To say The Pitt is one of the most eventful shows on TV would be an understatement. Through the real-time nature of the Max medical series, we have seen the intrepid doctors and nurses of the Pittsburgh Trauma Medical Hospital treat everything from fentanyl overdoses to life-threatening hemorrhages. They've covered darker topics like abortion and pediatric death. And, somehow, that seems to simply be all in a day's work.
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The entire day–and The Pitt in general–gets turned on its head, though, in Episode 12. At the end of the previous week's installment, Dr. Robby (Noah Wyle) and company to learn that there was a mass shooting at the festival. Over 40 incredibly tense minutes, we see the staff go into hyperdrive. As victims are carted in, they're diagnosed in seconds, as doctors dart around the ER in an attempt to save as many people as they can. It's then that we realize, as fast-paced as The Pitt has been previously, that looks downright glacial compared to the triaging they have to do now.
While some fans were able to ascertain that something may be going down at "PittFest" early on, the suddenness of the shooting took everybody–on and off-screen–for a loop. It's an audacious tactic, spending nearly 12 hours setting up the environment of The Pitt and its major players, only to completely shift the show four episodes from the finale. But, in talking with creator R. Scott Gemmill and executive producer Joe Sachs, the idea initially sprung up from a network demand.
"Scott's initial concept was to have a 12-hour shift," Sachs explains to Parade. "12 hours, 12 episodes. And the network said, 'We want 15 episodes.' So the challenge was, what would keep doctors and nurses in the hospital for an extra three hours? Because normally, everybody works a 12-hour shift and goes home. So, the concept of a mass casualty incident was an obvious answer that would keep everybody there working. So that was the kernel of the idea."
"Gun violence has become a huge problem in this country, if not the world," adds Gemmill. "And so it seemed like a subject that we should address in some way. And so the two meshed very well. Because depending on when we decide to have the mass casualty, it would force everyone to stay longer in order to accommodate the challenges. So it was a good combination of necessity and what we wanted to stories we wanted to tell."
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The beginning of Episode 12 has Robby briefing the entire staff on how to handle a mass casualty event. Upon receiving patients, they're quickly diagnosed and given a slap bracelet (straight out of the 2000s) based on the intensity of their injuries. The ER is sectioned off based on the colors of those bracelets, with doctors assigned to each group. Additionally, each patient gets a waterproof wrist card. As many come into the ER in critical condition and often unconscious, this is a way to denote their injuries and any personal information to pass off to the next doctor quickly.
Sachs is a former doctor who was part of the lifeblood of ER, starting as a technical advisor before becoming a writer and producer. It's there where he met Gemmill, who brought him onboard for The Pitt. In writing this episode alongside Gemmill, he not only pulled on his extensive medical experience to help give the mass casualty event as much verisimilitude as possible. He also consulted with the doctors who helped treat victims of notorious shootings like Columbine High School in 1999, and the Tree of Life synagogue in 2018.
But Sachs reveals, as much as he tries to make the situations on screen as true to life as possible, the team behind The Pitt saw this storyline as an opportunity to create some ideas that future first responders could use in the future. And so some of the more integral parts of the triaging process are completely fictional.
"The slap bands, that's something brand new," he says. "No one's ever seen before. The wrist charts, we created that. In the Las Vegas shootings, they were writing on the bed sheet or writing on people's foreheads. So we came up with this concept of a risk chart that would be waterproof and blood proof with Sharpies for everyone that would have everything they needed. The traditional triage tag was a tag around the neck that has been seen many times in film and television, where they tear off green, yellow, red, or black for dead. [A doctor] from Pittsburgh said he wished they had [them], and they were trying to incorporate in Pittsburgh."
Read on for our exclusive interview with The Pitt's R. Scott Gemmill and Joe Sachs.
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At what point in your planning process did the idea of doing a mass casualty event come about?Joe Sachs: I'll start with the short answer. Scott's initial concept was to have a 12-hour shift. 12 hours, 12 episodes. And the network said, "We want 15 episodes." So the challenge was, what would keep doctors and nurses in the hospital for an extra three hours? Because normally, everybody works a 12-hour shift and goes home. So the concept of a mass casualty incident was an obvious answer that would keep everybody there working. So that was the kernel of the idea.R. Scott Gemmill: And the other aspect was, at the beginning, we just talked about all the medical issues that we wanted to address over the course of the season. And, of course, we didn't get to all of them. But one was obviously that gun violence has become a huge problem in this country, if not the world. And so it seemed like a subject that we should address in some way. And so the two meshed very well. Because depending on when we decide to have the mass casualty, it would force everyone to stay longer in order to accommodate the challenges. So it was a good combination of necessity and what we wanted to stories we wanted to tell.Sachs: And the other aspect for me was that you read about mass shootings in the paper once or twice a week, very sadly. And I think the public becomes numb to that. But to actually see the tragedy of what happens and what goes on in the emergency department, and the trauma and the grief for family members. And also the psychological and moral trauma for the healthcare providers that have to step up and take care. So that's something that you don't really see or read about very often.Scott, you mention the timing of the event. Why did you choose to put it at this point in the season, rather than make it the big event of the penultimate episode or finale?Gemmill: Well, in terms of where it landed, that was more just a byproduct of, you know, just the functionality of the show. We know we're going to end on 15. And we don't want to end the last episode in the middle of a mass casualty. So we start to figure out where should where it should end, or where it should happen. Do we need to have an episode after the mass casualty to reset and then a finale? So those things are just practical decisions.And then it was really about addressing this issue and seeing it from the perspective of the first responders and those who suffer at the hands of these things and really show the human aspect that comes into it. Not just "thoughts and prayers." This was about these people who are really trying to save people's lives in what is unnecessary and horrific tragedy. And unfortunately, it's happened a lot. But we've been able to talk to people who have been through it and survived it and helped others to survive. And it was really about trying to show just what these men and women do in a situation like this, and it's phenomenal what they're able to do under such duress. Joe, you've obviously brought a lot of your medical experience into the shows that you work on. How much of that was incorporated into this mass casualty event?Sachs: It's interesting. I mean, personal experience: I worked at Northridge Hospital the day of the Northridge earthquake in January of 1994. We were the epicenter, so that was a big mass casualty incident. But I spoke to the doctors and first responders from the Columbine school shootings in 1999, the Aurora theater shootings, the shootings in San Francisco, the Tree of Life in Pittsburgh, two of the doctors at USC that received 200 injured patients when a Metrolink train crashed into an SUV that someone had intentionally parked on the tracks, derailed, hit another train going the other way. That was 200 injured. And then, of course, the Las Vegas shootings in 2017.There was a doc whose name is Rob Orman, who has an emergency medicine educational podcast website called Hippo Education. And he and his producer Tom Wolfson had conducted 10 hours of interviews with the lead emergency physician, trauma surgeon, and charge nurse at Sunshine Hospital in Vegas, where virtually everyone came to. So hearing all of the stories from all these people, what they did, what they wish they had done, allowed us to create a realistic story and also create some things that they wish they had had.The slap bands, that's something brand new. No one's ever seen before, the wrist charts, we created that. In the Las Vegas shootings, they were writing on the bed sheet or writing on people's foreheads. So we came up with this concept of a risk chart that would be waterproof and blood proof with Sharpies for everyone that would have everything they needed. The traditional triage tag was a tag around the neck that has been seen many times in film and television, where they tear off green, yellow, red. or black for dead. And there are some inherent problems with that, which is why we did the slap bands. [A doctor] from Pittsburgh said he wished they had [them], and they were trying to incorporate in Pittsburgh.Gemmill: We had the luxury of not being in a mass casualty. So we could think of things ahead of time, which hopefully may even help someone in the future.Sachs: We might just get requests from healthcare providers to the show. Can we please get some of those slap bands? Where can we get those charts?Scott, last time we talked, you showed me how much you carefully plan out where the patients and doctors are at all times in the form of a map on your wall. This mass casualty event becomes even more of an "all hands on deck" situation, with people coming and going in all parts of the ER. So, how were you able to keep everything organized in this high-intensity situation for the characters?Gemmill: Well, first, we got a new map. Because what happens in real life, and what we did on the show, is you broom everybody out of the emergency department. You can't have anybody in there because you don't have time to deal with them. And then all the patients, you're not going to use the rooms. Because one of the things we learned from those who have survived and treated these mass casualty events is that you can't put patients in rooms where you can't see them. Everybody has to be out in the open. And so the only rooms we use were the two trauma rooms that were held for patients each, then the red zone, and then the pink zone. So we got a new map; it's up on the wall there. And we just started putting in, "How many patients can we put out in this zone? How many patients can be out here?" And we knew the red zone was going to be for patients who were going to die within an hour. Pink was five minutes. And then yellow were extremity wounds. And so it was just planning and starting to put those people in, seeing first, just the raw numbers. How many background are we going to need? How many are hero patients? And then slowly, slowly building up. And we don't all want all of them be shootings, because we know there's tramplings involved. And we wanted to throw in a couple sort of puzzle cases for our people to solve. So it's like one step at a time sort of thing.Sachs: And the other thing was that we wanted to give a moment for each character. Going through each character and saying, "What is their moment going to be?" Is it going to be Javadi speaking up to her mother that she's independent? Is it going to be Robby seeing Langdon back? Is it going to be McKay worried about her son who's there? And so everyone has moments, and everyone has little victories. And that was part of the planning. That all those pieces could fall into place.
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