How Triage Works

going pretty good? Do you like my Scotland shirt? That's great. You're gonna wear that in Scotland. Yeah, that's why I got it. Okay, I got a shirt for each city nice country. Well Edinburgh, yeah, yeah, that's the city. Yeah. I think they'll be behind the Scotland shirt. And they will too. They're gonna stand up and do that Arsenio like, yeah, because they're living in the eighties. Yeah, about a shirt for each city on our UK tour because I'm just you know, I can write it off and that's just

the very mean thing to do. I'll keep the Manchester shirt a secret. Oh I know what it is, do you? I think? So? All right, Well, we'll talk later. Okay. In the meantime, Chuck, let's talk about trias. Let's talk about the French language. Okay, tree a okay means too short? Did you know that? Which means that Lars von Trier's name is Lars Vaughan. To sort, Yeah, sort or sift. I saw another meaning, but everywhere else said sort, and

apparently it was originally used exclusively in reference to sorting vegetables. Yeah, a little known fact. But the pre industrial French society was a grarian, so they would say, and that means and they snapped their fingers and point and pile of vegetables, sort of veggies, root veggies in France. Yeah, they have those everywhere, but but they they're bonkers for root veggies in France. They have good, clean, simple food in that country. Yeah,

good good food. Yeah. What's it called the French food? It's not not the trinity that's like a Cajun, but the mere poix. Oh I've not heard that before. Is it the same thing? No? I think mere poise carrot onion, and one other thing parsley, celery, celery. Jerry's the celery Jerry. I think you're right? Are you right? You know you're right, okay, in Cajun Land, it's like Bell Pepper onion and what

and uh garlic it would meet garlic. I was trying to think of something funny and I failed my brain just like, yeah, well it's late in the day, trying to think of something about like an angel Heart reference. Man, that movie is crazy. Still holds up. I saw it really well. Actually I can't say it holds up because I never saw it as a kid. I saw it as an adult recently. I think it's still on Netflix.

You know, Lisa Bonet is in the season of Ray Donovan and she looks exactly the same vampire perhaps very pretty lady. I was crushed on her big when I was a kid, and she's super laid back. Um, what was it Lisa Huxtable? Yeah, for sure they didn't. Her name wasn't Lisa Huxtable. It was something huxtable. Well probably not because the real names Lisa. Yes. You know, sometimes shows like used the actor's first name as the character's name,

even though they're not playing themselves. I always thought that was weird. Yeah. I always wonder if it's because they have a hard time I'm remembering their characters right, or the writers like I just can't come up with a name. Just call him the real name, okay, sue me. And I know people get so tired of screaming at us about like, oh, what was the name of that? And they're like her name was this? I do that to other podcasts, so I feel your pain. I heard one

just the other day. I think Judge John Hodgement he couldn't think of something, and I was like, no navy blue. Anyway, I apologize for all the things we don't know. Uh. Treer to sort was to sort vegetable foundation of the term triage. Yeah. And the reason why the French got to got naming rights for this process that will describe in a minute is because it was basically invented by a French person. Pretty remarkable guy from what I can tell. He had a great name. He was Napoleon's surgeon, the

chief surgeon of Napoleon's Imperial Guard. His name was Baron Dominique Jean Larrey. Yeah, and he was, uh, he was a bad dude in all the best ways. He was. And this was at a time when warfare was getting pretty serious. Um, I mean it was already serious, but people were dying and massive amounts of people soldiers dying on the field and great, great numbers. And so he said, you know what, we need to come up with the system,

a way to take care of these dudes. Uh, so they're not waiting over there with a bone sticking out of their leg waiting for attention. Well this dude also, I mean he came to this conclusion because he was running around battlefields like performing amputations and um, just in a sea of bodies. Like bite, bite on your gun barrel while I cut your leg off. Yeah that kind of thing. Yeah, um, and he barrel but stuck. Sure could bite on yourn, but be really, they needed up

needing new teeth. Um, the wood is much more comfortable when you're having your leg amputative without anesthetic, I would say so. Um, but while he's running around performing these battlefield amputations, he realizes quite quick quickly that some people

are in need of help more urgently than others. And he decided it would be pretty awesome if you could figure out a way, like you were saying, to devise a system of arranging people very quickly so that, um, you could give aid to the people who needed it most. And Uh, to do that, you would need to sort through the people, hence triage as if they were root vegetables.

Uh so what he did initially, and it's gone through some changes that we're going to talk about, but the initial incarnation of triage was only based on severity of injuries, no other factor. Well even before that, and this is another reason this guy is awesome when he like, there was a very vague form of triage before, but it

was based on your social standing. Oh really, so yeah, I was reading that, like, if you have a of course, a guy who's like, uh, an aristocrat with a broken leg, yeah, and just a grunt whose bowels are hanging out, you fix the broken leg first, which is senseless. And laure was like, no, we're not gonna do that anymore. It's going to be based on severity of of injury, yeah, their need for help. And Napoleon was like, that's great, but you know, I'm at the top of the list

no matter what. Right, Hey, have you heard people calling me the anti Christ behind my back? Because I could hear rumblings about this and it's bugging me. You know, I'm not really short, I'm average. Yeah, that's true. Uh. And the process went on to change a little bit more. With British surgeon naval surgeon John Wilson in six he said, you know what, let's refine this a little bit and let's put some focus on people who can be successfully treated,

so not necessary early. That guy's got all his bowels hanging out, he's the most severely injured. He thought, well, you know what, that guy might not make it, so maybe we shouldn't spend so much time. It's harsh, but it's war, it is. And that was a huge shift because it up to that point, if you were a medic um like you just treated people. Now you have a decision to make with each person. Do you let

that person die? Um, because they're probably going to die and you could be saving other people rather than wasting your talents and resources on this person right here, Make them comfortable, maybe throw some morphine their way, and then you know, go about your business. That was a big big shift in in triage, in battlefield triage, and in the US it didn't um, they didn't, We didn't. We didn't catch up very quickly by the Civil War. So that guy uh Laura was was working on triage, inventing

it in the seventeen nineties. Um, John Wilson refined it in the eighteen forties in the Civil War. Still we were doing like first come, first served. Whoever was closest to the medic was who got worked on first in the Civil War in the eighteen sixties. Still, it wasn't until um, I think the late eighteen sixties or early eighteen seventies that the US first started adopting even basic triage. So Britain led the way in this case, well, France

and then Britain. Yeah, yeah, France led the way in mercy. Britain led the way in um saying like, no, we gotta let some people die here. Well, I would say efficiency in saving lives overall. Yeah, I mean it's a very utilitarian way of looking at and like they're they're like gotta be gotta have nerves of steel, gotta have

a kung fu grip. World War One things changed again. Uh, they tweaked it and now they said, all right, maybe we should treat and you know, if this was what country, this was just generally this is a US Army manual. It was, but apparently the US wasn't alone in this. It was like a it seems like a worldwide movement shift in in triage, which was to treat, uh, how many people can you treat in the shortest amount of time,

So like maybe people that don't need as much. But yeah, and the basis of this is even more steely nerved than than um John Wilson's shift, because this is saying not ignore that person, they're probably going to die. It's this person is going to die, you could probably save, but it's gonna take up too much time. And the time that it takes to save this person's life and

you probably could save it. You could have fixed up twelve people who weren't going to die but can get back out and fight the war a lot faster if you work on them. And that was I think the thinking behind it, patching up people who are more likely to be a will it returned to battle, rather than saving lives of people who UH might not be able to or who would take up a lot of time,

hard choices. Yeah, that's super utilitarian. That was, like you said, a surgical manual out of the military at the time said this quote, a single case, even if it urgently requires attention, may have to wait for in that time a dozen others almost equally exigent but requiring less time might be cared for. And four people died while I read that on the battlefield it could have really sum

that up quicker. Uh, should we take a little break? Sure? Man, No, all right, my friend, Uh, there are we've been talking about the battlefield so far in its history. That was the origin of it. But uh, if you go to the e R. And actually I haven't been to the e R much at all in the last jeez much at all in my life. That's good. But since I was a kid, but I did go in New York remember, Oh yeah, that's right. When I got sick. I went to the emergency room in New York City, Beth Israel.

And it was, man, it was a little a little scary, just the scene there. Sure, yeah, it wasn't like I'm sort of used to the hospitals around here, kind of nicer, like it had seen its better days, the e R room and the waiting room, and it was it's sad to see the people that are in there that need help, you know, in a big city like that. It's um, it's not like you know, my kid fell down and bumped his head. It's like, you know, it was disturbing. I'll just say that. Yeah, but I was triaged when

I first got there. And that's what will happen to you when you go to a er there. There's gonna be a triage nurse. Somebody runs up to you and throws glitter in your face and said, you've been triaged. That's after someone already threw molasses on your face. That glitter would sticks. Yeah, So triage nurse is gonna come by and that that dude to that lady is gonna say, hi, welcome to Beth Israel. Sorry about the mess. Um, let's check you out. I'll watch your step. There's some blood. Seriously,

it's kind of like that. Um and uh, they will do an assessment. They're gonna look at you and say, you know, deep, this guy has a spoon coming out of his ear, so I can make a snap judgment that you need quick help. Yeah. Or this dude in my case was just holding his belly and so he looks like he can wait, Yeah, he looks like he was shooted duck. He can sit here and hold that for a little while. She said, here, let me pull

your finger. Everything will be all right. And there's what you're describing this e er triage that's done by a triage nurse, right, the first person about the first person you see when you come to an e er when they're doing triage. It's not constant necessarily they have been trained to do this, but they're also following float charts. There's there's triage protocols, different ones, and there's one from Manchester, UK and it's from what I understand, the international gold

standard for triage, the Manchester Triage system And it's a band. Yeah, it is like Manhattan Transfer. Um. But it's like it's a flow chart and it basically says like, um, are they breathing? No, get them immediate help, like stop right now and immediately get them into a place where a lifesaving intervention can be carried out right. Um. And there's some other ones, but it seems like breathing is the

focus of it. That's good, Yeah it is, but but I mean you think about it, you would think there'd be some other ones too, like as are there is their blood coming out of their ear or something like that. No, it's mostly breathing. Like if if you're breathing, there's a pretty good chance you're you're gonna make it, especially if you have a normal breathing pattern, right. Um. And but then there's some other ones like if if the person

is not responsive or if they're drooling. Apparently it's another one. Um, there are a couple of jewelers in the r Israel. They should have been seen immediately according to the Manchester UM triage system. So, um, there's like a float chart. You don't have to It's not necessarily just the nurses subjective judgment. It's not supposed to be. I'm sure it is in like high stress situations and with really highly trained triage nurses they can just be like, yeah, this

move that person there, you go sit down, you go home. Um. But for the most part, it's supposed to be a UM an objective system that you can just consult and be like, okay, well here here's where you fit paper. You're so smart, why don't you just treatage everybody yourself? Well beyond the initial UH flow chart to they're also

going to take some vitals. Um, here your complaint in your medical history, allergies, all that good stuff, medications you might be on, and then take your vitals, blood pressure, temperature, all that good stuff. Yeah, if if you're not in that group where they're just like to send them right back. Yes, And by the way, I'm not knocking beth is reel because Nurse Eddie there, this dude, the guy who didn't

believe that you were sick. Yeah, a little bit. He was amazing and took wonderful care of me and was like the typical New York nurse that you might think of this sort of like he had the accent, and he was like a very kind of cool customer dude, like I would have felt very comfortable walking into his arms like a gunshot, because I'm sure he could have

like totally taken care of me. But he did get a little like like I couldn't figure out what's wrong with me at first, and then after I got better and they knocked me out and gave me fluids and I woke up. I had a I was like, all right, great, and you know, I'm out of here. And I felt this lump, remember that, I felt a lump behind my ear the size of a golf ball. And I walked back in. I was like, Nurse Eddie, dude, I got like,

what is this? And he kind of gave me one of those looks like, oh, you're one of those guys. And I was like, I'm not a hypochondriac. I'm never at the doctor. I've never been to the e R hardly, like, please don't look at me those eyes. Nurse Eddie and um, he felt it and I was like, see, it's like it's huge. And I think he determined that it was some kind of like he had a doctor come over and they determined it was just a swelling of lymph

node from hypochondria brought on by my sickness. But anyway, big shout out. It turned out to be you had snakes in your belly. Yeah. If I passed out on the subway, woke up two days later in Coney Island, I had thirteen snakes in my belly, no more, no less. So weird. So um. They gather these details in the triage didn't take long. They use the color coded system in some hospitals. Numbers and some were both things on where you are. Yeah, what's this is astounding to me?

It's not universal, Like the colors aren't universal. Numbers seem to be like nobody does it backwards, but the color should be the exact same too. So for example, like in Manchester's jam Like the worst of all is red. See red? Making sense? No another trio system blues? The worst code blue. Yeah, I think you hear that a lot on American TV, but it's a It's a real thing, at least in the States. So I I think that everybody should get together and agree on a color system

because the whole point of triage is rapid fire. Let's get this done. Not oh, well, which system did you triage them? Because I'm I'm I enjoy a spotted t so I'm a fan of the Manchester system, so this this red is completely odd to me. Yeah, but you know the one your hospital uses, so you're probably not getting confused as the triage nurse. Yeah, I guess it's true, But I mean, I know what you mean. There's just you should you should go out of your way to

um take out any possible you get transferred to another hospital. Yeah, there's just I think there should be universal colors. I have a strong opinion on that. I totally agree. If you're a kid, you may get sent to closer to the front of the line um or if you have a history of illness or like you have cancer or something like, if you have an outstanding condition already, you may be shuffled to the front um or. And this

makes a lot of sense to me. A lot of times now they have what they call it a different track. They have two tracks. Um, if you're in severe distress, you're in one gets you right away. But if you have another one doesn't necessarily mean you're gonna wait eight hours. They'll just put you in a different track, right for the less severe cases. Yeah, you go see the doctor who's been caught drinking on the job. You know that's right. All right, Well, let's talk about those color codes since

you mentioned it. Okay, here in the US, code blue, like you said, is the most that means come right away. I understand the use of blue. It's um like they're turning blue, yes, cyanotic? Okay, right, that it makes sense. But again red makes sense too. Yeah, you hear code red and that doesn't sound great. It doesn't make me think like, oh, they'll be fine. Well code red it's category too though, so it is serious. That means they

require immediate attention. But they're just not blue, right, they're still breathing. Uh, then what he got got an orange mid level Okay, you got gray, which means you're sick, but it's like a bad cold. Really, gray should be the worst. If you're gray, you've already passed blue. That's true, you're uh. And then the least urgent is green, which just means you want someone to love you. Yeah, it means you're you're med seeking. Yeah, you shouldn't be in

the er basically, right, and that's not a joke. That literally means you don't have an emergency, right they they if if you are deemed code green five, do they send you home? Yeah? Or else they'll be like, there's a minute clinic down the street, go there. Yeah, you don't, you're wasting valuable resources here, go away. So then across the pond and then under the Manchester scale, the worst is code red, followed by code orange, then code yellow,

then code green, then code blue, then code earl gray. Wow, code blue is the least Yes, yeah, see you got a point like that's you can't have one color be the worst possible thing and one color be the the least dangerous, especially in an increasingly globalized world. I don't like it either, Um, what can we do? Should we start a movement? Yes? We should online petitions. How does that get done? Or just yell about it on Facebook? I think the Facebook wanna that's that's the best shot

we have. That's how you accomplish things. Um, triage if there's I mean, we talked about battlefield, we talked about regularly er. But then there's of course, like when bad things happen, like in New York when that building exploded. Yeah, those are called incident triage. Yea, like a natural disaster or something. Yeah, uh that Harlem explosion, right, it was a gas explosion in Harlem. Yeah. Um, so triage works anytime there's a scarcity of resources in a high demand

of for medical care. It's a good way to say. It's just it's healthcare rashing. It's it's it's saying like, we don't have enough resources for all you people, so we're gonna have to figure out who's worse, right, and you're supposed to do it very quickly. But yeah, with incident triage. Um, there's actually a really clever thing called

the met tag. Then that article you sent was awesome and it was a fast code design article, and there's basically a triage code system that's used out in the field Um that you'll see people who are victims of like an explosion or a plane crash or something like that, and they'll have tags around their necks with the color code attached. And that was invented by a guy named Robert bludgett Um in Jacksonville, Florida, in the early nineteen sixties,

in response to the Cuban missile crisis. Yeah. I thought that was so interesting. It did not exist. Um, he was a civil defense director and America was super scared, especially Florida at the time time, because the Soviet Union had nuclear missiles pointed at us right off the coast, what ninety miles off the coast of Florida, and people were freaking out. And um, he was one of him. He wasn't freaking out, and he seemed like a cool customer. Yeah,

but he was definitely worried. But no, he doesn't seem like he was freaking He wasn't running around going like oh my god, oh my god. But he had a bomb shelter at his house. Sure don't you think anybody who was anybody had a bomb shelter back then? I told I think I mentioned before my dad went to build one after the day after movie, and um it was his obsession for a month, like you know, every Saturday for a month. I don't remember. Did he complete it. He got about a third of this dirt room dug

out behind the wall. Like my brother and I basically were the was We were the cheap labor, you know, we were carrying buckets of dirt out in the woods. He'd come down with like a high left and be like, how's it going down here? How my project coming? He didn't drink, but yeah he would come down with his his buttermilk and corn bread I know, right, Um yeah, he know. Of course he didn't finish any didn't because

you guys went on strike or something. Uh No, he just like a lot of people that probably saw the day after a month later, they're like, yeah, not so scared. That's an awesome story. Um So anyway, this guy has uh Mr Blodgett definitely had completed shelter. Oh yeah, there's no way he bailed. He probably swept it like every couple of days. Even well, his deal was he made it. It was really pretty brilliant. It was a two sided laminated card on lanyard and he said, you know what

this thing needs to be kind of universal. Um, so I'm gonna put pictures and colors and things of uh, like you know a symbol that represents blood pressure in your sex and what time it is. Imagine those little clock on there. Um, So anyone can read this thing no matter what happened. Right. And then, um, you would be assigned a color code depending on the severity of your injury, your illness. Right, um, just like in an e er. Um. But this this lanyard around your neck,

they would tear off the colors that you weren't. So it was progressive, right if you had one, I think it was green, You're fine, no problems. Uh. And then it got progressively worse. And like you said, there were some pretty clever symbols, including, um, I think on the green one, there's an ambulance with a circle with a slash through it, Like, don't even put this person on an ambulance. They're fine, they can probably, they can probably help you out if you need assistance in like applying

pressure to a wound. Right, Green's fine. Um, it went all the way to black, and the black said morgue on it, and it's said in this article, it's really unsettling that if you had uh met around your neck and the only tag that was left was a black one because they ripped them off one by one, right, or they could rip off like three if like they

just knew it meant you're a goner. You might still be alive right now, you're looking you're about to die where you're laying right now, and that awful because it said Morgan it too, so you could look and be like, oh, I imagine if you're in that kind of condition, you don't need that black tag to let you know that time is near. Yeah, probably not. But if you're holding out hope, it does not help. No, Yeah, no, that's good. You give up the ghost. But again, the whole idea

of disaster or a battle battlefield triages. It's a necessary kind of sad thing that you have to do to save more people. It's the mercilessness of a compassionate um profession. Yeah all right, well let's take a break and we'll talk a little bit more about these tags right after this. So oh alright, So this guy Mr Blodgett, he actually sold these through I don't know if he got the money, that's what I was He didn't. I think he found somebody who was like, we can distribute these widely. Your

your idea will be set in stone. But we're keeping the money. The American Civil Defense Association is who he gave them too to sell. That's the impression I have. All Right, Well, good on him, you know, hero hero, anybody who gives up intellectual property rights as a hero. Agreed. Um. So it's said here in the heyday that they were selling about a hundred thousand of these a year, two agencies, which is uh no small number. And um I didn't

see how much they sold them for though. Yeah, they were in bulk, so like scantron sheets or something, probably not a lot of money. But um they went on to be refined years later in when was this? This was after the Oklahoma building explosion, right, yeah, the bombing, Yeah, the Alfred P. Murrah building. Is that pronounced right, Murmur? I think I'm pretty sure it's Maura. I just see out of the corn mon Jerry nodding and shaking her head.

I don't know what means. What's speaking circle? Um. There was a l A. P. D Fire department. Um. Well, two guys actually, Dennis Ortiz and his brother, and they were working that, like I said, at l A County Fire Department and when when were they on the scene in Oklahoma at the time or were they think they were moved by it? They were like, uh, if something happened like that in l A, would we do we

have like the resources we need. That's pretty amazing. So he went to get these tags from l A County and these MET tags, he said, we're basically disintegrating in my hand, I guess because they were just so old. And he said, there's there should be a new tag and this is sad but also necessary for terrorist disasters

and terrorist attacks, and it was pretty great idea. So he now included this new tag with things like biological contamination, radioactive contamination, UM diagrams for blast injuries, personal property receipts, stuff like that. Yeah, it's like a trifold package. It's it's got everything all the bells and whistles you need, right, including basically a revised, improved MET tag. So a MET tag for the new Yeah. I think they're called smart

tags now, really smart everything. Yeah. Well, another thing they can do too is UM, a lot of times you might not have these tags, so they'll literally right go around with sharpie's and write on people. Uh in in the case of a disaster. I wonder if people can feel you writing write the word on your forehead or something. Yeah, I can feel you're writing morge on my forehead. I

know what you're doing. That's not good. Did you ever play that game when you're a little word You would draw on someone's back and you would try to guess what they were. I was. That was terrible at that I was bad too, but it felt so good. Yeah, I love back scratches. So it was always like, draw something really elaborate, Jah Lawrenz attractor, that'd be wonderful, but chuck. Whether it's in an incident triage or e ER trias or something like that, it's um well, I should say.

And an e R triage. There's a spectrum of triage, right, and e R is about the most calm, stable version of it, even a chaotic, crazy e ER in a big city, compared to on the other end, the site of a massive disaster that's not just impacted a bunch of people, it's probably affected like the health care infrastructure as well. Within within that spectrum, there's different types of triage, and usually the worst it is the faster your assessment

has to be. So like out on a battlefield. Um, they've come up with basically a two two point um triage assessment. It's called the field triage score. It's part of the technical combat casualty care methodology, right where they feel your pulse and then they give you a rating of awareness on the Glasgow Coma scale, which we covered in our comma. Yeah, and apparently if you put those together, it's a pretty good predictor of whether somebody's going to

survive their injuries or not. So like, if you're out of it and your pulse is low, move along, that person is a goner in that situation. Whereas if that person came into an e R in the suburbs um or or trauma center or something like that, they might have a really good chance of making it. But depending on the situation along that spectrum of triage, UM, you're you're going to depending on where you are on that spectrum physically literally, Um, you may just get passed over

or you may have your life saved. Man, You've got to have nerves of steel to be a first responder. Yeah, and we should also say to once you're given a code. Um, but you're like, that's not it's not static, like it can change, You're you can deteriorate over right, switch tags that person next to you, right, But no, you're absolutely right, like to to to say, like I want to save your life, but I can't. I've got to leave you there to die. You're absolutely right. I mean it's metal,

not for me. That's metal in both spellings, two D s and a T, you know, two teas and an L E. Oh, it's M E T T L E. Why do I think it was emmy D D L E. Because it's like meddling. If you went and rearranged everybody's tags, that would be meddling. It's amazing metal and like metal. I know, it's amazing the amount of dope things I say on the show, and people still think I like have anything to offer the world. I've got you beat by like four or five times. I think I don't

think so, I think so. Um, all right, well let's talk a little bit about what's well, we've talked about what's good about it, um, pretty much everything because it will say ultimately more lives, yeah, but has its critics well yeah, and a lot of times you know when you go to the e er. We're not talking battlefield or disaster, but when you go to the er, you want to get seen as quickly as possible because it's

the worst. My thumb hurts, Yeah, and so long you look around and you're like, well, that person doesn't look so bad off, why are they going in? Or I've been here for an hour. This guy just came in and he got seen and he didn't look too bad that the kids breathing, Yeah, why is he going ahead of me? Yeah? I mean they hear a lot of I mean e ers have to feel a lot of complaints, yeah about wait times. And there's a lot of people who end up in what's called the l w B

S category. Is that where they send complainers left without being seen. Some people just give up there, like forget it, I'm not sitting around here any longer. I could see me doing that. Yeah, you just become indignant or you're like I feel like eating some cereal. Well, I just don't like to wait. And maybe it would have to be something where it's subsided enough to rouse like I think I'll be all right, right, not like an injury, right, Unless I thought I could set it up myself or

Rambo style, which Emily's dad did once. What did you like soda cut in his arm himself one time with needle and thread? Did he put gunpowder in it and light it on fire? He should have that would have done it. Uh. And apparently that they interviewed someone from for our House to Works article from our great children's hospital here Scottish right, and this doctor said, especially at children's hospitals, a lot of upset parents that don't really

get the triage thing. Well, um, there's been studies actually that there was. There was one very famous study from the nineteen nineties I think actually, and then it had there was such an outcry against it as far as criticism of the study went, because the study, the studies findings were very critical the trio triage as a whole, like the concept of it. Um that the authors actually wrote another study responding to the criticisms of their original study.

And I was reading that and they're basically in the original study they found that triage when it's actually done, leads to longer wait times for the people who need the most immediate care, like gets in the way, and that it didn't have any impact patient satisfaction, meaning people didn't feel like they were being cared for better than when they weren't exposed to triage. So um, they the the people just said this is what we found. A lot of people were like, this is a B S study,

but it does make sense. There are critics to triage saying like, no, this is unnecessary. Uh, it's clumsy, it gets in the way. It's an extra layer, a barrier between a patient and treatment. Um, like someone's gotta say this guy's got a spoon in his ear. I think for the most part, the critics don't have an alternative and that you know, triage can help. But I think there's a it's almost a cult of triage, where like, yeah, of course triage helps. You're an idiot for saying anything different.

Scientists are saying like, it's not it's not perfect. Um, but I don't know what an alternative would be in the case of really scarce resources. Well, here's one, not alternative, but one other way of doing things. And they did this, uh at the Kaiser Permanent South Sacramento Medical Center Kaiser Permanente. They forgot the e oh they did Kaiser Permanent. What they said here, Um, what does permanente? I mean either what does what does it think? It means permanent in Spanish? Okay,

who's kaiser? Uh? That means permanent in German? So the permanent permanent. No, that means a role, A delightful type of role that's permanent, a German role forever. Uh yeah yeah four times. So. Um they employed something from the l e A and the lean thinking principle in Japan and their businesses. Is this like when they have people do like calistinics and that kind of thing. Now, I don't know, I want to look into what that is. It sounds interesting. Well, it's like a cutting down on waste.

But I'm sure that the Japanese probably figured out a way to insert calisthenics into it. Um are Actually I might be thinking of China. No, Japanese are into too, okay. Um. So they used this lead methodology and what they would do, and this makes a lot of sense. It was sort of like the two track thing. But if you have the minor injury, you actually have a doctor come out to the waiting room and treat you in the waiting room, or at least see you at first in the waiting room.

And I think that definitely would give someone a sense of while I'm being tended to, at least I'm not just sitting over here holding my belly in pain. But it's also not like, uh, you're on track to go sit over there and wait for a bed to come open so you can see. It's like, you there, you don't have to wait for a bed. The doctor came to you instead. Yeah, that's a great idea. And they found it reduced the left without being seen rate from four point five percent to one point five percent. Uh,

and the wait times fell by half. Yeah, that's right. Wait times are one of my biggest complaints with modern medicine. Sure, it's the worst. Your appointments at one, you get in there at two. Oh man, boy, oh boy, you want to see me get mad? Stick me in the waiting room with bad magazines. But if you got some mad magazines, you're like, this is delightful. The other criticism of triage is that it shouldn't be done at all, That withholding care under any circumstances is unethical. So I just have

like eight times as many doctors and nurses. I guess it's come on. Uh, if you want to know more about triage you're sorting. Um, you can type those words into the search part how stuff works dot Com. And since I said that it's time for listening mail, I'm gonna call this lighthouse follow up. We've got a lot of really great pictures and emails from lighthouse enthusiasts. Yeah, it's pretty cool. Uh, including ones that were for sale so I could live about my fantasy. Yeah. Are you

going to know how much are they didn't see? Um, I don't know. I didn't. I don't remember any crisis looking up on Zilo. I bought like two of them and I didn't catch the price. You're just like, here's a bunch of money. Bring me those lighthouses. Hey, guys, I listened to your lighthouse episode and it was so excited to hear this. Last year, I visited every lighthouse on Oregon's coast her state. Uh, such a good year

long goal, That's what she said. I agree. Anyhow, I wanted to tell you about one of our coolest in my opinions, is Terrible Tilly. She was built on a rock a mile off shore and see pictures is really neat. That's what I needs. It's like just out there in the middle of the ocean. Many men died trying to construct in eighteen seventies, and many men died while keeping the light that was decommissioned in nineteen fifty seven and was sold after her sale, until he became a graveyard

so to speak. Sailors would be cremated and had their ashes stored in the lighthouse. During the seasonal storms, when the waves break into the lighthouse, the ocean chooses who she takes back with her to be buried in her bosom. Well, it's very poetic. It's pretty romantic in a Victorian or Gothic way. I totally agree. Thanks for all you guys do. I look forward to listening to your podcast every week. And I evangelized stuff you should know, the stuff you

should know gospel to all my friends. And that is from Kendra, and Kendra used the word evangelizing bosom in the same email and Gothic, so that means straight to the top of the pile. Thanks a lot, Kendra, that was indeed to create email. Uh. If you want to get in touch with us, you can tweak to us a S y S podcast. You can join us on Facebook dot com slash Stuff you Should Know You can

send us an email to Stuff podcast. The House suff works dot com and has always joined us at our home on the web Stuff you Should Know dot com. For more on this and thousands of other topics, visit how stuff Works dot com.