Grey's: Painful Triage, Painful Lessons

The Grey's Anatomy episode "Walk on Water" opens with the interns participating in a triage drill in the hospital.

Izzie has just overlooked a major injury in the "patient," played by the dreaded chirpy resident. Izzie's mistake has just caused the patient to pretend to die. In what the interns believe is a continuation of the drill, the Chief announces that a real-life emergency has occurred and there are mass casualties. A ferry boat ran into a container ship -- time for triage for real.

So, exactly what is triage?

Triage refers to the evaluation and categorization of the sick or wounded when there are insufficient resources for medical care of everyone at once. In mass casualty situations like this one, triage is used to decide who is most urgently in need of transportation to a hospital for care (generally, those who have a chance of survival but who would die without immediate treatment) and whose injuries are less severe and must wait for medical care.

Triage is also commonly used in crowded emergency rooms and walk-in clinics to determine which patients should be seen and treated immediately.

Bailey, Meredith, Izzie, Alex, and George are taken to the accident scene and confronted with the horror firsthand. They're given medical kits and triage tags to categorize the injured as follows:

• Red tags- (immediate) those who cannot survive without immediate treatment but who have a chance of survival.

• Yellow tags - (observation) those who require observation (and possible later re-triage). Their condition is stable for the moment and are not in immediate danger of death. These victims will still need hospital care and would be treated immediately under normal circumstances.

• Green tags - (wait) the "walking wounded" who will need medical care at some point, after more critical injuries have been treated.

• White tags - (dismiss) those with minor injuries for whom a doctor's care is not required.

There are also black tags (expectant), for the deceased and also sadly, for those whose injuries are so extensive that they will not be able to survive given the care that is available.

The interns learn that even with this system, most of the victims need far more care and attention than is available or possible. While a surgical intern wouldn't singlehandedly be responsible for lifesaving measures in a hospital O.R., here in the field they experience what it's like when there's no senior staff member to ask for advice.

But even with this level of organization, with tags and practice drilling, and reviewing procedures over and over, there is no way to prepare the interns for what they see when they pile out of the transport vehicle and onto the scene.

It's chaos, studded with moaning children, bleeding rescued passengers litter the ground --some with severe, charred black burns. The injured and panicked are all around, while emergency crews buzz all around. In the background the barge burns, fire fighters battling the blaze.

Izzie sends a bystander for help for her critically ill patient, screaming that "he's a red tag" only to hear the answer that there are 15 "red tags" ahead of hers. Meredith can't apply pressure to a wound and rummage through her medical kit for instruments at the same time, so she relies on the help of a young lost child. And George discovers that there's no way to discover the whereabouts of his patient's 7-year-old son or to even know if he is alive.

It's a painful lesson.

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