Chapter 152
“Ha, no.”
Fourteen.
And the dozens of patients who would come in after them.
If they all mixed together and became a cauldron of chaos, the patient who really needed care could get shoved into a corner and die.
Triage.
Classification is life itself.
‘For now, it’d be better if I went out myself.’
I burst out of the resuscitation room and ran out.
Tap-tap-tap.
I sprinted toward the main entrance of the Emergency Medical Center.
Screeeech!
An ambulance arrived, and the rear doors swung open.
Rrrrattle-!
“Male in his late twenties! Breathing—his breathing is a little rough! He inhaled a lot of smoke!”
A paramedic hurried in, pushing the gurney.
The patient was coughing while propping up his upper body.
“Cough! Cough! Ugh… Hahk!”
Ptui.
The patient spat onto the floor.
Jet-black phlegm.
It was carbonized spit mixed with charcoal dust.
In cases like this, you usually suspect an airway burn.
I immediately rushed over to the patient.
“What’s the patient’s SpO2(* oxygen saturation)?”
“Uh… it was 98 when we checked on the way here! It’s holding well.”
98%.
He wasn’t going to stop breathing just yet.
But airway burns were a delayed attack.
Even if he looked fine now, his throat could swell up an hour later and he could suffocate and die.
Is it an upper-airway problem?
I took out a penlight and shone it into the patient’s nose and mouth.
I needed to check.
“Hold still! Tilt your head up!”
The light pierced into his nostrils.
Nose hair.
It hadn’t burned.
Fine.
There was a little soot, but no sign of the mucosa peeling or blistering.
“Open your mouth! Say ahh!”
“Ah… aaah….”
Around the uvula and epiglottis.
No swelling for now, and no obvious mucosal damage either.
So, no swelling or mucosal damage.
It was just smoke inhalation.
“Can you say something, sir? What’s your name?”
“Cough… huh? Park… Park Min-won.”
His voice was clear.
No hoarseness, and no stridor when he inhaled.
Which meant his vocal cords were fine too.
This wasn’t a person who was going to die right now.
Meaning there was no need to intubate him right now.
“Triage him as minor, and just give him oxygen just in case! Five liters and send him to B Zone!”
“Yes! Moving him now!”
The nurses pushed the stretcher and wheeled him off to the right.
Before I could even catch my breath, the next ambulance stormed in.
Rrrrattle-!
“Aaaaagh! It hurts! My hand! My hand!! Aaaagh!”
The instant the doors opened, a horrific scream slammed into my eardrums.
A young man was writhing while clutching his right hand.
“Thirty-three-year-old male patient! He burned his hand grabbing a hot door handle bare-handed while escaping!”
The paramedic rushed in, holding the patient’s right hand wrapped in gauze.
I ran over and lifted the gauze slightly.
The blisters had burst, peeling off the epidermis, and the exposed dermis was red and inflamed.
‘At this level… a deep second-degree burn.’
Fluid was oozing from the peeled skin.
The nerves were still alive, so the pain would be intense.
But his airway was open, and his vitals were stable.
The hand is a functionally important area with joints, so it qualifies as a severe burn site under burn-center admission criteria, but….
It wasn’t a situation where his heart would stop right this second.
If I had to decide whether he’d live or die right now?
‘Borderline.’
His airway was fine, and his blood pressure was normal too.
Only his hand had been burned.
It was too wasteful to send this to the resuscitation room or A Zone.
That was where full-body burns or shock patients belonged.
Pain control and dressing were urgent, though….
‘B? A?’
A half-second of hesitation.
‘B, for now.’
I could just hit him with painkillers and do the dressing.
I had to keep A Zone open for worse critical patients, like full-body burn cases.
There were four resuscitation rooms in total.
If the resuscitation rooms filled up, even super-emergency cases would have to go to A Zone.
“Ah, yes. For now, he’ll go to B Zone, meaning minor!”
“Yes! Understood!”
Two patients triaged.
Beads of sweat formed on my forehead.
That was when it happened.
From the opposite side—that is, from the back door of the Emergency Medical Center connected to the hospital interior—a group in white coats came rushing out.
Are they saviors?
Did the professors come?
There looked to be at least four or five of them.
They were huffing as they ran, which made them look even more frantic.
“Doctor! Hah, hah… we came down from our ward… We got the call and came!”
The man in front shouted, gasping for breath.
I quickly scanned their name badges.
[Doctor Hwang Jin-myeong]
[Doctor Oh Seung-woo]
…
No department listed.
It just said doctor.
In cases like this, they were either general practitioners or, at a university hospital like ours, usually interns.
‘They’re rookies….’
I’d been hoping for specialists, senior residents, or at least junior residents, but the first people to arrive were interns.
I felt a bit disappointed, but this wasn’t the time to be picky.
Either way, they had hands and feet.
I might as well use them as dressing runners.
“Anybody here with some seniority? Someone who’s done this before?”
“Uh… we all started this month….”
Ah, shit.
Right, it was March.
I lowered my expectations drastically.
“Got it! You two, resuscitation room! You two, A Zone! And the rest of you—B Zone! Split up! Hurry!”
“Huh? Ah, yes!”
The interns looked around helplessly, flustered.
“Listen only to the emergency medicine resident in charge there! Don’t act on your own—just do what you’re told!”
“Yes!”
“Do you know when the residents or doctors from other departments are coming? Are you the only ones here?”
When I asked, the intern in the back answered hesitantly.
“Uh… I heard they’re on their way.”
“Got it, now go! Run!”
As soon as I sent the interns to their zones, the automatic doors opened again with another siren.
Rrrrattle.
This time it was a wheelchair.
“My stomach feels queasy… I keep feeling like I’m going to throw up….”
A late-teen girl clutching her head.
Her face was pale.
“Female teenage patient! She walked out of the scene on her own, but was transported for dizziness and headache! Vitals are BP 110 over 70, pulse 100!”
No burns.
No trauma.
Headache and nausea are the most common symptoms at a fire scene—in other words, carbon monoxide poisoning.
In that case, the treatment was simply to give high-concentration oxygen and wash out the carbon monoxide.
‘Send this one to a secondary hospital...’
Was triage off because she was an initial transport patient?
There was no need to lay her down on a bed.
“Uh… take her to the hallway. Just sit her in a hallway chair and give her 15 liters through a reservoir mask.”
“Yes! Understood!”
The paramedic pushed the wheelchair away into a corner.
Rrrrattle.
I rubbed my face dry.
“Ha….”
I’d only taken in three patients.
‘And I’m already drained, even though they’re all minor cases...’
Then it happened.
Someone called me urgently.
“Dr. Han! Dr. Han Hyeonjae!”
It was first-year Yoon Tae-hyun, who was in B Zone.
‘What now?’
Did the burn patient I just sent start crashing?
I frowned and turned my head.
“What?”
“Um… we’re trying to flush the hand-burn patient you sent earlier.”
Yoon Tae-hyun looked around awkwardly.
“We need to move him to the treatment room and wash it out, but the transport stretcher….”
“Ha.”
They needed to flush the burn area with saline, and since the water would run onto the floor, they were trying to move him to a treatment room with drainage.
“Just pour it on the bed!!”
Frustrated, I shouted.
“Just pour it straight on! It’s okay if some spills on the floor, so hurry up and get the heat out first!”
“Ah, oh. Yes! Understood!”
Yoon Tae-hyun jumped and tried to run off.
“Wait! And!”
I called Yoon Tae-hyun back again.
“What was it, call PS(* Plastic Surgery) as soon as they arrive and ask them to help with debridement(* removal of necrotic tissue) on the burn patients! We’re short-handed!”
“Yes! Understood!”
Yoon Tae-hyun hurried off in a fluster toward B Zone.
‘Endure.’
He’d only been an emergency medicine resident for less than a month.
Responsibility was different from when he was an intern, so it was only natural he’d hesitate.
Endure.
Endure….
Wee-oo-wee-oo!
Before I could even carve “endure” into my mind three times, another siren sounded.
Rrrrattle!
“Thirty-six-year-old male patient! History of asthma! After inhaling smoke at the fire, his Dyspnea(* shortness of breath) is really severe now!”
A paramedic hurried in, pushing the gurney.
The patient was gasping, his shoulders heaving.
The classic tripod posture.
It’s the posture people instinctively take when they can’t breathe.
“We gave him 10 liters of oxygen on the way, but his SpO2 won’t rise past 92! BP 150 over 90, pulse 120!”
An asthma patient inhaled smoke.
His airway had obviously constricted.
“Ah, yes! This way!”
I grabbed my stethoscope and rushed to the patient.
“Stethoscope. Hurry….”
I pulled the stethoscope I’d stuffed into my pocket and placed it on the patient’s chest.
Wheeze- wheeze-
The sound of air forcing its way through narrowed airways.
Wheezing.
It was an asthma attack.
The smoke irritated the airway and caused the bronchi to constrict.
If I left it like this, the airway would close completely and he’d suffocate.
“Mix Ventolin and Pulmicort and start a nebulizer right away! Prepare IV steroids too! Move him to B Zone!”
“Yes!”
The nurses pushed the stretcher, patient and all.
So far, this was still manageable.
For now.
Rrrrattle.
The doors opened again, and when I saw what was beyond the opening, a curse burst from my mouth.
“Ah, fuck.”
The paramedic’s gloves were soaked with blood.
The patient’s leg was twisted grotesquely, with bone sticking out through it.
The skin around it was blackened and charred.
“Forty-two-year-old male patient; he fell from the equivalent of a third-floor height during the explosion! He has an open fracture(* compound fracture) of the right lower leg and a third-degree burn! Heavy bleeding!”
The paramedic’s voice shook.
“BP is 80 over 50 and pulse is 30 per minu….”
“Ah.”
80 over 50.
Hypovolemic shock.
But a pulse of 30?
In shock, the pulse should be fast, but this was slow.
Bradycardia.
It was either combined with neurogenic shock, or he was right on the verge of arrest.
Either way, it was the worst possible situation.
“Ah, yes! I’ll get another line and send him straight to the resuscitation room! Eun-seo!”
I shouted toward Baek Eun-seo, who was in A Zone.
“Yes!”
“There aren’t any patients in A Zone right now, so go to the entrance and handle triage for me! I need to stay with this patient!”
“Ah, yes, Doctor! I’ll take it!”
Baek Eun-seo ran out.
“If A Zone gets a patient, toss it straight to the triage nurse!”
“Understood!”
As soon as I gave the orders, I grabbed the stretcher with the fall patient and ran to the resuscitation room.
Rrrrattle.
Thud!
“Sir! Move your big toe! Can you feel me touching it right now?”
“I’m cold… water… some water… my leg… my leg….”
He was conscious, but hazy.
“Ah, shit, this is insane.”
I’d check for nerve damage later.
He’d lost too much blood.
On top of that, the wound was a mess of burns and fractures.
First, it had to be washed out.
“Moving the patient. One, two, three!”
Just as the resus team moved the blood-soaked patient onto the resuscitation bed, I spotted a doctor who looked unusually restless.
‘That’s the one who said they came down from the ward earlier?’
“Hey, intern!”
“Yes! Yes!”
The intern came running over, startled.
“Bring saline right now and flush the wound area immediately!”
“Uh… how much should I use…?”
“Three liters! No, just keep pouring! If it’s not clean, pour more! Keep pouring until the bone fragments and debris are washed out!”
“Yes! Understood!”
The intern ran to get the IV fluids.
I gave the nurse orders quickly.
“Please run cefazolin mixed with gentamicin and give him a tetanus shot! His pain is severe, so give 5 mg of morphine first and we’ll give more depending on his response!”
“Understood, doctor!”
Nurses moved busily, and interns ran in carrying saline containers.
And me, standing in the middle of that hellscape.
It felt like an hour had passed.
I suddenly lifted my head and looked at the clock mounted on the resuscitation room wall.
‘It’s only been around ten minutes. Fuck.’