No further explanation was necessary for Ian, who moved out to set up the placards around the room. each color distinguishing patient priority. Green was Delayed, the minor injuries that didn’t require critical aid. Yellow was Urgent, for patients whose care couldn’t be put off for nearly as long. And the red meant Immediate, for casualties whose wounds were both life-threatening and able to be treated given the medical supplies on hand.
Reilly unzipped his aid bags, spreading apart flaps with bulging pouches marked by glow-in-the-dark patches reading AIRWAY, SPLINTS, MEDICATION, BLEEDING, and MINOR SURGICAL, among others.
Behind him, Worthy asked, “Where do you want me?”
“Immediate,” Reilly replied without looking, assigning the point man to the highest level of care. Reilly conducted frequent cross-training for his team back in the States, and developed a keen eye for each man’s medical aptitudes. As the team’s lone medic, this was critical—the more casualties there were, the less actual treatment Reilly would provide. Circumstances were far different with only a single casualty, especially a team member—he’d gladly walk through the fires of hell to save any one of them, as they would for him.
But when the situation was a mass casualty event, or MASCAL, the roles reversed.
The sheer number of casualties changed everything; as the team member with the greatest degree of medical training by a long shot, Reilly was of greatest use in a managerial position, screening incoming patients and assigning a priority status before sending them to one side of the triangle for treatment by another team member.
As Reilly moved to the door, Cancer was the next person to enter, his clothes and kit covered in tiny brambles. He was breathing hard, having recently extricated himself from whatever tangle of brush he’d chosen for a sniper position.
“You’re on Delayed,” Reilly said, and Cancer moved out to the green placard. No further explanation was needed; this was standard MASCAL procedure, and now that the site was fully prepped and manned, only one thing remained: to get some actual casualties inside.
When that didn’t immediately happen, Reilly wondered if this entire thing had been a waste of time. Maybe the villagers didn’t trust them, or maybe they were all gathering at the home of some witch doctor for superstitious backwater cures, he thought as he moved outside to scan the street.
His first step beyond the door brought him into a near-collision with a young woman carrying her four-year-old son. The boy’s forehead was lacerated by what he guessed was the buttstock of a rifle, blood running down the side of his face in torrents.
But Reilly focused on the boy’s eyes, finding one pupil dilated—a possible brain injury, but no immediate respiratory distress. Not much they could do but stop the bleeding and monitor his vitals, ensuring his breathing didn’t become compromised enough to require an artificial airway.
He directed them both inside and shouted, “One Minimal.”
Cancer waved them over, and no sooner had Reilly turned to the door than he saw his next casualty—another woman, this one in her twenties, with tears streaming over her face rather than blood.
She clutched a shawl tightly at her chin while holding a fist over her abdomen. Definitely in shock, but breathing and relatively alert—probably a rape victim, he assessed at a glance.
“One Minimal,” he called out, directing her toward Cancer.
Things happened quickly after that: a forty-something man arrived while holding one arm at the elbow, the upper sleeve distorted and malformed but no blood seeping through—proximal bone fracture.
Reilly shouted, “One Delayed,” and sent him to Cancer.
Next came an injured man clinging to a friend for support, holding a blood-soaked hand over a probable gunshot wound in his abdomen. He was gasping for air, gut shot with uncontrolled hemorrhaging, and he was going to have a rough ride if he survived.
“One Immediate,” he called, extending an arm toward Worthy as the two men struggled across the mosque.
Tolu entered then, followed by David, who quickly spoke.
“Villagers have a truck ready to evac casualties once you give the word. Nearest hospital is Damaturu, just over an hour from here. Driver’s waiting in the vehicle. What else do you need?”
“Just Tolu for now,” Reilly replied, and David ducked back outside the doorway to pull some semblance of security for the rest of his team while directing the remaining casualties inside.
A teenage boy appeared next, half-carrying and half-dragging an older man into the mosque. Reilly saw at once that the casualty was alive, but just barely. The terrorists hadn’t just used a buttstock to crack his head; they’d tried to kill him and damn near succeeded, a gaping wound in his shattered skull revealing traces of visible brain matter.
His escort was speaking in a panic to Tolu, who replied with some supplemental guidance in the local dialect before explaining to Reilly, “He was defending his wife—”
Reilly pointed them toward Worthy and called out, “One Expectant. Racegun?”
Without looking up from his treatment of the gut-shot man now laid on the ground before him, Worthy echoed, “One Expectant.”
The confirmation was, in this case, necessary.
While the man with the head injury would join the side of the triangle formation for Immediate casualties, Reilly’s designation told Worthy that this new patient would very likely die. As such, the point man should lay him down, keep him as comfortable as possible given the circumstances, but not waste any medical supplies or time treating him. Other patients with a chance of survival desperately needed both, and as far as the supplies went, so did the team.
Reilly’s two aid bags only held so much equipment, and every scrap of gauze or tourniquet that the team committed to saving these locals was one less than they’d have for themselves in the mission ahead. The upcoming night raid in Maiduguri had tremendous potential to take a turn for the worse, and Reilly would be left to treat any team injuries using whatever supplies remained.
If the man with his brain exposed were the only casualty, Reilly could dedicate his full medical resources to saving him. But in this case, doing so would endanger many others, and he was forced to maintain a measure of objectivity in the interests of a greater good that was, at present, hard to discern.
Grabbing Tolu by the arm, Reilly said, “Anyone who brought in a casualty but isn’t injured, get them out of here through the back door. They need to wait outside until we’re done.”
Tolu set off to comply while Reilly turned to appraise a man who’d walked in under his own power—but just barely. He staggered toward Reilly without any visible injuries but almost doubled over wheezing in an attempt to breathe. The medic stopped him before conducting a hasty visual sweep of his back—one side bore what looked like a stab wound. His respiratory distress indicated a developing tension pneumothorax, which would quickly prove fatal if untreated.
“One Immediate.”
He pointed the man toward Worthy, who was still treating the abdominal gunshot as he called out, “Support!”