July 26, 2016 • 43 mins
Triage is a system that provides immediate attention and categorization for medical emergencies that hopefully will never be a big part of your life. Unless you work in an ER. Learn all about the interesting history and current methods for this life saving system today.
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Speaker 1 (00:00):
This episode of Stuff You Should Know is sponsored by
squar Space. Whether you need a landing page, a beautiful
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with the square space website. Go to squarespace dot com
and set your website apart. Welcome to Stuff you Should
Know from House Stuff Works dot com. Hey, and welcome
(00:26):
to the podcast. I'm Josh Clark, and there's Chuck Bryant
and there's Jerry and it's Stuff you Should Know. How's
going pretty good? Do you like my Scotland shirt? That's great.
You're gonna wear that in Scotland. Yeah, that's why I
got it. Okay, I got a shirt for each city
nice country. Well Edinburgh, yeah, yeah, that's the city. Yeah.
(00:49):
I think they'll be behind the Scotland shirt. And they
will too. They're gonna stand up and do that Arsenio like, yeah,
because they're living in the eighties. Yeah, about a shirt
for each city on our UK tour because I'm just
you know, I can write it off and that's just
(01:09):
the very mean thing to do. I'll keep the Manchester
shirt a secret. Oh I know what it is, do you?
I think? So? All right, Well, we'll talk later. Okay.
In the meantime, Chuck, let's talk about trias. Let's talk
about the French language. Okay, tree a okay means too short?
(01:33):
Did you know that? Which means that Lars von Trier's
name is Lars Vaughan. To sort, Yeah, sort or sift.
I saw another meaning, but everywhere else said sort, and
apparently it was originally used exclusively in reference to sorting vegetables. Yeah,
a little known fact. But the pre industrial French society
(01:54):
was a grarian, so they would say, and that means
and they snapped their fingers and point and pile of vegetables,
sort of veggies, root veggies in France. Yeah, they have
those everywhere, but but they they're bonkers for root veggies
in France. They have good, clean, simple food in that country. Yeah,
(02:17):
good good food. Yeah. What's it called the French food?
It's not not the trinity that's like a Cajun, but
the mere poix. Oh I've not heard that before. Is
it the same thing? No? I think mere poise carrot onion,
and one other thing parsley, celery, celery. Jerry's the celery Jerry.
(02:41):
I think you're right? Are you right? You know you're right, okay,
in Cajun Land, it's like Bell Pepper onion and what
and uh garlic it would meet garlic. I was trying
to think of something funny and I failed my brain
just like, yeah, well it's late in the day, trying
(03:02):
to think of something about like an angel Heart reference. Man,
that movie is crazy. Still holds up. I saw it
really well. Actually I can't say it holds up because
I never saw it as a kid. I saw it
as an adult recently. I think it's still on Netflix.
You know, Lisa Bonet is in the season of Ray
Donovan and she looks exactly the same vampire perhaps very
(03:29):
pretty lady. I was crushed on her big when I
was a kid, and she's super laid back. Um, what
was it Lisa Huxtable? Yeah, for sure they didn't. Her
name wasn't Lisa Huxtable. It was something huxtable. Well probably
not because the real names Lisa. Yes. You know, sometimes
shows like used the actor's first name as the character's name,
(03:53):
even though they're not playing themselves. I always thought that
was weird. Yeah. I always wonder if it's because they
have a hard time I'm remembering their characters right, or
the writers like I just can't come up with a name.
Just call him the real name, okay, sue me. And
I know people get so tired of screaming at us
about like, oh, what was the name of that? And
(04:14):
they're like her name was this? I do that to
other podcasts, so I feel your pain. I heard one
just the other day. I think Judge John Hodgement he
couldn't think of something, and I was like, no navy blue. Anyway,
I apologize for all the things we don't know. Uh.
Treer to sort was to sort vegetable foundation of the
(04:38):
term triage. Yeah. And the reason why the French got
to got naming rights for this process that will describe
in a minute is because it was basically invented by
a French person. Pretty remarkable guy from what I can tell.
He had a great name. He was Napoleon's surgeon, the
chief surgeon of Napoleon's Imperial Guard. His name was Baron
(05:01):
Dominique Jean Larrey. Yeah, and he was, uh, he was
a bad dude in all the best ways. He was.
And this was at a time when warfare was getting
pretty serious. Um, I mean it was already serious, but
people were dying and massive amounts of people soldiers dying
(05:23):
on the field and great, great numbers. And so he said,
you know what, we need to come up with the system,
a way to take care of these dudes. Uh, so
they're not waiting over there with a bone sticking out
of their leg waiting for attention. Well this dude also,
I mean he came to this conclusion because he was
running around battlefields like performing amputations and um, just in
(05:46):
a sea of bodies. Like bite, bite on your gun
barrel while I cut your leg off. Yeah that kind
of thing. Yeah, um, and he barrel but stuck. Sure
could bite on yourn, but be really, they needed up
needing new teeth. Um, the wood is much more comfortable
when you're having your leg amputative without anesthetic, I would
(06:08):
say so. Um, but while he's running around performing these
battlefield amputations, he realizes quite quick quickly that some people
are in need of help more urgently than others. And
he decided it would be pretty awesome if you could
figure out a way, like you were saying, to devise
a system of arranging people very quickly so that, um,
(06:30):
you could give aid to the people who needed it most.
And Uh, to do that, you would need to sort
through the people, hence triage as if they were root vegetables.
Uh so what he did initially, and it's gone through
some changes that we're going to talk about, but the
initial incarnation of triage was only based on severity of injuries,
(06:54):
no other factor. Well even before that, and this is
another reason this guy is awesome when he like, there
was a very vague form of triage before, but it
was based on your social standing. Oh really, so yeah,
I was reading that, like, if you have a of course,
a guy who's like, uh, an aristocrat with a broken leg, yeah,
and just a grunt whose bowels are hanging out, you
(07:17):
fix the broken leg first, which is senseless. And laure
was like, no, we're not gonna do that anymore. It's
going to be based on severity of of injury, yeah,
their need for help. And Napoleon was like, that's great,
but you know, I'm at the top of the list
no matter what. Right, Hey, have you heard people calling
me the anti Christ behind my back? Because I could
(07:39):
hear rumblings about this and it's bugging me. You know,
I'm not really short, I'm average. Yeah, that's true. Uh.
And the process went on to change a little bit more.
With British surgeon naval surgeon John Wilson in six he said,
you know what, let's refine this a little bit and
let's put some focus on people who can be successfully treated,
(07:59):
so not necessary early. That guy's got all his bowels
hanging out, he's the most severely injured. He thought, well,
you know what, that guy might not make it, so
maybe we shouldn't spend so much time. It's harsh, but
it's war, it is. And that was a huge shift
because it up to that point, if you were a
medic um like you just treated people. Now you have
(08:20):
a decision to make with each person. Do you let
that person die? Um, because they're probably going to die
and you could be saving other people rather than wasting
your talents and resources on this person right here, Make
them comfortable, maybe throw some morphine their way, and then
you know, go about your business. That was a big
big shift in in triage, in battlefield triage, and in
(08:44):
the US it didn't um, they didn't, We didn't. We
didn't catch up very quickly by the Civil War. So
that guy uh Laura was was working on triage, inventing
it in the seventeen nineties. Um, John Wilson refined it
in the eighteen forties in the Civil War. Still we
(09:05):
were doing like first come, first served. Whoever was closest
to the medic was who got worked on first in
the Civil War in the eighteen sixties. Still, it wasn't
until um, I think the late eighteen sixties or early
eighteen seventies that the US first started adopting even basic triage.
So Britain led the way in this case, well, France
(09:26):
and then Britain. Yeah, yeah, France led the way in mercy.
Britain led the way in um saying like, no, we
gotta let some people die here. Well, I would say
efficiency in saving lives overall. Yeah, I mean it's a
very utilitarian way of looking at and like they're they're
like gotta be gotta have nerves of steel, gotta have
(09:47):
a kung fu grip. World War One things changed again. Uh,
they tweaked it and now they said, all right, maybe
we should treat and you know, if this was what country,
this was just generally this is a US Army manual.
It was, but apparently the US wasn't alone in this.
It was like a it seems like a worldwide movement
(10:12):
shift in in triage, which was to treat, uh, how
many people can you treat in the shortest amount of time,
So like maybe people that don't need as much. But yeah,
and the basis of this is even more steely nerved
than than um John Wilson's shift, because this is saying
(10:34):
not ignore that person, they're probably going to die. It's
this person is going to die, you could probably save,
but it's gonna take up too much time. And the
time that it takes to save this person's life and
you probably could save it. You could have fixed up
twelve people who weren't going to die but can get
back out and fight the war a lot faster if
(10:54):
you work on them. And that was I think the
thinking behind it, patching up people who are more likely
to be a will it returned to battle, rather than
saving lives of people who UH might not be able
to or who would take up a lot of time,
hard choices. Yeah, that's super utilitarian. That was, like you said,
a surgical manual out of the military at the time
(11:15):
said this quote, a single case, even if it urgently
requires attention, may have to wait for in that time
a dozen others almost equally exigent but requiring less time
might be cared for. And four people died while I
read that on the battlefield it could have really sum
that up quicker. Uh, should we take a little break? Sure? Man, No,
(11:56):
all right, my friend, Uh, there are we've been talking
about the battlefield so far in its history. That was
the origin of it. But uh, if you go to
the e R. And actually I haven't been to the
e R much at all in the last jeez much
at all in my life. That's good. But since I
(12:18):
was a kid, but I did go in New York remember,
Oh yeah, that's right. When I got sick. I went
to the emergency room in New York City, Beth Israel.
And it was, man, it was a little a little scary,
just the scene there. Sure, yeah, it wasn't like I'm
(12:38):
sort of used to the hospitals around here, kind of nicer,
like it had seen its better days, the e R
room and the waiting room, and it was it's sad
to see the people that are in there that need help,
you know, in a big city like that. It's um,
it's not like you know, my kid fell down and
bumped his head. It's like, you know, it was disturbing.
(13:00):
I'll just say that. Yeah, but I was triaged when
I first got there. And that's what will happen to
you when you go to a er there. There's gonna
be a triage nurse. Somebody runs up to you and
throws glitter in your face and said, you've been triaged.
That's after someone already threw molasses on your face. That
(13:20):
glitter would sticks. Yeah, So triage nurse is gonna come
by and that that dude to that lady is gonna say, hi,
welcome to Beth Israel. Sorry about the mess. Um, let's
check you out. I'll watch your step. There's some blood. Seriously,
it's kind of like that. Um and uh, they will
(13:41):
do an assessment. They're gonna look at you and say,
you know, deep, this guy has a spoon coming out
of his ear, so I can make a snap judgment
that you need quick help. Yeah. Or this dude in
my case was just holding his belly and so he
looks like he can wait, Yeah, he looks like he
was shooted duck. He can sit here and hold that
(14:02):
for a little while. She said, here, let me pull
your finger. Everything will be all right. And there's what
you're describing this e er triage that's done by a
triage nurse, right, the first person about the first person
you see when you come to an e er when
they're doing triage. It's not constant necessarily they have been
trained to do this, but they're also following float charts.
(14:23):
There's there's triage protocols, different ones, and there's one from Manchester,
UK and it's from what I understand, the international gold
standard for triage, the Manchester Triage system And it's a band. Yeah,
it is like Manhattan Transfer. Um. But it's like it's
a flow chart and it basically says like, um, are
(14:45):
they breathing? No, get them immediate help, like stop right
now and immediately get them into a place where a
lifesaving intervention can be carried out right. Um. And there's
some other ones, but it seems like breathing is the
focus of it. That's good, Yeah it is, but but
I mean you think about it, you would think there'd
(15:07):
be some other ones too, like as are there is
their blood coming out of their ear or something like that. No,
it's mostly breathing. Like if if you're breathing, there's a
pretty good chance you're you're gonna make it, especially if
you have a normal breathing pattern, right. Um. And but
then there's some other ones like if if the person
is not responsive or if they're drooling. Apparently it's another one. Um,
(15:29):
there are a couple of jewelers in the r Israel.
They should have been seen immediately according to the Manchester
UM triage system. So, um, there's like a float chart.
You don't have to It's not necessarily just the nurses
subjective judgment. It's not supposed to be. I'm sure it
is in like high stress situations and with really highly
(15:50):
trained triage nurses they can just be like, yeah, this
move that person there, you go sit down, you go home. Um.
But for the most part, it's supposed to be a
UM an objective system that you can just consult and
be like, okay, well here here's where you fit paper.
You're so smart, why don't you just treatage everybody yourself?
(16:12):
Well beyond the initial UH flow chart to they're also
going to take some vitals. Um, here your complaint in
your medical history, allergies, all that good stuff, medications you
might be on, and then take your vitals, blood pressure, temperature,
all that good stuff. Yeah, if if you're not in
that group where they're just like to send them right back. Yes,
And by the way, I'm not knocking beth is reel
(16:33):
because Nurse Eddie there, this dude, the guy who didn't
believe that you were sick. Yeah, a little bit. He
was amazing and took wonderful care of me and was
like the typical New York nurse that you might think
of this sort of like he had the accent, and
he was like a very kind of cool customer dude,
like I would have felt very comfortable walking into his
(16:55):
arms like a gunshot, because I'm sure he could have
like totally taken care of me. But he did get
a little like like I couldn't figure out what's wrong
with me at first, and then after I got better
and they knocked me out and gave me fluids and
I woke up. I had a I was like, all right, great,
and you know, I'm out of here. And I felt
this lump, remember that, I felt a lump behind my
(17:16):
ear the size of a golf ball. And I walked
back in. I was like, Nurse Eddie, dude, I got like,
what is this? And he kind of gave me one
of those looks like, oh, you're one of those guys.
And I was like, I'm not a hypochondriac. I'm never
at the doctor. I've never been to the e R hardly, like,
please don't look at me those eyes. Nurse Eddie and um,
(17:39):
he felt it and I was like, see, it's like
it's huge. And I think he determined that it was
some kind of like he had a doctor come over
and they determined it was just a swelling of lymph
node from hypochondria brought on by my sickness. But anyway,
big shout out. It turned out to be you had
snakes in your belly. Yeah. If I passed out on
(18:02):
the subway, woke up two days later in Coney Island,
I had thirteen snakes in my belly, no more, no less.
So weird. So um. They gather these details in the
triage didn't take long. They use the color coded system
(18:23):
in some hospitals. Numbers and some were both things on
where you are. Yeah, what's this is astounding to me?
It's not universal, Like the colors aren't universal. Numbers seem
to be like nobody does it backwards, but the color
should be the exact same too. So for example, like
in Manchester's jam Like the worst of all is red.
(18:47):
See red? Making sense? No another trio system blues? The
worst code blue. Yeah, I think you hear that a
lot on American TV, but it's a It's a real thing,
at least in the States. So I I think that
everybody should get together and agree on a color system
because the whole point of triage is rapid fire. Let's
get this done. Not oh, well, which system did you
(19:09):
triage them? Because I'm I'm I enjoy a spotted t
so I'm a fan of the Manchester system, so this
this red is completely odd to me. Yeah, but you
know the one your hospital uses, so you're probably not
getting confused as the triage nurse. Yeah, I guess it's true,
But I mean, I know what you mean. There's just
you should you should go out of your way to
(19:32):
um take out any possible you get transferred to another hospital. Yeah,
there's just I think there should be universal colors. I
have a strong opinion on that. I totally agree. If
you're a kid, you may get sent to closer to
the front of the line um or if you have
a history of illness or like you have cancer or
something like, if you have an outstanding condition already, you
(19:56):
may be shuffled to the front um or. And this
makes a lot of sense to me. A lot of
times now they have what they call it a different track.
They have two tracks. Um, if you're in severe distress,
you're in one gets you right away. But if you
have another one doesn't necessarily mean you're gonna wait eight hours.
They'll just put you in a different track, right for
the less severe cases. Yeah, you go see the doctor
(20:17):
who's been caught drinking on the job. You know that's right.
All right, Well, let's talk about those color codes since
you mentioned it. Okay, here in the US, code blue,
like you said, is the most that means come right away.
I understand the use of blue. It's um like they're
turning blue, yes, cyanotic? Okay, right, that it makes sense.
(20:39):
But again red makes sense too. Yeah, you hear code
red and that doesn't sound great. It doesn't make me
think like, oh, they'll be fine. Well code red it's
category too though, so it is serious. That means they
require immediate attention. But they're just not blue, right, they're
still breathing. Uh, then what he got got an orange
(21:01):
mid level Okay, you got gray, which means you're sick,
but it's like a bad cold. Really, gray should be
the worst. If you're gray, you've already passed blue. That's true,
you're uh. And then the least urgent is green, which
just means you want someone to love you. Yeah, it
means you're you're med seeking. Yeah, you shouldn't be in
(21:23):
the er basically, right, and that's not a joke. That
literally means you don't have an emergency, right they they
if if you are deemed code green five, do they
send you home? Yeah? Or else they'll be like, there's
a minute clinic down the street, go there. Yeah, you don't,
you're wasting valuable resources here, go away. So then across
(21:43):
the pond and then under the Manchester scale, the worst
is code red, followed by code orange, then code yellow,
then code green, then code blue, then code earl gray. Wow,
code blue is the least Yes, yeah, see you got
a point like that's you can't have one color be
(22:04):
the worst possible thing and one color be the the
least dangerous, especially in an increasingly globalized world. I don't
like it either, Um, what can we do? Should we
start a movement? Yes? We should online petitions. How does
that get done? Or just yell about it on Facebook?
(22:25):
I think the Facebook wanna that's that's the best shot
we have. That's how you accomplish things. Um, triage if
there's I mean, we talked about battlefield, we talked about
regularly er. But then there's of course, like when bad
things happen, like in New York when that building exploded. Yeah,
(22:45):
those are called incident triage. Yea, like a natural disaster
or something. Yeah, uh that Harlem explosion, right, it was
a gas explosion in Harlem. Yeah. Um, so triage works
anytime there's a scarcity of resources in a high demand
of for medical care. It's a good way to say.
It's just it's healthcare rashing. It's it's it's saying like,
(23:07):
we don't have enough resources for all you people, so
we're gonna have to figure out who's worse, right, and
you're supposed to do it very quickly. But yeah, with
incident triage. Um, there's actually a really clever thing called
the met tag. Then that article you sent was awesome
and it was a fast code design article, and there's
basically a triage code system that's used out in the
(23:30):
field Um that you'll see people who are victims of
like an explosion or a plane crash or something like that,
and they'll have tags around their necks with the color
code attached. And that was invented by a guy named
Robert bludgett Um in Jacksonville, Florida, in the early nineteen sixties,
in response to the Cuban missile crisis. Yeah. I thought
(23:50):
that was so interesting. It did not exist. Um, he
was a civil defense director and America was super scared,
especially Florida at the time time, because the Soviet Union
had nuclear missiles pointed at us right off the coast,
what ninety miles off the coast of Florida, and people
were freaking out. And um, he was one of him.
(24:13):
He wasn't freaking out, and he seemed like a cool customer. Yeah,
but he was definitely worried. But no, he doesn't seem
like he was freaking He wasn't running around going like
oh my god, oh my god. But he had a
bomb shelter at his house. Sure don't you think anybody
who was anybody had a bomb shelter back then? I
told I think I mentioned before my dad went to
build one after the day after movie, and um it
(24:35):
was his obsession for a month, like you know, every
Saturday for a month. I don't remember. Did he complete it.
He got about a third of this dirt room dug
out behind the wall. Like my brother and I basically
were the was We were the cheap labor, you know,
we were carrying buckets of dirt out in the woods.
(24:56):
He'd come down with like a high left and be like,
how's it going down here? How my project coming? He
didn't drink, but yeah he would come down with his
his buttermilk and corn bread I know, right, Um yeah,
he know. Of course he didn't finish any didn't because
you guys went on strike or something. Uh No, he
just like a lot of people that probably saw the
(25:18):
day after a month later, they're like, yeah, not so scared.
That's an awesome story. Um So anyway, this guy has
uh Mr Blodgett definitely had completed shelter. Oh yeah, there's
no way he bailed. He probably swept it like every
couple of days. Even well, his deal was he made it.
(25:39):
It was really pretty brilliant. It was a two sided
laminated card on lanyard and he said, you know what
this thing needs to be kind of universal. Um, so
I'm gonna put pictures and colors and things of uh,
like you know a symbol that represents blood pressure in
your sex and what time it is. Imagine those little
clock on there. Um, So anyone can read this thing
(26:02):
no matter what happened. Right. And then, um, you would
be assigned a color code depending on the severity of
your injury, your illness. Right, um, just like in an
e er. Um. But this this lanyard around your neck,
they would tear off the colors that you weren't. So
it was progressive, right if you had one, I think
(26:23):
it was green, You're fine, no problems. Uh. And then
it got progressively worse. And like you said, there were
some pretty clever symbols, including, um, I think on the
green one, there's an ambulance with a circle with a
slash through it, Like, don't even put this person on
an ambulance. They're fine, they can probably, they can probably
help you out if you need assistance in like applying
(26:45):
pressure to a wound. Right, Green's fine. Um, it went
all the way to black, and the black said morgue
on it, and it's said in this article, it's really
unsettling that if you had uh met around your neck
and the only tag that was left was a black
one because they ripped them off one by one, right,
(27:07):
or they could rip off like three if like they
just knew it meant you're a goner. You might still
be alive right now, you're looking you're about to die
where you're laying right now, and that awful because it
said Morgan it too, so you could look and be like, oh,
I imagine if you're in that kind of condition, you
don't need that black tag to let you know that
time is near. Yeah, probably not. But if you're holding
(27:30):
out hope, it does not help. No, Yeah, no, that's good.
You give up the ghost. But again, the whole idea
of disaster or a battle battlefield triages. It's a necessary
kind of sad thing that you have to do to
save more people. It's the mercilessness of a compassionate um profession.
(27:51):
Yeah all right, well let's take a break and we'll
talk a little bit more about these tags right after this.
So oh alright, So this guy Mr Blodgett, he actually
(28:22):
sold these through I don't know if he got the money,
that's what I was He didn't. I think he found
somebody who was like, we can distribute these widely. Your
your idea will be set in stone. But we're keeping
the money. The American Civil Defense Association is who he
gave them too to sell. That's the impression I have.
All Right, Well, good on him, you know, hero hero,
(28:44):
anybody who gives up intellectual property rights as a hero. Agreed. Um.
So it's said here in the heyday that they were
selling about a hundred thousand of these a year, two agencies,
which is uh no small number. And um I didn't
see how much they sold them for though. Yeah, they
(29:05):
were in bulk, so like scantron sheets or something, probably
not a lot of money. But um they went on
to be refined years later in when was this? This
was after the Oklahoma building explosion, right, yeah, the bombing, Yeah,
the Alfred P. Murrah building. Is that pronounced right, Murmur?
(29:26):
I think I'm pretty sure it's Maura. I just see
out of the corn mon Jerry nodding and shaking her head.
I don't know what means. What's speaking circle? Um. There
was a l A. P. D Fire department. Um. Well,
two guys actually, Dennis Ortiz and his brother, and they
were working that, like I said, at l A County
Fire Department and when when were they on the scene
(29:49):
in Oklahoma at the time or were they think they
were moved by it? They were like, uh, if something
happened like that in l A, would we do we
have like the resources we need. That's pretty amazing. So
he went to get these tags from l A County
and these MET tags, he said, we're basically disintegrating in
my hand, I guess because they were just so old.
(30:12):
And he said, there's there should be a new tag
and this is sad but also necessary for terrorist disasters
and terrorist attacks, and it was pretty great idea. So
he now included this new tag with things like biological contamination,
radioactive contamination, UM diagrams for blast injuries, personal property receipts,
(30:39):
stuff like that. Yeah, it's like a trifold package. It's
it's got everything all the bells and whistles you need, right,
including basically a revised, improved MET tag. So a MET
tag for the new Yeah. I think they're called smart
tags now, really smart everything. Yeah. Well, another thing they
can do too is UM, a lot of times you
(31:02):
might not have these tags, so they'll literally right go
around with sharpie's and write on people. Uh in in
the case of a disaster. I wonder if people can
feel you writing write the word on your forehead or something. Yeah,
I can feel you're writing morge on my forehead. I
know what you're doing. That's not good. Did you ever
play that game when you're a little word You would
draw on someone's back and you would try to guess
(31:23):
what they were. I was. That was terrible at that
I was bad too, but it felt so good. Yeah,
I love back scratches. So it was always like, draw
something really elaborate, Jah Lawrenz attractor, that'd be wonderful, but chuck.
Whether it's in an incident triage or e ER trias
or something like that, it's um well, I should say.
And an e R triage. There's a spectrum of triage, right,
(31:48):
and e R is about the most calm, stable version
of it, even a chaotic, crazy e ER in a
big city, compared to on the other end, the site
of a massive disaster that's not just impacted a bunch
of people, it's probably affected like the health care infrastructure
as well. Within within that spectrum, there's different types of triage,
(32:11):
and usually the worst it is the faster your assessment
has to be. So like out on a battlefield. Um,
they've come up with basically a two two point um
triage assessment. It's called the field triage score. It's part
of the technical combat casualty care methodology, right where they
feel your pulse and then they give you a rating
(32:34):
of awareness on the Glasgow Coma scale, which we covered
in our comma. Yeah, and apparently if you put those together,
it's a pretty good predictor of whether somebody's going to
survive their injuries or not. So like, if you're out
of it and your pulse is low, move along, that
person is a goner in that situation. Whereas if that
(32:55):
person came into an e R in the suburbs um
or or trauma center or something like that, they might
have a really good chance of making it. But depending
on the situation along that spectrum of triage, UM, you're
you're going to depending on where you are on that
spectrum physically literally, Um, you may just get passed over
(33:17):
or you may have your life saved. Man, You've got
to have nerves of steel to be a first responder. Yeah,
and we should also say to once you're given a code. Um,
but you're like, that's not it's not static, like it
can change, You're you can deteriorate over right, switch tags
that person next to you, right, But no, you're absolutely right,
(33:38):
like to to to say, like I want to save
your life, but I can't. I've got to leave you
there to die. You're absolutely right. I mean it's metal,
not for me. That's metal in both spellings, two D
s and a T, you know, two teas and an
(34:01):
L E. Oh, it's M E T T L E.
Why do I think it was emmy D D L E.
Because it's like meddling. If you went and rearranged everybody's tags,
that would be meddling. It's amazing metal and like metal.
I know, it's amazing the amount of dope things I
say on the show, and people still think I like
(34:21):
have anything to offer the world. I've got you beat
by like four or five times. I think I don't
think so, I think so. Um, all right, well let's
talk a little bit about what's well, we've talked about
what's good about it, um, pretty much everything because it
will say ultimately more lives, yeah, but has its critics
well yeah, and a lot of times you know when
you go to the e er. We're not talking battlefield
(34:42):
or disaster, but when you go to the er, you
want to get seen as quickly as possible because it's
the worst. My thumb hurts, Yeah, and so long you
look around and you're like, well, that person doesn't look
so bad off, why are they going in? Or I've
been here for an hour. This guy just came in
and he got seen and he didn't look too bad
that the kids breathing, Yeah, why is he going ahead
(35:06):
of me? Yeah? I mean they hear a lot of
I mean e ers have to feel a lot of complaints,
yeah about wait times. And there's a lot of people
who end up in what's called the l w B
S category. Is that where they send complainers left without
being seen. Some people just give up there, like forget it,
I'm not sitting around here any longer. I could see
me doing that. Yeah, you just become indignant or you're
(35:28):
like I feel like eating some cereal. Well, I just
don't like to wait. And maybe it would have to
be something where it's subsided enough to rouse like I
think I'll be all right, right, not like an injury, right,
Unless I thought I could set it up myself or
Rambo style, which Emily's dad did once. What did you
like soda cut in his arm himself one time with
(35:51):
needle and thread? Did he put gunpowder in it and
light it on fire? He should have that would have
done it. Uh. And apparently that they interviewed someone from
for our House to Works article from our great children's
hospital here Scottish right, and this doctor said, especially at
children's hospitals, a lot of upset parents that don't really
(36:13):
get the triage thing. Well, um, there's been studies actually
that there was. There was one very famous study from
the nineteen nineties I think actually, and then it had
there was such an outcry against it as far as
criticism of the study went, because the study, the studies
findings were very critical the trio triage as a whole,
(36:35):
like the concept of it. Um that the authors actually
wrote another study responding to the criticisms of their original study.
And I was reading that and they're basically in the
original study they found that triage when it's actually done,
leads to longer wait times for the people who need
the most immediate care, like gets in the way, and
(36:58):
that it didn't have any impact patient satisfaction, meaning people
didn't feel like they were being cared for better than
when they weren't exposed to triage. So um, they the
the people just said this is what we found. A
lot of people were like, this is a B S study,
but it does make sense. There are critics to triage
(37:20):
saying like, no, this is unnecessary. Uh, it's clumsy, it
gets in the way. It's an extra layer, a barrier
between a patient and treatment. Um, like someone's gotta say
this guy's got a spoon in his ear. I think
for the most part, the critics don't have an alternative
(37:41):
and that you know, triage can help. But I think
there's a it's almost a cult of triage, where like, yeah,
of course triage helps. You're an idiot for saying anything different.
Scientists are saying like, it's not it's not perfect. Um,
but I don't know what an alternative would be in
the case of really scarce resources. Well, here's one, not alternative,
(38:03):
but one other way of doing things. And they did this,
uh at the Kaiser Permanent South Sacramento Medical Center Kaiser Permanente.
They forgot the e oh they did Kaiser Permanent. What
they said here, Um, what does permanente? I mean either
what does what does it think? It means permanent in Spanish? Okay,
who's kaiser? Uh? That means permanent in German? So the
(38:28):
permanent permanent. No, that means a role, A delightful type
of role that's permanent, a German role forever. Uh yeah
yeah four times. So. Um they employed something from the
l e A and the lean thinking principle in Japan
(38:49):
and their businesses. Is this like when they have people
do like calistinics and that kind of thing. Now, I
don't know, I want to look into what that is.
It sounds interesting. Well, it's like a cutting down on waste.
But I'm sure that the Japanese probably figured out a
way to insert calisthenics into it. Um are Actually I
might be thinking of China. No, Japanese are into too, okay. Um.
(39:15):
So they used this lead methodology and what they would do,
and this makes a lot of sense. It was sort
of like the two track thing. But if you have
the minor injury, you actually have a doctor come out
to the waiting room and treat you in the waiting room,
or at least see you at first in the waiting room.
(39:35):
And I think that definitely would give someone a sense
of while I'm being tended to, at least I'm not
just sitting over here holding my belly in pain. But
it's also not like, uh, you're on track to go
sit over there and wait for a bed to come
open so you can see. It's like, you there, you
don't have to wait for a bed. The doctor came
to you instead. Yeah, that's a great idea. And they
(39:56):
found it reduced the left without being seen rate from
four point five percent to one point five percent. Uh,
and the wait times fell by half. Yeah, that's right.
Wait times are one of my biggest complaints with modern medicine. Sure,
it's the worst. Your appointments at one, you get in
there at two. Oh man, boy, oh boy, you want
(40:20):
to see me get mad? Stick me in the waiting
room with bad magazines. But if you got some mad magazines,
you're like, this is delightful. The other criticism of triage
is that it shouldn't be done at all, That withholding
care under any circumstances is unethical. So I just have
like eight times as many doctors and nurses. I guess
(40:41):
it's come on. Uh, if you want to know more
about triage you're sorting. Um, you can type those words
into the search part how stuff works dot Com. And
since I said that it's time for listening mail, I'm
gonna call this lighthouse follow up. We've got a lot
of really great pictures and emails from lighthouse enthusiasts. Yeah,
it's pretty cool. Uh, including ones that were for sale
(41:03):
so I could live about my fantasy. Yeah. Are you
going to know how much are they didn't see? Um,
I don't know. I didn't. I don't remember any crisis
looking up on Zilo. I bought like two of them
and I didn't catch the price. You're just like, here's
a bunch of money. Bring me those lighthouses. Hey, guys,
I listened to your lighthouse episode and it was so
excited to hear this. Last year, I visited every lighthouse
(41:27):
on Oregon's coast her state. Uh, such a good year
long goal, That's what she said. I agree. Anyhow, I
wanted to tell you about one of our coolest in
my opinions, is Terrible Tilly. She was built on a
rock a mile off shore and see pictures is really neat.
(41:47):
That's what I needs. It's like just out there in
the middle of the ocean. Many men died trying to
construct in eighteen seventies, and many men died while keeping
the light that was decommissioned in nineteen fifty seven and
was sold after her sale, until he became a graveyard
so to speak. Sailors would be cremated and had their
ashes stored in the lighthouse. During the seasonal storms, when
(42:08):
the waves break into the lighthouse, the ocean chooses who
she takes back with her to be buried in her bosom. Well,
it's very poetic. It's pretty romantic in a Victorian or
Gothic way. I totally agree. Thanks for all you guys do.
I look forward to listening to your podcast every week.
And I evangelized stuff you should know, the stuff you
should know gospel to all my friends. And that is
(42:30):
from Kendra, and Kendra used the word evangelizing bosom in
the same email and Gothic, so that means straight to
the top of the pile. Thanks a lot, Kendra, that
was indeed to create email. Uh. If you want to
get in touch with us, you can tweak to us
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Facebook dot com slash Stuff you Should Know You can
send us an email to Stuff podcast. The House suff
(42:52):
works dot com and has always joined us at our
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and set your website apart. Welcome to Stuff you Should
Know from House Stuff Works dot com. Hey, and welcome
(00:26):
to the podcast. I'm Josh Clark, and there's Chuck Bryant
and there's Jerry and it's Stuff you Should Know. How's
going pretty good? Do you like my Scotland shirt? That's great.
You're gonna wear that in Scotland. Yeah, that's why I
got it. Okay, I got a shirt for each city
nice country. Well Edinburgh, yeah, yeah, that's the city. Yeah.
(00:49):
I think they'll be behind the Scotland shirt. And they
will too. They're gonna stand up and do that Arsenio like, yeah,
because they're living in the eighties. Yeah, about a shirt
for each city on our UK tour because I'm just
you know, I can write it off and that's just
(01:09):
the very mean thing to do. I'll keep the Manchester
shirt a secret. Oh I know what it is, do you?
I think? So? All right, Well, we'll talk later. Okay.
In the meantime, Chuck, let's talk about trias. Let's talk
about the French language. Okay, tree a okay means too short?
(01:33):
Did you know that? Which means that Lars von Trier's
name is Lars Vaughan. To sort, Yeah, sort or sift.
I saw another meaning, but everywhere else said sort, and
apparently it was originally used exclusively in reference to sorting vegetables. Yeah,
a little known fact. But the pre industrial French society
(01:54):
was a grarian, so they would say, and that means
and they snapped their fingers and point and pile of vegetables,
sort of veggies, root veggies in France. Yeah, they have
those everywhere, but but they they're bonkers for root veggies
in France. They have good, clean, simple food in that country. Yeah,
(02:17):
good good food. Yeah. What's it called the French food?
It's not not the trinity that's like a Cajun, but
the mere poix. Oh I've not heard that before. Is
it the same thing? No? I think mere poise carrot onion,
and one other thing parsley, celery, celery. Jerry's the celery Jerry.
(02:41):
I think you're right? Are you right? You know you're right, okay,
in Cajun Land, it's like Bell Pepper onion and what
and uh garlic it would meet garlic. I was trying
to think of something funny and I failed my brain
just like, yeah, well it's late in the day, trying
(03:02):
to think of something about like an angel Heart reference. Man,
that movie is crazy. Still holds up. I saw it
really well. Actually I can't say it holds up because
I never saw it as a kid. I saw it
as an adult recently. I think it's still on Netflix.
You know, Lisa Bonet is in the season of Ray
Donovan and she looks exactly the same vampire perhaps very
(03:29):
pretty lady. I was crushed on her big when I
was a kid, and she's super laid back. Um, what
was it Lisa Huxtable? Yeah, for sure they didn't. Her
name wasn't Lisa Huxtable. It was something huxtable. Well probably
not because the real names Lisa. Yes. You know, sometimes
shows like used the actor's first name as the character's name,
(03:53):
even though they're not playing themselves. I always thought that
was weird. Yeah. I always wonder if it's because they
have a hard time I'm remembering their characters right, or
the writers like I just can't come up with a name.
Just call him the real name, okay, sue me. And
I know people get so tired of screaming at us
about like, oh, what was the name of that? And
(04:14):
they're like her name was this? I do that to
other podcasts, so I feel your pain. I heard one
just the other day. I think Judge John Hodgement he
couldn't think of something, and I was like, no navy blue. Anyway,
I apologize for all the things we don't know. Uh.
Treer to sort was to sort vegetable foundation of the
(04:38):
term triage. Yeah. And the reason why the French got
to got naming rights for this process that will describe
in a minute is because it was basically invented by
a French person. Pretty remarkable guy from what I can tell.
He had a great name. He was Napoleon's surgeon, the
chief surgeon of Napoleon's Imperial Guard. His name was Baron
(05:01):
Dominique Jean Larrey. Yeah, and he was, uh, he was
a bad dude in all the best ways. He was.
And this was at a time when warfare was getting
pretty serious. Um, I mean it was already serious, but
people were dying and massive amounts of people soldiers dying
(05:23):
on the field and great, great numbers. And so he said,
you know what, we need to come up with the system,
a way to take care of these dudes. Uh, so
they're not waiting over there with a bone sticking out
of their leg waiting for attention. Well this dude also,
I mean he came to this conclusion because he was
running around battlefields like performing amputations and um, just in
(05:46):
a sea of bodies. Like bite, bite on your gun
barrel while I cut your leg off. Yeah that kind
of thing. Yeah, um, and he barrel but stuck. Sure
could bite on yourn, but be really, they needed up
needing new teeth. Um, the wood is much more comfortable
when you're having your leg amputative without anesthetic, I would
(06:08):
say so. Um, but while he's running around performing these
battlefield amputations, he realizes quite quick quickly that some people
are in need of help more urgently than others. And
he decided it would be pretty awesome if you could
figure out a way, like you were saying, to devise
a system of arranging people very quickly so that, um,
(06:30):
you could give aid to the people who needed it most.
And Uh, to do that, you would need to sort
through the people, hence triage as if they were root vegetables.
Uh so what he did initially, and it's gone through
some changes that we're going to talk about, but the
initial incarnation of triage was only based on severity of injuries,
(06:54):
no other factor. Well even before that, and this is
another reason this guy is awesome when he like, there
was a very vague form of triage before, but it
was based on your social standing. Oh really, so yeah,
I was reading that, like, if you have a of course,
a guy who's like, uh, an aristocrat with a broken leg, yeah,
and just a grunt whose bowels are hanging out, you
(07:17):
fix the broken leg first, which is senseless. And laure
was like, no, we're not gonna do that anymore. It's
going to be based on severity of of injury, yeah,
their need for help. And Napoleon was like, that's great,
but you know, I'm at the top of the list
no matter what. Right, Hey, have you heard people calling
me the anti Christ behind my back? Because I could
(07:39):
hear rumblings about this and it's bugging me. You know,
I'm not really short, I'm average. Yeah, that's true. Uh.
And the process went on to change a little bit more.
With British surgeon naval surgeon John Wilson in six he said,
you know what, let's refine this a little bit and
let's put some focus on people who can be successfully treated,
(07:59):
so not necessary early. That guy's got all his bowels
hanging out, he's the most severely injured. He thought, well,
you know what, that guy might not make it, so
maybe we shouldn't spend so much time. It's harsh, but
it's war, it is. And that was a huge shift
because it up to that point, if you were a
medic um like you just treated people. Now you have
(08:20):
a decision to make with each person. Do you let
that person die? Um, because they're probably going to die
and you could be saving other people rather than wasting
your talents and resources on this person right here, Make
them comfortable, maybe throw some morphine their way, and then
you know, go about your business. That was a big
big shift in in triage, in battlefield triage, and in
(08:44):
the US it didn't um, they didn't, We didn't. We
didn't catch up very quickly by the Civil War. So
that guy uh Laura was was working on triage, inventing
it in the seventeen nineties. Um, John Wilson refined it
in the eighteen forties in the Civil War. Still we
(09:05):
were doing like first come, first served. Whoever was closest
to the medic was who got worked on first in
the Civil War in the eighteen sixties. Still, it wasn't
until um, I think the late eighteen sixties or early
eighteen seventies that the US first started adopting even basic triage.
So Britain led the way in this case, well, France
(09:26):
and then Britain. Yeah, yeah, France led the way in mercy.
Britain led the way in um saying like, no, we
gotta let some people die here. Well, I would say
efficiency in saving lives overall. Yeah, I mean it's a
very utilitarian way of looking at and like they're they're
like gotta be gotta have nerves of steel, gotta have
(09:47):
a kung fu grip. World War One things changed again. Uh,
they tweaked it and now they said, all right, maybe
we should treat and you know, if this was what country,
this was just generally this is a US Army manual.
It was, but apparently the US wasn't alone in this.
It was like a it seems like a worldwide movement
(10:12):
shift in in triage, which was to treat, uh, how
many people can you treat in the shortest amount of time,
So like maybe people that don't need as much. But yeah,
and the basis of this is even more steely nerved
than than um John Wilson's shift, because this is saying
(10:34):
not ignore that person, they're probably going to die. It's
this person is going to die, you could probably save,
but it's gonna take up too much time. And the
time that it takes to save this person's life and
you probably could save it. You could have fixed up
twelve people who weren't going to die but can get
back out and fight the war a lot faster if
(10:54):
you work on them. And that was I think the
thinking behind it, patching up people who are more likely
to be a will it returned to battle, rather than
saving lives of people who UH might not be able
to or who would take up a lot of time,
hard choices. Yeah, that's super utilitarian. That was, like you said,
a surgical manual out of the military at the time
(11:15):
said this quote, a single case, even if it urgently
requires attention, may have to wait for in that time
a dozen others almost equally exigent but requiring less time
might be cared for. And four people died while I
read that on the battlefield it could have really sum
that up quicker. Uh, should we take a little break? Sure? Man, No,
(11:56):
all right, my friend, Uh, there are we've been talking
about the battlefield so far in its history. That was
the origin of it. But uh, if you go to
the e R. And actually I haven't been to the
e R much at all in the last jeez much
at all in my life. That's good. But since I
(12:18):
was a kid, but I did go in New York remember,
Oh yeah, that's right. When I got sick. I went
to the emergency room in New York City, Beth Israel.
And it was, man, it was a little a little scary,
just the scene there. Sure, yeah, it wasn't like I'm
(12:38):
sort of used to the hospitals around here, kind of nicer,
like it had seen its better days, the e R
room and the waiting room, and it was it's sad
to see the people that are in there that need help,
you know, in a big city like that. It's um,
it's not like you know, my kid fell down and
bumped his head. It's like, you know, it was disturbing.
(13:00):
I'll just say that. Yeah, but I was triaged when
I first got there. And that's what will happen to
you when you go to a er there. There's gonna
be a triage nurse. Somebody runs up to you and
throws glitter in your face and said, you've been triaged.
That's after someone already threw molasses on your face. That
(13:20):
glitter would sticks. Yeah, So triage nurse is gonna come
by and that that dude to that lady is gonna say, hi,
welcome to Beth Israel. Sorry about the mess. Um, let's
check you out. I'll watch your step. There's some blood. Seriously,
it's kind of like that. Um and uh, they will
(13:41):
do an assessment. They're gonna look at you and say,
you know, deep, this guy has a spoon coming out
of his ear, so I can make a snap judgment
that you need quick help. Yeah. Or this dude in
my case was just holding his belly and so he
looks like he can wait, Yeah, he looks like he
was shooted duck. He can sit here and hold that
(14:02):
for a little while. She said, here, let me pull
your finger. Everything will be all right. And there's what
you're describing this e er triage that's done by a
triage nurse, right, the first person about the first person
you see when you come to an e er when
they're doing triage. It's not constant necessarily they have been
trained to do this, but they're also following float charts.
(14:23):
There's there's triage protocols, different ones, and there's one from Manchester,
UK and it's from what I understand, the international gold
standard for triage, the Manchester Triage system And it's a band. Yeah,
it is like Manhattan Transfer. Um. But it's like it's
a flow chart and it basically says like, um, are
(14:45):
they breathing? No, get them immediate help, like stop right
now and immediately get them into a place where a
lifesaving intervention can be carried out right. Um. And there's
some other ones, but it seems like breathing is the
focus of it. That's good, Yeah it is, but but
I mean you think about it, you would think there'd
(15:07):
be some other ones too, like as are there is
their blood coming out of their ear or something like that. No,
it's mostly breathing. Like if if you're breathing, there's a
pretty good chance you're you're gonna make it, especially if
you have a normal breathing pattern, right. Um. And but
then there's some other ones like if if the person
is not responsive or if they're drooling. Apparently it's another one. Um,
(15:29):
there are a couple of jewelers in the r Israel.
They should have been seen immediately according to the Manchester
UM triage system. So, um, there's like a float chart.
You don't have to It's not necessarily just the nurses
subjective judgment. It's not supposed to be. I'm sure it
is in like high stress situations and with really highly
(15:50):
trained triage nurses they can just be like, yeah, this
move that person there, you go sit down, you go home. Um.
But for the most part, it's supposed to be a
UM an objective system that you can just consult and
be like, okay, well here here's where you fit paper.
You're so smart, why don't you just treatage everybody yourself?
(16:12):
Well beyond the initial UH flow chart to they're also
going to take some vitals. Um, here your complaint in
your medical history, allergies, all that good stuff, medications you
might be on, and then take your vitals, blood pressure, temperature,
all that good stuff. Yeah, if if you're not in
that group where they're just like to send them right back. Yes,
And by the way, I'm not knocking beth is reel
(16:33):
because Nurse Eddie there, this dude, the guy who didn't
believe that you were sick. Yeah, a little bit. He
was amazing and took wonderful care of me and was
like the typical New York nurse that you might think
of this sort of like he had the accent, and
he was like a very kind of cool customer dude,
like I would have felt very comfortable walking into his
(16:55):
arms like a gunshot, because I'm sure he could have
like totally taken care of me. But he did get
a little like like I couldn't figure out what's wrong
with me at first, and then after I got better
and they knocked me out and gave me fluids and
I woke up. I had a I was like, all right, great,
and you know, I'm out of here. And I felt
this lump, remember that, I felt a lump behind my
(17:16):
ear the size of a golf ball. And I walked
back in. I was like, Nurse Eddie, dude, I got like,
what is this? And he kind of gave me one
of those looks like, oh, you're one of those guys.
And I was like, I'm not a hypochondriac. I'm never
at the doctor. I've never been to the e R hardly, like,
please don't look at me those eyes. Nurse Eddie and um,
(17:39):
he felt it and I was like, see, it's like
it's huge. And I think he determined that it was
some kind of like he had a doctor come over
and they determined it was just a swelling of lymph
node from hypochondria brought on by my sickness. But anyway,
big shout out. It turned out to be you had
snakes in your belly. Yeah. If I passed out on
(18:02):
the subway, woke up two days later in Coney Island,
I had thirteen snakes in my belly, no more, no less.
So weird. So um. They gather these details in the
triage didn't take long. They use the color coded system
(18:23):
in some hospitals. Numbers and some were both things on
where you are. Yeah, what's this is astounding to me?
It's not universal, Like the colors aren't universal. Numbers seem
to be like nobody does it backwards, but the color
should be the exact same too. So for example, like
in Manchester's jam Like the worst of all is red.
(18:47):
See red? Making sense? No another trio system blues? The
worst code blue. Yeah, I think you hear that a
lot on American TV, but it's a It's a real thing,
at least in the States. So I I think that
everybody should get together and agree on a color system
because the whole point of triage is rapid fire. Let's
get this done. Not oh, well, which system did you
(19:09):
triage them? Because I'm I'm I enjoy a spotted t
so I'm a fan of the Manchester system, so this
this red is completely odd to me. Yeah, but you
know the one your hospital uses, so you're probably not
getting confused as the triage nurse. Yeah, I guess it's true,
But I mean, I know what you mean. There's just
you should you should go out of your way to
(19:32):
um take out any possible you get transferred to another hospital. Yeah,
there's just I think there should be universal colors. I
have a strong opinion on that. I totally agree. If
you're a kid, you may get sent to closer to
the front of the line um or if you have
a history of illness or like you have cancer or
something like, if you have an outstanding condition already, you
(19:56):
may be shuffled to the front um or. And this
makes a lot of sense to me. A lot of
times now they have what they call it a different track.
They have two tracks. Um, if you're in severe distress,
you're in one gets you right away. But if you
have another one doesn't necessarily mean you're gonna wait eight hours.
They'll just put you in a different track, right for
the less severe cases. Yeah, you go see the doctor
(20:17):
who's been caught drinking on the job. You know that's right.
All right, Well, let's talk about those color codes since
you mentioned it. Okay, here in the US, code blue,
like you said, is the most that means come right away.
I understand the use of blue. It's um like they're
turning blue, yes, cyanotic? Okay, right, that it makes sense.
(20:39):
But again red makes sense too. Yeah, you hear code
red and that doesn't sound great. It doesn't make me
think like, oh, they'll be fine. Well code red it's
category too though, so it is serious. That means they
require immediate attention. But they're just not blue, right, they're
still breathing. Uh, then what he got got an orange
(21:01):
mid level Okay, you got gray, which means you're sick,
but it's like a bad cold. Really, gray should be
the worst. If you're gray, you've already passed blue. That's true,
you're uh. And then the least urgent is green, which
just means you want someone to love you. Yeah, it
means you're you're med seeking. Yeah, you shouldn't be in
(21:23):
the er basically, right, and that's not a joke. That
literally means you don't have an emergency, right they they
if if you are deemed code green five, do they
send you home? Yeah? Or else they'll be like, there's
a minute clinic down the street, go there. Yeah, you don't,
you're wasting valuable resources here, go away. So then across
(21:43):
the pond and then under the Manchester scale, the worst
is code red, followed by code orange, then code yellow,
then code green, then code blue, then code earl gray. Wow,
code blue is the least Yes, yeah, see you got
a point like that's you can't have one color be
(22:04):
the worst possible thing and one color be the the
least dangerous, especially in an increasingly globalized world. I don't
like it either, Um, what can we do? Should we
start a movement? Yes? We should online petitions. How does
that get done? Or just yell about it on Facebook?
(22:25):
I think the Facebook wanna that's that's the best shot
we have. That's how you accomplish things. Um, triage if
there's I mean, we talked about battlefield, we talked about
regularly er. But then there's of course, like when bad
things happen, like in New York when that building exploded. Yeah,
(22:45):
those are called incident triage. Yea, like a natural disaster
or something. Yeah, uh that Harlem explosion, right, it was
a gas explosion in Harlem. Yeah. Um, so triage works
anytime there's a scarcity of resources in a high demand
of for medical care. It's a good way to say.
It's just it's healthcare rashing. It's it's it's saying like,
(23:07):
we don't have enough resources for all you people, so
we're gonna have to figure out who's worse, right, and
you're supposed to do it very quickly. But yeah, with
incident triage. Um, there's actually a really clever thing called
the met tag. Then that article you sent was awesome
and it was a fast code design article, and there's
basically a triage code system that's used out in the
(23:30):
field Um that you'll see people who are victims of
like an explosion or a plane crash or something like that,
and they'll have tags around their necks with the color
code attached. And that was invented by a guy named
Robert bludgett Um in Jacksonville, Florida, in the early nineteen sixties,
in response to the Cuban missile crisis. Yeah. I thought
(23:50):
that was so interesting. It did not exist. Um, he
was a civil defense director and America was super scared,
especially Florida at the time time, because the Soviet Union
had nuclear missiles pointed at us right off the coast,
what ninety miles off the coast of Florida, and people
were freaking out. And um, he was one of him.
(24:13):
He wasn't freaking out, and he seemed like a cool customer. Yeah,
but he was definitely worried. But no, he doesn't seem
like he was freaking He wasn't running around going like
oh my god, oh my god. But he had a
bomb shelter at his house. Sure don't you think anybody
who was anybody had a bomb shelter back then? I
told I think I mentioned before my dad went to
build one after the day after movie, and um it
(24:35):
was his obsession for a month, like you know, every
Saturday for a month. I don't remember. Did he complete it.
He got about a third of this dirt room dug
out behind the wall. Like my brother and I basically
were the was We were the cheap labor, you know,
we were carrying buckets of dirt out in the woods.
(24:56):
He'd come down with like a high left and be like,
how's it going down here? How my project coming? He
didn't drink, but yeah he would come down with his
his buttermilk and corn bread I know, right, Um yeah,
he know. Of course he didn't finish any didn't because
you guys went on strike or something. Uh No, he
just like a lot of people that probably saw the
(25:18):
day after a month later, they're like, yeah, not so scared.
That's an awesome story. Um So anyway, this guy has
uh Mr Blodgett definitely had completed shelter. Oh yeah, there's
no way he bailed. He probably swept it like every
couple of days. Even well, his deal was he made it.
(25:39):
It was really pretty brilliant. It was a two sided
laminated card on lanyard and he said, you know what
this thing needs to be kind of universal. Um, so
I'm gonna put pictures and colors and things of uh,
like you know a symbol that represents blood pressure in
your sex and what time it is. Imagine those little
clock on there. Um, So anyone can read this thing
(26:02):
no matter what happened. Right. And then, um, you would
be assigned a color code depending on the severity of
your injury, your illness. Right, um, just like in an
e er. Um. But this this lanyard around your neck,
they would tear off the colors that you weren't. So
it was progressive, right if you had one, I think
(26:23):
it was green, You're fine, no problems. Uh. And then
it got progressively worse. And like you said, there were
some pretty clever symbols, including, um, I think on the
green one, there's an ambulance with a circle with a
slash through it, Like, don't even put this person on
an ambulance. They're fine, they can probably, they can probably
help you out if you need assistance in like applying
(26:45):
pressure to a wound. Right, Green's fine. Um, it went
all the way to black, and the black said morgue
on it, and it's said in this article, it's really
unsettling that if you had uh met around your neck
and the only tag that was left was a black
one because they ripped them off one by one, right,
(27:07):
or they could rip off like three if like they
just knew it meant you're a goner. You might still
be alive right now, you're looking you're about to die
where you're laying right now, and that awful because it
said Morgan it too, so you could look and be like, oh,
I imagine if you're in that kind of condition, you
don't need that black tag to let you know that
time is near. Yeah, probably not. But if you're holding
(27:30):
out hope, it does not help. No, Yeah, no, that's good.
You give up the ghost. But again, the whole idea
of disaster or a battle battlefield triages. It's a necessary
kind of sad thing that you have to do to
save more people. It's the mercilessness of a compassionate um profession.
(27:51):
Yeah all right, well let's take a break and we'll
talk a little bit more about these tags right after this.
So oh alright, So this guy Mr Blodgett, he actually
(28:22):
sold these through I don't know if he got the money,
that's what I was He didn't. I think he found
somebody who was like, we can distribute these widely. Your
your idea will be set in stone. But we're keeping
the money. The American Civil Defense Association is who he
gave them too to sell. That's the impression I have.
All Right, Well, good on him, you know, hero hero,
(28:44):
anybody who gives up intellectual property rights as a hero. Agreed. Um.
So it's said here in the heyday that they were
selling about a hundred thousand of these a year, two agencies,
which is uh no small number. And um I didn't
see how much they sold them for though. Yeah, they
(29:05):
were in bulk, so like scantron sheets or something, probably
not a lot of money. But um they went on
to be refined years later in when was this? This
was after the Oklahoma building explosion, right, yeah, the bombing, Yeah,
the Alfred P. Murrah building. Is that pronounced right, Murmur?
(29:26):
I think I'm pretty sure it's Maura. I just see
out of the corn mon Jerry nodding and shaking her head.
I don't know what means. What's speaking circle? Um. There
was a l A. P. D Fire department. Um. Well,
two guys actually, Dennis Ortiz and his brother, and they
were working that, like I said, at l A County
Fire Department and when when were they on the scene
(29:49):
in Oklahoma at the time or were they think they
were moved by it? They were like, uh, if something
happened like that in l A, would we do we
have like the resources we need. That's pretty amazing. So
he went to get these tags from l A County
and these MET tags, he said, we're basically disintegrating in
my hand, I guess because they were just so old.
(30:12):
And he said, there's there should be a new tag
and this is sad but also necessary for terrorist disasters
and terrorist attacks, and it was pretty great idea. So
he now included this new tag with things like biological contamination,
radioactive contamination, UM diagrams for blast injuries, personal property receipts,
(30:39):
stuff like that. Yeah, it's like a trifold package. It's
it's got everything all the bells and whistles you need, right,
including basically a revised, improved MET tag. So a MET
tag for the new Yeah. I think they're called smart
tags now, really smart everything. Yeah. Well, another thing they
can do too is UM, a lot of times you
(31:02):
might not have these tags, so they'll literally right go
around with sharpie's and write on people. Uh in in
the case of a disaster. I wonder if people can
feel you writing write the word on your forehead or something. Yeah,
I can feel you're writing morge on my forehead. I
know what you're doing. That's not good. Did you ever
play that game when you're a little word You would
draw on someone's back and you would try to guess
(31:23):
what they were. I was. That was terrible at that
I was bad too, but it felt so good. Yeah,
I love back scratches. So it was always like, draw
something really elaborate, Jah Lawrenz attractor, that'd be wonderful, but chuck.
Whether it's in an incident triage or e ER trias
or something like that, it's um well, I should say.
And an e R triage. There's a spectrum of triage, right,
(31:48):
and e R is about the most calm, stable version
of it, even a chaotic, crazy e ER in a
big city, compared to on the other end, the site
of a massive disaster that's not just impacted a bunch
of people, it's probably affected like the health care infrastructure
as well. Within within that spectrum, there's different types of triage,
(32:11):
and usually the worst it is the faster your assessment
has to be. So like out on a battlefield. Um,
they've come up with basically a two two point um
triage assessment. It's called the field triage score. It's part
of the technical combat casualty care methodology, right where they
feel your pulse and then they give you a rating
(32:34):
of awareness on the Glasgow Coma scale, which we covered
in our comma. Yeah, and apparently if you put those together,
it's a pretty good predictor of whether somebody's going to
survive their injuries or not. So like, if you're out
of it and your pulse is low, move along, that
person is a goner in that situation. Whereas if that
(32:55):
person came into an e R in the suburbs um
or or trauma center or something like that, they might
have a really good chance of making it. But depending
on the situation along that spectrum of triage, UM, you're
you're going to depending on where you are on that
spectrum physically literally, Um, you may just get passed over
(33:17):
or you may have your life saved. Man, You've got
to have nerves of steel to be a first responder. Yeah,
and we should also say to once you're given a code. Um,
but you're like, that's not it's not static, like it
can change, You're you can deteriorate over right, switch tags
that person next to you, right, But no, you're absolutely right,
(33:38):
like to to to say, like I want to save
your life, but I can't. I've got to leave you
there to die. You're absolutely right. I mean it's metal,
not for me. That's metal in both spellings, two D
s and a T, you know, two teas and an
(34:01):
L E. Oh, it's M E T T L E.
Why do I think it was emmy D D L E.
Because it's like meddling. If you went and rearranged everybody's tags,
that would be meddling. It's amazing metal and like metal.
I know, it's amazing the amount of dope things I
say on the show, and people still think I like
(34:21):
have anything to offer the world. I've got you beat
by like four or five times. I think I don't
think so, I think so. Um, all right, well let's
talk a little bit about what's well, we've talked about
what's good about it, um, pretty much everything because it
will say ultimately more lives, yeah, but has its critics
well yeah, and a lot of times you know when
you go to the e er. We're not talking battlefield
(34:42):
or disaster, but when you go to the er, you
want to get seen as quickly as possible because it's
the worst. My thumb hurts, Yeah, and so long you
look around and you're like, well, that person doesn't look
so bad off, why are they going in? Or I've
been here for an hour. This guy just came in
and he got seen and he didn't look too bad
that the kids breathing, Yeah, why is he going ahead
(35:06):
of me? Yeah? I mean they hear a lot of
I mean e ers have to feel a lot of complaints,
yeah about wait times. And there's a lot of people
who end up in what's called the l w B
S category. Is that where they send complainers left without
being seen. Some people just give up there, like forget it,
I'm not sitting around here any longer. I could see
me doing that. Yeah, you just become indignant or you're
(35:28):
like I feel like eating some cereal. Well, I just
don't like to wait. And maybe it would have to
be something where it's subsided enough to rouse like I
think I'll be all right, right, not like an injury, right,
Unless I thought I could set it up myself or
Rambo style, which Emily's dad did once. What did you
like soda cut in his arm himself one time with
(35:51):
needle and thread? Did he put gunpowder in it and
light it on fire? He should have that would have
done it. Uh. And apparently that they interviewed someone from
for our House to Works article from our great children's
hospital here Scottish right, and this doctor said, especially at
children's hospitals, a lot of upset parents that don't really
(36:13):
get the triage thing. Well, um, there's been studies actually
that there was. There was one very famous study from
the nineteen nineties I think actually, and then it had
there was such an outcry against it as far as
criticism of the study went, because the study, the studies
findings were very critical the trio triage as a whole,
(36:35):
like the concept of it. Um that the authors actually
wrote another study responding to the criticisms of their original study.
And I was reading that and they're basically in the
original study they found that triage when it's actually done,
leads to longer wait times for the people who need
the most immediate care, like gets in the way, and
(36:58):
that it didn't have any impact patient satisfaction, meaning people
didn't feel like they were being cared for better than
when they weren't exposed to triage. So um, they the
the people just said this is what we found. A
lot of people were like, this is a B S study,
but it does make sense. There are critics to triage
(37:20):
saying like, no, this is unnecessary. Uh, it's clumsy, it
gets in the way. It's an extra layer, a barrier
between a patient and treatment. Um, like someone's gotta say
this guy's got a spoon in his ear. I think
for the most part, the critics don't have an alternative
(37:41):
and that you know, triage can help. But I think
there's a it's almost a cult of triage, where like, yeah,
of course triage helps. You're an idiot for saying anything different.
Scientists are saying like, it's not it's not perfect. Um,
but I don't know what an alternative would be in
the case of really scarce resources. Well, here's one, not alternative,
(38:03):
but one other way of doing things. And they did this,
uh at the Kaiser Permanent South Sacramento Medical Center Kaiser Permanente.
They forgot the e oh they did Kaiser Permanent. What
they said here, Um, what does permanente? I mean either
what does what does it think? It means permanent in Spanish? Okay,
who's kaiser? Uh? That means permanent in German? So the
(38:28):
permanent permanent. No, that means a role, A delightful type
of role that's permanent, a German role forever. Uh yeah
yeah four times. So. Um they employed something from the
l e A and the lean thinking principle in Japan
(38:49):
and their businesses. Is this like when they have people
do like calistinics and that kind of thing. Now, I
don't know, I want to look into what that is.
It sounds interesting. Well, it's like a cutting down on waste.
But I'm sure that the Japanese probably figured out a
way to insert calisthenics into it. Um are Actually I
might be thinking of China. No, Japanese are into too, okay. Um.
(39:15):
So they used this lead methodology and what they would do,
and this makes a lot of sense. It was sort
of like the two track thing. But if you have
the minor injury, you actually have a doctor come out
to the waiting room and treat you in the waiting room,
or at least see you at first in the waiting room.
(39:35):
And I think that definitely would give someone a sense
of while I'm being tended to, at least I'm not
just sitting over here holding my belly in pain. But
it's also not like, uh, you're on track to go
sit over there and wait for a bed to come
open so you can see. It's like, you there, you
don't have to wait for a bed. The doctor came
to you instead. Yeah, that's a great idea. And they
(39:56):
found it reduced the left without being seen rate from
four point five percent to one point five percent. Uh,
and the wait times fell by half. Yeah, that's right.
Wait times are one of my biggest complaints with modern medicine. Sure,
it's the worst. Your appointments at one, you get in
there at two. Oh man, boy, oh boy, you want
(40:20):
to see me get mad? Stick me in the waiting
room with bad magazines. But if you got some mad magazines,
you're like, this is delightful. The other criticism of triage
is that it shouldn't be done at all, That withholding
care under any circumstances is unethical. So I just have
like eight times as many doctors and nurses. I guess
(40:41):
it's come on. Uh, if you want to know more
about triage you're sorting. Um, you can type those words
into the search part how stuff works dot Com. And
since I said that it's time for listening mail, I'm
gonna call this lighthouse follow up. We've got a lot
of really great pictures and emails from lighthouse enthusiasts. Yeah,
it's pretty cool. Uh, including ones that were for sale
(41:03):
so I could live about my fantasy. Yeah. Are you
going to know how much are they didn't see? Um,
I don't know. I didn't. I don't remember any crisis
looking up on Zilo. I bought like two of them
and I didn't catch the price. You're just like, here's
a bunch of money. Bring me those lighthouses. Hey, guys,
I listened to your lighthouse episode and it was so
excited to hear this. Last year, I visited every lighthouse
(41:27):
on Oregon's coast her state. Uh, such a good year
long goal, That's what she said. I agree. Anyhow, I
wanted to tell you about one of our coolest in
my opinions, is Terrible Tilly. She was built on a
rock a mile off shore and see pictures is really neat.
(41:47):
That's what I needs. It's like just out there in
the middle of the ocean. Many men died trying to
construct in eighteen seventies, and many men died while keeping
the light that was decommissioned in nineteen fifty seven and
was sold after her sale, until he became a graveyard
so to speak. Sailors would be cremated and had their
ashes stored in the lighthouse. During the seasonal storms, when
(42:08):
the waves break into the lighthouse, the ocean chooses who
she takes back with her to be buried in her bosom. Well,
it's very poetic. It's pretty romantic in a Victorian or
Gothic way. I totally agree. Thanks for all you guys do.
I look forward to listening to your podcast every week.
And I evangelized stuff you should know, the stuff you
should know gospel to all my friends. And that is
(42:30):
from Kendra, and Kendra used the word evangelizing bosom in
the same email and Gothic, so that means straight to
the top of the pile. Thanks a lot, Kendra, that
was indeed to create email. Uh. If you want to
get in touch with us, you can tweak to us
a S y S podcast. You can join us on
Facebook dot com slash Stuff you Should Know You can
send us an email to Stuff podcast. The House suff
(42:52):
works dot com and has always joined us at our
home on the web Stuff you Should Know dot com.
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