History Main / TriageTyrant

There is a tendency for many people (who don't understand the [[http://en.wikipedia.org/wiki/Triage concept of triage]]) to decide that the ER staff is indulging in this, even when they aren't. Add to that that the desk staff at an ER have to be firm about who they're calling, but can't explain to the other patients why they're being taken in that order, and you get an appearance of petty tyranny. While desk nurses are the most likely to get this portrayal, medical personnel in general are often seen as petty dictators who are unreasonable about things like visiting hours; admittance to the ICU; flowers, candy and food being brought to the patients; and all the other annoyances about having a loved one in the hospital.

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* ''Series/{{MASH}}'': Given that the camp typically receives dozens of wounded at a time at least, triage is a matter of life and death every time, which has lead to disputes:
** In one episode, Frank Burns deliberately sends in American troops over Koreans even when there are Koreans in much greater need than soldiers.
*** The above is also a prime example of a [[ObstructiveBureaucrat bureaucratic mentality.]] Regulations say "Americans first, allies second, enemies last." Nothing about severity or urgency...
** In another episode, Hawkeye is on the bus doing triage, and gets into a fight with a soldier over being a commie-lover by prioritising seriously wounded North Koreans over wounded American soldiers.

* Justified in an episode of ''Series/TheBigBangTheory''. Howard is faking an allergic reaction to keep Leonard's birthday party a secret, and the nurse refuses to play along. She looks like a tyrant when she tells Leonard that Howard is not a legitimate patient - until Howard appears having actually eaten nuts and given himself a severe reaction.

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* In the ''WesternAnimation/CodenameKidsNextDoor'' episode "Operation: H.O.S.P.I.T.A.L., Sector V had to get into a hospital to rescue an injured operative [[spoiler:who later turned out to be Bradley]], because operatives who were treated there were being assaulted. Numbuh One had no luck with the triage nurse; even though she seemed friendly and harmless, she didn't take his authoritarian demands seriously. Numbuh Five, who was more polite and often the [[OnlySaneMan Only Sane Member]] of the team had more luck and got some information, but was still unable to get them admitted formally. Despite this, seeing as AdultsAreUseless in this cartoon (the ones who aren't evil, anyway), sneaking in was surprisingly easy, and no-one tried to stop them. Lucky thing too, [[spoiler:because Bradley ''was'' targeted by the assailant, who happened to be Numbuh Five's evil sister Cree.]]

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* By law in most countries, emergency department staff cannot turn any patient away until he/she has been provided a medical screening exam and, if necessary, adequate care to stabilize his/her condition. In the United States, this law is called [[http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act EMTALA]]. If the patient isn't really that sick or injured, then they'll get the basic assessment and will be put in the triage queue to wait until the higher-priority cases are handled. Patients who are known to abuse EMTALA for drugs, attention, or other non-health-related reasons are much looked down upon by emergency department staff, as these cases are perceived as wasting time, staff and bed space that could have been better used on a legitimately sick patient.

* Nicole Sullivan, as the "Vancome lady", as a nurse at [[ChristianityIsCatholic Sisters of Mercy Hospital]] in ''Series/{{MADtv}}''. She turns away an unmarried woman going into premature labor, a hemophiliac because "[[MistakenForGay we don't condone that lifestyle choice]]," and sends a man with a flesh-eating disease to [[DisproportionateRetribution the doctor who fired her]].

* Nicole Sullivan, as the "Vancome lady", as a nurse in ''Series/{{MADtv}}''. She kept turning people away for stupid reasons. They'd describe their emergency and she'd explain, in chirpy tones, why they should head down the street. The only one I remember was a hemophiliac who was told that Sisters of Mercy didn't support [[MistakenForGay that lifestyle]]... [[https://www.youtube.com/watch?v=bdyf3Ja1KaI Link to the episode]] (until it's removed)

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* In an episode of ''Series/TheIncredibleHulk'' David's friend-of-the-episode, a badass biker, gets a broken arm. David takes him to a doctor's office, where they end up sitting for hours. David finally calls the doctor on this; the doctor says that he can tell by looking that the biker is only there to get some prescription drugs and he refuses to participate in such activities.
-->Doctor: I've found that, contrary to the saying you ''can'' judge a book by its cover.
-->David: [[SarcasmMode That's amazing]] doctor. You can stand all the way over here, on the other side of the room, and just from a glance you can tell that that man doesn't have a broken arm.

* The ''Franchise/{{Emergency}}'' episode, "Musical Mania," had two yokels taking their son with a bad case of lead poisoning and the emitting nurse brusquely tells them to wait while she fills out a report. However, Head Nurse [=McCall=] immediately tells her to process them, noting that people in need take priority over bureaucracy any day.

* In the first novel of the ''StarTrekVanguard'' series, the ''Bombay'''s CMO complains bitterly about "battlefield triage" - she and her staff can't treat crewmen who may need their help the most if they aren't critical to keeping the ship from being destroyed while under attack. To her, it feels like a perversion of the Hippocratic Oath.

* She's not a nurse, but the "bereavement liaison" in ''LittleMissSunshine'' certainly qualifies.

* ''{{Friends}}'', the one who ends up with a face full of hockey puck.

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* In the ''WesternAnimation/CodenameKidsNextDoor'' episode "Operation: H.O.S.P.I.T.A.L., Sector V had to get into a hospital to rescue an injured operative [[spoiler:who later turned out to be Bradley]], because operatives who were treated there were being assaulted. Numbuh One had no luck with the triage nurse; even though she seemed friendly and harmless, she didn't take his authoritarian demands seriously. Numbuh Five, who was more polite and often the [[OnlySaneMan Only Sane Member]] of the team had more luck and got some information, but was still unable to get them admitted formally. Despite this, seeing as AdultsAreUseless in this cartoon (the ones who aren't evil, anyway), sneaking in was surprisingly easy, and no-one tried to stop them. Lucky thing too, [[spoiler:because Bradley ''was'' targeted by the assailant, who happened to be Numbuh Five's evil sister Cree.]]

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<<|DoctorIndex|>>

* ''OneTreeHill'': "I didn't like cheerleaders when I was in school" "But she's pregnant and in pain!" "[[KickTheDog Guess who's waiting a little longer?]]"

* One of the cruel realities of any mass casualty incident, such as a large multi-vehicle wreck in the middle of nowhere or something on the scale of Katrina or September 11th, is that not everyone can be saved, even with the miracles of modern medicine. Mass casualty triage rests upon providing the most benefit to the greatest number of people; if you expend all your resources saving one catastrophically injured patient, you may have just doomed ten more to die for lack of care. Enter the principle of Simple Triage and Rapid Treatment. If you can walk: Priority 3, help carry the person next to you over to the casualty collection point. If you can't walk, but follow commands, Priority 2: We'll get to you as soon as we can. On the other hand, if the only thing you do is breathe or babble incoherently, you get out of there pretty fast: Priority 1. Unsurvivable injuries, such as massive burns or amputations, no pulse, or no spontaneous breathing? Expectant/Morgue.

** In "Critical Care," the holographic Doctor gets stolen and sold to an alien hospital, where patients are assessed not according to urgency, but according to how "valuable" their skills are to society. As a result, the working classes suffer in crowded, undersupplied halls while the rich recover in luxury. In the Doctor's efforts to help, both the Prime Directive and the Hippocratic Oath get severely bent.
** In "Latent Image," The Doctor is faced with two patients (Harry Kim and a RedShirt) who have an exactly equal chance of survival. He can only treat one of them in time, and the other will die. Because his program cannot find a logical way to decide, he chooses to save Harry because he's a friend. This causes a [[HeroicBSOD severe malfunction in his program]] that forces the crew to erase his memory of the event or risk losing their only medical officer.
** In the two-part episode "The Killing Game," the ship is taken over by Hirogen who place the crew into brutal holographic simulations and force the doctor to treat them. When a crewmember with life-threatening injuries and a Hirogen with minor burns are both brought in, the Hirogen medical officer orders the doctor to treat the Hirogen patient first. He protests that this goes against the rules of triage is that critical injuries take priority. The Hirogen replies "your rules, not mine" and deactivates him when he refuses to comply.
** A Variation occurs in "Author, Author"--The Doctor has written a holo-novel in which the user plays the part of an EMH in a triage situation. A bridge officer is brought in with a minor concussion, but there is already a [[RedShirt patient]] dying from a ruptured aorta. Captain Jenkins (Captain Janeway's EvilCounterpart) ends the debate by shooting the poor RedShirt.
* Justified in an episode of ''TheBigBangTheory''. Howard is faking an allergic reaction to keep Leonard's birthday party a secret, and the nurse refuses to play along. She looks like a tyrant when she tells Leonard that Howard is not a legitimate patient - until Howard appears having actually eaten nuts and given himself a severe reaction.

* In most hospitals in North America, emergency department presentations are assessed according to a 5-point scale called the Emergency Severity Index, which assigns a "priority level" based on the patient's chief complaint, vital signs and a few other factors. Priority 1 patients, such as CPR in progress, major trauma, STEMI (heart attack) and stroke, skip the triage queue entirely and go straight back to the Trauma/Resuscitation area ("Resus" in department slang). Non-emergent events, such as suture removal or medication refills, are classed as Priority 5. Patients are seen in order of ESI priority, ''not'' in order of arrival time and ''not'' necessarily in order of graphic or exaggerated symptoms (i.e. nausea and vomiting isn't usually an emergency, respiratory distress is). Explaining the concept of triage to lay people without sounding like a petty tyrant is one of the hardest tasks of the triage nurse.

* In reality, there's a federal law called [[http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act EMTALA]] that requires hospitals and EMS services to at least assess a patient to determine how much of an emergency the patient really has. Once the patient walks through the hospital doors or is brought in by ambulance, they have to be seen and can't be sent away until they are considered stabilized. If the patient isn't really that sick or injured, then they'll get the basic assessment and put in the triage queue to wait until there's room for the less sick and injured.\\
\\
People who abuse this law just to get attention or watch the parade of gore cases go by are known as [=GOMER=]s. Nothing to do with Jim Nabors or Leonard Lawrence, it's an acronym that stands for "Get Out Of My Emergency Room!"
* One of the cruel realities of any mass casualty incident, such as a large multi-vehicle wreck in the middle of nowhere or something on the scale of Katrina or September 11th, is that not everyone can be saved, even with the miracles of modern medicine. On the same venue, time spent dealing with those patients who cannot be helped will cause those that can to die. Enter the principle of Simple Triage and Rapid Treatment. If you can walk: Priority 3, help carry the person next to you over to the casualty collection point. If you can't walk, but follow commands, Priority 2: We'll get to you as soon as we can. On the other hand, if the only thing you do is breathe or babble incoherently, you get out of there pretty fast: Priority 1. Unsurvivable injuries, such as massive burns or amputations, no pulse, or no spontaneous breathing? Expectant/Morgue.

There is a tendency for many people (who don't understand the concept of triage) to decide that the ER staff is indulging in this, even when they aren't. Add to that that the desk staff at an ER have to be firm about who they're calling, but can't explain to the other patients why they're being taken in that order, and you get an appearance of petty tyranny. While desk nurses are the most likely to get this portrayal, medical personnel in general are often seen as petty dictators who are unreasonable about things like visiting hours; admittance to the ICU; flowers, candy and food being brought to the patients; and all the other annoyances about having a loved one in the hospital.

* She's not a nurse, but the "bereavement liason" in ''LittleMissSunshine'' certainly qualifies.

* ''Bringing Out the Dead'' has the triage nurse giving lectures to the patients that come in. "Let me get this straight. You snorted cocaine and now you feel like your heart is going to explode. We didn't buy you the cocaine, we didn't shove it up your nose..."

* ''Series/{{Mash}}'': Given that the camp typically receives dozens of wounded at a time at least, triage is a matter of life and death every time, which has lead to disputes:

* In the ''Series/{{Star Trek Voyager}}'' episode "Critical Care," the holographic Doctor gets stolen and sold to an alien hospital, where patients are assessed not according to urgency, but according to how "valuable" their skills are to society. As a result, the working classes suffer in crowded, undersupplied halls while the rich recover in luxury. In the Doctor's efforts to help, both the Prime Directive and the Hippocratic Oath get severely bent.

* Justified in an episode of TheBigBangTheory. Howard is faking an allergic reaction to keep Leonard's birthday party a secret, and the nurse refuses to play along. She looks like a tyrant when she tells Leonard that Howard is not a legitimate patient - until Howard appears having actually eaten nuts and given himself a severe reaction.

* In one ''Series/{{Star Trek Voyager}}'' episode, the holographic Doctor gets stolen and sold to an alien hospital, where patients are assessed not according to urgency, but according to how "valuable" their skills are to society. As a result, the working classes suffer in crowded, undersupplied halls while the rich recover in luxury. In the Doctor's efforts to help, both the Prime Directive and the Hippocratic Oath get severely bent.
** In another, The Doctor is faced with two patients (Harry Kim and a RedShirt) who have an exactly equal chance of survival. He can only treat one of them in time, and the other will die. Because his program cannot find a logical way to decide, he chooses to save Harry because he's a friend. This causes a [[HeroicBSOD severe malfunction in his program]] that forces the crew to erase his memory of the event or risk losing their only medical officer.
** In yet ''another'' episode, the ship is taken over by Hirogen who place the crew into brutal holographic simulations and force the doctor to treat them. When a crewmember with life-threatening injuries and a Hirogen with minor burns are both brought in, the Hirogen medical officer orders the doctor to treat the Hirogen patient first. He protests that this goes against the rules of triage is that critical injuries take priority. The Hirogen replies "your rules, not mine" and deactivates him when he refuses to comply.

* One of the cruel realities of any mass casuality incident, such as a large multi-vehicle wreck in the middle of nowhere or something on the scale of Katrina or September 11th, is that not everyone can be saved, even with the miracles of modern medicine. On the same venue, time spent dealing with those patients who cannot be helped will cause those that can to die. Enter the principle of Simple Triage and Rapid Treatment. If you can walk: Priority 3, help carry the person next to you over to the casuality collection point. If you can't walk, but follow commands, Priority 2: We'll get to you as soon as we can. On the other hand, if the only thing you do is breathe or babble incoherently, you get out of there pretty fast: Priority 1. Unsurvivable injuries, such as massive burns or amputations, no pulse, or no spontaneous breathing? Expectant/Morgue.