There is DATA on her SCREENS and aaaaaaaaaaaaah Merrin needs someone to recalibrate her alarm settings right flaming now because there are like six people with O2 sats under 60%, including that one guy over there who sort of superficially looks fine, and 20+ people under 85%. They can put it back to higher sensitivity once she has FIXED some of the GLARING PROBLEMS and will benefit from being alerted of NEW SURPRISING PROBLEMS. 

(This is subvocalized to her Exception Handling personal admin over the radio link, not yelled out loud, the injured bystanders running around being helpful don't need to worry about it at this point.) 

All right. Oxygen masks and portable bottles that will last twenty minutes each, here, go, the casualties are numbered off and locations displayed on her main foldout screen, get the flashing red ones first. (The helicopter en route has a big oxygen concentrator, but even the "portable field" kits are not really portable when your entry method is plummeting out of the sky and you already have 100kg of other medical gear.) 

- blood pressure monitoring, she does not in fact have enough non-invasive BP cuff kits for everyone, they're lightweight but it adds up. She has 15 of them (and 10 invasive kits but even she can't place one of those in less than two minutes). Anyone with a heart rate over 140 gets priority, that's those 13 people, then they're paired up thisaways with hopefully-more-stable casualties to rotate around. It's terrible for infection risk but she is eating a lot of "terrible for infection risk" here and that's ignoring the HORRIFYING SHIRT MEDICINE performed before her arrival. 

...Carissa is ablebodied. 

"Can you multitask the cold spell thing while running around?" Merrin snaps to her. "Have tasks need delegating." 

"The spell has ten feet of range."

She doesn't seem to mind being snapped at - it's not really relevant to whether she survives this - but she doesn't answer the way a dath ilani would, either; in her culture you don't just say 'no' to a superior.

This is slightly weirdly indirect and Merrin is momentarily irritated that she has to stop and parse it rather than just knowing, but - it's not this poor woman's fault that she ended up here unexpectedly from another world and has no idea how anything works in dath ilan. Merrin would die of social anxiety. 

Awww, so she can't make one of the few totally uninjured people run up and down delivering additional medical supplies to her recruited volunteers. 

"Okay." She glares at her layout-screen with the varyingly colored and flashing dots marking the location and condition of the casualties. "- I'm assigning you to hang out in the cockpit area, then, that's where the worst-injured people are."

Fewer of them than before, though, and headless bodies have been unceremoniously sort of shoved to one side; there's more floorspace than there was, though Merrin could really wish she'd had weight capacity for some absorbent towels so she doesn't have to do everything squatting in a slippery layer of blood everywhere. It just feels incredibly unsanitary to her hospital instincts. 

"Take these with you," she says, handing over a box with five precious 1L bags of IV fluids and a UV light hand-sterilizer. (20kg of her total weight capacity is dedicated to IV fluids). "Think there's someone on-site who can place IVs, not expecting you to learn it on the spot, but they'll need someone handing them things."

And Merrin is not going to be able to get to focus on any individual patient for at least five minutes, because she's busy Frantically Orienting To The Overall Situation; her eyes are currently on zoomed-in video footage of one of the patients, it's worse for visually assessing them but faster than running back and forth, and it would be awful if she slipped on a rock and fell on top of someone wearing over 150kg of power armor.

"...Put your hands in that box to sterilize them," she adds. "Whoever's on point in that section will show you how. ....Uhhhh." Magic user probably cannot carry a crate and a moderately heavy box alone? "Pink jacket!" She wishes people had NAMETAGS, she hates calling people by their clothing descriptions even if it's Standard In Emergencies. "Carry the box while she carries the heads." 

On point for coordinating treatment in the very very very makeshift Complicated Patient Area is still the Keeper; she's the best person at rapidly taking in and processing multiple streams of input, even if she has very little specific medical background. She did not previously know how to place IVs but will be able to do it after watching one of the airline staff do it once. 

She nods to Carissa and makes a gesture to Pink Shirt for where she wants the box of supplies. 

"Set of the tubing and one of the bags of liquid and one of the little opaque bags for each patient," she tells Carissa. "And carry the UV light sterilizer around - that's the gray 2kg flattened-cube. Airline attendant two will tell you how to use it." 

Well, she doesn't know which one is airline attendant two, and she's going to lose the spell at some point if she tries to cast it repeatedly simultaneous with using the uvlightsterilizer and handing out random bendy objects to everyone -

- nope. This is a test, she will simply have to not lose the spell while she does those other things. Tests don't have to be fair.

(Airline attendant two is helpfully waving! She also has a large numeral on her uniform, but it is of course in Baseline script.)

The Keeper cannot in fact read Carissa's facial expressions (Carissa is much more practiced at concealing those than dath ilan accounts for), but she didn't miss the hesitation. She had modeled in advance, having observed the magic user concentrating on spells, that this might be close to the edge of her abilities, despite her clearly having a lot of experience of working under conditions of duress. It might also have been something she could do just fine! The markets were really unsure of that and giving odds not far from 50/50. 

They don't actually desperately need the spell at this point - the heads won't rewarm much in the next fifteen minutes, and Merrin has chemical cold packs - though fewer of them than would have been included under the original plan, because the original plan did not really include there being 20 people still in any condition to benefit from IV fluids or supplementary oxygen. And they really desperately need people with working arms and legs, even unskilled people, because most of the bystanders with "minor" injuries are nonetheless impaired at one of walking or carrying.

It's interesting that she didn't communicate it, whether explicitly or - actually, by literally any indirect verbal hinting, she seemed ready to just do the thing that was pretty clearly, in her own self-assessment, probably not going to work? That seems very relevant for working with her even during this emergency, and definitely for making sense of her as an unanticipated (helpful! but terrifying!) anomaly in the longer run. There are much higher-ranked Keepers - not to mention global experts in social modeling - are going to be watching the now high-fidelity footage coming from Merrin's drone camera, trying to figure out recommendations for working across what is predictably going to be a vast cultural gulf, and plausibly one of basic psychological architecture. Just because she looks human on a visual level doesn't mean that she is, or at least not the kind of human that dath ilan knows. 

"We have non-magical cooling available now," she says. "We may still need your spell later, but we don't need it active constantly for cooling the current heads." 

(Carissa acknowledges this with a slight dip of the head and drops the cooling to focus on handing out of unfamiliar mechanical objects. ...so it was a test testing whether she'd object? They seem to be acting competently and it's their peoples' lives on the line, she's not going to argue with them about her orders. Usually people who give you orders have one of a good reason or a way to hurt you, and they presently have both.)

There are seven patients in the cockpit area. Five are, like, literally imminently dying; two of them, the miscarriage woman and the guy who got emergency liver surgery with a red-hot dagger, are in pretty terrible shape but, on the scale of the next 5-10 minutes, at least slightly stabilized.

Their most critical patients: 

#1: young guy with the horrifying chest injury, who is SOMEHOW STILL ALIVE and even still responding to painful stimuli. Which is honestly remarkable, if not miraculous, given an oxygen saturation of 45% breathing room mountainside 4000m-above-sea-level air, and a blood pressure of 60/30. His fortunately young and healthy heart is laboring incredibly hard for that, racing at 170 beats per minute; his breathing is ragged and shallow and like fifty breaths a minute. Every single physiological system is turned toward keeping his circulation going for just a few minutes longer, and he was physically fit enough to compensate really quite impressively well, but he's running out of slack. He desperately needs oxygen - really he needs invasive ventilation as soon as possible, but nobody except Merrin is certed to set that up - and IV fluids, and a blood-type-compatible transfusion as soon as possible. 

(They did not send Merrin down with transfusable blood. She has the blood type of all the passengers recorded, and a suggested protocol for who is least-injured and can afford to give up some blood, to cover the fifteen minutes before a much better-stocked medicopter reaches them.) 

#2: woman in her early 50s who lost a lot of blood from a half-severed femoral artery before Carissa got to her. She's actually not badly injured apart from that, her heart and lungs are fine, but she's unconscious, pale to the point of translucency, breathing labored. Her heart rate is up at like 190 now, which is not a rate that 50-year-olds are really supposed to hit, and her blood pressure is 75/40. Her measured oxygen saturation isn't disastrous, but she has a serious dearth of red blood cells and hemoglobin right now, so "85% saturated" is massively insufficient for her body's oxygen needs and the estimated equivalent is closer to 50% - but her brain is still getting circulation. Oxygen and IV fluids will help buy a few minutes for them to get, like, probably multiple people to contribute some blood. 

#3: seventeen-year-old boy with a head injury. They held off on immediate cryo because he still had a strong pulse and was breathing on his own, had reactive if sluggish pupils, and is slightly responsive to pain and not showing altered brainstem reflexes. Really what they need is a diagnostic scan, to determine whether to try medical management, messy field brain surgery, or go for cryo anyway. Irris is currently shaving his head to place the EEG electrodes, and Merrin will be sending someone over in like three minutes with their one ultrasound diagnostic scanner, once she's had time to teach a person who can both walk and use her hands - it happens to be the famous serial author - how to use it. His vital signs are, as predicted, mostly fine: heart rate 75, blood pressure 130/90, oxygen saturation 89%. 

#4: Man in his early 40s with slightly-less-catastrophic blunt trauma to his chest and abdomen (and a broken humerus and collarbone, neither of which matter.) He's clearly bleeding internally, probably including into the space between his lung membranes; his breathing has been getting more and more labored and his level of consciousness has been deteriorating rapidly. He still responds to auditory stimuli at all, but only with incoherent sounds. Heart rate 145, blood pressure 65/40, O2 saturation 76% and dropping. He's going to be in serious trouble on the scale of hours due to almost certainly having multiple small bowel perforations leaking gut bacteria into his abdominal cavity; if they couldn't rely on healing magic being available tomorrow, he would have very poor odds, but they might be able to hold off catastrophic sepsis for just long enough. 

#5. Woman in her 20s. Spinal injury, damage estimated at the T2 mid-thoracic vertebra given the symptoms observed. No sensation or motor function below the ribcage (which has some benefits, given that both of her legs are badly broken), and her diaphragm and chest wall muscles are significantly weakened; she's breathing on her own, but having a rough time of it, and coughing is basically not functioning, so she's not managing to clear her airway even of her own saliva. She's conscious, but very drowsy and confused, responding to questions with non-sequiturs or a slur of jumbled words. Heart rate 45 and blood pressure 55/25; a lot of that regulation is pretty borked. Oxygen saturation apparently 55%. She needs assisted ventilation, and probably vasopressors, and a scan to determine what else if anything is wrong because she can't super report pain to them. 

Their very critical imminently-dying patient #6 is not in the cockpit area! He's a man in his 30s who they thought mostly just had broken bones (though, like, REALLY A LOT of broken bones.) He's conscious if not very coherent, his breathing doesn't appear that worryingly labored, and his bleeding was fairly easily controlled before he lost that much blood. However. His oxygen saturation is at 52%, so clearly something is SERIOUSLY WRONG. He needs oxygen and a really urgent scan to try to determine exactly what is wrong, and probably urgently needs assisted ventilation. Other vital signs are less scary: heart rate 135, blood pressure 90/45. 

"Less critical" patients in the cockpit area: 

#1: internal injuries guy is actually not breathing very effectively! It was harder to tell because he's too out of it to complain of shortness of breath and his skin coloration is a bit darker, but the monitor doesn't lie: O2 saturation 57%. His heart rate is unsurprisingly up at 145, but blood pressure surprisingly adequate, clinging to 80/50. He clearly needs oxygen, probably assisted ventilation, and something to be done about the shirt-packed hole in him, but hopefully further emergency field surgery can wait until they have proper facilities including a sterile operating room.  

#2: miscarrying woman is semi-conscious and lost a ton of blood.  The worst hemorrhaging seems to actually be sort of under control now, but she's likely to need surgical intervention, once she's a little more stabilized. Heart rate of 165 - maybe partly from pain, because her blood pressure is holding up surprisingly well, at 85/45. Oxygen saturation 82%, but likely to rise once she has better perfusion including to her hopefully-undamaged lungs. 

Less critical patients not in the cockpit area and instead lying on cushions on the rocks outside: 

#3: Fourteen-year-old girl with a penetrating abdominal wound from flying metal. Carissa cauterized the worst of the bleeding, but she has intestines hanging out, and an anxious grandmother-gendertrope woman holding a rolled up jacket against the wound. She's deep in shock, conscious but her responses to questions don't really make sense. It's fortunate, in one way; the endorphins sloshing around her bloodstream mean that she's not, currently, screaming in agony. Her blood pressure was 72/30, heart rate 125, but she's a tiny girl for her age, that's at least a less scary blood pressure on her. O2 saturation 79%. She hopefully just needs supportive treatment until the helicopter with the mobile hospital facility arrives and someone can perform emergency surgery and a really thorough abdominal washout, but she could start deteriorating faster basically at any moment, and if Merrin has time it would be great to get her intubated and sedated so she's at least, like, prepped for surgery, and also definitely not going to confusedly move around and worsen the injuries any more. 

#4: Mid-40s man with...probably some kind of internal injuries? He's vomiting blood everywhere. Vital signs are, like, remarkably okay given that? Heart rate 115, blood pressure 95/60, initial O2 saturation 87%. He needs a diagnostic scan, and possibly Merrin can stop some of the bleeding via endoscopic procedure while they're waiting for the mobile hospital. How highly they prioritize his treatment will depend what they find on the scan, and whether his vital signs start to become less surprisingly okay. 

#5: Mid-20s young man who took a blunt-force injury to the chest and definitely has a pneumothorax - air in the pleural space between his lung membranes - and one lung mostly collapsed. It may or may not be about to become a much worse tension pneumothorax (where the air would be trapped and actually under positive pressure, resulting in not just a collapsed lung, but pressure on his remaining healthy lung and on his heart.) His initial O2 saturation was 59%, but his other basic vital signs were actually holding up pretty well, heart rate at 125, blood pressure at 88/40. He's responding well to supplementary oxygen, though, and able to communicate that, while breathing is very difficult right now, he is able to get some air and thinks he can manage for fifteen minutes until Merrin has the equipment for an emergency chest tube placement. If he deteriorates sooner than that - notably, if his blood pressure and heart rate get rapidly worse - they're going to assume a developing tension pneumothorax, and Merrin will detour to do a faster needle decompression and let the air out of his pleural space, pending the chest tube equipment being available. 

#6: Woman in her late 30s with a lumbar spinal injury and shattered pelvis. If not for the availability of HEALING MAGIC, she (and likely the young woman with the high thoracic spinal injury, though her medical advance directive is less firmly clear on this) would almost certainly be a candidate for early cryo. Though not right now, as a head in a crate; they would try to stabilize her enough for transport to an actual hospital facility, because even if the Future probably can still work with damaged brains, it's, like, better to do it under controlled conditions, and with "elective" cryopreservation, they can start infusing first stage cryoprotectants on a (heavily sedated) still-living patient. Anyway, Carissa stopped some serious but non-catastrophic bleeding before she could lose too much blood, and she's conscious and even vaguely oriented. Heart rate at 140 and blood pressure at 90/50, oxygen saturation actually up at 91% on room air; she took basically all of the force on her lower abdomen, not her lungs or heart. She's almost certainly bleeding internally and at pretty high risk of slipping further into shock, but it's going to be a complicated emergency surgery, not a 90-second procedure, and if at all possible they'll prefer to stretch her along with supportive treatments until the flying operating room arrives and they have a dozen highly trained emergency medtechs as opposed to one. 

#7: Man in his early 50s with multiple broken ribs - though, incredibly, no sign that any bone fragments pierced his lungs. His lungs definitely took some crushing force, he's coughing up pink foam, but his oxygen saturation was initially 71%. (It kind of says a lot about this situation that, to Merrin, this is a "slight sigh of relief" number; in a normal hospital setting it would be very much an aaaaaaaaah number.) His left arm was also more or less traumatically amputated by hitting a piece of torn and crumpled metal in the second impact. He lost a lot of blood even in the first seconds before Carissa showed up to shove a red-hot dagger up against torn gushing arteries. His heart rate is at 165, which is again not super safe for someone at his age but is better than 190, and his blood pressure is still only 85/50. He's conscious, though, if drowsy and not entirely oriented. He needs IV fluids and oxygen, and a blood transfusion but not quite as urgently as some of the other casualties do. If he manages to hang on without deteriorating any further until the full medicopter-hospital gets here, he'll be okay. Probably. 

That makes twelve. There were, initially, 32 patients with injuries triaged as life-threatening. Another nine of them are now cold heads in a crate. Ten are - not stable, by any means, but amateur first aid was enough that they're not thought to be especially at risk of deteriorating in the next 15 minutes. (12 minutes, now, until the first helicopter reaches them.) 

And one little girl is lying on a pile of cushions, blinking and rubbing her eyes and trying to figure out why she can't actually remember any of how she ended up down here on a mountainside; she just woke up, feeling kind of like she was in a doompunk-themed TV show that would be ill-advised for someone in her age group. It was going to be very exciting. There was a lady with ALTERNATEPHYSICS ECONOMICMAGIC POWERS who was going to try to save everyone, and she MISSED IT. 

Okay. 

She can do this. She's done sims that were - okay, not worse overall, but worse on some dimensions, like "having 100kg of carefully optimized field equipment on her" or "having backup incoming in twelve minutes." 

Merrin haaaaaaates triage. Especially when she cannot delegate anything more than the most basic of first aid, because her assistants are untrained laypeople most of whom have at least one broken bone. Her brain is screaming fifty affordances at her to DO SOMETHING RIGHT NOW about basically all twelve of her most at-risk casualties, and she cannot do fifty things at once. She can't even do five things at once, once you add the constraint that they are on five different patients who are not physically in the same location and where she can only be in reach of one at a time - 

- and everyone is on a countdown timer right now, but one with its exact numbers obscured from her, reflected only in updating Diagnostic prediction markets, and WAY TOO MANY of the individual-patient markets have their 20% probability interval on imminent deteriorating and death without heroic treatment being in less than 12 minutes. And Merrin has to focus almost all of her efforts on, not even fixing anything, just - buying more time on those timers, at the cheapest exchange rate she can. 

(And it's okay if even she plus, at this point, tens of thousands of secrecy-cleared experts contributing to the markets, don't get everything exactly right. It's okay if they were always going to be too late. There's a box of heads being kept cool and they aren't going to lose anyone forever.) 

Updates on short-term patient stabilization: 

Patient #1 - the young man with the horrifying chest wall injuries - is, at least temporarily, responding super well to even the most basic of supportive treatment. A push of IV vasopressors (much more effective than the intramuscular shock-treatment drug blend; you can't actually administer real vasopressors by any route but IV, if you try to inject them into a muscle, it just pinches off all the nearby small blood vessels and cuts off local tissue circulation.) A liter of saline is now in a pressurized sleeve to shove it as fast as possible through the IV line in his arm, and he's breathing 100% oxygen through a facemask. Heart rate is still at 170, but his blood pressure is up to 90/60, his oxygen saturation is up to 77%, and he's actually back to conscious enough to squeeze his volunteer-unskilled-medtech's hand on request. 

Patient #2, the older woman with massive blood loss, is - not so much. IV fluids and vasopressors are bringing her blood pressure up a bit, but saline is only going to dilute her already-hemoglobin-depleted blood, and even an O2 saturation of 100% on supplemental oxygen isn't that meaningful; they're waiting for a capillary-stick blood gas reading, which is significantly worse than an arterial sample but nobody here except Merrin (and maybe the Keeper, if she's able to watch Merrin do it once) can safely stick a needle into an artery to draw blood. She's still deeply unconscious, her breathing irregular. 

Patient #3, the teenager with the head injury, has a pretty abnormal EEG and is now getting an ultrasound. His vital signs are fine, his oxygen saturation is 100% on not even that much supplementary oxygen, but his skull is at least cracked, if not in a way that deformed the bone, and it sure does look like there's bleeding in his skull. Probably an epidural hematoma, given the immediate unconsciousness and the fact that it's developed so rapidly. The location of the bleed is sort of lucky; it's near the occipital lobes, at the back of his head, nice and far from the prefrontal cortex and not, yet, putting pressure on the sections of his brain that maintain basic vital functions. He probably already has significant damage to his visual cortex, but not necessarily the brain regions that do global cognition and reasoning. 

Patient #4, blunt trauma to chest and abdomen, is responding at least modestly to supportive treatment. His blood pressure is up to 80/45, heart rate down to 135, oxygen saturation actually up to 89% when breathing 100% O2. His level of consciousness is not any better, though, and he's already vomited once since the accident and is now no longer in any shape to protect his airway against aspiration if he vomits again. The unskilled-bystander caring for him has him on his side in recovery position, but especially given that they're looking at major emergency surgery as soon as they have facilities for it, Merrin should probably prioritize intubating him pretty soon. 

Patient #5, young woman with the spinal injury, is responding well to fluids and vasopressors, including a drug to directly stimulate her heart to beat faster and harder, given that her nervous system is no longer capable of sending that message. Heart rate 70, blood pressure 90/45. She is correspondingly a little more alert; she's pretty disoriented but is at least trying to answer questions rather than saying something apparently random. Her oxygenation isn't improving as well as one might hope, though; she's working with massively impaired respiratory muscles, and she's exhausted. Even on 100% oxygen, her shallow uneven breathing only has her O2 saturation up to 78%. Invasive ventilation needed pretty urgently. 

Okay. 

She can do this. 

Merrin has now handed out all of the basic supplies and sensors. Everyone has monitoring. Everyone whose initial O2 saturation reading was below 80% now has an oxygen bottle. (She doesn't have enough on her for everyone; they are optimized hard for being lightweight and approximately indestructible, and still weigh 0.75kg each.) Every cluster of patients has an appointed Coordinator and she's handed out radio earbuds and throat microphones. The three airline staff who are trained in placing IVs and also at all mobile are going around and doing that for the less-immediately-critical patients; they don't have enough IV fluids for everyone but they still may want access for giving drugs. 

She picks up her pack - it's much lighter, now, it mostly still contains her direct-donor-to-recipient blood transfusion kits and her field surgical kit and the stuff for intubating people - and she picks up her unfolded portable-LCD-screen assembly by its base, and fortunately she is in POWER ARMOR so she can just carry 40kg of pack and a big unwieldy screen, one in each hand, without it bothering her even a little bit. 

She makes her way to the not-Complicated Patient Area. The floor is sloped. Ugh. And, like, definitely sort of buckled. Makes for a terrible work surface. At least it has the side benefit that the blood has mostly oozed down to pool at one side, and they can make that the Decapitated Bodies Side? 

Terrible how she shouldn't use her magic user, who might have a weird alternatephysics blood type, for blood transfusions even though she's one of the few totally uninjured people here

She sets up her screens so the base is at least not sitting in a pool of blood, magnetic-locks it to the flooring, and she taps her control console to select Major Blood Loss Woman and check who on the plane has a compatible blood type and only minor injuries.

She subvocalizes instructions to the comms staffperson, who has been her mobile-errand-assistant throughout the initial triage. Requests that a particular passenger be pulled off whatever unskilled-care-aide work they're currently doing and swap in here. 

- oh, there's the magic user, generally being a pair of hands for the Keeper why is Merrin having to delegate medical tasks to a FIRST-RANK KEEPER this should be BANNED, but not actually occupied right this second? 

Merrin digs out a pack of premixed injection syringes. "Hey. Can you administer painkillers to everyone in here? You can watch me do one but it's very straightforward. Cap goes off, like so - pick a big muscle, thigh probably best, not in the middle of an injury - tear open a sterilizing wipe and clean the skin - then just put the yellow marked end and press it firmly against the skin. Try not to stick yourself, it's not harmful to dath ilan humans but you're from another world and you might be allergic." 

(Someone has warned her that the magic user, while clearly both reasonably intelligent and probably experienced at some form of something at least adjacent to emergency Exception Handling work, is definitely not used to Baseline medical shorthand and is using ??conceptualmagic translation?? that they don't understand well, and so Merrin should try to communicate clearly and simply. Merrin is pretty good at doing this, since she can mostly fall back on "how she wants people to explain things to her when she's 20 hours into a sim.") 

"Pain...killers?" she repeats skeptically, but she is happy to press the not-magic-items against peoples' skin and it does not in fact look very complicated.

That sure was a reaction! Does her world...not have drugs that treat pain? Sounds horrific. Though maybe there would just be limited development pressure and financial incentives for pharmaceuticals research, if nobody stayed sick or injured very long because they have near-instantaneous magical healing??? 

"We don't have magical healing but we do have effective drugs, and untreated pain is a risk factor for shock," she explains, because it might be relevant and also she wasn't using her mouth for anything else that exact second. 

Time to UV-sterilize her inner gloves (the outer gloves are powered and let her grip and climb things; the inner ones are just protective, while basically not at all getting in the way of manual dexterity), and then carefully catheterize a nervous but cooperative fellow passenger's radial artery – you don't normally donate arterial blood, it's meaningfully riskier, but the field direct-donor-to-recipient blood transfusion kit doesn't come with a pump. Pumps weigh something, and need battery power, which also weighs something. So in this case, the donor's own blood pressure, plus positioning them for gravity to assist, will be doing that work. 

All her tubing is pre-primed with saline, which makes it good for only 12 hours, but cuts 10 seconds of work off every procedure. She unhooks the spent bag of saline, sterilizes the IV port, hooks up the donor tubing. Unclamps it. 

"I'll stop this once once you've donated 400 ml," she tells the woman, "unless you feel unwell first, so flag right away if you're dizzy, short of breath, any chest pain -"

She taps her screen controls to bring up the data from the flow sensor and sets a ten-second warning alarm and a more urgent STOP alarm, though of course lots of experts are watching from a distance and someone will tell her if she misses it.

Aaaaaaand then it's time to put a breathing tube in the guy with horrifying chest injuries! Because this will be faster than drilling a hole in the seventeen-year-old kid's skull as a temporary measure to drain some of the blood and reduce his intracranial pressure until it's safer to do full-on invasive neurosurgery. 

She doesn't want to give him full anesthesia for it, because he's barely maintaining his vital signs right now and sedation will tank his blood pressure and cut out his respiratory drive, and he might be difficult to intubate, and she can't afford for his oxygenation to drop further while she's struggling with it. 

She explains loudly and clearly what she's going to do, while she gives an IV injection of a mild sedative that will at least help him stay calm, and sprays the back of his throat to numb the area and temporarily block his gag reflex, and then has the Keeper and his volunteer-unskilled-care-aide position him for it. 

This terrified guy who definitely looks like he's dying is ABSURDLY cooperative about holding still while they for some reason shove a plastic tube as thick as Carissa's index finger down his throat! His eyes are watering as he desperately tries not to cough, and he's sort of crushing the Keeper's hand. 

It still looks pretty uncomfortable once Merrin is done! But she can get him gently propped against a wall against a cushion so his torso is elevated at an angle, and hand the unskilled volunteer a bag to squeeze as it fills with oxygen from the bottle, and his color is already improving. 

Merrin shows the Keeper and volunteer where the tiny screen on the portable O2 saturation reader is displayed. "Keep it above 90%." 

She starts getting out her surgical kit. The box has a wide array of very sharp-looking tools in it; they don't really look designed to be weapons, but it's unclear what they are for, if not literal torture implements. 

She moves over to the unconscious teenager and starts getting out the bone drill. ...She needs more than one person whose hands she can borrow. The Keeper should probably hand her surgical tools and have charge of the field suction unit, since she, you know, actually speaks Baseline without a weird poorly understood conceptualmagic translation. 

"Magic user, can you hold the light and my portable ultrasound." It's a smaller model than the one that the serial author - who is also the woman with birds on her face - is currently carrying around getting diagnostic scans on everyone flagged for that. "I'll just - this end goes against the skin like so, I want the image to be showing this area -" she pulls up a still shot of the previous ultrasound, "- if you're stuck I'll tell you to move it left or right or up or down. Can you do that." 

Can she hold things? Is it a trick question? "...yes? If you want me to hold them with a Mage Hand and administer pain-killers at the same time I need to stay within fifty feet."

The cockpit area is substantially less than fifty feet across. "- Let's try it like that and see if you can control it well enough. I don't need it for long, and I only need giving painkillers to the patients in this area." 

The device is, in fact, super easy to use; it's meant to be something that a field medtech can hand off to an unskilled bystander if they need both hands for something else. Carissa can get it into position with Mage Hand and then occasionally adjust it per Merrin's requests. 

Merrin sterilizes a patch of scalp and opens an incision and flap in the skin and then drills a burr hole in the kid's skull. "Suction. Ultrasound left and down. Good." 

It's not great. Whatever's torn in there is still bleeding. Merrin gets the half-clotted blood out with some determined suction and sticks a (sterile) sensor in there because why not, but she can't just sit there with their single field suction unit in use on this patient, she needs it for other people. 

She places and secure a generic drainage tube instead with a compressible bulb suction thingy on the end; she'll have to position the patient so it can keep just sort of draining out before it clots. But he hasn't lost much blood up to this point, and it's really not long now until help arrives. 

She does give the unskilled-care-aide assigned to the kid a pop-and-fold-out clear plastic container to empty the compressible bulb into when it fills, so they can at least measure his total blood loss. 

Moving on? 

Patient #5 with the spinal injury is not breathing effectively right now and needs invasive ventilation as soon as possible. Patient #2 with the massive blood loss is still unconscious and should really be intubated for airway protection. Patient #4, blunt trauma, is definitely super not protecting his airway, also needs to be intubated. Patient #3 with the head injury really should also be intubated for airway protection, given the "unconscious", but he's actually less concerning in the immediate term, his breathing is deeper and steadier now that his intracranial pressure is being relieved, and his vital signs are still fine.  

However, the Keeper has now seen Merrin do this once and can do everyone else in the cockpit area? 

(Keepers are really scary sometimes.) Yes, that would be amazing, there are other patients who are not physically located here and are way too unstable to move, and Merrin feels very aaaaaaaaaaah about not attending to them yet. 

Critical patient #8 is not here, he's inconveniently far away, but his oxygenation didn't really improve much with supportive treatment. A medically-untrained attempt at a scan did not entirely clarify things. Diagnostic Planning wants to know if Merrin can attempt a ventilation-perfusion contrast scan, his lungs look structurally okay on the low-resolution field ultrasound unit but something is clearly very badly wrong and he might have an embolism. He is, remarkably, still conscious with an O2 saturation of 73% while breathing 100% oxygen, but he super needs assistive ventilation, and for Merrin to try to keep him alive if not stable until the second medicopter arrives with better scanning and interventional radiology suites. 

High-risk patient #5, the young man with the suspected pneumothorax, is also deteriorating. Unclear if it's a tension pneumothorax or if he's also bleeding into the pericardial space around his heart, but his blood pressure is tanking fast and didn't respond basically at all to IV fluids. 

Merrin should probably charge off and deal with...one of...those things??? 

Is Treatment Planning in agreement that she can try a needle decompression on the pneumothorax guy, with the premise that it will take her literally fifteen seconds and might stabilize him enough that she can afford to be distracted for more like three entire minutes attempting a ventilation-perfusion scan? 

(There are about six minutes to go until the first helicopter arrives, at which point Merrin will at least not be the only trained medtech on the scene, though the small-regional-hospital team is not really certed up to Exception Handling standards.) 

Scan isn't the highest next-minute priority. She should try the needle decompression and get both patients on assisted ventilation and then try it, if nothing else changes in the vicinity before that. 

The Keeper would like Carissa to pass things to her and help hold patients for intubation (either awake or with sedation, depending on how unstable they are) with Mage Hand again. 

She gives instructions calmly, maybe making a deliberate effort to use phrasings that don't assume one is familiar with the denser Baseline compound-words for emergency coordination usage.

(Carissa will maybe have noticed that there's some sort of interesting dynamic in the interactions between Merrin and the Keeper, where it's - almost that they're both deferent to the other, along different dimensions? Merrin does not conceal emotional reactions nearly to Chelish standards, and was visibly and audibly - not nervous, exactly, but self-conscious, put on the spot, like someone unexpectedly running into a high-ranking noble. The older woman, on the other hand, is just - paying incredibly close attention to exactly what Merrin says to do, including in a way where she seems to be modeling and anticipating requests for surgical instruments and such in advance, and then doing it efficiently and perfectly, sometimes even before Merrin actually asked. 

She did also just watch someone who clearly seems like a very highly trained adventurer do a bizarre and complicated procedure once, clarified that she is now adequately familiarized with it, and is now executing it herself apparently without difficulty, though she goes more slowly.)