The whole hospital was paged to the pit for a multiple trauma incident, they were going on site at a large concert after a portion of the stadium collapsed.
"Triage quickly and safely," Owen directed, "Deputy Chief Hunt will be leading on scene. Going with her as fifth year residents coordinating field triage. Jones, Riggs Jr, mini Altman. Jones and Riggs will be mobile where crews need you with Hunt, Altman is at the command center triaging and distributing patients to all area hospitals. Only us and pres are level 1 trauma centers."
"Red tags need care now, yellow can delay, green walking wounded, black tags we can't save," Meghan reiterated, "use black sparingly call me if unsure. Red tags go here and to Seattle pres, we're closer, fill us first, send yellow to the smaller hospitals, green to urgent care and walk in clinics. Work fast and work safely."
"Keep your hospital jackets on and zipped up so they don't catch on anything and your badge on the outside of your jacket," Owen commanded.
Annie's hand shot up, "I need a different jacket."
"Grab one from the locker room," Owen said, "or be careful you don't get caught on something."
Cassidy said, "mines bigger than yours trade me and I'll stay here you don't need OB on scene."
Annie looked, "you sure?"
"It's an extra large it should zip over your bump," Cassidy said, "your cardio and have field trauma experience they'll send you if your mother doesn't stop them."
Annie passed her jacket to Cassidy and gratefully took the one her friend offered checking that it did indeed zip over her baby.
"Teams," Meghan directed, "rig one mini Altman, Grewal, Posen, Ratzlaff, Yee and Eakert."
"Yes mam," Annie called, "get your kits and follow me. You have 3 minutes to be in the rig."
Annie dashed to the ambulance and helped load equipment.
Teddy was supervising in the ambulance bay.
"I have group one," Annie said, "we'll get in and start triage. Sending most emergent here."
"Go Annie," Teddy said, "come back with any complex cardio Nathan and I will need your hands. Annie be careful, not in the worst of it and crawling in rubble. Come back as soon as you can. Get the triage station set up and make the calls there. I don't want you in the thick of it. You're at the command center, you can not go into the middle of it, you can't risk falling."
"Yes mama," Annie replied as she hopped into the ambulance with her interns and junior residents. The paramedics turned on the sirens and drove at top speed towards the arena. While they were driving Annie gave a crash course of field work and what to expect out there, reminding them that in doubt to get an attending or senior resident, that Josh, Meghan and Duncan would be moving around and could help.
Meghan sent the teams off deciding who would stay back, mainly attendings, fourth and fifth year residents. Sending the second and third years out with half the interns. Duncan, Annie and Josh were the only fifth years going with her to manage the scene. She didn't love sending Annie into the thick of it but Annie was smart and could do it calmly. Annie was steady in chaos, she could manage complex cases in the field with limited equipment, she had inherited her mother's calm demeanor in a crisis, when others got worked up they got calm, made a list and followed it through. She would get triage coordinated from the command center and teams where they were needed. Meghan wondered if sending Annie out was the best idea at 28 weeks pregnant but Annie had field trauma experience from their humanitarian trip to Haiti the spring before. She knew what she was doing in the field. With Owen, Teddy and Nathan staying back Meghan needed Annie and Josh with her on scene.
Alex explained the photo board system he had developed after the ferry crash his intern year and distributed polaroid cameras to a few interns. Showing them how to sort information and explaining how to run the family information center. Arizona who was now only doing fetal surgery offered to run the family information center and keep things calm and organized.
Teddy was helping Owen and Meghan get organized her years running things on this scale for the army coming in handy. Soon the first ambulances came back loaded with red tag patients many destined straight for the OR. Teddy could see their lesson in labeling with sharpie had come in handy some patients had names written in them or ages and dates of birth.
Teddy paused when she saw the name and date of birth on the arm of one patient in the second wave.
Jessica Courtney McKellar May 30 1994. Call Dan and Leslie McKellar in Cloverdale, T. Altman, J. Riggs O. Hunt have the number. No known allergies or medications. All Lifesaving measures to be given G. Altman.
It was in Annie's writing and signature, the patient had come in with an intern. Jessica had been intubated in the field and had a chest tube placed. The writing on the tag was also Annie's. Annie had triaged her sister, the one who had hated her and wished her dead, the one who had tried to kill her. Annie had told them to do whatever it took to keep her sister alive.
"Eaket what do you know about this patient," Teddy demanded.
"Full name and date of birth were identified by Dr Altman in the field. Dr Altman said it's her sister Jessica and to tell you right away," Kira Eaket replied, "chest tube was placed with no breath sounds bilaterally. Suspected open book pelvis and possible cardiac tamponade. Dr Altman is on the next rig back with an open chest; she cracked it in the field. Dr Altman and Dr Riggs were doing things out there the rest of us wouldn't try. Dr Hunt is doing a field amputation. Dr Riggs is right behind them with a head injury he did bore holes with a dewalt drill."
"Page Owen Hunt and Nathan Riggs," Teddy directed.
Owen ran into the trauma bay.
"It's Jessica McKellar," Teddy said, "Annie triaged her and is on the next rig with a patient whose chest she apparently cracked in the field. Josh is on his way back as well."
"Like her mama," Owen said, "I'll get Jessica up to the Or and page Nathan. Annie's note here is good."
"Get Robbins to call Leslie and Dan. And you need ortho," Teddy said.
"I'll deal with Jessica," Owen replied.
Teddy thought this would be hard. Annie hadn't seen her sister in almost two years. Why now?
Teddy was impressed hearing Annie was cracking chests and placing trachs in the field. Maybe there was a trauma surgeon in her soft spoken peds loving daughter. Teddy met Annie in the ambulance bay and together they rushed the patient to the OR barley having time to scrub. They fully opened the chest and began to repair the damage and the aortic dissection that was forming.
"That's a good save," Teddy said.
"I cracked his chest in the field mama," Annie said, "I just did it there was no choice."
"You're thinking like a trauma surgeon," Teddy smiled.
"It was 50/50 if it would work but I was better to try this than do nothing," Annie said, "it was hard doing it kneeling on the ground with my belly in the way, my range of motion is decreasing."
"Trauma surgery. Do nothing, they die, do something they might live," Teddy said, "babies do that. You did well."
"I triaged Jessica after intubating her and placing a chest tube," Annie said, "she was in bad shape. Who took her to the OR?"
"I saw her when she came in. She's in OR 6 with Owen and Nathan," Teddy said, "they'll do everything they can."
"Did you see my note to call," Annie asked.
"Arizona is on it, she's doing notifications," Teddy replied.
In Cloverdale the phone rang.
"Hello," a sleepy Leslie answered.
"Hello Mrs McKellar, this is Dr Arizona Robbins from Grey Sloan memorial hospital in Seattle," Arizona said.
"Annie what happened to Annie," Leslie panicked.
"Annie is fine," Arizona said, "I'm calling about Jessica. Jessica was injured at a concert in the stadium collapse she is in surgery now. Her older sister, Dr. Grace Altman gave permission for all lifesaving measures to be taken."
"Annie did what," Leslie asked.
"She told our staff to do what they needed to to keep Jessica alive," Arizona clarified, "you need to come to Grey Sloan and see the family information center in the cafeteria. I have Jessica's digital chart she is being operated on by Dr. Owen Hunt and Dr. Nathan Riggs. Dr Josh Riggs is the resident."
"Owen Hunt, Annie's uncle Owen and Josh Riggs Annie's husband," Leslie asked.
"Yes," Arizona confirmed, "our Chief of surgery Dr Teddy Altman assigned them herself."