Stuff You Should Know - How Triage Works

Episode Date: July 26, 2016

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. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

On the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s.

We lived it, and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. Do you ever think to yourself, what advice would Lance Bass

and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. And a different hot, sexy teen crush boy bander each week to guide you through life. Tell everybody, ya everybody, about my new podcast and make sure to listen so we'll never, ever have to say. Bye, bye, bye.

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Go to squarespace.com and set your website apart. Welcome to Stuff You Should Know from howstuffworks.com. Hey, and welcome to the podcast. I'm Josh Clark, and there's Chuck Bryant, and there's Jerry and Stuff You Should Know. How's it going? Pretty good. You like my Scotland shirt?

That's great. You're going to wear that in Scotland? Yeah, that's why I got it. Oh, OK. I got a shirt for each city. Nice. Scotland Country. Well, Edinburgh.

Yeah, yeah. That's a city. Yeah, I think they'll be behind the Scotland shirt in Edinburgh. I think they will, too. They're going to stand up and do that arsineo, like, woo, woo, woo. Yeah, because they're living in the 80s. Yeah, I bought a shirt for each city on our UK tour,

because I'm just, you know, I can write it off. And that's just a very me thing to do. Yeah. I'll keep the Manchester shirt a secret. Oh, I know what it is. Do you? I think so. All right.

We'll talk later. OK. OK. In the meantime, Chuck. Yeah. Let's talk about triage. Let's talk about the French language. OK.

Trier means to sort. Did you know that? Which means that Lars von Trier's name is Lars von 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. Oh, really?

Yeah. Little known fact, but the pre-industrial French society was agrarian. So they would say vegetable trier. And that means. And they'd snap their fingers in point at a pile of vegetables. Sort veggies.

Root veggies in France. Yeah. Well, they have those everywhere, but. But they're bonkers for root veggies in France. Sure. They have good, clean, simple food in that country. Yeah. Good, good food.

Yeah. What's it called? French food. It's not the trinity. That's like Cajun, but the mirepoix. Oh, I've not heard that before. Yeah. Is it the same thing?

No, I think mirepoix is carrot, onion, and one other thing. Parsley. Celery. Celery? Jerry says celery. Jerry, I think you're right. Are you right? You know you're right.

OK. In Cajun land, it's like bell pepper, onion, and what? And garlic? It wouldn't be garlic. I was trying to think of something funny, and I failed. My brain just went, pew.

Yeah. Well, it's late in the day. Trying to think of something about an angel heart reference. Man, that movie is crazy. Yeah. 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. Yeah. Vampire.

Perhaps. Very pretty lady. I was crushed on her big when I was a kid. Oh, yeah, sure. And she was super laid back. Was it Lisa Huckstable? Yeah, for sure. Or no.

They didn't. Her name wasn't Lisa Huckstable. It was something Huckstable. Well, probably not, because her real name's Lisa. Yes, you know, sometimes shows use the actor's first name as the character's name, even though they're not playing themselves. Yeah.

I always thought that was weird. Yeah, I always wonder if it's because they have a hard time remembering their character's name. Or the writers, like, I just can't come up with a name. Just call them their real name, OK? Sue me. And I know people get so tired of screaming at us about, like, oh, what was the name of that?

And they're like, her name was this. I do that to other podcasts, so I feel your pain. Sure. I heard one just the other day. I think Judge John Hodgeman, he couldn't think of something. And I was like, no, navy blue. Yeah. Anyway, I apologize for all the things we don't know.

Trier, to sort, was the foundation of the term triage. Yeah, and the reason why the French got naming rights for this process that we'll describe in a minute is because it was basically invented by a French person, a pretty remarkable guy from what I can tell. He had a great name. He was a Napoleon surgeon, the chief surgeon of Napoleon's imperial guard.

His name was Baron Dominique Jean Larray. Yeah. And he was a bad dude in all the best ways. He was. And this was at a time when warfare was getting pretty serious. I mean, it was already serious. But people were dying in mass amounts of people, soldiers, dying on the field.

Yeah. And great, great numbers. And so he said, you know what? We need to come up with a system, a way to take care of these dudes. So they're not waiting over there with the 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. Oh, I'm sure. Just in a sea of bodies. Yeah, like bite on your gun barrel while I cut your leg off. Yeah. That kind of thing.

Yeah. And he. Not a barrel, but stock. Sure. You could bite on your gun barrel. That'd be really, yeah. They needed a new teeth. Sure.

The wood is much more comfortable when you're having your leg amputated without anesthetic. I would say so. But while he's running around performing these battlefield amputations, he realizes quite 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 you could give aid to the people who needed it most. Yes. And to do that, you would need to sort through the people, hence triage. As if they were root vegetables. 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. 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 if you have a guy who's like an aristocrat with a broken leg and just a grunt whose bowels are hanging out, you fix the broken leg first, which is senseless. And Laura was like, no, we're not going to do that anymore. It's going to be based on severity of injury. Oh, nice. Yeah, our need for help.

And Napoleon was like, that's great, but I'm at the top of the list no matter what, right? Yeah, hey, have you heard people calling me the anti-Christ behind my back? Because I've been hearing rumblings about this and it's bugging me. You know I'm not really short, I'm average. Yeah, that's true.

And the process went on to change a little bit more with British surgeon, naval surgeon, John Wilson. Right. In 1846, 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. So not necessarily, 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. Right. 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 up to that point, if you were a medic, like you just treated people, now you have a decision to make with each person. Do you let that person die?

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. Yeah, make them comfortable, maybe throw some morphine their way and then go about your business. That was a big, big shift in triage, in battlefield triage. And in the US, we didn't catch up very quickly

by the Civil War. So that guy, Larey, was working on triage, inventing it in the 1790s. John Wilson refined it in the 1840s. In the Civil War still, we were doing like first come, first serve, whoever was closest to the medic was who got worked on first. In the Civil War, in the 1860s still.

Crazy. It wasn't until, I think, the late 1860s or early 1870s that the US first started adopting even basic triage. So Britain led the way in this case? Well, France led the way in mercy. Britain led the way in saying, no, we've got to let some people die here. Right.

Well, I would say efficiency in saving lives overall. Yeah, that was the idea. I mean, it's a very utilitarian way of looking at things. And they've got to have nerves of steel, got to have a kung fu grip. World War I, things changed again. They tweaked it. And now they said, all right, maybe we should treat.

And do you know if this was what country this was, or 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, a shift in triage. Which was to treat, how many people

can you treat in the shortest amount of time? So maybe people that don't need as much, but are saveable? Yeah. And the basis of this is even more steely, nerve than John Wilson's shift. Because this is saying, not ignore that person, they're probably going to die. This person is going to die.

You could probably save, but it's going to 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 12 people who weren't going to die, but can get back out and fight the war a lot faster if you work on them. And that was, I think, the thinking behind it,

patching up people who were more likely to be able to return to battle, rather than saving lives of people who might not be able to, or who would take up a lot of time. Hard choices. That's super utilitarian. That was, like you said, a surgical manual out of the military at the time.

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. We could really sum that up quicker. Should we take a little break? Sure, man.

Stop, stop, you should know. On the podcast, Hey Dude, the 90s, called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slipdresses and choker necklaces. We're going to use Hey Dude as our jumping off point, but we are going to unpack and dive back

into the decade of the 90s. We lived it, and now we're calling on all of our friends to come back and relive it. It's a podcast packed with interviews, co-stars, friends, and nonstop references to the best decade ever. Do you remember going to Blockbuster? Do you remember Nintendo 64? Do you remember getting Frosted Tips?

Was that a cereal? No, it was hair. Do you remember AOL Instant Messenger and the dial-up sound like poltergeist? So leave a code on your best friend's beeper, because you'll want to be there when the nostalgia starts flowing. Each episode will rival the feeling of taking out

the cartridge from your Game Boy, blowing on it and popping it back in as we take you back to the 90s. Listen to Hey Dude, the 90s, called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to when questions arise or times get tough,

or you're at the end of the road. OK, I see what you're doing. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation? If you do, you've come to the right place, because I'm here to help. This, I promise you.

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And a different hot, sexy teen crush boy bander each week to guide you through life, step by step. Oh, not another one. Kids, relationships, life in general, can get messy. You may be thinking, this is the story of my life. Just stop now. If so, tell everybody, yeah, everybody, about my new podcast and make sure to listen so we'll never, ever have to say bye,

bye, bye. Listen to Frosted Tips with Lance Bass on the iHeart Radio app, Apple Podcasts, or wherever you listen to podcasts. All right, my friend. There are, we've been talking about the battlefield so far and its history. Yeah, that was the origin of it. But if you go to the ER, and actually, I haven't been to the

ER much at all in the last, jeez, much at all in my life. That's good. But since I was a kid, but I did go to 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 scary, just the scene there. Sure, yeah.

It wasn't like, I'm sort of used to the hospitals around here kind of nicer. Like, it had seen its better days. Oh, I got you. The ER 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 not like, you know, my kid fell down and bumped his head.

It's like, you know, it was disturbing. I can imagine. I'll just say that. Yeah. But I was triaged when I first got there. And that's what'll happen to you when you go to an ER. There's going to 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. Glitter would stick. Make sure it sticks. Yeah. So a triage nurse is going to come by, and that dude or that lady is going to say hi. Welcome to Beth Israel.

Sorry about the mess. Let's check you out. Watch your step. There's some blood. Seriously, it's kind of like that. And they will do an assessment. They're going to look at you and say, you know, 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 just needs to shoot a duck. He can sit here and hold that for a little while. She said, here, let me pull your finger.

Everything will be all right. And what you're describing, this ER triage that's done by a triage nurse, about the first person you see when you come to an ER, when they're doing triage, it's not constant necessarily. They have been trained to do this. But they're also following flow charts. 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. Wow. And it's. It sounds like a band. Yeah, it is, like Manhattan transfer. Sort of.

But it's a flow chart. And it basically says, are they breathing? No, get them immediate help. Like stop right now and immediately get them into a place where a life-saving intervention can be carried out, right? And then there's some other ones. But it seems like breathing is the focus of it.

That's good. Yeah, it is. But I mean, you think about it, you would think there'd be some other ones too, like is there blood coming out of their ear or something like that? No, it's mostly breathing. Like if you're breathing. Then you're alive.

There's a pretty good chance you're going to make it. Especially if you have a normal breathing pattern, right? But then there's some other ones. Like if the person's not responsive or if they're drooling, apparently is another one. There are a couple of droolers in the ear at Beth Israel. They should have been seen immediately, according to the

Manchester triage system. So there's like a flow chart. You don't have to. It's not necessarily just the nurse's subjective judgment. It's not supposed to be. I'm sure it is in high stress situations. And with really highly trained triage nurses, they can just be like, yeah, let's move that person there.

You go sit down. They've seen it all. You go home. But for the most part, it's supposed to be an objective system that you can just consult and be like, oh, OK. Well, here. Here's where you fit. Yeah.

So. Here's a piece of paper. You're so smart. Why don't you just triage everybody yourself? Well, beyond the initial flow chart too, they're also going to take some vitals. Here are your complaint and 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 you're not in that group where they're just like, send them right back. Yes. And by the way, I'm not knocking Beth Israel. 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. Sure. 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 arms like a gunshot, because I'm sure he could have like totally taken care of me. Yeah. But he did get a little like, like they couldn't figure out what was wrong with me at first. Right. 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 the lump behind my ear, the size of a golf ball. Yeah. 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. Or med seeking. I'm never at the doctor. I've never been to the ER hardly. Like please don't look at me with those eyes, nurse Eddie. Yeah.

And then he felt it and I was like, see, it's like, it's huge. Right. 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 a lymph node. Yeah, brought on by hypochondria. Yeah, brought on by my sickness. But anyway, big shout out to nurse Eddie.

It turned out to be you had snakes in your belly. Yeah. I passed out on the subway. Yeah. Woke up two days later in Coney Island and I had 13 snakes in my belly. No more, no less. So weird.

Yeah. So they gather these details in the triage, then take long. They use a color coded system in some hospitals, numbers in some, or both, depends 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 colors should be the exact same too. I agree. So for example, like in Manchester's jam, like the worst of all is red. Code red. You can see red making sense. Yeah.

No, another triage system, blue is the worst, code blue. Yeah, I think you hear that a lot on American TV. But it's a real thing, at least in the States. So I think that everybody should get together and agree on a color system. Right. Because the whole point of triage is rapid fire. Let's get this done.

Yeah. Not, oh, well, which system did you triage them on? Because I'm, I enjoy a spot of tea, so I'm a fan of the Manchester system. So 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?

Yeah, I guess. That's true. But I mean, I know what you mean. There's just, you should, you should go out of your way to take out any possible confusion to another hospital. Yeah, there's just, I think there should be universal colors. I agree.

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. Or if you have a history of illness or like you have cancer or something, like if you have an outstanding condition already, you may be shuffled to the front. Yeah.

Or, and this makes a lot of sense to me, a lot of times now they have what they call a different track. They have two tracks. Yeah. If you're in severe distress, you're in one, get to you right away. But if you have another one, that doesn't necessarily mean you're going to wait eight hours.

They'll just put you in a different track for the less severe cases. Yeah, you go see the doctor 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. OK.

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... Like they're turning blue? Yes, cyanotic. OK. Right, it makes sense. But again, red makes sense too.

Yeah, you hear code red and that doesn't sound great. No, it doesn't make me think like, oh, it'll be fine. Well, code red is category two though, so it is serious. OK. That means they require immediate attention, but they're just not blue. Right, they're still breathing. Then what do you got?

You got orange, mid-level. OK. 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 a cadaver.

And then the least urgent is green, which just means you want someone to love you. It means you're med-seeking. Yeah, you shouldn't be in the ER, basically. Right. And that's not a joke. That literally means you don't have an emergency. Right, 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. You're wasting valuable resources here. OK. Go away. So then across the pond, 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, so you've got a point. You can't have one color be the worst possible thing, and one color be the least dangerous.

Especially in an increasingly globalized world. Yeah, I don't like it either. What can we do? Should we start a movement? Yes, we should. Online petitions? How does that get done? Or does yell about it on Facebook?

I think the Facebook one, that's the best shot we have. That's how you accomplish things. Yeah. Triage, if there's, I mean, we talked about battlefield, we talked about regular ER. But then there's, of course, when bad things happen, like in New York when that building exploded. Yeah, those are called incident triage.

Yeah, like a natural disaster or something. Yeah. That Harlem explosion, right? It was a gas explosion in Harlem? Yeah. So triage works any time there's a scarcity of resources in a high demand for medical care. Yeah, that's a good way to say it.

It's just, it's health care rationing. It's saying like, we don't have enough resources for all you people, so we're going to have to figure out who's worse, right? And you're supposed to do it very quickly. But yeah, with incident triage, there's actually a really clever thing called the MET tag that. And that article you sent was awesome.

And it was a fast code design article. And there's really neat. There's basically a triage code system that's used out in the field that you'll see people who are victims of an explosion or a plane crash or something like that. And they'll have tags around their necks with a color code attached. And that was invented by a guy named Robert Bludgett in

Jacksonville, Florida in the early 1960s in response to the Cuban Missile Crisis. Yeah, I thought that was so interesting. It did not exist. He was a civil defense director. And America was super scared, especially Florida at the time, because the Soviet Union had nuclear missiles pointed at us right off the coast.

What, 90 miles off the coast of Florida? And people were freaking out. And he was one of them, but 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, 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 think I mentioned before, my dad went to build one after the day after movie. And it was his obsession for a month, every Saturday for a month. I don't remember.

Did he complete it? No. He got about a third of this dirt room dug out behind a wall. My brother and I basically were the cheap labor. We were carrying buckets of dirt out in the woods. Yeah, he'd come down with a high left and be like, how's it going down here?

How's my project coming? He didn't drink. But yeah, he would come down with his buttermilk and cornbread. I know, right? Yeah, of course he didn't finish it. Because you guys went on strike or something? No, he disliked a lot of people that probably saw the day

after. A month later, they're like, eh. Not so scared. That's an awesome story. So anyway, this guy has, Mr. Blodgett definitely had a completed shelter. Oh yeah. There's no way he bailed.

He probably swept it like every couple days, even. Well, his deal was he made it, 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. So I'm going to put pictures and colors and things of a symbol that represents blood pressure and your sex and what time it is.

Imagine those little clock on there. So anyone can read this thing no matter what happened. Right, and then you would be assigned a color code depending on the severity of your injury or illness, right? Just like in an ER, but 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 it was green, you were fine.

No problems. And then it got progressively worse. And like you said, there were some pretty clever symbols, including, 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 help you out if you need assistance in

applying pressure to a wound, right? Green's fine. It went all the way to black. And the black said morgue on it. And it said in this article, it was really unsettling that if you had a met tag around your neck and the only tag that was left was a black one. Yeah, because they ripped them off one by one, right?

Or they could rip off like three if they just knew. It meant you're a goner. You might still be alive right now. And you're looking at that tag. You're about to die where you're laying right now. Oh, boy. Isn't that awful? Because it said morgue on it, too.

Yeah. So you could look and be like, ow. 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 out hope. Yeah, it does not help. No.

Yeah. No, that's good. You give up the ghost. But again, the whole idea of disaster or battlefield triage is it's a necessary kind of sad thing that you have to do to save more people. Yeah, it's the mercilessness of a compassionate profession.

Yeah. All right, well, let's take a break and we'll talk a little bit more about these tags right after this. Stuck, stuff you should know. All right, so this guy, Mr. Blodgett, he actually sold these through, I don't know if he got the money. That's what I was thinking. He didn't.

I think he found somebody who was like, we can distribute these widely. Your idea will be set in stone, but we're keeping the money. The American Civil Defense Association is who he gave them to to sell. That's the impression I have. All right, well, good on him, you know? Yeah.

Hero. Hero. Anybody who gives up intellectual property rights as a hero. Agreed. So it's said here in the heyday that they were selling about 100,000 of these a year to agencies, which is no small number.

I didn't see how much they sold them for, though. They're in bulk, so. Yeah, like Scantron sheets or something. Yeah, probably not a lot of money. But they went on to be refined years later. When was this? This was after the Oklahoma building explosion, right? Yeah, the bombing.

Yeah, the Alfred P. Murrah building. Is that pronounced right? Murrah. Murrah? I think. I'm pretty sure it's Murrah. I just see out of the corn migiary, nodding and shaking her head.

I don't know what means what. She's making circles. There was a LAPD fire department. Well, two guys actually, Dennis Ortiz and his brother. And they were working, like I said, at LA County Fire Department. And were they on the scene in Oklahoma at the time? No, no, I think they were moved by it.

They were like, if something happened like that in LA, do we have the resources we need? That's pretty amazing. So he went to get these tags from LA County. And these Met Tags, he said, were basically disintegrating in my hand, I guess, because they were just so old. And he said, there should be a new tag.

And this is sad, but also necessary, for terrorist disasters and terrorist attacks. And it was a pretty great idea. So he now included this new tag with things like biological contamination, radioactive contamination, diagrams for blast injuries, personal property receipts, stuff like that. Yeah, it's like a tri-fold package.

It's got everything. All the bells and whistles you need, including basically a revised, improved Met Tag. So a Met Tag for the new age. Yeah, I think they're called Smart Tags now. Oh, really? Smart everything. Yeah.

Well, another thing they can do, too, is a lot of times you might not have these tags. So they'll literally go around with Sharpies and write on people in the case of a disaster. I wonder if people can feel you writing the word on your forehead or something. Yeah. I can feel you writing morgue on my forehead.

I know what you're doing. That's not good. Did you ever play that game when you're a little where you would draw on someone's back and you'd try to guess what they were drawing? Yeah, I was always terrible at that. I was bad, too, but it felt so good. I love back scratches, so it was always like, oh,

draw something really elaborate. Draw a Lorenzo tractor. Oh, that'd be wonderful. But Chuck, whether it's in an incident triage or an ER triage or something like that, it's, well, I should say, in an ER triage, there's a spectrum of triage, right? Yes. And ER is about the most calm, stable version of it,

even a chaotic, crazy 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 the health care infrastructure as well. Within that spectrum, there's different types of triage. And usually, the worse it is, the faster your assessment has to be.

So out on a battlefield, they've come up with basically a two-point triage assessment. It's called the field triage score. It's part of the tactical combat casualty care methodology, where they feel your pulse, and then they give you a rating of awareness on the Glasgow Coma Scale. Right, which we covered in our Coma podcast.

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 if you're out of it, and your pulse is low, move along. That person's a goner in that situation. Wow. Whereas if that person came into an ER in the suburbs,

or a 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, you're going to, depending on where you are on that spectrum, physically, literally, you may just get passed over. 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, too, once you're given a code, that's not static. Like, it can change. You can deteriorate over time. You can wipe it off and switch tags with the person next to you. Right.

But no, you're absolutely right. To say, like, I want to save your life, but I can't. I've got to leave you there to die. Unbelievable. You're absolutely right. I mean, that's metal. Yeah, not for me. That's metal in both spellings.

Yeah, it is. Two D's and a T, or a T. No, two T's and an L-E. Oh, it's M-E-T-T-L-E. Yeah. Why do I think it was M-E-D-D-L-E? Because it's like meddling. If you went and rearranged everybody's tags,

that would be meddling. I'm saying metal and, like, metal. I know. It's amazing the amount of dopey things I say on the show and people still think I, like, 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.

All right, well, let's talk a little bit about what's, well, we've talked about what's good about it. Pretty much everything, because it will save, ultimately, more lives. Yeah, but it has its critics. Well, yeah. And a lot of times, you know, when you go to the ER, we're not talking battlefield or disaster.

But when you go to the ER, you want to get seen as quickly as possible, because it's the worst. Yeah, my thumb hurts. Yeah. And it's taking so long. You look around, and you're like, well, that person doesn't look so bad off.

Yeah. Why are they going in? Or I've been here for an hour. This guy just came in, and he got seen, and he doesn't look too bad. That kid's breathing. Yeah. Why is he going ahead of me?

Yeah, I mean, they hear a lot. I mean, ERs have to feel they lot of complaints. Yeah. About wait times. And there's a lot of people who end up in what's called the LWBS category. Is that where they send complainers? Left without being seen.

Oh, yeah. Some people just give up. They're 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 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 or else I think I'll be all right. Not like an injury, unless I thought I could sew it up myself or a Rambo style, which Emily's dad did once. What did he sew?

He'd like to sew to cut in his arm himself one time with needle and thread. Did he put gunpowder in it and light it on fire to cauterize the rain? He should have. I would have done it. And apparently, they interviewed someone from our House of Works article from our great children's

hospital here, Scottish Rite. And this doctor said, especially at children's hospitals, get a lot of upset parents. Sure. But they don't really get the triage thing. Yeah. Well, there have been studies, actually, that there was one very famous study from the 1990s,

I think actually 1990. And then there was such an outcry against it as far as criticism of the study went, because the study's findings were very critical of the triage as a whole, like the concept of it, that the authors actually wrote another study responding to the criticisms of their original study. Wow.

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 it gets in the way, and that it didn't have any impact on patient satisfaction, meaning people didn't feel like they were being cared for better than when they weren't exposed to triage.

So the people just said, this is what we found. A lot of people were like, this is a BS study. But it does make sense. There are critics to triage saying, no, this is unnecessary. It's clumsy. It gets in the way. It's an extra layer, a barrier between a patient and treatment. So what should be the first come first served?

Like someone's got to say this guy's got a spoon in his ear. I think, for the most part, the critics don't have an alternative. Oh, OK. And that 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 were saying like, it's not perfect. But I don't know when an alternative would be in the case of really scarce resources. Well, here's one, not alternative, but one other way of doing things. And they did this at the Kaiser Permanent South Sacramento Medical Center. Kaiser Permanente.

They forgot the E. Oh, they did. Kaiser Permanent is what they said here. What does Permanente mean, either? What is that? I think it means Permanent in Spanish. Oh, OK. Who's Kaiser? That means Permanent in German.

So the Permanent Permanent. No, that means a role, a delightful type of role that's permanent. Gotcha. A German role forever. See? Yeah, yeah. Four times.

So they employed something from the L-E-A-N, the lean thinking principle in Japan and their businesses. Is this like when they have people do like calisthenics and that kind of thing? No? I don't know. I want to look into what that is. It sounds interesting.

Well, it's like cutting down on waste. Right. I'm sure the Japanese probably figured out a way to insert calisthenics into it. Or actually, I might be thinking of China. No, the Japanese are in the calisthenics, too. OK. So they use 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. And I think that definitely would give someone a sense of, well, 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 you're on track to go sit over there and wait for a bed to come open so you can see. It's like, there, you don't have to wait for a bed. The doctor came to you instead. Yeah, that's a great idea. They found it reduced the left without being seen rate

from 4.5% to 1.5%. And the wait times fell by half, by 50%. Wait times are one of my biggest complaints with modern medicine. Sure, it's the worst, yeah. Your appointment's at one, you get in there at 2.15. Oh, man. Boy, oh boy, you wanna see me get mad?

Stick me in a waiting room with bad magazines. But if you got some mad magazines, you're like, this is delightful. Sure. The other criticism of triage is that it shouldn't be done at all, that withholding care under any circumstances is unethical. So what, just have like eight times as many doctors

and nurses? Yes. Come on. If you wanna know more about triage or sorting, you can type those words into the search bar at housestuffworks.com. And since I said that, it's time for listening mail. I'm gonna call this lighthouse follow up.

We got a lot of really great pictures and emails from lighthouse enthusiasts. Yeah. It's pretty cool, including ones that were for sale. So I could live out my fantasy. Yeah, are you going to? No. How much are they?

I didn't see. I don't know. I didn't, I don't remember any prices. Look it up on Zillow. 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, as last year I visited every lighthouse on Oregon's coast. Wow. All six. Her state. Such a good year long goal, that's what she said. I agree. That's cool.

Now I wanted to tell you about one of our coolest, in my opinions, is Terrible Tilly. She was built on a rock, a mile offshore, and see pictures is really neat. It's one of these that's like just out there in the middle of the ocean. Many men died trying to construct it in the 1870s and many men died while keeping the light.

That was decommissioned in 1957 and was sold. After her sale, Tilly became a graveyard, so to speak. Sailors would be cremated and have their ashes stored in the lighthouse. During the seasonal storms, when 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 evangelize stuff you should know, the stuff you should know gospel to all my friends. And that is from Kendra. And Kendra used the word evangelize and bosom

in the same email. And Gothic. So that means straight to the top of the pile. Thanks a lot, Kendra. That was indeed a great email. If you want to get in touch with us, you can tweet to us at SYSKpodcast. You can join us on facebook.com slash stuffyoushouldknow.

You can send us an email to stuffpodcast.howstuffworks.com and as always join us at our home on the web, stuffyoushouldknow.com. For more on this and thousands of other topics, visit howstuffworks.com. On the podcast, Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude,

bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called

on the I Heart Radio app, Apple Podcasts or wherever you get your podcasts. Bye bye bye. Listen to Frosted Tips with Lance Bass on the I Heart Radio app, Apple Podcasts or wherever you listen to podcasts.