You are the medical registrar. Three crash bleeps go off in 60 seconds: a peri-arrest on AMU, a cardiac arrest on the stroke ward, and a deteriorating GI bleed in ED. How do you prioritise?

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This is a **resource allocation** problem, and I would think about it the way I think about an ABCDE — fix what kills fastest, with the team I have.

First, **information in 30 seconds**. I would ask switchboard or each team to give me an SBAR snapshot: arrest team is already running the stroke-ward arrest, so they have leadership; the AMU peri-arrest has a nurse and an SHO; the ED GI bleed is hypotensive and actively bleeding.

**Prioritise by reversibility and need for *me*.** The cardiac arrest has a full ALS team and a team leader — me adding a fourth registrar there adds little. The AMU peri-arrest needs senior input but my SHO can hold it for two minutes with clear instructions. The exsanguinating GI bleed needs decisions only I can make: **activate the major haemorrhage protocol now**, request endoscopy and ITU.

**Plan** — I would phone the SHO en route: 'Go to AMU now, ABCDE, call me in two minutes, put out another peri-arrest if NEWS rises.' I would attend the GI bleed, activate MHP via switchboard, transfuse, terlipressin and antibiotics if variceal, and phone GI on-call and ITU. I would also phone the arrest team leader at the stroke ward for situational awareness once the GI bleed is controlled.

**Escalate** — this triple-bleep is a **major incident at registrar level**; I would phone my consultant and the site manager so they can mobilise additional support, and I would Datix the simultaneous bleep load as a system safety issue.

Throughout, **continuous SBAR updates** between sites, real-time documentation, and a debrief with the team afterwards.

Three simultaneous crash bleeps on the medical take

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