Kathmandu - At Nepal's crowded National Trauma Centre, overwhelmed doctors make split-second life or death decisions, arranging earthquake victims into order of priority and trying where possible to avoid amputations.
Santush Paudel inspects a frail 65-year-old woman lying still and silent on a stretcher in the Kathmandu hospital, before hanging a yellow badge around her neck during triage.
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"Building stones fell on her during the earthquake, fracturing her pelvis," the doctor said, placing her in the intermediate category.
A red badge is for the most seriously injured requiring an urgent operation while a green one means the patient is free to leave hospital after an examination.
Injured forced to sleep outside
The centre, attached to the Nepalese capital's Bir Hospital, is swarming with overworked medics, aid officials and volunteers following Saturday's monster 7.8-magnitude quake that has killed more than 6 000 people.
In the immediate hours after the disaster, some 2 000 people seeking treatment descended on the centre, which has only 150 beds.
"We have faced logistical problems of space and personnel," said the centre's coordinator Thapa Buland.
"We've opened up the halls, and some injured have been sleeping on mattresses on the floor and even outside. The situation has improved a little but now we're facing an influx of casualties arriving from the mountains and districts far from the capital," the doctor added.
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Aftershocks and a rugged, mountainous terrain meant it was a couple of days before wounded survivors from remote villages could be airlifted to safety.
Pushpak Kumar Newar of non-governmental organisation Handicap International said: "When districts are evacuated and helicopters turn up, there can be 30 victims all arriving at once."
Newar said the volume of arrivals made spending the appropriate amount of time examining each patient properly difficult and avoiding amputations was a major challenge.
On the fourth floor of the centre on Thursday, a five year-old girl, with both her legs and a hand in plaster, sobbed down the telephone to her mother.
'I thought she was going to die'
It was the first time Sabita Nepal had spoken to her mother since the immediate aftermath of the quake, the deadliest to strike Nepal in more than 80 years.
"On Saturday I carried Sabita for three kilometres to find some transport," wept her father. "I saw that her legs were limp and swinging from side to side. I thought she was going to die," he wailed.
The quake destroyed her family's livelihood in a village in worst-hit Sindhupalchowk district, northeast of Kathmandu.
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"Our animals are dead, there was nothing for us to eat, there are fears of epidemics. Here there is a lot more help," said Sabita's father.
In the next bed lay eight-year-old Salina Dhakal, whose skull was fractured during the quake and who travelled three hours with her family to Kathmandu for treatment. She clutched her teddy bear and wiped her eyes as her mother lamented their predicament.
Downstairs in the waiting room, dozens of patients who were assigned green badges sat on mattresses free to go. But many seemed reluctant to leave - they had nowhere to head to after their homes were turned into piles of rubble.