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This week on Challenge Accepted, I'm going to see what it's like to be a triage officer in an emergency room during a mass casualty incident.

How about this come down?

Sounds good.

The catch is, I'm not a doctor.

And this entire hospital, it's not real.

We're putting Michelle through a real -life simulation of a one -hour mass casualty incident.

This is where real doctors, nurses learn we've essentially designed a live -action hospital video.

Over 30 actors playing patients, real nurses, and doctors.

Where Michelle will have to make split -second life or death decisions.

I'm worried about her.

Her airway's closer.

Can I make the vertical incision?

How do you tell someone that someone has died?

We've seen it a million times on TV, but how close is it to the real thing?

Everyone needs a tag.

Find out on this week's episode of Challenge Acceptable.

Simulation starts in three, two, one, two, one, two, one.

One.

We want to get to Southern California on alert this morning after getting hit by the largest earthquake there in two decades,

sparking more than 160 aftershocks.

You can see the damage of 500 people were hurt.

All right, there's an earthquake, so we're going to get people coming in left, right, and center.

Ambulances, people walking in, crawling in, personal cars.

Do we know how many are coming?

We have no idea so we have to prepare for anything

and that's where your triage skills are really going to be essential

That you need to sort all these patients

that are coming in My role as a triage officer is to quickly assess the patients arriving at the emergency department

And assign them a color based on their injury severity level with the hope of saving as many lives as possible So

if you've seen the pit what Michelle is going to be

experiencing today during an MCI is very similar with one big distinction They're actors.

They have lines.

Michelle does not know what she's walking into.

She has to rely on this one -day quick education that we presented to her.

So I don't envy her.

Dr. Mike, good to see you again.

Good to see you, yes.

I'm Dr. Mike Varshavski, board -certified family medicine physician and content creator online, especially on YouTube.

Star chest impressions!

One of the most influential medical educators online.

25 million followers, the legendary Dr. Mike Marschewski.

Yes, Dr. Mike is in our video!

So Dr. Mike has the incredible experience of not only being a healthcare and science communicator,

but also practicing every single week in the field on real patients.

So I asked Dr. Mike to come in and make this simulation as real as possible.

In one day, we're going to try

and simulate four years of medical school to teach Michelle what to do during the MCI.

What you're going to be going through tomorrow is very similar to what we train all our emergency department staff on.

Yes, I'm a doctor.

I'm a family medicine physician.

So the training I have doesn't really prepare me fully for an MCI.

It's the experts like Ryan, like Brett.

They're the ones who have the experience to not just practice it in real life,

but also to teach it on a very high level to doctors like myself.

So I'll be getting a lot of value today, too.

So we're going to teach you how to sort patients so

that we make sure that we can do the most good for the greatest number of patients possible.

How do I do that?

So there will be four categories I can sort patients into.

Whoa!

What the?

We have a simulated patient here.

I can do it.

Fortunately there's a tool available.

It's called Start Triage and we have a flow chart here that will direct you through the algorithm.

I love flow charts!

The Start Triage flow chart gives medical professionals a starting guideline

to quickly assess patients as as they are brought into the emergency room.

Starting with the green, we have the patients that are gonna be your most minimally injured.

The first question is, is the patient able to walk?

If yes, they're immediately assigned to green.

Please walk towards me.

Yes, that's already green.

Easy.

Bam.

We're done.

Ow.

Going on to yellow, this is called delayed.

So the patients that are definitely going to need care, but they don't need it right away.

Yellow means the patient cannot walk, but might still have stable vitals and mental status.

Breathing, they are breathing.

Respiratory rate is less than 30.

Okay, perfusion.

When you check for perfusion, you push down on their nail.

And when you let go, if it goes from white to normal color in less than two seconds, we move on to check their mental status.

Can you wave your hand?

Okay, so, you have a final answer.

The red patients are gonna be your most critical patients, the ones that need immediate medical care.

They have something that you're detecting is abnormal in either their breathing rate, their perfusion.

or the way that they're responding to you and following commands.

They're not walking.

Heavy breathing.

Respiratory rate is...

40!

High respiratory rate.

That's red.

These are the patients that have the most emergent needs.

100

The black category are the patients that are either deceased or, unfortunately, there's not a lot that can be done to save them.

101

It doesn't mean that we ignore them.

102

We're still going to provide palliative care, but unfortunately, just there aren't the resources available like there might be on a daily basis.

103

He is not walking.

104

Okay, are they breathing?

105

He is not breathing.

106

Can we position their airway?

107

So you would go over there, do a head tilt, chin lift.

108

This does not include CPR.

109

Unfortunately, again, because we only have one minute, and we don't have the resources to devote that many people,

110

that many resources to a single patient at this point.

111

But I like where you're going.

112

Okay.

113

I like that you're thinking about it.

114

Okay.

115

So unfortunately, we're going to have to tag this patient into the black category. That sucks.

116

I hesitate to put the black wristband on a patient.

117

It can be extremely challenging, and this algorithm helps you do a calculated evaluation on them that takes the emotion out of it.

118

After the incident, people start to break down.

119

They have big emotional outbursts because they were putting away their emotions for so long.

120

So expect after your simulation tomorrow to feel quite stressed out.

121

Simulation starts in three.

122

Two.

123

One.

124

Let's get started with our first set here.

125

My first challenge is to perform triage on an incoming wave

126

of patients who were injured in a collapsed apartment building during the earthquake.

127

Ma 'am, are you injured?

128

She's walking, so it's green.

129

I'm just gonna put this here, but if you're able to walk, go ahead and hit this way.

130

Excuse me?

131

Where do you feel pain, sir?

132

My knees are all cut up.

133

Okay.

134

Hi, are you able to walk towards my voice?

135

Yeah, I'm okay.

136

You could probably help somebody else while you help me.

137

Okay, okay.

138

Well, I'm just gonna tag you here.

139

This is gonna tell us how to treat you in the hospital.

140

Please head in this way.

141

Can you pull this thing out?

142

No, do not touch it.

143

So the first couple of people I see, they're walking, they're breathing, they're talking, they're responding.

144

I'm green.

145

Are you able to walk towards my voice?

146

There's confusion here.

147

There's confusion.

148

Why?

149

What is happening?

150

She's airways.

151

She's breathing.

152

She has airways.

153

Yeah, she's talking, but there's confusion.

154

I don't know what to tag her because she can walk, but her mental stats, I'm going to say yellow.

155

You have another patient.

156

You have to be quicker.

157

Get your staff out.

158

Michelle, your patient is leaving.

159

Oh my God.

160

But then the cases start to become trickier and a little more complex.

161

Like a patient who appears and they're able to walk, they're able to talk, but they don't seem all there mentally.

162

Trying to triage this patient is sort of like trying to have a conversation with someone

163

while also doing a math problem in your head

164

because I am trying to calm down the patient at the

165

same time trying to visually remember what the flow chart looks like and how I'm supposed to assign them.

166

Ma 'am, you have lots of cuts.

167

What?

168

I have cuts?

169

Yeah.

170

I have cuts?

171

Ah!

172

These are humans, so they're going to give you imperfect answers at times.

173

So when you're trying to evaluate someone's mental status, you say, give me a thumbs up.

174

They don't give you a thumbs up.

175

You can miscategorize them.

176

Hi, what are you working with here?

177

Okay, can you hear my voice?

178

Their guts are coming out of there.

179

Yeah, yeah, not important.

180

Okay.

181

What's important?

182

They can't walk.

183

Okay, I'm gonna put a red on this.

184

Okay, based on what?

185

Based on short of breath, can't walk.

186

What are we getting breaths -wise here?

187

He's breathing really slow, actually.

188

He is breathing really slow.

189

Okay, so you're going red, okay.

190

Okay, I'm just gonna use it.

191

That's okay.

192

Patriage isn't my only responsibility.

193

It is also my job to perform procedures on the patients that are most high risk that I categorized as red.

194

When you're in front of the hospital, you're triaging.

195

When you're inside the hospital, you're treated.

196

This guy's got an evisceration.

197

He's full blown on oxygen.

198

Still able to wake up a little bit.

199

Sir, are you still with us?

200

What do you think of the vitals so far here?

201

His heart rate is somewhat elevated.

202

Yes, he's tachycardic.

203

But what is the issue right here?

204

We need to cover it and dress through it and call surgery immediately.

205

Yes, you should love it.

206

So we're going to take a look at a patient that has an evisceration.

207

And an evisceration happens when you cut to your abdominal wall and some of your bowel comes out.

208

It's a really bad day.

209

It is a bad day.

210

You do not want to ever push the abdominal contents back in

211

because forcing them back in is actually not the correct move.

212

So this patient is going to have to go to the OR and see a surgeon to get it put back in.

213

But what you're going to do is you're going to try to preserve the bowel.

214

All of the medical professionals in this simulation are actual doctors and nurses who have been instructed to carry out my commands, even if I'm wrong.

215

What you want to get first is a big trauma dress.

216

This is sterile saline, and you're just going to pour some in there.

217

Now go ahead and pull it out and cover the bowel with that.

218

We are just going to cover the wound for now and prepare you to go into surgery.

219

Now this is like an inclusive type dressing.

220

It's going to help keep that moisture in.

221

Oh gosh, it has a very strong smell.

222

Yeah, there we go.

223

Let's put one there.

224

Now I want you to grab that roll of tape.

225

Perfect.

226

Okay.

227

Yeah, there you go.

228

Thank you for the assist.

229

Okay, did we call the OR?

230

Can we call him?

231

Yep, I'll call the OR.

232

Thank you.

233

OK, we'll get there all our prep.

234

OK, move on right away.

235

How are we doing in here?

236

We're done here.

237

The real Dr. Kare is actually not me.

238

It is my dad.

239

Growing up, I was actually on a course to become a physician, just like my dad.

240

Instead, I became a YouTuber.

241

So doing this episode is my one opportunity to hopefully make him proud.

242

Also, my dad says to subscribe.

243

So doctor's orders, you better subscribe.

244

The biggest issue that I'm seeing in Michelle right now is that she's making mistakes triaging patients.

245

Sir, can you hear my voice?

246

Yes.

247

OK, Brad.

248

I'm starting to see emotions creep up, panic set in.

249

She's freezing.

250

Can you walk towards my voice?

251

Can he walk on his own?

252

Yeah, yeah.

253

OK, OK, OK.

254

That's a green.

255

Yeah.

256

OK.

257

Green?

258

You see that?

259

Well, OK, chest injury.

260

But he's walking.

261

But he's not walking by himself.

262

Does anyone know what they're doing around here?

263

Red, red, red.

264

OK.

265

I'm just going to do red on that.

266

Once you miscategorize a patient, You're starting to give resources to that patient they didn't need.

267

You could be losing resources for people who can be helped.

268

This is the domino effect that if you make a mistake early, it can cause you a lot of harm down the line.

269

Hey.

270

Hey, can we get some help?

271

Can you walk towards my voice?

272

My wife cannot walk.

273

Okay.

274

Okay, they can walk so they're both green.

275

Somebody over here, please.

276

Okay. Where?

277

Okay.

278

Hey, my name is Dr. Kari, and we're going to treat you inside.

279

Keep going inside.

280

After I assign a color to each patient, they will be put into a room based on that color.

281

Now each of these rooms have limited beds, staff and resources.

282

And the problem is, if you mis -categorize someone, it creates a chain reaction of problems in the future.

283

For example, if a patient is over -categorized,

284

that patient will end up taking resources from someone who needs them more.

285

And a patient who is under categorized will ultimately not receive the resources they need and thus be at risk of death.

286

So this is kind of like a resource allocation challenge.

287

It sure is.

288

Okay, how do you feel?

289

That was so overwhelming.

290

Remember, you have secondary triage always after the fact.

291

Okay, I'm going to be more confident.

292

Okay.

293

While mistakes are bound to happen because patients are going to be changing their severity level, usually that severity only gets worse.

294

That's why there's always a consideration made for secondary triage where we can adjust for that and catch those mistakes early.

295

We're just sort of wondering when we can be seen.

296

We're getting around some vitals.

297

Maybe just see if any of those guys found their money.

298

When inside, try not to run.

299

Very easy with charms to get hurt.

300

Okay.

301

Remember, take care of yourself first.

302

All right, start.

303

Vomiting with head trauma.

304

Can you tell me what happened?

305

Something fell like a beam.

306

ABC, you have patience.

307

I'm going to teach you this basic trauma assessment.

308

It's called the primary assessment.

309

So first thing you want to know is just, do I have an airway?

310

So that's A.

311

Airway clear.

312

I'm going to check breathing.

313

The next one is B.

314

It's breathing.

315

Now we're seeing if their breathing is effective.

316

Breathing is OK.

317

You hear good breath sounds on both sides?

318

Yeah, I mean, do you want me to double check?

319

Yeah, yeah.

320

And then after that, we're going to move to circulation.

321

There's two big things you want to know about circulation.

322

One, you want to know if they have a pulse.

323

Then the second thing we're going to check is we're going to look for any major bleeds.

324

So now we've done airway, breathing, circulation.

325

Most of our problems are gonna happen in those three areas, and we'll have to address them to save that person's life.

326

Is there a reason why you classified her as red?

327

We could secondary triage her and change it.

328

I think we need to move her down to yellow.

329

We only have so many beds.

330

Yeah.

331

So I just wasted two gurneys.

332

Yep.

333

Make moves.

334

If you put someone into the red zone where they should be in the yellow zone,

335

just switching them could cause people to lose their lives you're using staff to mobilize those patients, and that can be really difficult.

336

It's gonna be this female right here, so she's been complaining of blindness in her left eye and some pain.

337

And I just have a lot of pain, and also my right ankle, I can't.

338

She cannot walk, she's blind in one of her eyes.

339

She's got glasses sticking out of it.

340

And the pain's really starting to kick in.

341

Like, is this gonna be, like, forever thing?

342

It may not ever gonna be able to see out of my eye.

343

I'm just freaking out a little bit.

344

Okay.

345

Yeah, yeah, I understand.

346

Can we get some care, like, now?

347

So right now, are you okay if I just put an IV hand in and give her some pain medications?

348

And we'll get some morphine again?

349

Okay, great.

350

We'll get some morphine and it'll help with the pain.

351

Okay?

352

It's gonna be...

353

I try not to lie to patients, right?

354

I don't say you're gonna be okay but I do try to, I think reassurance is very important during this stuff.

355

It's going to be, it's, uh, we're doing the best we can.

356

Okay.

357

Thank you so much.

358

Okay, this gentleman here has some abdominal trauma.

359

I'm fine.

360

Just find my people.

361

He's saying he's okay.

362

I need pain medications and a CT scan.

363

Okay, that sounds good.

364

I agree with that.

365

Four milligrams sounds good.

366

We're just waiting on that.

367

What are you doing here?

368

Nothing.

369

Literally nothing.

370

Keaton Everett.

371

He was the lead in the construction site and he's concerned about his med.

372

Okay, we'll just give him something for the anxiety.

373

Anxiety?

374

What, distress? For pain?

375

Four milligrams of morphine?

376

Okay.

377

I'm fine!

378

Is he allergic to morphine?

379

Are you allergic to morphine?

380

No, I'm...

381

That's like, I think we need to prioritize the patient's.

382

Okay, then do it.

383

Oh my God, okay.

384

Okay, what are you doing?

385

What are you doing?

386

Ask questions, ask questions.

387

She's unresponsive.

388

If you need to manage your airway on the EMS currently, feel free to do it.

389

Mike, I'm...

390

You wanna listen?

391

Do you want to listen first?

392

Yeah, yeah, yeah.

393

Listen?

394

Yeah.

395

Get some vitals.

396

So there's a lot of things that could be happening that are disruptive that you can't even plan for.

397

Being pulled in one direction then another direction is really difficult.

398

How much should they be squeezing?

399

Okay.

400

Um, every six seconds, right?

401

Yep.

402

Okay.

403

And then we should prep an IV for intubation so that we can give her medication so we can intubate.

404

Okay.

405

I'll get an IV started.

406

Okay.

407

We're gonna work on intubation, and that's where we're gonna secure somebody's airway.

408

We would have to put a tube down their throat to help them maintain their airway.

409

But the other thing it could be used for is breathing, too, because if somebody's not breathing, we could breathe for them.

410

Your vital signs are coming up.

411

Our sats are terrible.

412

Okay, sats are terrible.

413

You need to get an IV in quickly.

414

Non -dominant hand.

415

There we go, because you want to control the tube with your dominant hand.

416

And this has to be in a place that you can see it, not where the nurses can see it.

417

I am ready, yes.

418

Okay.

419

120 sucks us in.

420

Okay.

421

You have your monitor.

422

What are you looking for?

423

What do you see?

424

I'm looking for the epiglottis.

425

And then just slide that in there.

426

Nice.

427

You see, that's the epiglottis.

428

There you go.

429

Try to hit in the middle of the epiglottis.

430

Back up.

431

Oh, I heard teeth.

432

Oh!

433

I just broke someone's tooth.

434

Malpractice.

435

Okay.

436

Oh, my God.

437

And you're going to take that.

438

And then this is the twisting thing once it's in there.

439

Twist it.

440

There you go.

441

Push it just a little bit further.

442

Boom.

443

Okay, good.

444

Now then, pop this out with your thumb.

445

Out towards the stomach.

446

Out towards the stomach.

447

Out.

448

Then bring it forward.

449

Grab it with your other hand.

450

This.

451

Good.

452

So then I will come up here, and bagging it means assist ventilations.

453

Attach.

454

Put on your stethoscope.

455

Put on your stethoscope.

456

Quick.

457

Check the stomach first.

458

Okay, it's not on the stomach.

459

Okay.

460

Chess rises present.

461

Good on the left side.

462

Good on the right.

463

O2 sat's coming up to 94.

464

Okay, that's good.

465

Okay, do you want them to secure the tube?

466

Yes, secure the tube.

467

She's stable.

468

What do you want to do?

469

Now we need to push 50 micrograms of fentanyl, 2 milligrams of Versed, and a propofol drip, please.

470

Can someone repeat that back to me?

471

Okay.

472

50 of fentanyl, 2 of Versed, and propofol drip.

473

Yes.

474

Thank you.

475

Okay.

476

During an earthquake, you're having all sorts of scenarios happen at the same time.

477

But then you're also having really surprising incidents.

478

Seeing a young child, someone you feel bad for.

479

Hi.

480

Can you hear me?

481

Can you come towards me?

482

Okay, she's able to move.

483

Let's see if she can walk.

484

I can't walk.

485

You can't walk.

486

Let me feel her pulse.

487

Let me see your wrist. Does that hurt?

488

Okay, you have multiple patients.

489

Okay, got it.

490

There's lots of different people speaking lots of different languages.

491

Sofia, mi hija Sofia, donde estas?

492

Okay.

493

Lo siento hablo espanol.

494

Muy malo.

495

Uh...

496

Can she walk?

497

Can she walk?

498

Sabes donde eres?

499

No. She doesn't know where she is.

500

Mi hija Sofia, donde estas?

501

What do you think about that?

502

Fracture, which she can breathe.

503

She has a pulse.

504

I think it's yellow.

505

I think it's yellow.

506

Okay, fair.

507

Tell your staff.

508

And that's why during an MCI like this, you have to be prepared for absolutely anything.

509

My water broke about 20 minutes ago.

510

Wait a minute.

511

Okay.

512

Can we get a stretcher for her?

513

Her water just broke.

514

Michelle, there's two people.

515

We're still going to have patients that are coming to the hospital for other things

516

that were not related to this specific incident.

517

We should still triage them because we're overflip.

518

Correct.

519

It's for everyone because it is balancing the resources

520

that are available for everyone with the number of people that are coming in.

521

Hi, can you talk to me?

522

Yes.

523

Tell me what your name is.

524

Genevieve Fink.

525

Okay, what's going on?

526

My water broke 20 minutes ago.

527

20 minutes ago.

528

Are you having contractions right now?

529

Yes, right this morning.

530

How far apart are they?

531

Two minutes.

532

Two minutes.

533

Okay, yeah, let's proceed with green.

534

The ladies are going to deliver a baby, I think.

535

Do we have OB room a bit?

536

I called OB.

537

You want to put her in a room?

538

Call Dovey.

539

And any response?

540

No. I'll call him again.

541

We need to have the 11.

542

Why did you change to Rhett?

543

Because she's about to deliver a baby.

544

Okay.

545

That's not on the algorithm.

546

I don't know what to do about that.

547

So this patient.. is about to give birth.

548

But because of all of the mistakes I've made, over categorizing people, all of the operating rooms are now full.

549

See, her contractions are getting closer and closer.

550

Like if she starts to deliver, I told her we're gonna have to cut her pants off.

551

I just, we're out in the open, so.

552

Meaning I now need to perform a procedure on one of the red tagged patients so that I can create space.

553

Um.

554

Yeah.

555

I'm seeing what I'm seeing.

556

I got another co -worker I still haven't been told what's going on with him.

557

This was not going well.

558

I'm worried about her.

559

Her airway's closed enough.

560

Her airway's just swelling up.

561

We need to do rapid intubation.

562

Yeah, I mean, we could try.

563

She's got a lot of swelling.

564

Can we go through a cry?

565

That would make sense.

566

Then we need to prepare for a cry.

567

Okay, we're waiting for you.

568

When you're ready, he's ready.

569

Okay, great, great, great.

570

I need the scalpel.

571

There you go. And this.

572

All right, now I'm going to be feeling for the thyroid cartilage.

573

Good.

574

And I'm going to make the vertical incision between thyroid cartilage and the cryo ring.

575

Okay, I'm cutting through the skin now.

576

Okay.

577

It just seems like after the pain medicine, she started to feel really dizzy.

578

Ow!

579

Sorry, my dear.

580

We're going to get her into the yellow.

581

We need to work with her lining.

582

We're right.

583

Okay.

584

I think this is right.

585

How far are you going to push this in?

586

Just a few inches so that we don't go down into the lungs.

587

Correct.

588

Is that the direction?

589

Thank you.

590

Can somebody pay attention to me please for a moment?

591

Hey!

592

You're last in line, bro!

593

Dude, I got here before you.

594

I don't care.

595

He can't feel his legs.

596

She can't see.

597

Okay, can we prepare a syringe so I can inflate it?

598

Tube.

599

Put it up on the tube.

600

No!

601

No!

602

No!

603

Can we just have you sit down?

604

Now this comes out.

605

Now this comes out.

606

Now this comes out.

607

And switch the CO2 onto that.

608

Okay.

609

And I promise I will call them and we'll make sure that she's taken care of.

610

You will call them?

611

Yes.

612

And they have not been called?

613

The longer that I speak to you, I can't get on the phone.

614

Okay, but can you...

615

Please take a seat and I will call to you.

616

How have you not called when we talked about it like 20 minutes ago?

617

Oh.

618

Yo, dude, dude, dude.

619

Get back in bed.

620

Oh my God.

621

The baby's coming.

622

Get back in bed.

623

Oh.

624

Hey, what's going on here?

625

Get back in bed.

626

Hey, real quick.

627

I got this.

628

Okay.

629

Okay.

630

Gold is good.

631

Let me listen to see if it's working.

632

Okay.

633

What are you listening for?

634

I'm listening to make sure that it's both lungs and not just one.

635

Oh, wait, I think I know you.

636

Wait, I know her.

637

I know her.

638

Why are you just kidding me?

639

What is happening?

640

Come on.

641

Repeat back.

642

I think it's working.

643

Okay.

644

Brad, do you feel good?

645

Yeah, I'll check it out.

646

Okay.

647

Hey, can we get the OB kit?

648

We have got to get her jeans off because that baby can help.

649

Yeah, I think she's going to deliver any second time.

650

What do you think?

651

Should we cut our jeans off?

652

Where's my doctor?

653

Get the scissors.

654

All right, come on.

655

Okay, okay.

656

Um...

657

We did a video on how to deliver a baby two years ago.

658

But that was two years ago.

659

I don't remember anything on how to do this.

660

Um...

661

Do your best.

662

Open the kit.

663

Start the process.

664

Ma 'am, Dr. Kari's here.

665

She's going to do a great job.

666

My back hurts so bad.

667

She's going to cut your jeans, okay?

668

Set this up.

669

Set this up.

670

I, uh, this is crazy.

671

This is actually crazy.

672

So we should cut her clothes off.

673

Yes.

674

Hey, listen real quick.

675

Obi just called.

676

They are upstairs.

677

The doc said he'd much rather deliver this baby upstairs.

678

I would much rather that, too.

679

Are you okay?

680

Is she stable enough for that?

681

Yes.

682

Or do you want to deliver here?

683

I think she's got to go see an upstairs.

684

Yeah, the doc says it's much better upstairs for this.

685

Tell the patient.

686

Okay.

687

We're headed up now, okay?

688

Give us five minutes.

689

We'll be there in five minutes, okay?

690

Okay, thank you.

691

Oh, thank God.

692

Easy breaths, easy breaths.

693

You're doing well.

694

But the chaos still isn't over.

695

While I was treating my patients, my staff was triaging even more patients who were now flooding into the hospital.

696

Mom!

697

Mom!

698

This is Mom.

699

Hey, Mom.

700

What's Mom's name?

701

It's Ruth.

702

Hey, Ruth.

703

It's Jack.

704

Hey.

705

The hospital is quickly approaching critical mass with every room at full capacity.

706

If my wife goes blind, I'm gonna f*ing sue you guys.

707

Like, I don't know what to tell you.

708

We get it.

709

You're important, right?

710

We get it.

711

You're the most important.

712

We've been here four times longer than you do.

713

I just checked in on this.

714

You're still in line.

715

What position in line?

716

When, when, how do I know if we're moving closer or farther?

717

And all these people are coming, we just get bumped down again and again.

718

And my wife's gonna go f*ing blind.

719

I just checked in and that's the best for you.

720

Michelle, this patient doesn't look good.

721

Do you want to check vitals?

722

That's the best you could do?

723

It's the best we can do.

724

There are tons of people here.

725

Yeah, I see that we've been here longer than all of them.

726

I think what's really difficult to grapple with is that on a normal day in the emergency room, many of these debilitating injuries could be resolved.

727

But because it is a mass casualty incident, you have to pick and choose and ultimately try to save the most number of lives possible.

728

This means making really difficult decisions like choosing to allow a patient to go blind

729

because those resources need to be used to save the life of someone else.

730

This is a patient that I miscategorized.

731

Maybe she could have gotten treatment sooner if I hadn't messed that up.

732

I'm leaving.

733

Sir.

734

I have scratches on my legs and I have a dog that's locked in.

735

These are all her current vitals.

736

She got two milligrams of morphine and she has an IV in place.

737

It's me.

738

I'm so fan of this stuff.

739

She's still looking for a child.

740

Did we call...

741

What about the young child that came in earlier?

742

Could that be her child?

743

Please, Michelle.

744

Michelle.

745

Michelle, they want a CT scan.

746

Okay, we got a CT scan.

747

Ma 'am.

748

It's very easy to freeze, to feel overwhelmed.

749

And I'm worried about Michelle feeling that emotion in the midst of all of the drama that's ongoing.

750

Patients screaming, family members getting angry about time.

751

Hello?

752

Oh, s*.

753

I didn't close it.

754

Sir, if you continue to raise your voice, I'm going to have to ask you to leave.

755

Please, please, please cooperate with that.

756

Come on, squeeze, squeeze, squeeze, squeeze.

757

You need to be able to snap yourself out of it quickly in order to respond to the call

758

that is your patience.

759

Can you talk to us?

760

Can you start a BBM?

761

Can you wake up?

762

So we just could have been down a couple more inches, get her out, and then we can put in there.

763

I want to take a look.

764

You call them red, but he's agonally breathing.

765

He hasn't been responsive since you've seen him.

766

Then I think we have to move into black.

767

Okay, make choices, make choices.

768

Due to my mistakes, every red room is completely full.

769

And there was a chance that if I had been more efficient with my resource allocation, there would have been space available,

770

and we could have saved this patient.

771

But I didn't.

772

And so I have to make a really difficult choice to give him a black tag.

773

Having to be so objective about black tag is horrible, especially in a situation where if it wasn't an MCI,

774

we could have done chest compressions to try and save them.

775

But to, like, actively have to say, we have to walk away from this person.

776

That's so hard.

777

So we will have to get the name, which I'll go get with the ENTs, just for the toe tag.

778

I feel so overloaded with stimuli and decision -making fatigue

779

that I feel like I just need to sit in a quiet room and look at a wall for a few hours.

780

I have no good news for anyone,

781

and like, emotionally, not being able to provide closure is very difficult for me, and in general.

782

Brett?

783

Yes.

784

The black tag patient that came in.

785

Yeah.

786

Was he at the construction site with the other two?

787

They are.

788

That is part of the construction crew.

789

With HIPAA, are we allowed to tell them?

790

Just making sure.

791

You're a call on this.

792

Sir, can you hear my voice?

793

They did recover Brunson.

794

He came to the hospital, but when he arrived, he was unresponsive.

795

He's unfortunately passed.

796

I just wanted to tell you...

797

...because you were asking about him.

798

Thank you.

799

I'm...

800

I'm very sorry to tell you this news.

801

What we're going to experience and show the general public with this MCI is happening at scale with our healthcare system.

802

We are facing a tremendous shortage, stress, difficulties trying to give them care with limited resources.

803

So if you don't want this MCI style of healthcare, we need to make changes.

804

And I'm hoping that it starts with being kind to healthcare frontline workers,

805

being gracious when you're going in and understanding that they too are humans first and are under tremendous amount of stress.

806

Second, understanding how beautiful and limited life is, that it can be pulled away from you at any moment,

807

and you need to be grateful for it.

808

You ready for your grade?

809

Okay.

810

If we had to break up the categories for which we grade Michelle, we start with triage.

811

So we're going to have to give her an F on that one, because there were times where she was a bit panicked.

812

She was starting to get caught up.

813

Treatment, I'll give her a B minus.

814

She didn't know exactly what to do in a lot of the scenarios, not surprisingly so, but then where she really was shining is in communication.

815

Just being able to work with your team and to move people around and to prioritize and to keep checking in,

816

that is really what would save lives in a situation like this.

817

For a human being to have to be the decision maker,

818

even just today having the microscopic taste of what that means and what that feels like,

819

I have infinite love and admiration for anyone who does this profession.

820

Most people at any given moment are not sick.

821

But I can say with 100 % certainty, there will be a moment where they will be sick, where they need care.

822

Think about habits that you can change in your life, that you can improve your health, to perhaps have a better quality of life for longer.

823

This episode is dedicated to healthcare professionals everywhere who save lives every single day in real life.

824

If you enjoyed this episode, please consider subscribing.

825

And you can check out this other episode

826

I did where I worked a real 24 -hour paramedic shift in a real ambulance.

827

If you enjoyed this episode, I think you're going to love that one.

828

Till then, I'll see you in the next challenge.

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このレッスンの語彙とスピーキングのポイント

このスピーキングレッスンは、動画「I Tried Working an Emergency Room」を教材にしています。この動画には、シャドーイング用の文が827文、単語が5814語あります。音声の長さは30:54です。話す速さは速く、1分あたり約188語です。音のつながりや弱く発音される音が多くなります。単語の85%は英語の頻出3,000語に含まれます。残りは練習の前に確認しておきましょう。全827文のうち132文が疑問文なので、疑問文のイントネーションや短い受け答えの練習に向いています。

この動画の重要語彙

動画に出てくる覚えておきたい単語15語を、発音と意味つきで紹介します。

単語	発音	意味
breathe 動詞	/bɹiːð/	呼吸する, 息をする
tube 名詞	/tuːb/	チューブ
simulation 名詞	/ˌsɪm.jəˈleɪ.ʃn̩/	真似, 模擬
chart 名詞	/t͡ʃɑɹt/	チャート, 図表
stomach 名詞	/ˈstʌmək/	胃, 胃袋
nurse 名詞	/nɝs/	看護師, 看護士
emotion 名詞	/ɪˈməʊ.ʃən/	感情, 心緒
earthquake 名詞	/ˈɝθkweɪk/	地震
trauma 名詞	/ˈtɹɔm.ə/	外傷, 損傷
squeeze 動詞	/skwiːz/	押す, 締め付ける
upstairs 副詞	/ˌʌpˈstɛɹz/	階上
assign 動詞	/əˈsaɪn/	割り当てる
stable 名詞	/ˈsteɪ.bəl/	馬小屋, 厩舎
confusion 名詞	/kənˈfjuːʒən/	混乱
physician 名詞	/fəˈzɪʃən/	医者, 医師

動画に出てくる句動詞

単語	発音	意味
come out 動詞	/ˌkʌm ˈaʊt/	出る
come up 動詞		上がる, 登る
go ahead 動詞	/ˌɡoʊ əˈhɛd/	どうぞお先に
wake up 動詞	/ˌweɪk ˈʌp/	目覚める, 目を覚ます
calm down 動詞		落ち着く
carry out 動詞	/ˈkæ.ɹi aʊt/	行う, 実行する
check out 動詞		試験する, 検査する
come down 動詞		降りる

繰り返し練習したい文

動画に出てくる短く完結した文です。日常会話でそのまま使えます。

Can I make the vertical incision?
Do we know how many are coming?
How do I do that?
Can you wave your hand?
That's the best you could do?

この動画の文法

話し手がよく使っている文型を、動画の実際の表現とともに紹介します。

文型	動画での表現
現在完了形 have/has + 過去分詞 — 過去の出来事が今も関係している	We've seen · you've seen · have been instructed
受動態 be + 過去分詞 — 誰がするかより、何が起きるかに焦点を当てる	were hurt · are brought · is called
関係詞節 who / which + 節 — 人や物について情報を加える	ones who have · people who can · someone who needs

注意したい発音

話し手はI'm, we're, you'reなど、短縮形や弱形を197回使っています。聞こえたとおりの短い形で発音しましょう。

「th」の音: breathe /bɹiːð/, earthquake /ˈɝθkweɪk/, algorithm /ˈælɡəɹɪðm̩/, thumb /ˈθʌm/, thyroid /ˈθaɪ.ɹɔɪd/
「sh」と「zh」の音: simulation /ˌsɪm.jəˈleɪ.ʃn̩/, emotion /ɪˈməʊ.ʃən/, confusion /kənˈfjuːʒən/, physician /fəˈzɪʃən/, medication /mɛdɪˈkeɪʃən/
長い単語（アクセントの位置に注意）: medication /mɛdɪˈkeɪʃən/, circulation /ˌsɝkjʊˈleɪʃən/, respiratory /ɹɪˈspɪ.ɹət.ə.ɹi/, severity /səˈvɛɹ.ə.ti/, casualty /ˈkæʒu.əlti/

日本語話者が苦手な音：

/r/ と /l/ の区別 — /l/ は舌先を歯茎につけ、/r/ はどこにもつけない: algorithm /ˈælɡəɹɪðm̩/, horrible /ˈhɔɹ.ɪ.bəl/, grateful /ˈɡɹeɪtf(ə)l/, rely /ɹɪˈlaɪ/, legendary /ˈlɛd͡ʒ.ənˌdɛɹ.i/
/v/ — /b/ にならないように、上の歯を下唇に当てる: vital /ˈvaɪtəl/, severity /səˈvɛɹ.ə.ti/, vertical /ˈvɝ.tɪ.kəl/, arrive /əˈɹaɪv/, objective /ɒbˈd͡ʒɛk.tɪv/
/f/ — 「フ」ではなく、上の歯と下唇で出す: confusion /kənˈfjuːʒən/, physician /fəˈzɪʃən/, freeze /ˈfɹiːz/, efficient /ɪˈfɪʃənt/, grateful /ˈɡɹeɪtf(ə)l/

この動画での練習方法

まず声を出さずに動画を最後まで聞き、知らない単語をメモします。
まず0.75倍速で一文ずつシャドーイングし、慣れてきたら通常の速度に戻します。
自分の声を録音して元の音声と比べます。breathe, tube, simulationなどの単語に特に注意しましょう。

シャドーイングとは？英語上達に効果的な理由

シャドーイング（Shadowing）は、もともとプロの通訳者養成プログラムで開発された言語学習法で、多言語習得者として知られるDr. Alexander Arguelles によって広く普及されました。方法はシンプルですが非常に効果的：ネイティブスピーカーの英語を聞きながら、1〜2秒の遅延で声に出してすぐに繰り返す——まるで「影（shadow）」のように話者を追いかけます。文法ドリルや受動的なリスニングと異なり、シャドーイングは脳と口の筋肉が同時にリアルタイムで英語を処理・再現することを強制します。研究により、発音精度、抑揚、リズム、連音、リスニング力、そして会話の流暢さが大幅に向上することが確認されています。IELTSスピーキング対策や自然な英語コミュニケーションを目指す方に特におすすめです。

シャドーイングのやり方: ステップ別の完全ガイドを読む →

シャドーイング練習: I Tried Working an Emergency Room - 動画で英語スピーキングを学ぶ

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このレッスンの語彙とスピーキングのポイント

この動画の重要語彙

動画に出てくる句動詞

繰り返し練習したい文

この動画の文法

注意したい発音

この動画での練習方法

シャドーイングとは？英語上達に効果的な理由