I was out in the ambulance bay when the first police cars arrived with patients. There were three to four people inside each cruiser. Two people on the floorboards and two in the back seat, and they were in bad shape. These patients were “scoop and run”—minimal to no prior medical care but brought in a timely manner. They had thready pulses, so they went directly to Station 1, our red tag area. By textbook standards, some of these first arrivals should have been black tags, but I sent them to the red tag area anyway. I didn’t black tag a single one. We took everybody that came in—I pulled at least 10 people from cars that I knew were dead—and sent them straight back to Station 1 so that another doc could see them. If the two of us ended up thinking that this person was dead, then I knew that it was a legitimate black tag.
I would pull a patient and yell “Rapid track. Station four. Station two. Station one.” The staff would then wheel the patients in gurneys or wheelchairs to those areas, drop then off, and come back for more.
Over the years in the ED and working with SWAT, I’ve honed what I call Applied Ballistics and Wound Estimation. It’s a visual CT scanner. We all do it as emergency physicians. You look at a GSW and guess the trajectory and the potential internal injuries. Then you decide if they’re dying now, in a few minutes, or in an hour. Instead of wasting valuable resuscitation time actually tagging the patients, they were sent to their respective tagged areas. I would look at these patients as they came in, and I would grade them red to green.