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

At eight o'clock in the morning, half of the people in the emergency room conference room looked like they had just been pulled out of the water.

Nurse Zhao sat in the last row, with the steamed buns that Liu Zhenhua had brought in front of her.

She took a bite and commented, "It's alright, it's not cold."

Liu Zhenhua stood in front of the projector, his face tense: "Thank you for your recognition."

Qin Hai spread the emergency records on the table: "Stop talking nonsense, let's begin."

The first item on the agenda for the debriefing meeting was the high-speed chain-reaction rear-end collision.

The whiteboard lists four patients from the red zone.

Patient No. 1, an unidentified patient, suffered from acute subdural hematoma complicated by pneumothorax and was admitted to the intensive care unit post-surgery.

Wang Cheng, patient number two, suffered abdominal bleeding and is currently in the intensive care unit after surgery.

Patient number three, Li Xiaoya, is in stable condition after a cesarean section, while her premature infant is in the neonatal intensive care unit.

Lele, number four, was placed in a pediatric intensive care unit for monitoring after surgery for a ruptured spleen.

Liu Zhenhua pointed to the timeline: "From the arrival of the first ambulance to the fourth patient entering the red zone for surgery, it took a total of forty-seven minutes. The result was very good, but I asked about the procedure."

He looked at Lin Ye.

Why was Lele, a child with no external bleeding, taken directly to the red zone?

Many people in the conference room also looked over.

This doesn't seem like nitpicking.

It's like trying to break down last night's "feelings" into something that can be taught to others.

Lin Ye opened the record.

"First, the mechanism of the car accident was a high-energy impact. Second, there was a seatbelt-like abdominal wall bruise, located across the upper left abdomen. Third, the child was unusually quiet, which is not typical of children with minor injuries. Fourth, there was cold and clammy extremities, a rapid heart rate, and low blood pressure. Fifth, there was tenderness in the upper left abdomen, and a bedside trauma ultrasound revealed a fluid-filled area in the spleen and kidney recesses."

He paused for a moment, then continued, "So it wasn't because he was a child that he was allowed into the red zone, but because the evidence against him was strong enough."

Qin Hai tapped the table: "Write this into the supplementary terms for the triage of the emergency team."

Liu Zhenhua lowered his head to take notes: "Unusual quietness after a child's trauma should not be taken as evidence of a mild condition. Abdominal wall seatbelt sign combined with circulatory abnormalities, and anterior displacement of the red zone."

Nurse Zhao whispered from the back row, "That sounds like human language."

Liu Zhenhua looked up: "I heard you."

"That's even better," Nurse Zhao said. "It means you write loudly."

A few people couldn't help but laugh, and their drowsiness dissipated a little.

The second item is trauma to pregnant women.

Shen Ruomei sat opposite her, her hair tied up tightly.

"Pregnant women shouldn't just look at the amount of external bleeding. Last night, Li Xiaoya didn't have much vaginal bleeding, but her contractions were obvious, and the fetal heartbeat kept dropping. Placental abruption is dangerous enough. The emergency room did the right thing; they didn't delay and wait for the obstetrics department to examine her."

Liang Xiulan added, "The neonatal ward was called in promptly. For a 29-week premature baby, every second counts."

Qin Hai looked at Lin Ye: "Why didn't you run off with the pregnant woman last night?"

Lin Ye turned to the page for the first injured person on the debriefing sheet: "At that time, the airway and circulation of the first injured person still needed to be monitored. Director Qin had already assigned me to guard the first injured person. The pregnant woman's line was being handled by Director Shen, the anesthesiologist, and the neonatologist. If I went over there, it would only cause chaos."

Sun Zhiqiang sat next to him, his lips twitching slightly.

"That sounds like something someone in the emergency room would say. He used to flock to wherever there was popularity."

Lin Ye lowered his head: "Teacher Sun, I can hear you."

Sun Zhiqiang: "I just wanted you to hear that."

Liu Zhenhua wrote a line in his notebook: In high-risk scenarios, resident physicians must not leave their designated posts to pursue risk points.

After he finished writing, he paused for a moment.

A month ago, similar words were still recorded in Lin Ye's conversation log.

The same words were now written by Liu Zhenhua into the supplementary clauses for the emergency team.

The third item was fever following chemotherapy on the second night.

The infectious disease doctor was not present; he participated by phone.

"A neutrophil count of 0.05 and lactate of 3.6 indicate a high risk of severe infection. The correct sequence was to initiate emergency culture, administer antibiotics as soon as possible, provide fluid resuscitation, and assess the patient in the intensive care unit."

The oncologist added, "The seventh to tenth day after chemotherapy is the trough of bone marrow suppression. A low body temperature in patients does not mean they are safe."

Liu Zhenhua looked at the projector: "So this process also needs to be written out. Fever after chemotherapy, especially low white blood cell count or expected low white blood cell count, the red zone moves forward, before high fever."

Nurse Zhao raised her hand: "Could you add another sentence: 'The family said they came for an IV drip because they only had a low-grade fever,' and that this shouldn't be used as a triage criterion?"

Qin Hai nodded: "Write it."

Liu Zhenhua looked at her and said, "Why are all your emergency room's policy terms so harsh?"

Nurse Zhao: "Because the patients came in with a temper."

There was another laugh in the meeting room.

Liu Zhenhua did not laugh.

He put down his pen and looked up at the woods.

"Now there's a problem. As you all know, the hospital can't possibly write the rules as 'Take a second look when Lin Ye is on duty.' The emergency team needs to be expanded, the residents need to rotate, the nurses need to rotate, and the director can't be on the front line every day."

Qin Hai frowned: "What are you trying to say?"

Liu Zhenhua turned on the next page of the projector.

The title is: Emergency Department Nighttime High-Risk Warning List (Trial Version).

The bottom half of the page is blank.

"I want the emergency department to take the lead in compiling a list of typical cases we've treated during this period into a high-risk warning list for nighttime use. It's not a research paper or a press release; it's something for frontline staff to use. Stomach pain, back pain, head injuries from alcohol consumption, unusually quiet children, low-grade fever after chemotherapy, elderly patients with head injuries and a history of antithrombotic medication... I'll write down the evidence and procedures for each one."

The meeting room fell silent.

Qin Hai looked at the blank page but didn't immediately start cursing.

Sun Zhiqiang didn't say anything either.

Lin Ye stared at the blank page, the corner of the document in his hand bent from being squeezed.

Several photocopies were placed on top of the documents.

Aortic CTA request form.

Cranial CT scan report.

Electrocardiogram (ECG) for myocardial infarction.

Behind every piece of paper is a director who is woken up in the middle of the night.

Liu Zhenhua continued, "The hospital leadership's idea is to first pilot this on the emergency room night shift. Lin Ye is involved in compiling the documents, but his name alone cannot be written down. Director Qin is in charge, Dr. Sun is guiding him, and Nurse Zhao is supplementing the triage clauses."

Nurse Zhao swallowed the last bite of her bun: "I can make up for it, but don't write it in such a flowery style. Nobody at the nurses' station is memorizing classical Chinese essays in the middle of the night."

Liu Zhenhua nodded: "That's why I had you make the payment."

Qin Hai finally spoke: "Okay. But I have conditions."

"explain."

"The checklist is an aid, not a substitute for a doctor's judgment. We can't allow the medical affairs department to use the checklist to punish someone if an item is missed."

Liu Zhenhua remained silent for two seconds.

"Included in the trial implementation instructions: This is to highlight the risks, but it does not replace clinical judgment; it is used to trigger triage and consultations, but it is not used as a separate basis for accountability."

Qin Hai looked at Lin Ye: "Did you hear that?"

"I heard you."

"Don't sleep too much this afternoon, list out the first ten items first."

Lin Ye: "I'm off my night shift..."

Qin Hai: "I'll let you sleep until four in the afternoon."

Nurse Zhao sighed from the back row, "So kind."

When the meeting ended, Lin Ye carried a stack of debriefing materials back to the emergency room.

Liu Zhenhua followed in the corridor.

"Linye."

Lin Ye stopped: "Director Liu."

Liu Zhenhua glanced at him: "I used to be afraid that you would mess up the emergency room procedures."

"And now?"

"Now I'm afraid you'll just try to plug the hole yourself," Liu Zhenhua said. "One person can't do it all."

The hallway light shone on the stack of review documents, the edges of the papers glaringly white.

Lin Ye hugged the documents tightly: "I know."

He woke up in the duty room at four o'clock in the afternoon, and there was a piece of paper written by Nurse Zhao on the table.

The line of text above, written in a flamboyant style:

[Number one on the high-risk list for night shifts: People who seem fine – first ask why they seem fine.]

Below are additional small print added by Sun Zhiqiang:

Please be more specific, otherwise the medical affairs department won't understand.

Lin Ye couldn't help but chuckle.

He turned on his computer and created a new document.

When you type the title, a system notification light up softly.

[Capability Development Log: Risk identification is being transformed into a team process.]

[Zero-fatal ER weekly progress: 2/7]

Lin Ye watched the cursor flash.

The system remained silent.

Lin Ye made the first move.

He typed the first line himself.

[I. Patients with atypical chest and abdominal pain but accompanied by abnormal vital signs should not be simply triaged as those with ordinary stomach pain, anxiety, or discomfort after drinking alcohol.]

The sky outside the window darkened.

The third night, already on the road.