MVI on Highway 1. Four patients. Two crews. It’s 3am, raining, and everyone’s looking at you because you’re the senior medic. Sound familiar?
Used to make me want to puke. Now? It’s just another Thursday. Here’s how I learned to manage chaos without losing my mind.
The 30-Second Scene Size-Up That Matters
Forget the textbook scene size-up. Here’s what you actually need in 30 seconds:
- How many can walk? – Get them to one spot. They’re green tags.
- How many are talking? – Probably yellow tags.
- How many aren’t? – Your reds. Start here.
- What resources do I actually have? – Not what’s coming. What’s here NOW.
The Delegation Formula
You can’t do everything. Stop trying. Here’s my formula:
Your partner: Takes the sickest patient. Period. No discussion.
Fire (if there): Vitals and basic first aid on walking wounded. They love helping, use them.
Second crew: Takes second sickest OR helps you with patient #1 if they’re circling.
You: Float. Triage. Direct. Make transport decisions.
The Magic Words
Learn these phrases. Use them:
- “You – take this patient. Full assessment. Report back in 2 minutes.”
- “Can you get vitals on everyone in that car?”
- “I need you to hold C-spine and nothing else.”
- “Call for another car. We need X more units.”
Clear. Specific. No room for confusion.
The Transport Tetris
Biggest scene management failure? Transport chaos. Here’s the system:
- Count cars, count patients. Do the math early.
- Load reds first. Always. No exceptions.
- Yellows can wait if another unit is 5 minutes out.
- Greens go last OR with yellows if room.
- One crew member per car unless patient is circling.
When It’s Going Sideways
Signs you’re losing control:
- People standing around asking “what do you want me to do?”
- You’re doing hands-on care instead of managing
- Nobody knows transport plan
- You’re running between patients
The reset: Stop. Stand in the middle. Loud voice: “Everyone stop what you’re doing and look at me.” Reassign. Restart.
The Mental Game
Real talk – multi-patient scenes are 80% mental. Your brain wants to focus on one sick patient. Fight that urge. You’re the conductor, not a musician.
Think of it like this: Your job isn’t to provide perfect care to one patient. It’s to provide good-enough care to everyone until more resources arrive.
After Action
Every multi-patient scene, debrief with your partner:
- What worked?
- What was chaos?
- What would we do differently?
Learn from the mess. Next one gets easier.
The Bottom Line
You’re not going to save everyone perfectly. That’s not the job. The job is organized chaos. Get everyone somewhere safe with someone competent watching them.
Perfect is the enemy of good enough. And on multi-patient scenes, good enough saves lives.
– Stay safe in the chaos