Roy Exum
When I was a senior in high school, the Vietnam catastrophe held the guys who were in my class spellbound. Back then, and has since been proven again and again, the conflict was a terrible error in our nation’s judgment and almost 60,000 young and promising Americans died in some stinking South Asian battle zone that didn’t mean squat to our freedom or our nation’s future.
In the first place, we didn’t have a government with the courage to win. We had the greatest military ever assembled and, instead of ending it in just one weekend with our collection of bombers and three of our nuclear submarines, guys in my neighborhood went to funerals instead. Each of us had a lottery number and when a date was called, you were forced to go.
At one point the life expectancy of a 2nd Lieutenant was 30 minutes on his first time in the jungle. Whew, don’t get me started, especially since my older brother felt so strongly about it at Lonnie Floyd’s funeral, he promptly enlisted, and arranged to report to the Marine Corps the day after he got his diploma.
Again, Vietnam should have gotten the likes of Lyndon Johnson and Robert McNamara their just dues. But as in every tragedy there are lessons to be learned, and quite possibly one of my strongest emotions that was stirred during the Vietnam fiasco came one week when Life magazine featured “the tag system.”
About 50 years ago, I first I thought it was a bigger atrocity than the war itself but when it was fully explained to me, I realized that as brutal and as calloused as it first appears, the use of tags was actually a genius stroke that not only saved thousands of lives but would have accomplished much the same thing in Korea, World War II, or any other conflict between two adversaries where multiple deaths are an occurrence.
After I lambasted our Erlanger Hospital’s Board of Trustees and top management earlier this week over my disgust of giving a sick or injured patient no option other than to wait five or six hours to be seen in our Level One trauma center, I got close to a dozen email responses – three readers including they first learned of this in Vietnam.
At first it seems too simple but the Erlanger bottleneck has been allowed to go on for so long – without so much as a care in the public’s opinion – it is adversely affecting patients’ decision to avoid “anything Erlanger” by all measures. The ER debacle is a huge part of a “no confidence” letter to the Board of Trustees because one of the biggest ways staff physicians are referred new patients is – hello! – through the ER.
Because Erlanger has failed to meet the challenge for three years (and Memorial Hospital’s wait times are equally atrocious) my readers believe a skilled triage team could see any incoming patient within five or 10 minutes. In Vietnam, when several MedVac helicopters would bring as many as 50 wounded GIs at the same time to a field hospital, everybody knew that a “first come, first served” plan was lethal.
Remember the TV show, M.A.S.H.? Pandemonium would break out until the triage nurse would calmly and very professionally, affix one of five tags within minutes:
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COLOR CODES COMMONLY USED DURING LARGE ARRIVALS AT FIELD HOSPITAL
* -- RED: CRITICAL – May survive if simple lifesaving measures are applied. This is a full emergency case. Priority 1.
* -- YELLOW: URGENT – Likely to survive if proper care is received within hours. Priority 2.
* -- GREEN: NONURGENT – Minor injuries – Care may be delayed while other priority patients are treated. Priority 3.
* -- BLUE: CATASTROPHIC – Patient unlikely to survive, or those who require intensive care within minutes. Priority 2 or 3.
* -- BLACK: Those who are dead or severely injured and not expected to live. No priority.
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It is important to note the Head Triage Nurse constantly monitors every tagged patient constantly. The head nurse can change priority codes in the triage unit, administer pain meds, allow fluid or food intake on a surgery-pending basis and oversees the next case called.
Reader suggestions for Erlanger is to install and activate a fully functioning out-patient “Insta-Care” clinic nearby. The triage nurse could send many emergency patients to be seen in a non-ER setting. The nurse could also advise the patient their health problem does not merit an ER visit but could make an appointment at the Family Medicine for the next day or in the future.
There is one study that shows the average wait in a doctor’s office is 20 minutes as compared to a four-hour wait in an emergency room. Another study shows behavioral cases can be evaluated, alternate care suggested, and, if necessary, would-be patients can be banned from the ER at the discretion of a law enforcement officer. If the waiting area is full, those who are accompanying a patient and not being seen can wait in an auxiliary waiting area rather than disrupt the treatment flow.
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CORRECTION: "In a story that I wrote on July 15, “A Nursing Shortage?” I mistakenly identified Erlanger Hospital as one hospital that offers prospective nurses a $20,000 signing bonus.
"A hospital spokesperson said this is not true and I apologize for confusing my sources and committing the error."
royexum@aol.com