ER s04e15 Episode Script
Exodus
ER Previously on ER You come here every day.
Sometimes you're really cooking, and sometimes you're not.
- Alright, let's autotransfuse him.
- You're kidding.
- He needs blood, Carter.
- And he's gonna get it.
- Dad, I told you I'd rent a car.
- Your mother appreciates you coming.
Oh, here you are! Oh, I'm so glad! - Jerry! - What! Answer de damn phone! Did you withhold treatment from that kid? It's my decision.
It was good that you stayed focused on the patient.
- Thanks - How much time do you need? I'll wait.
"Exodus" We pull into the ambulance bay with a gunshot victim.
What are you thinking? - Excuse me? - A fresh trauma patient.
What goes through your mind? The basics: Airway, breathing, circulation.
Yeah.
But you docs don't think about the scene.
You see two IVs, c-collars, backboards, monitors all packaged and ready to go.
But you don't know what we go through.
Which is why I'm here.
A one-day ride-along is not gonna tell you the whole story.
Sometimes we get shot at.
Sometimes we're saving a banger, and there's airmail coming at us.
Airmail? Garbage, bottles, bricks.
Thrown from the windows, from the roof.
And we're in the streets trying to save a life.
You gotta keep your mind right.
It can make you cynical.
Well, let's hope we have an easy day.
It usually is when you docs ride along.
That's why you don't get the big picture.
You're here as an observer.
We have protocols, so don't go off on your own.
Don't worry.
Sure picked the right day for your ride-along.
- Where do we begin? - Right here.
- Come through here.
- What do you got? Lacerations, burns.
One fatality.
We set up triage out there.
We're all shored up.
I need to take a paramedic down.
A guy's trapped under rubble.
I'll go.
I'm a trauma surgeon.
County General, Dr.
Corday.
Have any experience with confined-space rescue? No, but take me to him, I'll see what I can do.
Okay.
Gear her up and take her down.
First section's vertical, eight to 10 feet.
Better to go head first.
- Head first? - There's no room to turn around.
The walls are pretty uneven so it's easy to brace yourself with your hands.
Do any rock climbing? No, I haven't.
Will I actually fit in there? It's tight at first but opens up near the victim.
You claustrophobic? No, not really.
All right.
Best you go first.
If something goes wrong I'll drag you out.
Yeah.
Okay, let's get on with it.
- Okay.
- All right, it's not far now.
Be careful, don't bump against those four-by-fours.
That's all that's holding this place up.
It's a little more open here.
We jacked up as far as we can.
All this is pretty unstable.
I can see him! We're on the way! Sir, are you okay? Get me out.
It hurts.
Yes, I'll give you something for the pain.
Then we're going to get you out, okay? Don't leave me.
We won't.
We won't leave you, I promise.
Give me the drug bag.
I need to start a line.
It's okay, sir.
If you just hang on.
- Lilac.
- It's called "Spring Rain.
" - It's nice.
- You think it's too young for me? No way.
My mom wears something just like that.
I don't have time to sit down.
I'm on from 3 to 11.
- How's it been going? - Got busy after lunch.
Doyle's out with the flu.
Heard from Mark? He's gonna try to catch a flight back today or tomorrow.
- One coffee, please.
- Sixty cents.
Hey, Carter! How's the Optho rotation going? Only a week to go.
Long week.
Maybe you can help me out.
I've been getting headaches reviewing these financial reports.
I need a new pair of reading glasses.
Sure, come on up.
I'll check you out.
- Get you a new prescription.
- Thank you.
You can keep that.
Jack Arteburn, 52.
Fainted at a breakfast meeting.
A and O on arrival, vitals normal.
Started a line for kicks.
Did you have any chest pain? No, I was just a little dizzy.
My secretary overreacted.
- Are you a doctor? - I'm a physician assistant.
But I'll be seeing a real doctor? County dispatch says there's been an explosion at a chemical warehouse.
They want to send us six minors with burns.
- Yeah, no problem.
- No problem.
Just a little bee sting, Leo.
Sorry.
It's the only place to put an IV.
Get me out of here! Yep.
We're working on that.
Hang on.
I'll give you some morphine.
Make you feel much better.
Dewey, can you lift up the saline? He's got a good pulse.
Some broken ribs, and he can wriggle his toes.
I can't assess the right arm.
It's pinned at his shoulder.
If we could raise the concrete just another inch or two.
No.
Any movement could bring all this down.
Just an inch, then we might free it.
And I won't have to amputate.
No! No, please don't cut off my arm.
No.
We're trying to save it, Leo.
We're gonna lift up that slab.
What else can we do if we're to get him out? Okay.
I'm gonna need more shoring before we try anything.
I need a bone saw.
No.
Don't do it, please.
Only as a last resort, Leo.
What about something to reduce the friction? Grease? No, it's too thick.
We need something we can pour, like vegetable oil.
- We got motor oil.
- Yeah.
Motor oil.
Lots of it.
We'll get you slick as an eel and slide you out.
E- L-M.
N- E.
Very good.
Very good, Mrs.
Melenger.
Okay.
Now I want you to tell me which one is clearer, okay? Number one or number two? Number two is very dark.
Okay, let's try that again.
Number one or number two? It's black.
I can't see through that.
Yes.
I think that is probably a little too much tint for you.
Is everything okay? Not really.
I think your student needs some help.
Why don't I finish up here, Dr.
Carter? There's a glaucoma patient in the ER.
Needs a consult.
Glenn Krakowski, 32, from the chemical warehouse.
Right tib-fib fracture.
Complaining of abdominal pain.
BP 132/75.
Pulse 92.
IV's in the field.
What about these guys? Minor burns and lacerations from glass.
- Anything for me? - Blood trauma, abdominal pain.
- Is T-1 open? - Yeah.
Start on him.
I'll take the others.
- Sir, are you on any medication? - No, nothing.
I never get sick.
Message from Dr.
Anspaugh.
He's giving a lecture.
- That's the hotel phone number.
- Is that Mr.
Arteburn's chart? Yeah, yeah.
Actually, check this out.
Blue Cross.
Not the HMO, not the PPO.
Traditional indemnity plan, gold.
- Jerry, we treat everyone the same.
- I'm thinking about the budget deficit.
Mr.
Arteburn, I have some preliminary results and I'd like to- If there's any cause for concern, I'd rather go see my own doctor.
Changes in your EKG suggest that you may have had a small heart attack.
- Heart attack? - We'll check a blood test to make sure there was no heart muscle damage.
If that's normal, we'll do a treadmill heart scan.
Would you call my doctor, Greg Fonarow? He's up on Chestnut.
I want his opinion on what you're doing.
I'll call him when I get the test results.
Don't worry.
You'll find we give the highest standard of care.
It's your last quart, Leo.
I raised it an inch.
That's it.
Right.
You ready? One, two, three! Let me check his arm.
- You got room? - Yep.
You said you wouldn't amputate.
It won't come to that.
Another good tug and we'll get you out of the hole.
- You ready? - Yeah.
Then pull! We don't have enough leverage to lift him out.
- I need a come-along.
- What's that? It's a kind of winch- - What was that? - I don't know.
Dewey here.
What the hell's going on? Explosion in the chemical area.
Abort and get out.
Acknowledged.
Cap says out.
No.
Tell them to bring what we need so we can get him out! He won't let anyone come down.
- Then you go get it.
- And leave you? Yes.
They've gotta let you back down if I'm here.
Now go! I'm not leaving him! - But hurry! - Okay.
I'll be back.
We're gonna die down here.
It's okay, Leo.
Just one more piece of equipment and we'll get you out.
I've got an 8-year-old with altered mental status, short of breath.
Babysitter called 911.
- I stopped by this morning.
- I had an early morning meeting.
Before 7:00? Are you monitoring me? Just offering you a ride.
Sophie? This is Dr.
Ross.
- Hi, Sophie.
- Hi.
How long's she been sick? Her mom said she's had diarrhea for a couple days now.
She said to give her a spoonful of bee pollen and raspberry tea.
How are you feeling, Sophie? - I have to practice the piano.
- She's altered.
When did that start? I found her on the floor.
She had a bowel movement with blood in it.
I couldn't wake her up.
Give her an ABG, a CBC, a chem 20 and a chest x-ray.
Want an IV of saline? No, just a HEP block.
She's gonna be all right? - Did you talk to her parents? - I beeped her mom.
Could you try again? Yeah.
If you'd gone to public school, you could've seen my science program.
I started them right after the war.
Try and keep your eyes still.
Look at my earlobe.
You know, about 1950, I was on a TV program.
I liked it so much I wanted to make it my life's work.
What happened? What happened? I'll tell you what happened.
That son of a bitch, Mr.
Wizard, came along and left me dead in the water.
Yeah.
Go ahead, laugh.
Well, it looks good.
I'm gonna need to check your eye pressure with a tono-pen, Mr.
Bikel.
- Dr.
George.
- Dr.
George? Tono-pen? The state-of-the-art we used to get was the big one with the air puff.
I'll put numbing drops in and then measure the pressure.
Solid-state microcircuitry.
But all in all, just a simple pressure transducer.
That's what- That's numbing already.
The numbing's coming fast.
Press this button and it works.
Don't you wanna know how? I could build you one.
Out of an ink jar, finger cot and a swizzle stick.
All right.
Thirty-five.
Your pressure's up a bit.
It doesn't look good.
Creatinine's 6.
8.
Potassium's 7.
3.
She's got acute renal failure.
Get me glucose, insulin, and Kayexalate.
What's shutting down her kidneys? It could be bloody diarrhea.
E.
coli, probably.
Push two of Versed.
Get an ET tube 6.
5.
That's good.
She needs a central line for dialysis.
Call for a pediatric nephrology consult.
When can I go home? Not for a little while.
Dr.
Ross will give you some medicine that will make you very sleepy.
When you wake up, you'll have a tube in your mouth to help you breathe.
You won't be able to speak, so we'll do hand signals.
Do you know what this means? Okay? Good.
Are you good at charades? Here we go.
Hold on.
Crike, crike, crike.
Honey? What's going on? All right.
Hang on.
I'm in, bag her.
Are you the mother? Get me an 11 French catheter.
Sophie? Sophie? Why is she unconscious? We had to sedate her to get the breathing tube down her throat.
She wasn't sick when I left.
She had some diarrhea.
We believe it's an E.
coli infection causing the kidney failure.
E.
coli? That comes from meat.
It's impossible, she doesn't eat meat.
It can also come from raw juices or sprouts.
Well, however she got it, she needs dialysis.
Oh, no.
I want another opinion before you put her on some machine.
There's no time.
This is my daughter.
I have a right to decide how she's treated.
Her high potassium could cause a cardiac arrest.
She needs dialysis.
If she doesn't get it, she'll die.
Sign the consent.
Please? No.
My leg! I'm caught! His foot's caught.
I'm gonna try and free it.
Can you reach it? Can you loosen it? - What are you doing? - Just a tiny bit.
The shoring's down! Get out! He's free! Pull! Pull! Pull! Pull! Pull! How are you doing? Last one.
See you tomorrow for a wound check.
Make sure you call the employee-health coordinator at the chemical plant.
- Fax them all- - I need some help! - What happened? - We're from Prusack Chemco.
We were behind Building 5 when the tank blew.
Manny went into the stuff.
- What kind of stuff? - Everyone got soaked.
It was a mess.
I threw these guys in back of my pickup.
What is that smell? Solvent.
Everyone got sick.
Jeanie, take the other guys.
Bag and seal the clothes.
Glove up, everybody.
I'm gonna open some doors.
I want you to use one drop, three times a day.
Three times a day, one drop.
Thank you.
What's the matter? - Benzene.
- What? It's benzene.
Don't you smell it? Probably just stripping the floors.
Stripping floors with benzene? I don't think so.
It's much too toxic.
Doctor, before I go find out where that smell is coming from as quick as possible.
Set up oxygen.
Pulse is weak and thready.
Bilateral wheezes.
- What's going on? - Chemical spill.
Yosh, bag these clothes up and get them outside.
Take slow, deep breaths.
You want me to call your wife? - You might be here a while.
- We need fans.
I'll call Maintenance.
Get Housekeeping to clean up- - Give me a hand! - Oh, my God! Wait! No one touch her without gloves on.
Her clothes are soaked through.
Ready? One, two, three! - Get a mask on her! - Pulse ox.
Roll her on her side.
- Don't let her aspirate! - Suction.
Ativan, two milligrams IV, now! - She needs a line.
- It's Dr.
Weaver! Don't walk there.
It's benzene.
What is that? It's a solvent.
It's toxic.
We don't want to spread this stuff around.
Keep it contained.
- Let's go with the Ativan.
- Need to intubate.
When we give an order, it's for a reason! - I'm sorry.
But we were so close.
- You could've died! - I'd have three deaths to explain! - I was worried about you! Leo Leipziger.
Crush injury to the right arm.
BP 90 palp.
Pulse 110.
- We had a prolonged extrication.
- No kidding! Stay to the right.
We've got an unknown solvent leaking from a tank.
HazMat's setting up for decontamination.
Chuny, we need more of these to cover the floor.
I'll call Central.
Here.
Anna, check Ellenhorn's Toxicology and find out about benzene exposure.
Where to? Trauma 1.
Move the sickest patients away from here.
Double-bag all of the contaminated clothes.
Get the clean patients to the back.
Randi, grab their charts now! You need to air this place.
Did you call HazMat? - They're on the way.
- There's another one in the closet.
We'll blow it out of here in no time.
No, no, no! Don't plug that in! Sparks might ignite the fumes.
- Great.
- Jerry, give me a phone! What's the ETA on HazMat? You gotta find that disaster manual.
I need surgical drapes, waterproof ones.
Better send a dozen.
- Dispatch, this is County General ER.
- They'll be here in five! This is an emergency! Send the drapes up now! I need oxygen.
We're closing down to all paramedic- No, immediately! Hang in there, Leo.
Trauma patient.
What's going on? Benzene fumes are contaminating patients.
Dr.
Corday, we're moving everybody out.
He needs x-rays, peritoneal lavage and immediate surgery on his arm.
Take him to the back hall.
I'll call X-ray.
In the hall? - Prep that guy and notify the OR.
- You got it.
Where are you taking me? What are we doing in the hall? Get out of here! Fumes are coming off the gurney! I want to get out of here! - What happened to Randi? - She's fainted.
- The lobby? - Let's go! Clean patients only! How do we know who's clean? - Is Randi contaminated? - If it's on her clothes.
- You okay? - Fine, but my patient's critical.
If the CEO's in a meeting, get me her assistant.
I'm in disaster mode.
Three victims from the blast.
Decontaminated.
- What's this? - You can't come in.
ER's contaminated.
- What happened? - They came covered in benzene.
- Clear the lobby! - You shouldn't have let them in! You didn't control it! They came in a truck! Move this gurney out of the way! Move! Just move! Somebody clear out the lobby! Send them to Mercy or something! All right, everybody shut up! - Everybody shut up! - Send them to Mercy! We' re going to evacuate the entire ER! Check every room.
All contaminated patients and staff go to the ambulance bay right now! How do we know who's contaminated? If you got a spot on your skin, your gurney, or your clothes go outside right now! Move, move! Let's get him out.
Let's get her out.
- Dr.
Weaver, how you doing? - Her seizing stopped.
She's postictal.
I won't go outside without my jacket! Can you get some blankets for them? Send home any non-urgent cases now.
If you need stitches or x-rays, go to the lobby! Let me have this for a second.
How many critical are there? I got three here in the ambulance bay! Seven, eight.
There's three outside.
That's 11.
All critical patients should move to Go to the cafeteria.
It's big enough.
Let's stock it with portable monitors and oxygen cylinders.
That's where we're moving.
Let's go! It's not good to move during dialysis.
Can this thing run off a battery? - No battery.
There's a hand crank.
- Then start cranking.
Pedes Unit has a bed.
All right.
Get her ready.
Joint Admission Protocols, Quality Assessment and Improvements.
What are you doing? I need Ellenhorn.
Check under the stack.
The disaster manual has gotta be here somewhere.
- What does it say? - I just found it.
What about Policy and Procedures? Maybe something in here- Forget it.
Grab all the charts and take them to Benton in the cafeteria.
- I'm sure there's probably- - Run to the cafeteria! It's under Hydrocarbons.
"Excreted in urine as sulfate conjugates-" No, not that.
Go to Clinical Presentation.
Pulmonary System.
"Coughing, choking, pulmonary edema where aspiration occurs.
" I think Manny aspirated, but not Weaver.
Central Nervous System.
"Inhalation causes depression and rarely, seizures from hypoxia.
" Supportive Care.
"Treat with oxygen.
" - That's what we're doing.
- She should be okay.
Let's move this table up against the wall.
Let's go! - You're scratching my floor! - You, help him.
- Don't order my people around! - Where are the outlets? Along that wall and that wall.
All right, everybody, listen up! When I call the patient's name, give me the diagnosis.
Arteburn? Right here.
Rule out Ml.
Let's get him over here.
Center aisle.
- Nguyen? - Shock, respiratory failure.
Against the wall.
He'll need a vent.
Where are you going? I can't wait.
I need to get him cleaned and up to the OR.
Williams! We gotta get some heat.
We're gonna freeze.
HazMat.
What's up? There's a benzene spill.
Patients are contaminated.
- We need some shelter.
- We'll set them up out here.
Take these to the cafeteria and set up a portable suction.
- Where's the spill? - On the other side.
We're evacuating.
- That means you too, Dr? - Carter.
Captain Dannaker.
We're setting up a decon.
We're stocking the ambulance bay and cafeteria with supplies.
We'll get you what you need.
Get everyone out now.
You won't know what to look for.
Give me five minutes.
- You got two! - Okay! Grab a crash cart, defibrillator and a bunch of mayo stands.
- Right! - You guys okay? - We're on our way.
- Okay.
Chuny, get a lot of saline.
Lots of it.
Anybody in Exam 4? I need you down here.
Inga Paulson, coronary artery disease, dopamine drip.
Help me move her out.
I'll do it.
You take ACLS drugs to the cafeteria.
Grab a big cart and load it full.
- You're gonna move her and bag her? - Yeah.
Go, go, go! Don't worry, Inga.
We'll get you out of here.
This is ridiculous! It won't work.
There's no room.
We should go to the cafeteria.
No, I need her in the ICU.
Stop cranking, I'll disconnect.
- Her blood's in that machine.
- I'm aware of that.
- We should go to the cafeteria now.
- Hang on.
All right.
Now we got a loop.
Start cranking and come with me.
Take the other elevator and meet us at PICU.
Don't let that blood clot! Good, Inga.
Big squeeze every three seconds.
Doing fine.
This is the last one.
Get moving.
- What the hell? - A fire alarm.
I'll get it.
Dannaker here.
Get me the fire control room.
What's that? Fire alarm.
Hang on.
I lost the bag! Can you stabilize the tube? - What did you push? - Nothing.
I- What the hell's going on? Elevator recall, down to the lobby.
Happens during emergencies.
Sophie, you okay? - Why have we stopped? - I don't know.
How's her oxygen? She's got two-thirds of a tank.
Look at that! - Think they'll hear that? - Yeah, they'll hear it.
- Excuse me.
You're a doctor? - Yes, I am.
My daughter's a patient in the ER.
They won't let me in.
- Okay.
- You can't be here, ma'am.
No! Somebody help me! - Check in the cafeteria.
- Let go of me! - Captain Dannaker? - Copy.
No fire verified on floor two.
Fire patrol, do a reset.
False alarm.
Somebody smelled fumes and panicked.
- Jeanie, why are we outside? - We're taking you to the cafeteria.
- Is she okay? - She's still altered.
It's not the benzene, it's the seizures.
She should be fine.
Some may need attention before they go inside.
- You're in the cold zone.
- Cold zone? Out here.
In there's the warm zone.
Nobody goes in there without a suit.
Same goes for the ER, it's a hot zone.
- Are you Carter? - Yeah.
Harriet Spooner, VP of Operations.
I'm the incident commander.
- Did you evacuate to the cafeteria? - Yeah.
The disaster plan calls for evacuation to Physical Therapy.
It got chaotic.
We had to improvise.
We have an elevator stuck.
- I'll get the engineer.
- Anybody on it? Don't know.
The phone's dead and the alarm's going off.
Just keep your eye on it.
Now listen, Sophie? We're going on a little adventure.
You'll have cool stories to tell.
Multifocal PVCs.
Let me see this.
Potassium's too high.
Push an amp of bicarb.
Buy us a little time.
Run of seven.
Here, take it.
Bicarb.
She'll go into V-tach.
We don't have any.
Did you check the box? You can't treat hyperkaliemia without bicarb.
It wasn't my idea to move her like this.
- It's okay.
It's okay, Sophie.
- What do you have? All right.
We got epi, atropine.
How about lidocaine? I'll take lidocaine.
and 5 every five minutes.
How's the oxygen? Ten minutes.
You'll be fine.
Lavage is negative.
Let's get him to the OR.
Hey, Transport! Give us a hand.
Dr.
Weaver? I'm sorry.
Have we met? You're my doctor.
We should let her rest.
We got two more vents coming down.
Who gets the first one? Let's start with Inga.
Are you sure, Inga? It could be awhile.
Carter, where's your Attending? Dr.
Weaver's over here.
- Do you need more nurses? - Yes, we do.
All right.
I can float you three from the ICU.
Kerry? Harriet.
What is going on? I am so sorry.
I had no idea you were debilitated by the incident.
What incident? Remember I told you there was a toxic spill? Will she be all right? Lack of oxygen caused a seizure.
We don't expect any long-term effects.
This is the action packet for the chief medical officer which I guess, for the moment, is you.
Here's a walkie.
I'll check in with you in half an hour.
I've got to deal with the elevator.
- Did you get them out? - Repairman's on the way.
It'll be an hour.
- There are two sets of doors? - Yeah.
- Help me when I open it.
- I can't.
I gotta bag her.
Reach in! Get your body in here.
- Right there.
- All right.
- Watch your knee.
Go.
- I got it.
Hang on.
We're two and a half feet short of the floor.
There's gotta be a latch.
Come down.
What if it moves? No worries about commitment.
- I'm serious.
- I got it.
Right there.
Pull it.
Give me another pull.
What's that? It's not the EKG.
It's her pulse ox.
The 02 sat's down to 89.
Oh, God! Sophie?! Sophie? - All right, I got it.
- She's unresponsive! - Anybody in there? - We got a little girl in here! Got that? Hold that there.
We need oxygen! - Get us out of here! - We don't have time! Let's go! It won't go any further than that! Come on! It's gonna work.
Watch your fingers.
Hang on.
- You all right? - Yeah.
Okay, hang on.
Hold it right there.
Try this.
All right.
- It's not gonna open.
- It's gonna open! - Come here.
Get your hands in here.
- Grab hold! All right, guys.
One, two, three! - She needs oxygen! - Got it.
Got it.
Hook her up.
Go.
- Here's our little action hero.
- How does it look? Like ground beef.
No, more like chopped liver.
Can we salvage the limb? Want my honest opinion? No, I don't think you do.
- I'd like to give it our best shot.
- You got it, Lizzie.
110 percent.
- Can you feel this? - It's kind of numb.
Is that bad? It means the leg's tensing.
I'll measure the internal pressure.
Transducer's up in the ER.
HazMat won't find it.
All right.
Then I need an 18-gauge needle, IV tubing and a BP manometer.
You got it.
Then I watched them put you on a gurney and give you oxygen.
Then what happened? They moved me from a yellow room to a green room.
That would be Trauma 2.
But where was I at that time? Then they put you in the yellow room.
That's where they removed all of your clothes and put them into a plastic bag.
Two more to go.
- What about the ER? - It'll take awhile.
- Is there a doctor around? - Right here.
Hard to breathe.
- I'm coming.
- No.
Suits only.
Suit me up.
He's in trouble.
It'll take 15 minutes to suit up.
He'll be out by then.
Doc, do something! You won't let me in? He could die.
- Mike, give him oxygen! - Morrie! - He's not talking! Do something! - Get me an airway kit now! Give him one more minute.
Tube him when he comes out.
Morrie! Morrie! Help him! Do something! Help him! That's pretty stupid.
Do something for Morrie! He's dirty now.
Let him do it.
- Anybody here an EMT? - I'm a medic.
Bag him when I'm done.
You got it.
I'm in.
- Scrub him.
- Let's go, doc.
- Let's go.
- Wait.
Dr.
Carter.
Come in, Dr.
Carter.
I need to talk to her.
I got you covered, doc.
How's he doing? He's picking up.
Looks good.
Great.
Sixty, 70.
What does that mean? The pressure's too high from the bleeding.
We need to operate.
I need you over here! Jerry, book a room! Charging to 200.
Clear! - Still in fib.
- All right.
Charge to 300.
Clear! - Can we take him inside? - In a minute.
What about my shoes? Ernie, take care of Dr.
Carter.
His heart's up to 98.
He's waking up.
He sounds pretty good.
I think you'll be okay, Morris.
- Dr.
Carter? - No, man.
Real shoes.
Malik! Help us move him inside? Hold up.
They're coding some old lady in the cafeteria.
I said charge it to 360.
Wait, it takes time.
The battery's low.
Okay.
Clear! Asystole.
How long have we been at this? Eighteen minutes.
She never had a rhythm or a pulse.
That's it.
Time of death: 22:09.
OR's ready for Krakowski.
I've got a fasciotomy.
See if you can find her family.
Did that lady just die? I mean, is she dead? They're not gonna leave her there? - Where are the pre-op labs? - Here.
- How long will I be in a cast? - Four to six weeks.
- Anna's running the code? - Yeah, but we just- Five rounds of epi.
Two of atropine.
Lidocaine- Bretylium, amiodarone.
- Should've been in the ICU.
- Wouldn't have made a difference.
Might've.
No.
You turned this place into an ICU.
This isn't an ICU.
This is just something we threw together.
This shouldn't have happened.
Look.
Inoperable triple-vessel disease.
It was only a matter of time.
Mr.
Arteburn, you okay? Dizzy.
Very dizzy.
Superventricular tachycardia.
Adenosine 6 mgs, IV.
We don't have any.
- Jerry, run to the pharmacy.
- Do you need some help? Jeanie, help out Dr.
Weaver.
Take it easy.
Pulse is weak and thready.
Any chest pain? We can't wait for adenosine.
It's a cardiovert.
Lily, grab a crash cart! Let's get him into Trendelenberg.
I'll try carotid sinus massage.
Yosh.
Can you get a BP? Lily, charge to 100.
Mr.
Arteburn? Mr.
Arteburn? - He's unresponsive.
- Give me the paddles.
- Battery's dead.
- I'll find an extension cord.
No, there's an outlet.
Help me move him.
- Move that gurney out of the way! - BP's 60 palp.
He's not moving much air.
I gotta tube him.
Carter? Carter? Get ready to start CPR.
I need an intubation tray.
Carter? Lily, when we get power, we need to move him.
Get over here! I need you to bag him.
Almost ready! Hold that.
Normal sinus rhythm.
What are you people doing to me?! You had an abnormal heart rhythm.
We had to treat you.
- By drowning me?! - It's a diving reflex.
It slows the heart, breaks the tachycardia.
You call this the highest standard of care? Get my doctor on the phone! I got the adenosine.
We're okay.
I'll meet you in Recovery.
I want to be there when he wakes up.
Yes.
- Elizabeth.
- Hello, Peter.
I'll be right there.
Oh, your eye looks worse.
I'm sure it looks nastier than it is.
Let me have a look anyway.
You could have a hyphema.
So I heard about the big rescue.
You were under a collapsed building? Went all out to avoid amputation.
But we had to take his arm anyway.
Okay.
You okay? Have to tell Leo about his arm when he wakes up.
What about you? You on call tonight? I've got a fasciotomy.
After that, I'm free.
I could do with some debriefing.
Take a deep breath in.
Now blow out.
Can we get a blood gas in 20 minutes? My throat's sore.
- Give her some water.
- Yep.
There you go.
That was pretty scary, wasn't it? No.
We do that kind of thing here every day.
No.
You were scared.
Tell the truth.
- I was pretty scared.
- I was really scared.
Honey, I've been looking all over for you.
Is she okay? She's fine.
I heard about the fumes.
- Was she exposed? - Her lungs weren't exposed.
- She was never in any danger? - No, Mom.
They took really good care of me.
Excuse me.
The ER.
Okay.
Dr.
Lemley, if you'll? I'll come back and check on you.
You're in good hands.
- Thank you.
- You're welcome.
Carol? - Have Pharmacy restock the drug boxes.
- Sure.
- Are you still mad at me? - I was mad? - You accused me of spying on you.
- I never said that.
That's what you meant.
I was annoyed.
You don't need to check on me.
I wasn't.
I just wanted to see you last night.
Me too.
We shouldn't let that happen too often, should we? I actually think we shouldn't let that happen at all, but- Here goes nothing.
Okay, Mr.
Arteburn.
Let's put you down into Curtain 1.
Take Manny and put him in Curtain 2.
- Morris, 2B.
- Carter, I can take it from here.
Put the sickest patients in the trauma rooms and curtains.
- Jeanie.
- Yeah? You and Jerry update the board and get the phones back.
- You okay? - Yeah.
I'm fine.
I spoke with Harriet Spooner, the incident commander.
I would like to thank you for helping me out.
The administration would like you to speak with the press.
We'll meet them together in the first-floor conference room at 11: 15.
In terms of dealing with these people, I've got more experience.
It's important that the emphasis- - No.
Morris gets that vent! - All right.
It's important that the emphasis be placed on the institutional response to the crisis as opposed to any individual efforts.
They would tend to sensationalize.
I think it's best to say simply that we followed a well-rehearsed disaster plan and worked with HazMat to ensure the safety of our patients and also the staff.
The fire captain wants to speak with you.
Oh, right.
11: 15? - That's right.
- I'll be there.
I've looked at some of the causative factors and I can now identify those at blame.
What are you talking about? I've been on nights, and during that time the day unit service coordinators have let the central area deteriorate.
Jerry, this was a chemical spill.
Yes, and we were impaired because we were unable to find this important manual.
Now that I'm back on days, you can count on a higher level of efficiency at the central work area.
If you pass out again, I'll have everything under control.
Dr.
Carter! Want these back? No.
Souvenir.
How do you think your people handled things? Oh, pretty good.
No.
It was a total disaster.
You guys were caught with your pants down.
But you personally did okay under the circumstances.
I think you're the guy to work with on a schedule of disaster drills.
I don't have that kind of authority.
I'm just an intern.
You had me fooled.
You should talk to our chief of staff.
It was good working with you.
Hey, Carter! Hey! When did you get back? Came straight from the airport.
I'm on in five minutes.
It's good to see you.
How's your mom? She's doing better.
What's with the boots? It's kind of a long story.
Sometimes you're really cooking, and sometimes you're not.
- Alright, let's autotransfuse him.
- You're kidding.
- He needs blood, Carter.
- And he's gonna get it.
- Dad, I told you I'd rent a car.
- Your mother appreciates you coming.
Oh, here you are! Oh, I'm so glad! - Jerry! - What! Answer de damn phone! Did you withhold treatment from that kid? It's my decision.
It was good that you stayed focused on the patient.
- Thanks - How much time do you need? I'll wait.
"Exodus" We pull into the ambulance bay with a gunshot victim.
What are you thinking? - Excuse me? - A fresh trauma patient.
What goes through your mind? The basics: Airway, breathing, circulation.
Yeah.
But you docs don't think about the scene.
You see two IVs, c-collars, backboards, monitors all packaged and ready to go.
But you don't know what we go through.
Which is why I'm here.
A one-day ride-along is not gonna tell you the whole story.
Sometimes we get shot at.
Sometimes we're saving a banger, and there's airmail coming at us.
Airmail? Garbage, bottles, bricks.
Thrown from the windows, from the roof.
And we're in the streets trying to save a life.
You gotta keep your mind right.
It can make you cynical.
Well, let's hope we have an easy day.
It usually is when you docs ride along.
That's why you don't get the big picture.
You're here as an observer.
We have protocols, so don't go off on your own.
Don't worry.
Sure picked the right day for your ride-along.
- Where do we begin? - Right here.
- Come through here.
- What do you got? Lacerations, burns.
One fatality.
We set up triage out there.
We're all shored up.
I need to take a paramedic down.
A guy's trapped under rubble.
I'll go.
I'm a trauma surgeon.
County General, Dr.
Corday.
Have any experience with confined-space rescue? No, but take me to him, I'll see what I can do.
Okay.
Gear her up and take her down.
First section's vertical, eight to 10 feet.
Better to go head first.
- Head first? - There's no room to turn around.
The walls are pretty uneven so it's easy to brace yourself with your hands.
Do any rock climbing? No, I haven't.
Will I actually fit in there? It's tight at first but opens up near the victim.
You claustrophobic? No, not really.
All right.
Best you go first.
If something goes wrong I'll drag you out.
Yeah.
Okay, let's get on with it.
- Okay.
- All right, it's not far now.
Be careful, don't bump against those four-by-fours.
That's all that's holding this place up.
It's a little more open here.
We jacked up as far as we can.
All this is pretty unstable.
I can see him! We're on the way! Sir, are you okay? Get me out.
It hurts.
Yes, I'll give you something for the pain.
Then we're going to get you out, okay? Don't leave me.
We won't.
We won't leave you, I promise.
Give me the drug bag.
I need to start a line.
It's okay, sir.
If you just hang on.
- Lilac.
- It's called "Spring Rain.
" - It's nice.
- You think it's too young for me? No way.
My mom wears something just like that.
I don't have time to sit down.
I'm on from 3 to 11.
- How's it been going? - Got busy after lunch.
Doyle's out with the flu.
Heard from Mark? He's gonna try to catch a flight back today or tomorrow.
- One coffee, please.
- Sixty cents.
Hey, Carter! How's the Optho rotation going? Only a week to go.
Long week.
Maybe you can help me out.
I've been getting headaches reviewing these financial reports.
I need a new pair of reading glasses.
Sure, come on up.
I'll check you out.
- Get you a new prescription.
- Thank you.
You can keep that.
Jack Arteburn, 52.
Fainted at a breakfast meeting.
A and O on arrival, vitals normal.
Started a line for kicks.
Did you have any chest pain? No, I was just a little dizzy.
My secretary overreacted.
- Are you a doctor? - I'm a physician assistant.
But I'll be seeing a real doctor? County dispatch says there's been an explosion at a chemical warehouse.
They want to send us six minors with burns.
- Yeah, no problem.
- No problem.
Just a little bee sting, Leo.
Sorry.
It's the only place to put an IV.
Get me out of here! Yep.
We're working on that.
Hang on.
I'll give you some morphine.
Make you feel much better.
Dewey, can you lift up the saline? He's got a good pulse.
Some broken ribs, and he can wriggle his toes.
I can't assess the right arm.
It's pinned at his shoulder.
If we could raise the concrete just another inch or two.
No.
Any movement could bring all this down.
Just an inch, then we might free it.
And I won't have to amputate.
No! No, please don't cut off my arm.
No.
We're trying to save it, Leo.
We're gonna lift up that slab.
What else can we do if we're to get him out? Okay.
I'm gonna need more shoring before we try anything.
I need a bone saw.
No.
Don't do it, please.
Only as a last resort, Leo.
What about something to reduce the friction? Grease? No, it's too thick.
We need something we can pour, like vegetable oil.
- We got motor oil.
- Yeah.
Motor oil.
Lots of it.
We'll get you slick as an eel and slide you out.
E- L-M.
N- E.
Very good.
Very good, Mrs.
Melenger.
Okay.
Now I want you to tell me which one is clearer, okay? Number one or number two? Number two is very dark.
Okay, let's try that again.
Number one or number two? It's black.
I can't see through that.
Yes.
I think that is probably a little too much tint for you.
Is everything okay? Not really.
I think your student needs some help.
Why don't I finish up here, Dr.
Carter? There's a glaucoma patient in the ER.
Needs a consult.
Glenn Krakowski, 32, from the chemical warehouse.
Right tib-fib fracture.
Complaining of abdominal pain.
BP 132/75.
Pulse 92.
IV's in the field.
What about these guys? Minor burns and lacerations from glass.
- Anything for me? - Blood trauma, abdominal pain.
- Is T-1 open? - Yeah.
Start on him.
I'll take the others.
- Sir, are you on any medication? - No, nothing.
I never get sick.
Message from Dr.
Anspaugh.
He's giving a lecture.
- That's the hotel phone number.
- Is that Mr.
Arteburn's chart? Yeah, yeah.
Actually, check this out.
Blue Cross.
Not the HMO, not the PPO.
Traditional indemnity plan, gold.
- Jerry, we treat everyone the same.
- I'm thinking about the budget deficit.
Mr.
Arteburn, I have some preliminary results and I'd like to- If there's any cause for concern, I'd rather go see my own doctor.
Changes in your EKG suggest that you may have had a small heart attack.
- Heart attack? - We'll check a blood test to make sure there was no heart muscle damage.
If that's normal, we'll do a treadmill heart scan.
Would you call my doctor, Greg Fonarow? He's up on Chestnut.
I want his opinion on what you're doing.
I'll call him when I get the test results.
Don't worry.
You'll find we give the highest standard of care.
It's your last quart, Leo.
I raised it an inch.
That's it.
Right.
You ready? One, two, three! Let me check his arm.
- You got room? - Yep.
You said you wouldn't amputate.
It won't come to that.
Another good tug and we'll get you out of the hole.
- You ready? - Yeah.
Then pull! We don't have enough leverage to lift him out.
- I need a come-along.
- What's that? It's a kind of winch- - What was that? - I don't know.
Dewey here.
What the hell's going on? Explosion in the chemical area.
Abort and get out.
Acknowledged.
Cap says out.
No.
Tell them to bring what we need so we can get him out! He won't let anyone come down.
- Then you go get it.
- And leave you? Yes.
They've gotta let you back down if I'm here.
Now go! I'm not leaving him! - But hurry! - Okay.
I'll be back.
We're gonna die down here.
It's okay, Leo.
Just one more piece of equipment and we'll get you out.
I've got an 8-year-old with altered mental status, short of breath.
Babysitter called 911.
- I stopped by this morning.
- I had an early morning meeting.
Before 7:00? Are you monitoring me? Just offering you a ride.
Sophie? This is Dr.
Ross.
- Hi, Sophie.
- Hi.
How long's she been sick? Her mom said she's had diarrhea for a couple days now.
She said to give her a spoonful of bee pollen and raspberry tea.
How are you feeling, Sophie? - I have to practice the piano.
- She's altered.
When did that start? I found her on the floor.
She had a bowel movement with blood in it.
I couldn't wake her up.
Give her an ABG, a CBC, a chem 20 and a chest x-ray.
Want an IV of saline? No, just a HEP block.
She's gonna be all right? - Did you talk to her parents? - I beeped her mom.
Could you try again? Yeah.
If you'd gone to public school, you could've seen my science program.
I started them right after the war.
Try and keep your eyes still.
Look at my earlobe.
You know, about 1950, I was on a TV program.
I liked it so much I wanted to make it my life's work.
What happened? What happened? I'll tell you what happened.
That son of a bitch, Mr.
Wizard, came along and left me dead in the water.
Yeah.
Go ahead, laugh.
Well, it looks good.
I'm gonna need to check your eye pressure with a tono-pen, Mr.
Bikel.
- Dr.
George.
- Dr.
George? Tono-pen? The state-of-the-art we used to get was the big one with the air puff.
I'll put numbing drops in and then measure the pressure.
Solid-state microcircuitry.
But all in all, just a simple pressure transducer.
That's what- That's numbing already.
The numbing's coming fast.
Press this button and it works.
Don't you wanna know how? I could build you one.
Out of an ink jar, finger cot and a swizzle stick.
All right.
Thirty-five.
Your pressure's up a bit.
It doesn't look good.
Creatinine's 6.
8.
Potassium's 7.
3.
She's got acute renal failure.
Get me glucose, insulin, and Kayexalate.
What's shutting down her kidneys? It could be bloody diarrhea.
E.
coli, probably.
Push two of Versed.
Get an ET tube 6.
5.
That's good.
She needs a central line for dialysis.
Call for a pediatric nephrology consult.
When can I go home? Not for a little while.
Dr.
Ross will give you some medicine that will make you very sleepy.
When you wake up, you'll have a tube in your mouth to help you breathe.
You won't be able to speak, so we'll do hand signals.
Do you know what this means? Okay? Good.
Are you good at charades? Here we go.
Hold on.
Crike, crike, crike.
Honey? What's going on? All right.
Hang on.
I'm in, bag her.
Are you the mother? Get me an 11 French catheter.
Sophie? Sophie? Why is she unconscious? We had to sedate her to get the breathing tube down her throat.
She wasn't sick when I left.
She had some diarrhea.
We believe it's an E.
coli infection causing the kidney failure.
E.
coli? That comes from meat.
It's impossible, she doesn't eat meat.
It can also come from raw juices or sprouts.
Well, however she got it, she needs dialysis.
Oh, no.
I want another opinion before you put her on some machine.
There's no time.
This is my daughter.
I have a right to decide how she's treated.
Her high potassium could cause a cardiac arrest.
She needs dialysis.
If she doesn't get it, she'll die.
Sign the consent.
Please? No.
My leg! I'm caught! His foot's caught.
I'm gonna try and free it.
Can you reach it? Can you loosen it? - What are you doing? - Just a tiny bit.
The shoring's down! Get out! He's free! Pull! Pull! Pull! Pull! Pull! How are you doing? Last one.
See you tomorrow for a wound check.
Make sure you call the employee-health coordinator at the chemical plant.
- Fax them all- - I need some help! - What happened? - We're from Prusack Chemco.
We were behind Building 5 when the tank blew.
Manny went into the stuff.
- What kind of stuff? - Everyone got soaked.
It was a mess.
I threw these guys in back of my pickup.
What is that smell? Solvent.
Everyone got sick.
Jeanie, take the other guys.
Bag and seal the clothes.
Glove up, everybody.
I'm gonna open some doors.
I want you to use one drop, three times a day.
Three times a day, one drop.
Thank you.
What's the matter? - Benzene.
- What? It's benzene.
Don't you smell it? Probably just stripping the floors.
Stripping floors with benzene? I don't think so.
It's much too toxic.
Doctor, before I go find out where that smell is coming from as quick as possible.
Set up oxygen.
Pulse is weak and thready.
Bilateral wheezes.
- What's going on? - Chemical spill.
Yosh, bag these clothes up and get them outside.
Take slow, deep breaths.
You want me to call your wife? - You might be here a while.
- We need fans.
I'll call Maintenance.
Get Housekeeping to clean up- - Give me a hand! - Oh, my God! Wait! No one touch her without gloves on.
Her clothes are soaked through.
Ready? One, two, three! - Get a mask on her! - Pulse ox.
Roll her on her side.
- Don't let her aspirate! - Suction.
Ativan, two milligrams IV, now! - She needs a line.
- It's Dr.
Weaver! Don't walk there.
It's benzene.
What is that? It's a solvent.
It's toxic.
We don't want to spread this stuff around.
Keep it contained.
- Let's go with the Ativan.
- Need to intubate.
When we give an order, it's for a reason! - I'm sorry.
But we were so close.
- You could've died! - I'd have three deaths to explain! - I was worried about you! Leo Leipziger.
Crush injury to the right arm.
BP 90 palp.
Pulse 110.
- We had a prolonged extrication.
- No kidding! Stay to the right.
We've got an unknown solvent leaking from a tank.
HazMat's setting up for decontamination.
Chuny, we need more of these to cover the floor.
I'll call Central.
Here.
Anna, check Ellenhorn's Toxicology and find out about benzene exposure.
Where to? Trauma 1.
Move the sickest patients away from here.
Double-bag all of the contaminated clothes.
Get the clean patients to the back.
Randi, grab their charts now! You need to air this place.
Did you call HazMat? - They're on the way.
- There's another one in the closet.
We'll blow it out of here in no time.
No, no, no! Don't plug that in! Sparks might ignite the fumes.
- Great.
- Jerry, give me a phone! What's the ETA on HazMat? You gotta find that disaster manual.
I need surgical drapes, waterproof ones.
Better send a dozen.
- Dispatch, this is County General ER.
- They'll be here in five! This is an emergency! Send the drapes up now! I need oxygen.
We're closing down to all paramedic- No, immediately! Hang in there, Leo.
Trauma patient.
What's going on? Benzene fumes are contaminating patients.
Dr.
Corday, we're moving everybody out.
He needs x-rays, peritoneal lavage and immediate surgery on his arm.
Take him to the back hall.
I'll call X-ray.
In the hall? - Prep that guy and notify the OR.
- You got it.
Where are you taking me? What are we doing in the hall? Get out of here! Fumes are coming off the gurney! I want to get out of here! - What happened to Randi? - She's fainted.
- The lobby? - Let's go! Clean patients only! How do we know who's clean? - Is Randi contaminated? - If it's on her clothes.
- You okay? - Fine, but my patient's critical.
If the CEO's in a meeting, get me her assistant.
I'm in disaster mode.
Three victims from the blast.
Decontaminated.
- What's this? - You can't come in.
ER's contaminated.
- What happened? - They came covered in benzene.
- Clear the lobby! - You shouldn't have let them in! You didn't control it! They came in a truck! Move this gurney out of the way! Move! Just move! Somebody clear out the lobby! Send them to Mercy or something! All right, everybody shut up! - Everybody shut up! - Send them to Mercy! We' re going to evacuate the entire ER! Check every room.
All contaminated patients and staff go to the ambulance bay right now! How do we know who's contaminated? If you got a spot on your skin, your gurney, or your clothes go outside right now! Move, move! Let's get him out.
Let's get her out.
- Dr.
Weaver, how you doing? - Her seizing stopped.
She's postictal.
I won't go outside without my jacket! Can you get some blankets for them? Send home any non-urgent cases now.
If you need stitches or x-rays, go to the lobby! Let me have this for a second.
How many critical are there? I got three here in the ambulance bay! Seven, eight.
There's three outside.
That's 11.
All critical patients should move to Go to the cafeteria.
It's big enough.
Let's stock it with portable monitors and oxygen cylinders.
That's where we're moving.
Let's go! It's not good to move during dialysis.
Can this thing run off a battery? - No battery.
There's a hand crank.
- Then start cranking.
Pedes Unit has a bed.
All right.
Get her ready.
Joint Admission Protocols, Quality Assessment and Improvements.
What are you doing? I need Ellenhorn.
Check under the stack.
The disaster manual has gotta be here somewhere.
- What does it say? - I just found it.
What about Policy and Procedures? Maybe something in here- Forget it.
Grab all the charts and take them to Benton in the cafeteria.
- I'm sure there's probably- - Run to the cafeteria! It's under Hydrocarbons.
"Excreted in urine as sulfate conjugates-" No, not that.
Go to Clinical Presentation.
Pulmonary System.
"Coughing, choking, pulmonary edema where aspiration occurs.
" I think Manny aspirated, but not Weaver.
Central Nervous System.
"Inhalation causes depression and rarely, seizures from hypoxia.
" Supportive Care.
"Treat with oxygen.
" - That's what we're doing.
- She should be okay.
Let's move this table up against the wall.
Let's go! - You're scratching my floor! - You, help him.
- Don't order my people around! - Where are the outlets? Along that wall and that wall.
All right, everybody, listen up! When I call the patient's name, give me the diagnosis.
Arteburn? Right here.
Rule out Ml.
Let's get him over here.
Center aisle.
- Nguyen? - Shock, respiratory failure.
Against the wall.
He'll need a vent.
Where are you going? I can't wait.
I need to get him cleaned and up to the OR.
Williams! We gotta get some heat.
We're gonna freeze.
HazMat.
What's up? There's a benzene spill.
Patients are contaminated.
- We need some shelter.
- We'll set them up out here.
Take these to the cafeteria and set up a portable suction.
- Where's the spill? - On the other side.
We're evacuating.
- That means you too, Dr? - Carter.
Captain Dannaker.
We're setting up a decon.
We're stocking the ambulance bay and cafeteria with supplies.
We'll get you what you need.
Get everyone out now.
You won't know what to look for.
Give me five minutes.
- You got two! - Okay! Grab a crash cart, defibrillator and a bunch of mayo stands.
- Right! - You guys okay? - We're on our way.
- Okay.
Chuny, get a lot of saline.
Lots of it.
Anybody in Exam 4? I need you down here.
Inga Paulson, coronary artery disease, dopamine drip.
Help me move her out.
I'll do it.
You take ACLS drugs to the cafeteria.
Grab a big cart and load it full.
- You're gonna move her and bag her? - Yeah.
Go, go, go! Don't worry, Inga.
We'll get you out of here.
This is ridiculous! It won't work.
There's no room.
We should go to the cafeteria.
No, I need her in the ICU.
Stop cranking, I'll disconnect.
- Her blood's in that machine.
- I'm aware of that.
- We should go to the cafeteria now.
- Hang on.
All right.
Now we got a loop.
Start cranking and come with me.
Take the other elevator and meet us at PICU.
Don't let that blood clot! Good, Inga.
Big squeeze every three seconds.
Doing fine.
This is the last one.
Get moving.
- What the hell? - A fire alarm.
I'll get it.
Dannaker here.
Get me the fire control room.
What's that? Fire alarm.
Hang on.
I lost the bag! Can you stabilize the tube? - What did you push? - Nothing.
I- What the hell's going on? Elevator recall, down to the lobby.
Happens during emergencies.
Sophie, you okay? - Why have we stopped? - I don't know.
How's her oxygen? She's got two-thirds of a tank.
Look at that! - Think they'll hear that? - Yeah, they'll hear it.
- Excuse me.
You're a doctor? - Yes, I am.
My daughter's a patient in the ER.
They won't let me in.
- Okay.
- You can't be here, ma'am.
No! Somebody help me! - Check in the cafeteria.
- Let go of me! - Captain Dannaker? - Copy.
No fire verified on floor two.
Fire patrol, do a reset.
False alarm.
Somebody smelled fumes and panicked.
- Jeanie, why are we outside? - We're taking you to the cafeteria.
- Is she okay? - She's still altered.
It's not the benzene, it's the seizures.
She should be fine.
Some may need attention before they go inside.
- You're in the cold zone.
- Cold zone? Out here.
In there's the warm zone.
Nobody goes in there without a suit.
Same goes for the ER, it's a hot zone.
- Are you Carter? - Yeah.
Harriet Spooner, VP of Operations.
I'm the incident commander.
- Did you evacuate to the cafeteria? - Yeah.
The disaster plan calls for evacuation to Physical Therapy.
It got chaotic.
We had to improvise.
We have an elevator stuck.
- I'll get the engineer.
- Anybody on it? Don't know.
The phone's dead and the alarm's going off.
Just keep your eye on it.
Now listen, Sophie? We're going on a little adventure.
You'll have cool stories to tell.
Multifocal PVCs.
Let me see this.
Potassium's too high.
Push an amp of bicarb.
Buy us a little time.
Run of seven.
Here, take it.
Bicarb.
She'll go into V-tach.
We don't have any.
Did you check the box? You can't treat hyperkaliemia without bicarb.
It wasn't my idea to move her like this.
- It's okay.
It's okay, Sophie.
- What do you have? All right.
We got epi, atropine.
How about lidocaine? I'll take lidocaine.
and 5 every five minutes.
How's the oxygen? Ten minutes.
You'll be fine.
Lavage is negative.
Let's get him to the OR.
Hey, Transport! Give us a hand.
Dr.
Weaver? I'm sorry.
Have we met? You're my doctor.
We should let her rest.
We got two more vents coming down.
Who gets the first one? Let's start with Inga.
Are you sure, Inga? It could be awhile.
Carter, where's your Attending? Dr.
Weaver's over here.
- Do you need more nurses? - Yes, we do.
All right.
I can float you three from the ICU.
Kerry? Harriet.
What is going on? I am so sorry.
I had no idea you were debilitated by the incident.
What incident? Remember I told you there was a toxic spill? Will she be all right? Lack of oxygen caused a seizure.
We don't expect any long-term effects.
This is the action packet for the chief medical officer which I guess, for the moment, is you.
Here's a walkie.
I'll check in with you in half an hour.
I've got to deal with the elevator.
- Did you get them out? - Repairman's on the way.
It'll be an hour.
- There are two sets of doors? - Yeah.
- Help me when I open it.
- I can't.
I gotta bag her.
Reach in! Get your body in here.
- Right there.
- All right.
- Watch your knee.
Go.
- I got it.
Hang on.
We're two and a half feet short of the floor.
There's gotta be a latch.
Come down.
What if it moves? No worries about commitment.
- I'm serious.
- I got it.
Right there.
Pull it.
Give me another pull.
What's that? It's not the EKG.
It's her pulse ox.
The 02 sat's down to 89.
Oh, God! Sophie?! Sophie? - All right, I got it.
- She's unresponsive! - Anybody in there? - We got a little girl in here! Got that? Hold that there.
We need oxygen! - Get us out of here! - We don't have time! Let's go! It won't go any further than that! Come on! It's gonna work.
Watch your fingers.
Hang on.
- You all right? - Yeah.
Okay, hang on.
Hold it right there.
Try this.
All right.
- It's not gonna open.
- It's gonna open! - Come here.
Get your hands in here.
- Grab hold! All right, guys.
One, two, three! - She needs oxygen! - Got it.
Got it.
Hook her up.
Go.
- Here's our little action hero.
- How does it look? Like ground beef.
No, more like chopped liver.
Can we salvage the limb? Want my honest opinion? No, I don't think you do.
- I'd like to give it our best shot.
- You got it, Lizzie.
110 percent.
- Can you feel this? - It's kind of numb.
Is that bad? It means the leg's tensing.
I'll measure the internal pressure.
Transducer's up in the ER.
HazMat won't find it.
All right.
Then I need an 18-gauge needle, IV tubing and a BP manometer.
You got it.
Then I watched them put you on a gurney and give you oxygen.
Then what happened? They moved me from a yellow room to a green room.
That would be Trauma 2.
But where was I at that time? Then they put you in the yellow room.
That's where they removed all of your clothes and put them into a plastic bag.
Two more to go.
- What about the ER? - It'll take awhile.
- Is there a doctor around? - Right here.
Hard to breathe.
- I'm coming.
- No.
Suits only.
Suit me up.
He's in trouble.
It'll take 15 minutes to suit up.
He'll be out by then.
Doc, do something! You won't let me in? He could die.
- Mike, give him oxygen! - Morrie! - He's not talking! Do something! - Get me an airway kit now! Give him one more minute.
Tube him when he comes out.
Morrie! Morrie! Help him! Do something! Help him! That's pretty stupid.
Do something for Morrie! He's dirty now.
Let him do it.
- Anybody here an EMT? - I'm a medic.
Bag him when I'm done.
You got it.
I'm in.
- Scrub him.
- Let's go, doc.
- Let's go.
- Wait.
Dr.
Carter.
Come in, Dr.
Carter.
I need to talk to her.
I got you covered, doc.
How's he doing? He's picking up.
Looks good.
Great.
Sixty, 70.
What does that mean? The pressure's too high from the bleeding.
We need to operate.
I need you over here! Jerry, book a room! Charging to 200.
Clear! - Still in fib.
- All right.
Charge to 300.
Clear! - Can we take him inside? - In a minute.
What about my shoes? Ernie, take care of Dr.
Carter.
His heart's up to 98.
He's waking up.
He sounds pretty good.
I think you'll be okay, Morris.
- Dr.
Carter? - No, man.
Real shoes.
Malik! Help us move him inside? Hold up.
They're coding some old lady in the cafeteria.
I said charge it to 360.
Wait, it takes time.
The battery's low.
Okay.
Clear! Asystole.
How long have we been at this? Eighteen minutes.
She never had a rhythm or a pulse.
That's it.
Time of death: 22:09.
OR's ready for Krakowski.
I've got a fasciotomy.
See if you can find her family.
Did that lady just die? I mean, is she dead? They're not gonna leave her there? - Where are the pre-op labs? - Here.
- How long will I be in a cast? - Four to six weeks.
- Anna's running the code? - Yeah, but we just- Five rounds of epi.
Two of atropine.
Lidocaine- Bretylium, amiodarone.
- Should've been in the ICU.
- Wouldn't have made a difference.
Might've.
No.
You turned this place into an ICU.
This isn't an ICU.
This is just something we threw together.
This shouldn't have happened.
Look.
Inoperable triple-vessel disease.
It was only a matter of time.
Mr.
Arteburn, you okay? Dizzy.
Very dizzy.
Superventricular tachycardia.
Adenosine 6 mgs, IV.
We don't have any.
- Jerry, run to the pharmacy.
- Do you need some help? Jeanie, help out Dr.
Weaver.
Take it easy.
Pulse is weak and thready.
Any chest pain? We can't wait for adenosine.
It's a cardiovert.
Lily, grab a crash cart! Let's get him into Trendelenberg.
I'll try carotid sinus massage.
Yosh.
Can you get a BP? Lily, charge to 100.
Mr.
Arteburn? Mr.
Arteburn? - He's unresponsive.
- Give me the paddles.
- Battery's dead.
- I'll find an extension cord.
No, there's an outlet.
Help me move him.
- Move that gurney out of the way! - BP's 60 palp.
He's not moving much air.
I gotta tube him.
Carter? Carter? Get ready to start CPR.
I need an intubation tray.
Carter? Lily, when we get power, we need to move him.
Get over here! I need you to bag him.
Almost ready! Hold that.
Normal sinus rhythm.
What are you people doing to me?! You had an abnormal heart rhythm.
We had to treat you.
- By drowning me?! - It's a diving reflex.
It slows the heart, breaks the tachycardia.
You call this the highest standard of care? Get my doctor on the phone! I got the adenosine.
We're okay.
I'll meet you in Recovery.
I want to be there when he wakes up.
Yes.
- Elizabeth.
- Hello, Peter.
I'll be right there.
Oh, your eye looks worse.
I'm sure it looks nastier than it is.
Let me have a look anyway.
You could have a hyphema.
So I heard about the big rescue.
You were under a collapsed building? Went all out to avoid amputation.
But we had to take his arm anyway.
Okay.
You okay? Have to tell Leo about his arm when he wakes up.
What about you? You on call tonight? I've got a fasciotomy.
After that, I'm free.
I could do with some debriefing.
Take a deep breath in.
Now blow out.
Can we get a blood gas in 20 minutes? My throat's sore.
- Give her some water.
- Yep.
There you go.
That was pretty scary, wasn't it? No.
We do that kind of thing here every day.
No.
You were scared.
Tell the truth.
- I was pretty scared.
- I was really scared.
Honey, I've been looking all over for you.
Is she okay? She's fine.
I heard about the fumes.
- Was she exposed? - Her lungs weren't exposed.
- She was never in any danger? - No, Mom.
They took really good care of me.
Excuse me.
The ER.
Okay.
Dr.
Lemley, if you'll? I'll come back and check on you.
You're in good hands.
- Thank you.
- You're welcome.
Carol? - Have Pharmacy restock the drug boxes.
- Sure.
- Are you still mad at me? - I was mad? - You accused me of spying on you.
- I never said that.
That's what you meant.
I was annoyed.
You don't need to check on me.
I wasn't.
I just wanted to see you last night.
Me too.
We shouldn't let that happen too often, should we? I actually think we shouldn't let that happen at all, but- Here goes nothing.
Okay, Mr.
Arteburn.
Let's put you down into Curtain 1.
Take Manny and put him in Curtain 2.
- Morris, 2B.
- Carter, I can take it from here.
Put the sickest patients in the trauma rooms and curtains.
- Jeanie.
- Yeah? You and Jerry update the board and get the phones back.
- You okay? - Yeah.
I'm fine.
I spoke with Harriet Spooner, the incident commander.
I would like to thank you for helping me out.
The administration would like you to speak with the press.
We'll meet them together in the first-floor conference room at 11: 15.
In terms of dealing with these people, I've got more experience.
It's important that the emphasis- - No.
Morris gets that vent! - All right.
It's important that the emphasis be placed on the institutional response to the crisis as opposed to any individual efforts.
They would tend to sensationalize.
I think it's best to say simply that we followed a well-rehearsed disaster plan and worked with HazMat to ensure the safety of our patients and also the staff.
The fire captain wants to speak with you.
Oh, right.
11: 15? - That's right.
- I'll be there.
I've looked at some of the causative factors and I can now identify those at blame.
What are you talking about? I've been on nights, and during that time the day unit service coordinators have let the central area deteriorate.
Jerry, this was a chemical spill.
Yes, and we were impaired because we were unable to find this important manual.
Now that I'm back on days, you can count on a higher level of efficiency at the central work area.
If you pass out again, I'll have everything under control.
Dr.
Carter! Want these back? No.
Souvenir.
How do you think your people handled things? Oh, pretty good.
No.
It was a total disaster.
You guys were caught with your pants down.
But you personally did okay under the circumstances.
I think you're the guy to work with on a schedule of disaster drills.
I don't have that kind of authority.
I'm just an intern.
You had me fooled.
You should talk to our chief of staff.
It was good working with you.
Hey, Carter! Hey! When did you get back? Came straight from the airport.
I'm on in five minutes.
It's good to see you.
How's your mom? She's doing better.
What's with the boots? It's kind of a long story.