When I'm on the night shift, all the department heads can't sleep.

The sensor door to operating room number one slammed shut behind us.

Under the operating lights, the young woman's face was ashen, and her blood pressure on the monitor had dropped to 40/22 mmHg.

A rusted hollow iron pipe, about the thickness of two fingers, pierced diagonally into the right groin. The serrated break was deeply embedded in the lower abdominal muscle layer, trembling slightly with each breath.

"Intubation complete, begin pressurized oxygen administration!"

Liang Shumin stood at the head of the patient.

"The dual intraosseous access is pumping pressurized whole blood, but the body temperature is only 35 degrees Celsius, showing signs of hypothermia!"

Zhao Feng stood at the surgeon's position, his expression serious: "Blindly pulling out foreign objects from penetrating wounds is strictly prohibited! The iron pipe itself serves to mechanically pack and compress the damaged blood vessel. If it is blindly pulled out, the artery, deprived of pressure, will bleed profusely and disrupt circulation within a minute!"

"Initiate a midline laparotomy and control the blood vessels from the proximal end." Lin Ye, positioned as the first assistant, picked up a round-bladed scalpel and handed it to Zhao Feng. "I'll stabilize the foreign object; you open the abdomen and dissect the retroperitoneal space."

"knife!"

Zhao Feng took the knife and decisively made a midline incision in the abdominal wall, from below the xiphoid process to above the pubic symphysis.

Dark red blood from the abdominal cavity gushed out through the incision.

Lin Ye used his left hand to hold the exposed metal tube on his abdomen with a sterile gauze pad to prevent it from shifting, while his right hand held a large-diameter metal suction device to remove the accumulated blood and clots at full speed.

"More than 1,000 milliliters of blood are trapped in the abdominal cavity!"

The circulating nurse stared at the drainage bottle and shouted.

The field of vision was quickly exposed.

Zhao Feng carefully examined the greater omentum and intestines: "The cecal serosa is slightly torn, but the small intestine is not ruptured. The bleeding source is in the retroperitoneum; the iron tube grazed the right external iliac vein, puncturing the venous wall and forming a high-pressure pulsating hematoma!"

"Prepare the vascular occlusion band." Sweat beaded on Zhao Feng's forehead. "Lin Ye, I'll count to three. You pull the iron tube out vertically and steadily, and I'll immediately clamp the proximal and distal veins!"

"Understood." Lin Ye gripped the metal tube tightly with both hands. "Ready."

"One, two, pull!"

Lin Ye pulled the iron pipe out vertically and smoothly, following the angle at which it was inserted.

The moment the rusted metal tube detached from the abdominal wall, a stream of dark red blood gushed from the compressed external iliac vein.

Zhao Feng precisely inserted two non-traumatic forceps into the external iliac vein, and with two clicks, firmly closed the proximal and distal ends of the vein.

The gushing blood flow was suddenly stopped.

"Suturing!" Zhao Feng switched to 5-0 non-traumatic vascular sutures and made continuous locking sutures deep in the pelvic cavity to repair the ruptured venous sidewall.

After the vein wall was repaired, the clamps were loosened, and only a small amount of puncture bleeding was observed at the suture site, with no active bleeding.

However, Liang Shumin, standing at the side of the patient's head, remained grave: "The injured person is on the verge of severe traumatic injury! Their body temperature has dropped to 34.8 degrees Celsius, blood gas analysis indicates severe metabolic acidosis, the wound is beginning to bleed extensively, and their coagulation function is deteriorating!"

In extreme conditions of severe shock, hypothermia, and acidosis, if several hours are spent meticulously suturing the intestines and abdominal wall, the injured person will inevitably die from irreversible coagulation failure.

"We can't do a standard primary repair!" Lin Ye looked at Zhao Feng and said decisively, "Initiate damage control surgery!"

"Agreed, damage control!" Zhao Feng immediately approved. "Get large-sized sterile dry gauze pads!"

The circulating nurse quickly unpacked the entire package of sterile gauze.

Zhao Feng and Lin Ye worked together seamlessly, tightly packing six thick gauze pads into the pelvic floor and deep iliac fossa, using the volume of the gauze to strongly compress the capillaries and small veins that were bleeding.

"Close the incision, only suture the skin!"

Zhao Feng used a large horn needle and thick silk thread to pull the abdominal wall skin together layer by layer, closing the abdominal cavity as quickly as possible.

From opening the abdomen, controlling bleeding, packing with large gauze, to temporarily sealing the abdominal cavity, the entire surgery took only twenty-two minutes.

The alarm on the monitor finally subsided:

Heart rate: 108 beats/min;

Blood pressure: 85/55 mmHg;

Blood oxygen saturation: 98%.

"Circulation has stabilized!" Liang Shumin breathed a sigh of relief. "Transfer to the intensive care unit, warm them with electric blankets, correct their acidosis, and wait for clotting to recover after 48 hours before performing the second-stage reconstruction!"

Zhao Feng stepped back from the operating table, took off his surgical gown, let out a long sigh of relief, and looked at Lin Ye beside him: "Captain Lin, if we had hesitated and done routine repairs just now, this girl would have died on the operating table today."

"It's because your vascular sutures were fast and steady enough." Lin Ye took off his mask, his expression finally relaxing.

When I pushed open the operating room door, it was already 3:30 a.m.

The sight in the corridor made the two pause slightly.

The once chaotic emergency room is now orderly.

In the left-hand hall, all the passengers with minor injuries had completed wound cleaning and suturing, their heads neatly bandaged with white gauze, and they sat quietly on benches receiving intravenous infusions; in treatment room number two, all the fracture patients had completed manual reduction and plaster fixation; the stretcher passage was unobstructed, and no injured person remained on the ground.

Guo Shusen's white coat was stained with iodine and mud. He held a medical record folder in his hand and was checking the vital signs of the wounded one by one in a hoarse voice.

Seeing Lin Ye and Zhao Feng come out, Guo Shusen quickly stepped forward, his eyes no longer showing the evasiveness and cynicism of the day, but filled with awe and emotion.

"Captain Lin, Dr. Zhao... has the girl with the penetrating wound been saved?" Guo Shusen asked anxiously.

"Damage control packing saved his life," Zhao Feng said.

Guo Shusen's hands trembled slightly as he handed the medical record folder to Lin Ye:

"There were 23 injured people on the bus, plus the farmer who was strangled in the evening, making a total of 24 critically injured patients. All six critically injured patients marked with red tags have had their bleeding stopped and punctures performed, all eight patients with fractures marked with yellow tags have had their injuries fixed, and all ten patients with minor injuries marked with green tags have been properly treated... There were no deaths and no cases were missed!"

The deputy director of the emergency department, who was in his fifties, had some tears welling up in his eyes.

"Captain Lin, I, Lao Guo, have spent half my life in Cangshan. When I encounter a major car accident, my first reaction is to get a transfer order to ensure everyone's safety... If we follow my old method and send them all to the city tonight, at least half of the twenty-odd lives in Erdaowan will be lost on the way!"

Guo Shusen took a deep breath and solemnly handed the emergency department duty roster and quality control seal to Lin Ye:

"Starting tonight, the emergency department's operational command, scheduling, and quality control will all be handled by you, Captain Lin! I, Lao Guo, will assist you. Anyone who dares to slack off will be the first to have their shift pay revoked!"

Lin Ye held the medical record folder and nodded earnestly: "Director Guo, you flatter us. We are all fighting side by side to save the lives of the people of Cangshan."

At 5:30 a.m., the morning sun dispelled the night among the peaks of the Cangshan Eighteen Bends.

Vice President Yan Mingcheng, accompanied by canteen staff, pushed insulated containers to the emergency room entrance and served bowls of hot soy milk and freshly steamed meat buns to the exhausted medical staff.

Twenty-four trauma patients achieved a miracle of zero deaths throughout the night in a poorly-equipped county hospital.

At 6:30 a.m., the morning light bathed the slope in front of the emergency room lobby.

The red secure phone on the emergency triage desk suddenly rang.

Lin Ye picked up the receiver, and the cold, stern voice of Liu Zhenhua, deputy director of the medical affairs department of the First Municipal Hospital, came from the other end:

"Lin Ye, it's me, Liu Zhenhua."

"Director Liu."

"Last night, the bus plunged into the ditch at Erdaowan on the Cangshan Eighteen Bends. The city's emergency response center notified us in the middle of the night," Liu Zhenhua said rapidly. "The First Municipal Hospital's emergency center cleared out twelve trauma intensive care beds overnight, and the ambulance fleet was on high alert with its hazard lights flashing, ready to pick up any critically injured patients you might be transferring. I waited all night, but I didn't see a single ambulance from the First Municipal Hospital transporting patients from Cangshan."

Liu Zhenhua's voice carried a scrutinizing and authoritative tone.

Lin Ye stood up straight, holding the receiver, and calmly reported to his superior:

"Reporting to Director Liu, the emergency department of Cangshan County Hospital received 24 patients with severe injuries from a major traffic accident and mechanical entanglement last night. Following START triage, bedside medullary cavity aspiration for resuscitation, tension pneumothorax puncture for drainage, autologous great saphenous vein bypass, and emergency injury control surgery, all 24 injured patients have received on-site treatment. There were no deaths, no transfers, and all vital signs are stable; they have all been admitted to the hospital."

There was a long, dead silence on the other end of the phone.

You could even hear the faint sound of Liu Zhenhua picking up a teacup from the edge of the receiver and then gently putting it down.

After a moment, Liu Zhenhua's voice unusually carried a hint of emotion:

"Twenty-four...not a single one turned?"

"Not a single one has been turned," Lin Ye replied.

Liu Zhenhua's steady and powerful voice came from the other end of the receiver:

"You haven't disgraced the First Municipal Hospital. The hospital's Party Committee just passed a resolution that, from this moment on, you are officially in full charge of the medical operations of the Emergency Department and Intensive Care Unit of Cangshan County Hospital. Go ahead and do it; the Medical Affairs Department of the First Municipal Hospital will back you up."

Morning light streamed through the glass doors of the emergency room, illuminating the forest and the golden-red sunrise that bathed the vast, layered forest in the mountains.

Lin Ye put down the receiver and looked out at the gradually awakening Cangshan County outside the door, his gaze calm and resolute.