Yeah?
There's an active shooter at Pitt Fest.
- As the nearest trauma center, we are going to be getting
the majority of the victims.
Triage is gonna assess and assign
every patient to a specific zone
with a colored slap band.
- We're a MASH unit now. No charting.
No electronic medical records. No board.
- David wouldn't do this. - I really hope you're right.
- This is the monitoring center.
Do you have permission to be outside this area?
- What is the point of this fucking thing
if it doesn't even work?
- Could a drug addict do what I do?
[sighs] Apparently.
[slams locker] You are done.
- What the fuck are you doing? - I'm saving lives.
You should not be here.
- None of these people should be here.
- I know you all want information
about your friends and family.
We have a QR code you can scan
for our patient identification website.
If we get a match, we'll let you know.
- Her pulse is stronger, but she needs more blood.
- We're already rationing our blood supply.
- What if we run out? - Running very low on O-neg.
- Perfect storm. - Listen up!
Central 789 is now the blood-donor center.
- Hey, what's up with the SWAT team?
It's just a precaution
in case the shooter heads this way.
Is that a possibility?
- Hey, Javadi, I need you to find Whitaker,
go up to the helipad-- we got blood flying in.
- Okay. - Stay behind the yellow line
between 10:00 and 2:00 so the pilot
- can see you the whole time. - Okay.
- We may not even be halfway through yet.
When is this gonna end?
[tense music]
- [breathes raggedly] Fuck.
[distant siren wails]
Need some help over here!
- Who called in SWAT? - Just a precaution.
They still haven't found the shooter yet.
- They need to stay out there, not in here.
- Officer down. You know the drill.
- 16 gauge in the right AC. - Definitely needs an airway.
Can you handle that bleeding?
- Need a sponge stick for the back.
- Dana, 100 of ketamine and get some 4x4s on a kelly.
You guys are doing a great job. Keep it up.
- Hang in there, Richie. You're in good hands.
- You're gonna be okay, man. - Hey, guys.
Back it up. We're trying to work here.
Come on. Both of youse, go.
- And chest tube output is minimal.
- Good for cardiothoracic ICU. - Nice. Okay.
As soon as transpo can lend us a hand.
What's up with the SWAT team?
- Maybe they think the shooter's coming here.
- Shit, is that true? - What?
My kid's in the break room.
- They think the shooter's heading this way?
Anything is possible.
Don't spread rumors.
I'm taking this one to the OR.
[indistinct PA announcement]
How are you doing?
- Yeah, I'm good. You?
I'm good.
- How much blood are we getting? - I don't know.
I hope it's enough.
We're supposed to stop here
and stay between 10:00 and 2:00.
- Where's 12? - I think the pilot's 12.
I think we just stay back, and they bring the blood to us.
I think.
- Here. - Thank you.
Yep.
- Do we take these to our supply room
- in Behavioral Health? - Trauma rooms first.
Then we'll make our way out to the patients in the hub.
- That the O-neg delivery? - Yeah, straight from the roof.
- Jesse, hang a unit, then right up to the OR.
Who else needs blood?
Everybody.
- Leave us four units, four next door,
and then check in with Robby and Abbot.
Okay, I've got next door.
- Blood's here. - All right.
Squeeze one in as fast as you can.
Bag for me.
- You guys need blood? - No, not just yet.
Leave it with Dana.
Hey, Whitaker. How you doing?
Yeah, fine.
Ask for help if you need it.
- I can't see the cords. Let's bag him.
Sorry, I'm used to the GlideScope.
Spoiled by technology.
Dana, you got a bougie back there?
- Completely out. Used them all up.
- Is he awake? - He was. Now he's sedated.
- Should be intubated by now. - Yeah, what's his pulse ox?
- All right, except for his partner,
all of you into BH-2 now.
You can watch from the window,
but you need to zip it, capisce?
Oh, God. Bridget, thank God.
Night shift to the rescue.
- What the hell happened to your eye?
Just another happy customer.
- Looks a lot worse than it is. - Yeah, right.
I tried to get here sooner, but it is gridlocked out there.
It's not much better in here.
Did you hear anything about the shooter?
- They may have slipped away in the crowd with all this chaos.
- Hey, where do you need me? - North is yellow.
- Keep an eye on the new kids. - Got it.
You holler if you're in trouble.
Yes, ma'am.
Jamie, what do you need?
IVs on everyone.
- Hi, I'm Dr. King. - Buster Pirelli.
- I take it you're a children's entertainer.
- Impressive observational skills.
Well, no active bleeding.
Can you tell me your pain on a scale of 1 to 10?
At least a 3.
- And can you wiggle your fingers?
- Uh-huh.
- The--the other hand.
Oh.
- Well, it doesn't seem like you have a broken bone,
but we're gonna put you on some IV antibiotics
and some pain meds.
Got it.
You, uh, see who shot you?
- No, I'm not even sure which direction the bullet came from.
Hey, am I going to lose any dexterity? Like...
- It's too soon to tell, but probably not.
- [sighs] I make balloon animals for a living.
Two birthday parties booked every Saturday, Sunday
for the next year, so...
- Wow, you must really love kids.
Not really.
- Okay, you're gonna feel a little pinprick here.
[screams] Fuck me!
- Uh, it's--it's in. It's just so we can give you antibiotics.
Oh.
That hurt just as bad as when I got shot.
You put in an IO?
- [groans] - Yeah.
Um, don't worry, sir.
There will be no more pain.
Okay.
Whitaker, um, team huddle.
[sighs]
- Join us, will you? - Mm-hmm.
Oh, my God.
Okay, um, why'd you do that?
- Dr. Robby said everyone gets an IO.
- If they are unconscious or unresponsive.
- If the patient is awake and alert,
it's just a standard IV, not an IO.
- Unless it's a mime. They can't scream.
Lidocaine for the clown.
More at the door.
Is this ever gonna end?
Pardon. Coming through.
- Bleed and bandage it. Bring him out.
To the other side?
Ah, too much blood.
Move that kelly to the right a little bit.
- Any better? - Not really.
- Radial pulse? - Still has it.
Maybe a little weaker.
I can try and give you a bubble.
Yeah, yeah, go for it.
No, nothing. I'm not seeing anything.
Okay, let's bag him. I want to prep the neck.
You don't have a bougie.
- I have an 11 blade and a prayer.
- Without a bougie, you could create a false passage
on top of the trachea and kill him.
- You're doing a crike? - Yep.
No skin hooks, no bougie-- old school.
- I got a tactical airway in my bag here.
- What is that? - It's a control crike kit.
Oh, that's perfect.
Use that on the battlefield.
- Works in the pitch-dark when you're under fire.
I can do these with my eyes closed.
- [chuckles] - For you.
Okay.
The knife leaves a trach hook behind,
so you can't miss, right?
Just...
good.
You slide in the introducer.
Okay.
Feel the tracheal rings. Good.
Bob's your uncle.
- That was incredibly fast. - Eh...
Balloon is up.
- Why don't we stock these? - No room in the budget.
- Yellow on end-tidal. [laughter]
- It's okay now? - Yeah.
- Thank you, Dr. Abbot. [knocking on window]
Okay, let's pack the oral cavity with Kerlix
and see how fast Head and Neck can take him up to the OR.
Great job, everybody.
- What else do you got in your go bag?
Oh, just wait and see.
[camera shutter clicking]
- [sighs] Javadi, this is Sally.
What does she need?
- Gunshot wound to the back at T11.
Good pulse, but probable spinal cord injury.
- Can you move your legs? - I'm trying.
Am I paralyzed?
- There's some hope for recovery.
Keep her on the backboard and monitor
for intra-abdominal hemorrhage,
and neuro-ICU will triage to CT, okay?
- Sally, pinprick right here, okay?
- Walsh knows about the case. They're holding an OR.
And the hits keep coming.
Let's go.
- [groans] - Who do you have?
- Semiconscious, only responds to pain.
- Decent carotid. - Strip him.
Let's go.
- Ah, left upper-quadrant entrance.
[yelling]
Hold him down.
Grab his foot! Grab his foot!
- Whoa, gun! Gun! He's going for his gun!
Get down, get down.
[all shouting]
- Stay down. Stay down.
Sig P365 9 mil.
- Driver's license? - He just got here.
Not responding to pain now.
All clear.
- You sure? - He's unconscious.
Everybody back to work.
- Agonal breathing. He needs an airway.
- Working on an IO. - Drawing up ketamine and sux.
Here, have at it.
Concealed carry permit.
We'll run his ID.
These wounds are too big for a 9.
Failed IO.
Guy's huge. Needle won't reach the bone.
- He needs induction meds and blood.
- I'm having the same problem here.
I don't see anything usable for an IV.
- Robby. - What?
- Guy needs access, but the IO won't reach the humerus.
Proximal tibia?
Yes?
Yeah.
Tibia's not great access.
You can only get a liter an hour down there.
You get what you get.
[ankle monitor blaring]
God damn it!
- Whatever that is, can you please turn it off?
- I can't hear myself think! - Stable for the ICU.
Get her up. I'll be right fucking back.
Copy that.
[blaring continues]
- I already have one. Keep that away from me.
It's not for you.
[blaring continues]
- This is the monitoring center.
We see that you're not in your inclusion zone.
Do you have permission--
[crowd gasping, murmuring]
- Show's over. - Uh...
are you gonna get in trouble for that?
Probably.
Hey.
What's going on out there?
- A lot of people were hurt at the festival.
I need to use the bathroom.
- I told him to use the sink. - What is wrong with you?
- Would you rather I take him out there?
- Hang on. I'll be right back, okay?
[door opens, closes]
Here.
- What's that? - It's a urinal.
- You pee in it. - I think I'll just hold it in.
- Pull out. I found a 4 blade.
This is better.
Shit.
I lost the light. The battery must be dead.
This one's dead, too.
Anybody have a laryngoscope with a light that still works?
- We will check. - Check quick.
This guy's paralytics are wearing off.
- Keep bagging. Give me a 7.0 ET tube.
- He's a big guy. He needs an 8.
- Not for this. - Number 7.
- What are you doing? - Tactile intubation.
My index finger goes into the vallecula.
And my middle finger will guide the tube past the epiglottis.
- But if you hit the esophagus, he's toast.
You told us never to pass a tube unless we see
- the vocal cords. - Correct. Not today.
If I stay in the midline,
I should be able to get it past the cords.
Okay.
Balloon up. Bag him.
- Looks good on the end-tidal. - Slick move, boss.
- No pulse. Start compressions.
OK. Get him up.
Try to get him back with two liters.
That is as much as we can afford per patient.
- Leg is too slow; upper arm is five times as fast.
- Best that we can do. Keep at it. We'll get him back.
Robby, need help here!
- Langdon! - Keep squeezing.
[indistinct chatter]
How are you making out?
- [sighs] Lots of emails and photos coming in
from concerned families.
- It'll be easier once they've entered
every patient's MCI number.
- Here we go. Look familiar?
MCI-7.
His name is Vincent Rivera.
- He must have had friends or family in the cafeteria
who sent in the photo.
I'll text them we're coming.
- What are you doing? - Giving this guy a chance.
He needs a big central line for fast transfusion.
- You can't do an IJ without an ultrasound,
- especially on a guy this big. - You'll kill him
if you collapse a lung or hit the carotid.
I'm not doing an IJ.
Unhook that blood line. Bring it up here.
This is a supraclavicular subclavian.
If you have to go in blind,
this is the only safe way to access a giant vein.
And hold compressions.
A centimeter
from the lateral head of the sternocleidomastoid,
a centimeter off the clavicle,
aiming at the contralateral nipple.
I'm in.
Okay, resume compressions.
And squeeze blood.
- Where'd you learn that? - "EM:RAP" podcast.
We'll be ready for a second unit in under a minute.
Boom.
- Okay, not too much blood on your dressing, Mr. Grayson.
You're looking good.
Mr. Grayson? Hey, Mr. Grayson!
Oh.
Oh, I must've dozed off.
This is like a bad dream.
- Yeah, no kidding. - [exhales deeply]
- You, um--did you happen to see who shot you?
No.
But I heard the shots.
They just kept coming, gunshots and screaming.
I'm never gonna get that out of my head.
- GSW to the right inguinal region.
Yeah.
Uh, hi, I'm Dr. Whitaker.
Carmen.
It's, uh, nice to meet you.
Uh...
I'm just gonna take this.
Okay.
- How's the pain? - I can handle it.
Okay.
What does this--"tem-bleek"? What does that mean?
- Tembleque--it's a coconut pudding from Puerto Rico.
We top it off with canela--cinnamon.
- Okay, wow. So you got a food truck?
- Just a folding table for now. - Pedal pulses are strong.
- Okay, let's start with antibiotics, pain meds,
and let's try to stop this bleeding.
- [whimpers] - Okay.
Here we go.
Okay, uh, could you take over?
Thank you, thank you, thank you.
Hey, hey, hey.
Inguinal GSW with active bleeding.
Um, try an Israeli bandage.
- What if it bleeds through? It's at the top of the leg.
There's no room for a tourniquet above the wound.
- Well, let's just hope the hemostatic bandage works.
Okay.
Coming in. Good.
Hey, so...
coconut.
Love coconut. [both chuckle]
[indistinct chatter]
- Kiara? - Yes.
This is Lupe.
Whitney. You texted me.
Let's take a walk over here.
- Can you tell us your husband's name?
Vincent Rivera.
- We're gonna show you some photos.
Can you tell us if this is Vincent?
- He's not talking? - No, he's not.
Yes, that's Vincent.
Can I see him?
- Vincent had a gunshot to the head.
When he arrived here,
there was no pulse or breathing.
My husband is dead?
- I'm so sorry. - We're sorry.
- [crying] What about my brother, Brian?
Vincent and Brian went to the festival together.
Is my brother okay?
- Can you send us his name and photo?
I did.
- Okay, well, as of now, he's not one of our fatalities.
- Do you have some relatives or friends we can call
to come be with you?
[crying]
Our kids are with my parents.
[sobs]
- Second unit's in. - Holding compressions.
- Carotid pulse--you feeling it? - I'm feeling it.
- He goes right up to pre-op.
- Let's go. Let's go. I need some help over here!
- Hey. Not a person of interest.
Jewelry store owner, no priors.
He's not our shooter.
- You guys good in here? - We got this.
Take a two-hour lunch.
I'm gonna go check on triage.
We'll save a spot for you.
Yellow gets a wheelchair.
- Hey, Ahmad, what number are we up to?
- 85 patients so far. - Need a gurney for pink.
- How are you guys doing? - Still going strong.
- Not bad, I guess. - You guys are triaging great.
Believe me. This is not easy.
Not everybody can pull this off.
- Is this your half-time locker room speech?
Yeah, possibly.
- Are we winning or losing the game?
Too soon to tell.
Come on, these heads have to be up 30 degrees.
- Let's go. - Got four back here.
[distant sirens wailing]
Through and through the head.
No pulse. Black and white.
Pink zone. Strong pulse. Unresponsive, no obvious GSW.
Red zone, GSW left chest.
- She was talking when we first got in the truck.
- [tires squeal] - Weak carotid, unresponsive.
- There--there was so much blood.
- I tried to stop it. - Jake!
- Robby! Leah got shot! It's really bad!
[helicopter blades whirring overhead]
I've been putting pressure on the wound the whole time.
- Yeah, that's good. That's good.
- Are you shot? - I don't--maybe my leg.
Most of this is her blood.
- Somebody you know, boss? - Yeah.
- You got this? - Yeah.
Okay, come on, let's go. Let's go. I got you. Come on.
Ready? Pull.
[distant wailing continues]
- Jake, you can't stay with her. - I have to.
- There's no room, and we need to work on Leah right now,
and you need to get your leg checked,
so please go sit down.
- Please come tell me how she's doing, okay?
- Please? - I will.
- Jake? - I-I'm okay.
Leah's with Robby.
- Can't feel carotid. - Start compressions.
Swap out with me.
I need an IO. Hang a unit of O-neg.
Got the IO.
- Leah? - Yeah.
- You need help over there? - No, we're good.
- That's Jake's girlfriend. - Oh, shit.
- Who's Jake? - It's, like, Robby's stepson.
I'll be right with you, sir.
My mom would be very happy.
She always says, wear clean underwear
in case you end up in the hospital.
- Just let us know if anything is too uncomfortable.
- It's okay. - This needs to be tighter.
You bled through the last one pretty fast.
- Try a 180-degree twist. It'll put more pressure.
Got it.
- I usually faint when my blood gets drawn.
- Must be all the adrenaline today.
Whitaker?
Old hippie's looking pretty out of it.
No, he's sleeping.
- No response to pain. - Shit.
Uh, Mr. Grayson. Mr. Grayson.
- Could be a delayed head bleed.
He's gonna need a head CT.
- He's not getting one anytime soon.
- Equal and reactive. No blown pupil.
- Santos, go get an attending. - I'll try, but no promises.
- Excuse me. I think I'm still bleeding.
I'll be with you in a minute.
- Pleur-evac ready. Here you go.
Princess, take over as primary.
- What about Bridget? - She's stuck in yellow.
- Mel needs an attending. - Find somebody who's free.
- Let's get blood. - Dr. Abbot, can you come--
Gonna be a minute.
- Dr. Walsh. - Taking one up to the OR.
Okay.
- Hey, I need a portable pulse ox for Mr. Grayson.
Here you go.
- Hey, what happened to the kid in the wheelchair
with the bloody right leg?
No idea.
- Pinpoint pupils-- probable OD.
Blood on his clothes wasn't his.
- I'll grab some Narcan. - Sublingual injection.
Okay here?
- Uh, looks like a opioid overdose.
How's Robby with Leah?
- If this guy doesn't wake up, we'll check for occult trauma.
- 1,400 of blood out the chest. First unit's in.
- Squeeze in a second unit fast,
and then we'll do another pulse check.
- She's needs a second line? - For FFP and platelets.
You sure, Robby?
Sophie, get the plasma.
I'm gonna take over compressions.
And swap.
- Social worker to the south corridor.
Social worker to the south corridor.
Jamie, wheelchair.
You can't be in here.
- They're working on my girlfriend.
I need to see what's going on.
- What's going on is, you're losing a lot of blood.
You're gonna pass out if we don't stop it.
- No, I'm not moving, man! Leave me alone!
- Jake, get in the damn wheelchair.
- No! - Now! Go!
[gasps]
[shouting]
- Welcome back, sir. You're in the ER at PTMC.
- What's your name? - [gasps] Martin.
- What'd you take, Martin? You overdosed at Pitt Fest.
- I took one Percocet so I could dance.
I've got a bad knee.
- Where'd you get the pill? - [sighs] From a friend.
- Okay, while you were overdosing from the fentanyl
in a fake pill, there was a mass shooting at Pitt Fest.
- What? - Hey, Samira,
see if you can go help Mel in the yellow zone.
- Take my new friend Martin with you.
Javadi, roll with me.
[breathing heavily]
Two units packed cells in.
- FFP still going? - Almost there.
Okay, holding compressions.
Can't feel carotid.
No femoral.
Resuming compressions.
- What's your next move, boss? - Platelets, another unit.
And then we can transfuse her with her own blood
from the Pleur-evac to get ahead.
Hang the cell saver.
- Squeeze all this in? - No.
Three-way stopcock on a 60-cc syringe.
- I'll push-pull. - Okay.
- Not exactly in our mass casualty game plan.
- I tried. No attendings available.
Okay.
[indistinct chatter]
All right.
Okay, those look pretty superficial.
- Might've been fragments from a ricochet off the ground.
Lost a lot of blood, but you're gonna be okay, bro.
- It's not bad. Just put me back in the wheelchair.
- No, no, stay in bed with your leg up.
We don't want you oozing to death.
Samira, what you got?
- Opiate OD needs observation after Narcan.
- Ugh, boring. No, thank you.
Mel, how's Ganja Grayson?
- Um, we can put him in pink while he waits for ICU.
Okay, one second.
- What are you doing? - I'm checking the retina.
- For detachment? - For intracranial pressure
by measuring the optic nerve sheath, which is--
holy shit--10 millimeters.
- What's normal? 5? - Yeah, 5.
It's an intracranial bleed.
The pressure's been building up.
- There's no blown pupil. - Yeah, not yet.
But if he keeps bleeding in his skull, he's gonna die.
- Yeah, he needs a one-inch, uh, burr hole in his--
with a cranial drill.
I'm just gonna see if Neurosurgery's here.
- We don't have time to wait for Neuro.
I got Betadine and a 10-cc syringe.
- Should we intubate, hyperventilate?
Mannitol decreases ICP.
[drill whirring]
- Holy shit! - What the hell?
[drill thuds]
- Relieving intracranial pressure
so he doesn't die.
With an IO drill?
That's sick.
I get the next one.
Long as it's not on me.
- Dana, is Neurosurgery down here?
Ask Princess.
- Princess... - Cardiothoracic ICU.
- I need a neurosurgeon. - They're all in the OR.
- Dr. Walsh, I have an epidural in the north corridor
with an elevated ICP.
Is there a blown pupil?
- No, but a 10-millimeter optic sheath on the ultrasound.
We need a burr hole.
What the fuck?
- Draining the ICH with an EZ-IO.
40 cc's out so far.
- Like she said, what the fuck? - There was a case report
in the 2022 "Journal of Emergency Medicine."
Patient survive?
- Went home neurologically intact.
- The optic sheath is back to normal.
- Starting purposeful movements.
- Ready to intubate. - Propofol, rock, and mannitol.
- I'll let Neurosurgery know. We'll get him up ASAP.
- Incredible save. - If he lives.
- Third unit's in. - Okay, pulse check.
[grunting]
- I think I'm feeling a femoral.
I got a carotid.
Emery, I got a chest case, needs to go to the OR.
- I saw you doing CPR on this girl.
- Two liters out of the left chest.
Got a pulse back after three packed cells.
600 out of the cell saver, 2 of FFP.
- I'm not feeling it. - Check the carotid.
[indistinct chatter]
- Nothing. Sorry. - Resume compressions.
No, no, we should take her up. She just had a pulse.
- Not now. We need a pulse to go to the OR.
- Call me if anything changes. - Got a Pink coming in.
- Do we have any more whole blood from the donors?
- Think so. - Okay, get another unit
that's got platelets and plasma.
- It'll help her clot. - Got it.
Four units.
Blood is for the ones we can save.
She is right on the edge.
One more can make the difference.
I'm in.
- Uh, end-tidal looks good.
- Okay, OR team can take it from here.
- We need to check on the others.
- I should get back to Pink. - Stay strong, Crash.
- Uh, hemostatic bandage still in place.
- How you doing, Carmen? - Not so great.
Okay, let's see.
- Looks arterial. - Agreed.
Can you stop it?
- Uh, direct pressure for now. - Yeah.
- We may have a junctional tourniquet
in the disaster supplies.
- Can you get that? Cool.
Um...
Whitaker, in the meantime, just put pressure on it.
- Try and stop the bleeding. - For how long?
As long as it takes.
- He bled through his Kerlix. - Um...
elastic--elastic pressure dressing.
- Yep. - Okay, got it.
All right.
Got a better bandage, and we're gonna elevate your leg.
- Do you know what's happening with my girlfriend?
Her name is Leah. She was shot in the chest.
- I'm sorry. We have a ton of patients,
and they're only marked by number.
- Robby and Dana were working on her--they were doing CPR.
- How do you know Robby and Dana?
- Robby and my mom were together for a couple years,
and I would--I would come, and I'd hang out here.
- Well, I'm sure if they're helping her,
then she's in great hands.
Can you check for me, please?
- Sure. Of course. Just after I finish this.
- Well, there's no additional bleeding.
Strong pulse.
- Two grams of Ancef running in.
- Can you, uh, spread your fingers?
Uh, no, like this.
Are you okay?
- Found the junctional tourniquet.
- Um, okay. Uh, I'll be right back.
- How much blood you pushing off the cell saver?
Every last drop.
- O-neg. Monitor the pulse.
She's stable for trauma ICU if an OR's not ready.
How many units so far?
Four, plus the cell saver.
- Last one? - Getting backed up out there.
I don't know.
Dana, why don't we try a little TXA?
1,000 milligrams of TXA might help her clot.
Got it.
- Bullet tore through her heart.
Anyone else with a wound like this
is pronounced dead in the field.
You can't keep up with the blood loss.
If she was our only patient,
we'd do a thoracotomy, maybe ECMO.
But even then, I doubt we'd get her back.
We're gonna lose ten other patients
if you put all your efforts into saving this girl.
[indistinct chatter]
Got the TXA.
Okay, push it fast,
and we'll do another pulse check.
And then can you get me a vascular Doppler too, please?
- GSW to the chest, faint pulse.
- Intubation, IO, chest tube, and a unit of blood.
Copy that.
All nonessential personnel,
please report to the patient waiting room.
All nonessential personnel,
please report to the patient waiting room.
[indistinct chatter]
Anything I can do?
- You can check on Shen and Ellis in the ambulance bay.
On it.
- Whitaker, lay down some fresh gauze
so we can assess the hemostasis.
- Yep. How you doing, Carmen?
I'm hanging in there.
- You want the circle of compression
directly over the wound.
Tighten.
Inflate the balloon. Come on, pump it up, Whittaker.
- Uh, how much pressure? - Until the bleeding stops.
Uh, excuse me, ma'am.
Ma'am, where are you--
uh, Whittaker, stay on this.
Ma'am? Ma'am?
Do you need something?
Are you--
- I need one more O-neg.
- Hey, do you have any O-positive over there?
- This guy bled through his bandage.
- All available transport to the ER immediately.
All available transport to the ER immediately.
Okay.
Let me just--just put your arm like that.
Just keep your hand like that.
Just--
- [distant sirens wailing] - How we doing out here?
Dancing as fast as we can.
- Pretty sure I'm past my union-mandated bathroom break.
I never should have had that second coffee.
[distant wailing continues]
- Hey, son, ER's closed unless you're injured.
- Oh, my mom's inside. I need to take her home.
- David? - Mom?
- You're the kid? You need to come with me.
- Hey! Grab him! - Wait, David! Stop!
- Grab him! - What are you doing?
- Stay down! - Don't hurt him!
What the hell's going on?
Four units of packed cells,
two of FFP, 1,000 of TXA...
and 1,200 auto-transfused.
- Did you check this? - Not yet.
[pulse beating]
- Okay, it's working. Hold compressions.
[pulse beating irregularly]
[tense music]
♪ ♪
Okay, we're done.
[high-pitched ringing]
[machine beeps, flatlines]
We stopped at 19:47.
Hey.
Move her to Pedes?
You want me to go with you to talk to Jake?
No, no, thanks, I got it.
Jesus Christ.
What's going on?
- This is bullshit. I didn't do anything.
- He came back to pick up his mom--they tackled him.
- We need to question him about the shooting.
- Okay. After we clear him medically.
You know the drill.
- He has head trauma-- probable concussion.
- Dr. Mohan, why don't we do a complete neurological exam
in BH-2 and put him in line for a CT?
We got a Pink coming in.
Where's his mom?
- Still outside talking to the police.
- This is fucked up. I didn't do anything.
- Then who shot all of these people, huh?
- I don't know, how about you go look for him, dumbass?
David, are you all right?
- No, man, I'm fucking far from okay.
- Okay, okay, we're gonna get this straightened out
right now.
[indistinct radio chatter]
- I'm still bleeding! Please. I need something.
- No hemotympanum, no head trauma.
- Pulse is strong at 72. O2 sat perfect at 99.
- Um, do you need pain medicine?
Ma'am, we're trying to help you.
We just need you to let us know.
Okay, let's try and find her a gurney
and give her a full neuro exam.
Can you put her in 9?
- Drug overdose? - No.
Normal pupils, normal pulse.
Brain injury?
- No, she was walking with a steady gait.
Still needs a head CT.
- Well, that's not gonna be for hours.
- I could drill EZ-IOs on both sides.
It worked on the last guy.
- Maybe it's PTSD from all she's seen.
Is Psych even here?
- No, but maybe she just needs a quiet place.
Well, knock yourself out.
What's up, Whitaker?
- Junctional tourniquet appears to be working.
No new blood on the gauze.
You're looking good, Carmen.
Is she--Carmen? Carmen?
- Pulse is thready. How long has she been like this?
- She was awake and alert a minute ago.
- All that blood loss is catching up with her.
Run in a liter wide open.
- Uh, huge collection of blood near the bladder.
- The bullet must have tracked north
and hit the external iliac.
- We stopped the bleeding near the leg,
but she's still bleeding internally--we need Mel.
- No, we need to give a unit of blood
and move her to the red zone.
- Okay, let me see if they have space.
- Coming through. - Where's Robby?
- In BH-2 with the possible shooter.
- Can you guys take a new patient?
- Not right now. What do you got?
Hypotensive pelvic bleed.
- Transfuse two units. We'll get to it.
Abbot!
I got a carotid injury, popped a clot.
I'll be right there!
Help me out.
- Is that Robby with David? - Yeah.
I saw the cops bring him in.
Who's David?
- High school kid who was making threats.
- You think he did this? - Guys, focus on the patients.
What do you got?
Ooh, okay, sterile IV tubing, umbilical tape,
and red rubber Robinson, and sterile gloves.
[indistinct radio chatter]
We got a Pink coming in.
- Let's take the long way around.
- I can put Jake in the family room.
- No, it's okay. I'll do it.
Defect bypass with IV tubing.
You ever done a Rummel tourniquet?
Robby, can you help me with a Rummel?
[indistinct chatter]
Toughest part is getting the umbilical tape
through the tubing.
And clamps.
- Very cool. - You guys got this?
Oh, we're good.
- Dr. Robby, I have a retroperitoneal bleed.
- Get Abbot. - He's busy.
- Okay, stabilize and find a surgeon.
Get in the chair.
Hey, what's going on?
- Leah's injuries were really serious.
She stopped breathing.
We put a tube down her throat to deliver oxygen.
We were able to drain the blood that was collapsing her lungs.
We gave her as much blood as we could.
We even transfused some of her own blood
that was in her chest.
But we were unable to...
get ahead of the massive blood loss.
Her heart stopped.
You saw me doing CPR.
[inhales sharply] We did everything that we could.
She's dead?
[sniffles]
No, no, but I-- 'cause I was talk--
I was talking to her after she got shot,
and she was talking.
- Her heart was damaged beyond repair.
There was nothing that we could do to save her.
- I want to-- I want to see her.
- I'm really sorry, man, but you can't.
Why not?
- Because this is an active police and FBI investigation.
- She's--she's dead. - I know.
They're gonna release her to her parents
in a couple days.
- No, please, you-- you have to let me see her.
Please, please, please.
Bringing in mail.
- How's she doing? - Still has a pulse.
- What are you doing? - Prepping for REBOA.
- Are you crazy? Did Abbot approve this?
- He said, do what you have to do.
Attendings are all tied up.
If I can blow up a balloon in the aorta,
it'll stop the bleeding.
- It'll cut off the blood supply to half her body.
- I'll only go in a few inches, zone three, below the kidneys,
until she gets up to the OR.
Glove up, Huckleberry.
- Okay, you're gonna need an ultrasound, X-ray.
Not today.
Have you done this before?
It's a central line.
I just need to hit the femoral artery...
like that.
Piece of cake.
All right, guidewire, then introducer sheath.
Santos is doing a REBOA.
- Oh, no, no, no way. - Yes way.
- Um, no, we need an attending or a senior resident for that.
Oh, ye of little faith.
Victim identification.
- Are you sure? - Yes.
- All these people are dead? - Yeah.
Which one is Leah?
- What number do you have on--on your wrist?
91.
[sighs]
I'm at 15 centimeters
with 5 cc's of saline so far.
A REBOA?
- Are you shitting me? - I told her to stop.
- Uncontrollable bleeding from a pelvic artery--
no other options.
- We need an art line to know if the BP's up.
- We'll go with pulse strength and mentation.
- Carotid's weak. Radial's barely there.
- Another 3 cc's in the balloon.
Injecting.
- I'll try for palpable systolic.
Yes, go for it.
- Whoa. Uh, radial's much stronger now.
- Lock the balloon. Check the wound.
Go.
- BP's 110 by palp. - That'll do.
- Yeah, wound's dry. Barely a trickle.
- That's because there's no blood going to her legs.
Okay, the clock is ticking.
Balloon can stay up for one hour, tops.
Get IR and Vascular on the case.
- On it. - [cries]
- Hey, hey, hang in there, Carmen.
You're good, okay? You're good.
- Okay, you never should have done that on your own, ever.
Do you understand?
[whispering] But that was pretty badass.
You saved her life. Good job.
[crying]
Did you-- did you call her parents?
- They'll give the number to our social worker,
who will contact them very soon.
I got their daughter killed.
This is not your fault.
[crying]
Why--why couldn't you save her?
I mean, this-- this is what you do.
I tried.
[voice breaking] I really tried. We all did.
If this had been any other day, man...
"Had been the other day"?
What the fuck does that mean, "any other day"?
What, you would've saved her life?
- Yes. No. I don't know.
I don't--I don't know.
We're getting slammed up there.
We've had dozens of shooting victims.
You've seen it.
The fact that we've saved as many people as we have
is a fucking miracle.
But you didn't save Leah.
No.
No, I didn't.
[sniffles]
And I don't know how many people I've helped today,
but I can tell you every other person who has died.
[somber music]
♪ ♪
There was a man named Mr. Spencer,
who died in front of his children,
and an 18-year-old who--
who was brain dead from a fentanyl overdose
and a guy with a heart condition
and a little girl who drowned trying to save her sister.
[sobbing] And I'm gonna remember Leah
long after you've forgotten her.
Oh, fuck. Oh, fuck. I'm sorry. I'm sorry.
You got to go, man. You--you got to go.
You got to go. You got to go.
- Wait, Robby. Robby, wait, wait.
- Put him back in his bed, please.
[high-pitched ringing]
♪ ♪
[sobbing]