A Grey’s Anatomy realism report

<< Inter-military camaraderie

How to spot a suicide bomber >>

Hello there. I was asked by a reader to do a realism report, a.k.a. a snide and pedantic review of Grey’s Anatomy. Specifically, there’s a double episode (episodes 16 and 17) in Season 2 which features a “bomb” inside a patient in an operating theatre. Since armchair commentary is my speciality, I considered this a valuable opportunity to sit on my posterior for two hours and shout at the television.

I’d only had passing encounters with Grey’s before watching this extravaganza, and having sampled it, I can’t say I’ve been missing out¹. I’m nowhere close to being a doctor, but I suspect its accuracy as a medical drama is way off the mark. That’s probably not the point of the show, so I won’t go too hard. Besides, there’s an actual doctor who does this, play by play, for the double episode in question:

Although I know nothing about realism in medical drama, I do know about realism in bomb disposal drama. So here we go, today’s post will deconstruct Grey’s Anatomy for its realism. I don’t think it’s much of a spoiler to say that this doesn’t get high marks for realism, but some of the inaccuracies might surprise you.

I’ll start by talking about the bomber / patient and his accomplice / buddy. They get a free pass in the show, but in reality, would be facing all kinds of Federal terrorism charges. Believe it or not, making bombs is frowned upon. Even in the USA. Even if you’re white.

Then I’ll discuss the munition itself: the improvised explosive device which is a semi-MacGuffin driving the dual episode’s plot². The show barely touches on the technical details of the improvised munition, but that’s what you’ve come here for, isn’t it?

Finally, I’ll talk about the bomb squad, or explosive ordnance disposal (EOD) team’s response to this incident. You won’t be surprised to hear that I have a few notes. I also have spoilers, so be warned if you’ve been waiting twenty years to watch this show.

One thing I won’t pull the show up on is the realism of the premise. You might think that an explosive hazard in an emergency room is far-fetched. Unfortunately, you would be wrong. I can think of two recent cases, one in England, one in France, where an EOD team was called to an Emergency Room to assess and make safe a munition which was inside a patient’s rectum. Because they slipped and fell on it, of course, and it lodged itself up there.

So, it’s not at all surprising that the team in Seattle Grace Hospital have a designated “Code Black” for an incident with an explosive threat. That bit, at least, passes the realism test.

Before we start, let me encourage you to subscribe to the blog using the link below. As always, I’d love to see your comments below, or you can contact me via webform here or email here. Finally, if you’ve enjoyed this post, please share it with a friend.

If you enjoy this blog and want to support it, please consider a donation. Keeping this blog going doesn’t cost much, but it isn’t free either, so any help would be very much appreciated👍

1. The people: Terrorists or re-enactors?

This double episode features two felony criminals being treated like good ol’ boys who were just horsin’ around and got into a little bit of trouble. Let’s be clear: the patient and his “moron friend” are bomb-makers who brought an improvised explosive device (IED) into a hospital.

Firstly, the fact that the ambulatory perpetrator isn’t in cuffs and underneath three burly federal agents seems like a remarkable oversight. Remember, these are the years right after September 11th 2001 and the 2004 Madrid Train Bombings. Honestly, we were all about terrorists back then. The second guy, while admittedly unconscious and bleeding out, is still a nefarious bomb-maker.

They clearly aren’t actual morons, since they were able to build a weapons system and ammunition for same. And I’ll come to the ammunition/IED in the next section but suffice to say for now that what they’ve done is no mean feat.

Perhaps the moron act is just that, designed to make them seem unthreatening? But then you come back to the fact that the second bomber got injured by standing in front of a misfired high explosive warhead, and you have to come down on the side of “moron” again. That, plus the fact that they decided to build a 60-year-old ammunition system in their garage in the first place.

Moron-ity and criminality aside, these guys (at least the one without the bomb inside him) are cooperative witnesses as well as perpetrators. You would have to assume that the friend does not want his buddy to die from an IED exploding in his chest cavity, so his interests and those of the EOD team (not to mention the medical team) are aligned.

So why the hell aren’t they talking to him? I doubt it’s happening off-screen, because Dylan the dishy EOD tech³ doesn’t seem to know anything about the IED. Why didn’t he talk to the dude? Talking is one of the most important skills and EOD operator has.

Speaking of the munition…

2. The bomb: Hair-trigger fuze?

Let’s align on some definitions first. An IED (improvised explosive device) is just a jargon-y term for a homemade bomb. A normal piece of ammunition (e.g. an M6A1 rocket for Bazooka anti-tank weapon, as depicted below) is called a “munition” and getting rid of it is called “conventional munitions disposal.”

The reason I mention this is because if the show presented this as a “real” M6A1 bazooka rocket lodged inside a patient, then the EOD teams could be a lot more certain about how to respond. It’s a conventional munition, they just need to RTFM⁴ (see links at bottom of this link for actual .pdfs of manuals).

If, however, it’s made at home, as the perpetrator claims, then it’s a different ballgame. Now you’re dealing with an IED, and your confidence in any standard safety features disappears. Something you build in your garage is inherently less predictable than something built in a factory with quality control processes.

Having said that, these idiots made the launcher and IED “exactly to specification,” so let’s indulge them and pretend that it’s built like a real M6A1 rocket. This will help us discuss the hazard and (in the next section) the actions that the EOD team take. After all, this is what Dylan seems to do, feeding information on the real munition into his planning and response:

If the IED is anything like its role model, then it will look something like this:

Here’s a quickfire reality check based on the technical hazard of the munition/IED:

• Could the terrorists WW2 re-enactors have built this, along with the launcher? Implausible but possible.
• Could it have misfired when they attempted to fire? Very plausibly.
• Could it have then fired when the victim stood in front of it? Yes. Either due to a bad electrical contact coming right or a slow-burning squib.
• Could the IED have entered his body without exploding? This is where it gets interesting. For most munitions, and virtually all modern ones, the answer is yes, because of their safe-arm mechanisms in the fuze. However, on researching the M6 munition (see cutaway above) I learned that it doesn’t have this. Once you remove the manual safety pin, that baby is live and ready to go bang. So, if this particular one didn’t go bang on hitting its target, it means that there’s something wrong with the fuze.
• Is the IED in a super-sensitive state once it’s inside his body? In short, yes and yes. Yes because, remember, it’s an IED and therefore homemade; but also yes because this particular fuze lacks a safe arm mechanism.
• Could you remove it without it blowing up? Almost certainly. Notwithstanding what I said above, it would probably still need a heavy jolt to initiate it. Would we put this to the test by handling it casually? Hell no. We’ll talk about how the EOD team handled this, literally and metaphorically, in the next section.
• Would it do that much damage on blowing up? Probably more. Three and a half pounds of bang-dough and another 10-15 lbs of munition casing would make a big bang indoors. But pretty Dylan and his body armour are shielding Meredith from the blast and fragmentation, so it’s plausible that she survives that, although her ears might take some time to recover. The people in the OR next door are brown bread though.

As a rule, we don’t touch or move IEDs. There are plenty of rules in EOD, but that one is pretty close to the top of the list, as this scene ought to illustrate. But they’re in a bit of a bind, thanks to the nefarious writers. What are the EOD and medical teams supposed to do?

One thing they should not have done—and this was a real facepalm moment—was moving the bomber patient, while someone still has their hand inside them, all so that the trolley won’t be on top of an oxygen mains if it blows up. After all, “if the bomb goes off, the whole hospital could blow up.”

Wait, what?

Okay, they’re taking a few liberties here. Yes, oxygen is, well, an oxidiser. Pure oxygen, especially under pressure (as it would be in a hospital) can cause things to burn that wouldn’t normally burn. But “blowing up” the whole hospital is pure nonsense. Oxygen isn’t a fuel, it doesn’t “explode,” but yeah, you could get a nasty fire as an after effect. How do you mitigate against that? Turn off the bloody supply at one of the many valves.

When it comes to the “technical hazard,” i.e. the hazard posed by the munition or IED itself, the EOD teams haven’t got a clue. At one stage the EOD operator says, “there’s no telling how dangerous it is.” I’m sorry, that’s just not true Dylan, you’ve had extensive training in exactly this. And if you still don’t know, don’t say it, for God’s sake.

This points to a deeper problem, which is how the bomb squad do (or don’t do) their job. Let’s talk about that next.

3. The process: How would the bomb squad really respond?

Let’s talk about the bomb squad response. The police who show up in this episode are chaotic, irresponsible, and ignorant. A real EOD response would be better. Before I discuss how, let’s look at the situation they’re presented with.

Most EOD operations pose an indirect threat to life. That is to say, once you’ve evacuated the area, you’ve eliminated the risk of someone dying. It’s a humbling fact for an EOD operator but nonetheless true: the most important part of the response is the bit that happens before you arrive: the police evacuating people and setting up a cordon.

With all that being said, there are some operations which pose a grave and immediate threat to life. These “Category A” operations entailed a different sort of response. The main characteristic of a “Cat A” operation is that evacuation is impossible. Perhaps it’s because the bomb in question is a nuke. Or perhaps it’s because the bomb is strapped to a hostage. Or perhaps it’s because the bomb is embedded in their chest cavity and they’re open on the operating table. Remember, things like this have happened.

Even in a “Cat A” scenario, however, where many of the normal rules of EOD go out the window, there are some things the responder needs to do. Let’s look at the three biggest.

3.1 Control

I mentioned that the responders in the show were chaotic. Responding to an EOD incident, as with any incident, requires taking control. The first thing you do is stop short of the scene itself and find out what you’re dealing with. Just like a first aider checking that the scene is safe, or the fire brigade putting out warning triangles at a road accident, the EOD team’s first job is to figure out what’s going on.

They need to stop short, talk to the doctors in charge, talk to the witness (even if he’s a perpetrator—especially if he’s a perpetrator) and find out what you can about the munition/IED.

Then they need to make a plan, quickly, get the kit they need, and then go “downrange” to the location of the bomb. Once there, they need to evacuate anyone who can safely get out, and start working on reassuring those unfortunates who are A) stuck there and B) still conscious.

Taking control means using every tool at your disposal. One of the advantages of being in a hospital would be getting to use their amazing x-ray machines rather than the clunky EOD ones that (presumably) take longer to process and develop. X-rays would be an extremely useful way of taking control of this IED, because the question of whether or not it’s explode-y depends on what’s happening to a few small components inside.

3.2 Responsibility

Remember the “there’s no telling how dangerous it is” quote from above? Yeah, that wouldn’t happen. Because it’s your job as the EOD operator to know how dangerous it is and to tell people, while also getting them to stay calm. Note how Dylan and his faceless team do precisely none of these things.

The EOD operator, once he/she arrives at the scene, doesn’t leave until it’s safe. This is probably the biggest problem I have with the EOD team in this show, and there are many problems. But when it comes to a Cat A scenario, you don’t leave the victims by themselves.

Perhaps if Dylan was there, doing his job, he could have diverted the conversation away from talk of “pink mist” and stopped the anaesthesiologist doing a runner. And no, it doesn’t make it okay that you put body armour on them. If anything, that just makes their really important and delicate jobs more difficult. Way to go.

3.3 Knowledge and skills

An EOD team is supposed to know things. Like how munitions work, and how an IED fashioned after a munition might function or not function. They’re also supposed to know how to do things. Like, for example, how to safely remove a sensitive explosive hazard and put it somewhere safe while you get everyone else out.

At the end of the mini-series, after about 90 minutes of screen time and hours of hospital time, Dylan the EOD operator decides to do what he should have done in the very first instance, and takes out the bomb. Then, instead of putting it somewhere safe, he strolls off into the sunset with it… and it explodes, killing him, his teammate (presumably), and nearly taking a few medical types with him.

How do I rate his drills? Let’s sum up below.

Conclusion: Less drama, faster response

A bomb in a hospital is always going to be a tense situation. It’s played for maximum drama in Grey’s Anatomy, but equivalent real-life situation would actually be a lot simpler. After all, the EOD team has a few trump cards:

• Two cooperative witnesses (friend and wife)
• Clearly no intent by the bombers to target the EOD teams themselves
• Despite their idiocy, seemingly no intent by the bombers to cause harm
• A plethora of information available on the munition design for the M6, the role model for this IED
• Not having to wait for the medics to arrive (you’re surrounded by them)
• Plenty of radiography available to diagnose the explosive threat

They’re operating in a benign and permissive environment with access to technology. Even though this is an improvised explosive device, and therefore posing a higher threat by default, there’s no intent to cause death or destruction. That’s a massive physical and psychological tailwind for any EOD team, and it would lead them to get the job done quickly (that, and not wanting the patient to bleed out).

I’m not saying this would be a simple task. On the contrary, this is a career-defining one (provided you don’t get blown up. In which case it’s still very much career defining but doesn’t do you as much good). But the “correct” answer is pretty clear. It’s less exciting but much quicker. Without going into specifics and ending up on a watch list, here’s how the “render safe procedure” (RSP) would look:

• Stabilise it (protect against sudden bumps etc.)
• Diagnose it. Use the array of x-ray machines, scanners, and other instruments to see what sort of explosives are involved
• Render it safe

An alternative and safer RSP is to evacuate the operating room and wait for the patient to bleed out and die. Then you can attempt to remove the bomb with a robot or something and move it away safely as above. “Oh no, what about the patient?” Never mind the patient. This is someone who’s going to a Supermax prison for a very long time. He’s not quite a terrorist, but he’s not far off. And no EOD operator is going to put their life (let alone the lives of those around them) at risk for a terrorist. This is perhaps a big difference between bomb disposal and medicine: there’s no Hippocratic Oath.

Did I enjoy the episode? Grudgingly I’ll admit that a part of me did. But it was mainly because I could sneer at the bad EOD team. No matter how bad they were, though, the doctors were much worse. I’m not qualified to judge, but even so, I can tell that these are some morally bankrupt and criminally incompetent people.

Is this a fair assessment? What do you think? Let me know in the comments below. As always, thanks for reading and make sure to subscribe if you haven’t already.

Cover picture: It’s the End of the World, Grey’s Anatomy Season 2 Episode 16, ABC (2006)

1. My sister-in-law has told me that I’m an uncultured swine. ↩︎
2. SPOILER ALERT. It’s only a semi-MacGuffin because it does actually blow up in the end. But because the person it kills isn’t a doctor, and its detonation has a minor effect on real people (i.e. doctors), it’s very MacGuffin-like. ↩︎
3. It’s a fact that EOD operators are all very attractive people. This part of the show gets top marks for realism. ↩︎
4. “Read The Manual” ↩︎