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Asked by Josh S to Stacey, Pip, Nicola on 16 Jun 2021.
Question: Assume there are limited resources available and you must make decisions in a major emergency with a wide assortment of patients from all ages, backgrounds, and degree of injury. Assume also that there is no “right answer” to this question, only considered and unconsidered responses. Who would you administer the treatment first and why?
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Pip C answered on 21 Jun 2021:
In my job role as a pharmacist I have to prioritise effectively as in the conundrum above. It is difficult to answer this question because the prioritisation strategy employed depends heavily on the circumstance. When I am on-call I assess which queries are most clinically urgent and attend to these first. Certain drugs and certain conditions should be seen to more urgently than others.
Comments
Jamie commented on :
Couple of ways to respond to this; hospitals have Major Accident protocols where a system of triage helps to highlight Red Amber and green those with critical or urgent need as priorities. As soon as you commit staff to something urgent their time is focussed there. The time spent on categorising the reds from the ambers etc is well spent to work out how many staff are required for those in greatest need.
The same principles of triage have been applied in Primary Care through the pandemic, thankfully with less immediate threat to life than a Major Accident plan!
Talking with patients remotely helps us identify who can be sorted remotely (green) from those needing video/photo/face-to-face appointments (amber) and those with serious symptoms that would need hospital attention straight away (red)
Thankfully most of our patients are green & amber; our job is to take pressure off hospitals where we can. Seeing 90% of NHS contacts across all of those GP surgeries each day gives us plenty of practice in this skill!
Laurence commented on :
Hi Josh. I used to work for British Red Cross who support people in crises or in major emergencies and used to do first aid at events. As part of the training a triage process was often talked about. So it may mean those with the most severe injuries are treated first. It was also noted that sometimes it wasn’t always the person screaming loudly and it may be the person that is quiet that needs most help.
Anna commented on :
Treat the people that aren’t shouting first, they need your help first.
James commented on :
Its a really tricky one – medical ethics is a complex subject!
It depends on the situation but you have to take into account:
– likelihood of survival – depends on severity of injury, existing medical problems
– severity of injury – ordinarily you would go to the most injured first!
– skills available – sometimes you might have to stabilise someone in the first place until a specific specialist can arrive!
I think my ultimate answer is – If there is a vital emergency right in front of me, that is what I would do first, but if I have a minute to think about it I would have a quick run down of everyone and then choose where my skills would be most helpful!