like this.
There are multiple casualty events but the number usually never overwhelms the facilities of the centre.
But what if there’s a mass casualty event say a flood or a bomb blast?

Suddenly there are a huge no of casualties to a level that overwhelms the facilities available.
This is a mass casualty event.
Is Something similar happening around us?

This is already a mass casualty event with record touching cases each day.
Say there are 50 patients with SPO2 ranging from 30 to 90 standing outside a chaotic emergency.
What can the triage team do?

They can’t facilitate everyone so lets say a “red coded” person eg SPO2 of 50% is taken in and a person with 86% is given a yellow card and asked to wait.

Normally the latter patient would be seen soon after stabilising the former patient.
But what if there are more red patients that while attending to them the yellow patients turn red?

And what if there are so many code “red” patients that people can’t even be color coded?
They will wait out or go to another place or keep getting sicker outside.
But what if every place seems similar where will the patient go all this while deteriorating?

So if a patient who despite visiting an emergency and waiting for hours and can’t get basic medical care and assistance.
This is not something any doctor in the world wishes but this is happening right now.
This is when we can informally call that the health system has collapsed.