So, beyond what we see on doctor shows, does anyone know anything about real ER protocol?  Say if someone was brought in for a stabbing (not too many real vamps, LOL), what's the first thing that happens?  Getting them stabilized, hooked up to IVs, stopping the bleeding (sometimes through surgery if arteries are severed?)?  Are they going to ask about blood types for a transfusion, or is there a test (I know there's a test, but I don't know how long it takes)?  Do you have to have an exact blood type match for a transfusion?

If they don't have knowledge of your blood type, they give you O-neg, the universal donor type. O-neg is the only type you can give to any person without there being a conflict of types.

If you walk in with a stab wound, you might not be seen right away if the ER is busy - really does happen. They take walk-ins based on seriousness of injury, though, so if you make your case....

If the paramedics picked you up, then they try to stop the bleeding, hook you up to an IV, the monitors, and rush you in. The doctor will assess the immediacy of your case based on the information the paramedics give, like your pulse, blood pressure, respiration stats, and severity of injury. If there's an arterial bleed, they clamp the artery and stabilize the patient, hooking them up to IV blood, and send them up to the OR. The ER doesn't do artery repairs. Their job is to stabilize the patient for further expert care. They just need to limit or stop the bleeding.

Of course, if the stab wound is minor, say just to flesh, then it is cleaned out and sutured. Antibiotics are standard to prevent infection, and they'll inquire about your tetanus shot being up to date. And you'll get pain meds.

Arteries are slippery, so it's harder to get a hold of the femoral (thigh) artery and clamp it, than to clamp off bleeds in the belly. For a stab wound to the abdomen, they'll use portable ultrasound to see what the damage looks like in there, and open the wound further to explore for bleeds to clamp if necessary. Again, they just want your stats to be stable enough to go to the OR. Surgery consult is standard procedure, I believe, for a belly wound.

If you're conscious, the ER tries to get as much info from you as you can provide. If you're not, then they call family. If you have an insurance card, that helps a lot, as they can get your file on the computer and look up your medical history. They need to know however they can if you're taking medications that could hinder or conflict with treatment. Patient histories are crucial to optimal care.

The blood type test doesn't take very long. Donor stations have to be able to type people that come in that don't know or can't remember what it is. By the way, our blood supplies are ALWAYS short, so if you're eligible to give blood, DONATE! For a female, you just have to be over 115lbs. They'll be able to tell you right away if you qualify just from a few questions (If you've had hepatitis, for instance, you cannot donate blood.).

Type O is the universal donor. Type AB is the universal receiver.

CM

CM - what a thorough an tautly accurate answer that was.  Are you in medicine?

Yes, the first stop is Triage for assessment and prioritization... unless you pass out on the waiting room floor like I did, LOL.  Triage will get the patients moving in the right direction in the order of severity. 

Nope, it's just always fascinated me, so I read and watch stuff. And my ex is certified as an EMT and worked as an Army medic. Got a few nurses in the family, too. :)  I've also spent a lot of time in hospitals and medical offices for family with longterm illnesses. Even been to the ER myself once.

CM

CM you did do an exellent job of decribing that.. and in all seriousness, if it'sjust a little stab wound and not really bleeding that much you could end up sitting in waiting room for hours. no joke. one other thing you might want to know is that there are different levels of hospitals and emergency rooms, . by different levels i mean, the hospital i work at for instance, if you came in with a semi serious stab wound, you'd be put in our "trauma" room, stabilised to the best of our abilities while at the same time some one would be working on a transffer to another hospital, because my hospital doesn't have the capablities or follow through to handle anykind of serious blood related trauma.[you'd get fixed up so you wouldn't die because i work at an army hospital and betweenthe medics and the doctors we'd find a way to stop the bleeding, but we couldn't garuntee your survival once you leave our floor] while at the same time one of the hospitals that we transfer to down town, does not under any circumstances except women in labor.they don't deliver babies AT ALL.  most of your bigger better funded hospitals are literally "trauma centers" and they are there for trauma purposes. as well as different levels of security on these places. i read in a lot of fic.s so and so was carried in the back door. in reality that would not happen, in just about any hospital. way to may people have come bursting in er doors and shot people up, almost all hospitals are locked and require some kind of security key or code to get in. this also applies to a greater portion of hospital wards ex icu.
that's all i can really think of right now, just got done with  hours so im wiped. but i work in a hospital so if you have any more questions shoot em my way, if i don't know the exact answer, i know plenty of people that i could get it for you to keep your stories as realistic as possible.

that was me by the way

Thank you both so much!  This helps a lot.

Well, I wasn't thinking so much 'walking in' with a stab wound, more like carried in and unconscious from blood loss.  So a major wound.  And so would the hospital try to find out your blood type first, or would they just go with O-neg?  I guess I mean, is your own blood type the best, or does O-neg work equally as well?

And does the whole "shoving forms at your relations" thing really happen the second you're whisked behind the doors and they're left standing there?

No, they don't have time to find type on someone in serious condition. They strap on the O-neg. Because O-neg won't hurt you. If you gave someone that's O-positive type A, for instance, you've just poisoned them. Your body will see those cells as invading objects, and attack. You'll get your own type later once you go up to surgery, but the ER can't take the time to find out by testing you. Now, if they can verify your type while you're still there, then it's best for the blood bank to use your type - O-neg is the first blood they grab for because it won't hurt anyone regardless of type, so the stockpile of the that is always lowest. So, it's strap on the O-neg first, add type specific later.

As for the second question, yeah, pretty much. Your relations will be filling out forms in the waiting room or family room or hallway, but part of the point, besides getting info and consent, is to give the family something to focus on besides your trauma, and get them out of the way of the ER docs. They want to be able to work without distraction, and family bombarding them with questions, standing in the way, or fainting in the way, REALLY doesn't help them.

CM

Could someone who works in a hospital or has knowledge about the types of wounds people tend to come into ERs with email me?  I have some more specific questions.  goldenusagi at hotmail

unless you pass out on the waiting room floor like I did - Did that get their attention, LB?  :) 

Thanks CM and Legen those are terrific posts.  I hope anyone who answers G's questions re wounds will post here, too. 

I used to work in a blood bank, and although this is old information, the basics have not changed much:

On blood typing:  if you are bleeding badly, you may get O negative red blood cells right away.  As CM said, they would not give you any other type unless they were certain they knew your blood type.  It takes VERY little time to type blood (plus transit time for the blood sample and then the units of blood) and then red blood cells of the right type could be given.  There's no big difference between giving O neg, or the patient's own type--either will work. But blood banks hate to send out O neg unless it is truly necessary, because it's a relatively rare blood group (about 7% of Americans), always in high demand, and always in very short supply.  If there was not enough O negative blood, and a patient was young and male and about to die, they might risk O positive--less than 15% of Americans are negative, and even if the patient was, if they had not had a transfusion before or been pregnant, it would be safe to give. 

Doctors HATE to give blood uncrossmatched unless they have to (extra risk) and it takes maybe 15 minutes to do a type and crossmatch stat plus transit.  If not stat, then about 30 minutes plus transit.  Computer crossmatching has speeded the process up from this, but there's a certain amount of incubation time that you just can't get away from.

It's up to the judgment of the ER doc or the surgeon whether to give O neg, or typed cells uncrossmatched, or to do a stat crossmatch, or to wait.  This can be a tricky decision to make;  if they guess wrong, the patient could bleed out without the blood, or on the other hand, they could react badly to the blood they get. The more time for typing and crossmatching, the safer the blood will be, but it takes time to do that the patient may not have.  If the patient is coming in on an ambulance, and is bleeding badly, they will call ahead to make sure the ER has O neg cells ready to go.

frey

the patient could bleed out without the blood -

Frey - isn't part of the problem that there just isn't enough liquid to circulate around?  Could giving plasma alleviate part of the problem?  Also, has there been any progress on the blood substitutes?  I worked for a guy who invented one, but the trials showed it was causing the recipients' blood pressure to ramp up, so they shut down the experiments.