"Code Orange! I repeat. Code Orange! Suspend all outpatient consultations immediately! Assemble in the emergency room!"
The emergency announcement rang out throughout the entire hospital.
Medical staff scattered across the hospital stopped what they were doing and began running toward the emergency room.
Director Kim Byeongjo arrived at the ER and gave his orders.
"Ms. Lee Miseon! Divide the emergency room into triage zones!"
"Yes, understood."
Head Nurse Lee Miseon issued instructions to the other nurses and divided the emergency room into three zones: the Red Zone, for those requiring immediate treatment; the Yellow Zone, for those whose treatment could be delayed; and the Green Zone, for patients with minor injuries. Lastly, the Black Zone, where deceased patients would be sent, was set up in a separate space.
"Nurse Kim! Set up a triage station at the entrance!"
"Yes. Will this do?"
Kim Sujin set up a temporary table for patient classification at the entrance to the emergency room. On top of it, she arranged colored tags, a blood pressure cuff, a pulse oximeter, and a penlight.
Taeho and Director Kim Byeongjo assigned nearly thirty public health doctors to each zone.
"Secure beds and prepare to receive patients!"
"Check whether the operating rooms can be activated immediately and report back!"
"Request emergency blood supplies from the blood bank! Quickly, including type O!"
"Check emergency drug inventory and prepare additional quantities!"
Waaah—waaah—
With the sound of sirens, the first ambulance arrived at the hospital entrance, and behind it, other ambulances lined up and stopped in front of the ER.
A paramedic brought a middle-aged male patient into the emergency room on a stretcher.
Park Hyeonwoo, the chief of internal medicine, hurried to the patient's side and assessed his condition.
"Sir, stay with me! Where does it hurt the most?"
With a pained expression, the patient pointed to his right leg.
"My leg, my leg hurts so much!"
Park Hyeonwoo examined the patient's lower limb. The right thigh was visibly deformed, and the swelling was severe.
"It looks certain to be a femur fracture..."
Park Hyeonwoo carefully palpated the thigh and hesitated. It was difficult to determine whether it was a simple fracture or a complex fracture accompanied by vascular injury.
There seems to be a lot of bleeding... It could be bleeding from the femur fracture, or there could be other internal damage. From experience, he knew that even a femur fracture could cause up to one or two liters of blood loss. When he palpated the abdomen, there was no particular tenderness or distension. But the patient's overall condition was ominous. He attached a red tag to the patient's wrist.
"Moving the patient."
The public health doctors came and moved the stretcher to the Red Zone.
Head Nurse Lee Miseon was checking the condition of an elderly woman brought in from another ambulance.
"Ma'am, can you hear my voice?"
"Oh dear, my arm hurts so much."
"Can you get up and walk?"
The patient tried to rise from the bed, then sank back down.
"It hurts. I'm dizzy."
Lee Miseon quickly counted the patient's breaths with her eyes.
Eight breaths in fifteen seconds. That was roughly thirty-two breaths per minute—rapid breathing.
She palpated the radial pulse.
"Pulse is fast and weak."
She pressed a fingernail with her finger to check capillary refill time.
"Circulation isn't good."
With twenty years of experience, Lee Miseon sensed it instinctively. For a simple arm fracture, her condition was strange.
"Her face is pale, too."
She observed the patient again. There was obvious deformity and swelling in the left upper arm, but her systemic condition was poor.
"Follow what I say. Make a fist."
The patient followed the command, but her response was sluggish.
Lee Miseon made a judgment. This patient needed precise measurements.
"Nurse Kim, check her blood pressure!"
Kim Sujin quickly brought over a blood pressure cuff and measured it.
"Blood pressure 85 over 55!"
"Pulse?"
"One hundred fifteen per minute!"
It was difficult for a simple humerus fracture to cause this level of shock. There was a high possibility of another injury.
She attached a red tag to the patient's wrist.
"Ma'am, go to the area marked with red tape over there."
The nurses swiftly began preparing for the next treatment.
But a bottleneck formed as patients continued to flood in.
Most of the medical staff were public health doctors.
Without diagnostic equipment such as CT or ultrasound, they had to rapidly judge conditions with the naked eye alone, and the time they spent deliberating for accuracy caused delays.
Taeho grasped the situation and approached.
"We need to pick up the pace."
Taeho began moving quickly between the patients, checking their conditions. As Bio Vision activated, the patients' conditions appeared in clear colors.
"Internal organ injury is suspected in this patient! Prepare an ultrasound immediately and get ready to move them to the operating room!"
Taeho attached a red tag.
Park Hyeonwoo, the chief of internal medicine, widened his eyes in surprise.
‘How did he judge that so quickly?’
Taeho was already looking at the next patient.
There were only fractures, with no internal organ injury. He attached a yellow tag to the patient's wrist.
"Please go to the yellow area over there."
The next patient had only minor contusions. Taeho attached a green tag and directed the patient to the Green Zone.
Then a middle-aged male patient caught his eye. The patient, who looked to be in his fifties, appeared relatively fine on the outside, unlike the other seriously injured patients.
The patient was sitting in a chair, fiddling with a minor abrasion with his hand. He was conscious and able to converse.
Public health doctor Lee Junho was guiding him toward the Green Zone.
"Sir, your wound isn't serious, so you can receive treatment in order over there."
"Yes, fortunately, I don't think I'm badly hurt. It's just a scrape..."
But in Taeho's eyes, a deep red aura was clearly visible around the patient's head.
Taeho quickly approached him.
"Wait a moment! I'll check a few things."
Taeho shone a penlight into the patient's eyes. The pupillary response was slightly slow, and the sizes of the left and right pupils were subtly different.
"Sir, did you hit your head during the accident?"
The patient thought for a moment, then said,
"Ah, when the bus overturned, my head did hit the ceiling... but it didn't hurt much."
"Do you have a headache right now?"
"It's bearable."
Taeho palpated the back of the patient's neck.
"There's slight neck stiffness as well. We'll proceed with a CT scan immediately!"
When Taeho attached a red tag, even the patient himself became flustered.
"What? But I'm fine. It's just a scrape on my arm..."
In the middle of speaking, the patient's face suddenly turned pale, and he began to vomit.
"Ugh, ugh."
As the patient vomited, the medical staff around him reacted immediately. A nurse quickly brought a suction device.
"Secure the airway and prepare to prevent aspiration!"
Taeho checked the pupils again with the penlight. This time, the left pupil had become larger, and the light reflex was markedly delayed.
"Anisocoria and delayed light reflex confirmed. Intracranial pressure is still rising! Prepare an emergency CT scan right now!"
"Yes! Understood."
The public health doctors loaded the patient onto a stretcher and ran off breathlessly.
Head Nurse Lee Miseon, who was beside him, looked at Taeho in astonishment.
"How on earth are you diagnosing them so quickly and accurately?"
"If you examine everything at once—the skin color, breathing, posture, and expression—you can grasp their condition to some extent."
A textbook answer.
Lee Miseon shook her head in disbelief and examined the next patient.
Patients continued pouring in.
Taeho made accurate judgments on each patient in less than thirty seconds.
The problem was that the number of patients requiring emergency surgery was increasing, but the only surgical specialist was Chief Yu Sihyeok.
The patient Taeho had sent for a CT scan a moment ago returned after the imaging.
"Sir! Open your eyes!"
"Mmm. Uh... I'm dizzy."
Public health doctor Lee Junho checked his vital signs.
"Blood pressure 180 over 100, pulse 55—bradycardia!"
Cushing's reflex. It was a classic sign of increased intracranial pressure.
Taeho immediately gave instructions.
"Raise the head of the bed thirty degrees! Lower jugular venous pressure and increase oxygen supply to ten liters to induce hyperventilation! Prepare mannitol—we'll administer it immediately to reduce intracranial pressure!"
The nurse quickly prepared the mannitol.
At that moment, radiology urgently contacted them.
"CT results are in! Right temporal epidural hemorrhage with a five-millimeter midline shift!"
"At this level, an emergency craniotomy is needed immediately. Prepare quickly! It's an epidural hematoma evacuation!"
However, Head Nurse Lee Miseon spoke with a worried expression.
"The operating rooms are full, so it's difficult right now!"
Without hesitation, Taeho made a quick decision.
"Then we'll perform emergency burr hole drainage here in the ER first. Lowering the intracranial pressure is the most urgent priority!"
The medical staff moved with urgency.
"Prepare local anesthetic injections!"
"The burr hole drill is ready!"
The sound of the drill rang out, and as a small hole was made in the skull, the cerebrospinal fluid that had been under high pressure drained out rapidly.
"Cerebrospinal fluid is draining! Pupillary response is starting to return!"
Public health doctor Lee Junho let out a deep breath of relief.
Head Nurse Lee Miseon pointed to another patient and asked urgently,
"Director, how should we handle this pelvic fracture patient?"
After swiftly checking the patient's condition with Bio Vision, Taeho said,
"The pelvic fracture is severe, but fortunately, the internal bleeding isn't serious. The vital signs are stable right now, and there's no abdominal distension, so if we stabilize the pelvis as an emergency measure and transfer them quickly to a higher-level hospital, it should be fine."
"Are you sure it's all right to transfer them?"
"Yes, there will be no problem. Please prepare immediately."
Director Kim Byeongjo promptly contacted the 119 situation room.
"Some of the eight critically injured patients here will be transferred to a higher-level hospital after emergency treatment is completed."
An urgent voice came through the phone.
—Gangneung Medical Center says they can accept patients now!
"Good. We'll stabilize them as quickly as possible on our end and send them off the moment preparations are complete."
After the initial emergency treatments were completed, five critically injured patients who absolutely required surgery remained.
At that moment, Go Hayeong, an ER nurse, looked around urgently, found Taeho, and ran to him. Since she had personally seen Taeho operate on a myocardial infarction patient last time, she did not hesitate.
"Doctor, Patient Five's condition is worsening."
"What's the situation?"
"The amount of intra-abdominal bleeding keeps increasing. Blood pressure has dropped to 80 over 50, and the abdominal distension is getting worse."
Taeho immediately ran to the patient.
"How much blood have they received?"
"Four units have been given, but the blood pressure keeps dropping. We suspect ongoing bleeding."
The patient needed surgery immediately.
"What's the operating room situation?"
"Chief Yu Sihyeok is in Operating Room One performing ORIF, metal plate fixation, on a patient with an open femur fracture, and Operating Room Two requires time for anesthesia preparation."
"How much longer will the ORIF take?"
After contacting Operating Room One, Go Hayeong answered,
"At least one more hour is expected until metal plate fixation is complete."
When Taeho looked with Bio Vision, the situation inside the patient's abdominal cavity was dire.
"What was the Hct, hematocrit, level?"
"It dropped sharply from 30 to 24."
"Blood pressure and pulse trends?"
Go Hayeong looked at the monitor and answered,
"Systolic blood pressure is continuing to fall at 75, and the pulse is rising at 135."
"It's judged to be ongoing intra-abdominal bleeding. An exploratory laparotomy is necessary. What's the anesthesia situation?"
"Anesthesiology says they can be ready in fifteen minutes."
A vertical crease deepened between Taeho's brows.
He won't last until then...
He checked the patient's condition again.
"Blood pressure is continuing to drop at 65."
"We don't have time to wait for anesthesia."
Taeho made his decision.
"We'll perform an emergency laparotomy under conscious sedation and local block!"
Nurse Go Hayeong was startled.
"You're going to open the abdomen under conscious sedation?"