Rich Serino had spent all day on April 15, 2013, at the finish
line of the Boston Marathon, monitoring it as deputy
administrator for the Federal Emergency Management Agency. He’d
just left to speak at a class at Harvard’s Kennedy School of
Government when he got the news that there’d been a bombing at
the finish line, with two homemade explosives ripping through the
crowds of bystanders. He raced back to the scene along with
Juliette Kayyem, a senior lecturer on national security and CNN
commentator whose class he was attending.
This past week, Serino, now a Distinguished Visiting Fellow at
Harvard’s National Preparedness Leadership Initiative (NPLI), and
Kayyem participated in a panel discussion at Harvard T.H. Chan
School of Public Health that focused on lessons learned in the
wake of the tragedy. Other panelists included S. Atyia Martin,
who was director of the Boston Public Health Commission’s Office
of Public Health Preparedness at the time; Eric McNulty,
associate director of NPLI; and Leonard Marcus, founding
co-director of NPLI. “It is incumbent upon us to reflect on the
lessons that can be learned from such shocking events so that the
learning serves to save lives, support responders, and
potentially even prevent such events in the future,” said Marcus,
who moderated the panel.
This webcast is provided by the Forum at Harvard School of Public
Health and was presented in collaboration with WBUR.
The webcast focus is primarily on the immediate aftermath of
the bombings and reveals the surprising underpinnings of a
successful emergency preparedness system.
Following the twin bombings at the Boston Marathon and a dramatic
search for the suspects, the city’s emergency preparedness and
response systems have been credited with saving lives.
The West blast exemplifies why trauma dollars are crucial.
Physicians and hospitals were able to be ready for blast victims
through coordination with the North Central Texas Trauma Regional
Advisory Council.
In all, 284 doctors, nurses and other caregivers answered the
call for reinforcements at Hillcrest Baptist Medical Center
following the West, Texas explosion.
At Hillcrest, 28 patients remained hospitalized the following
day, five of whom were in intensive care. Victims continued
to trickle in during the day for treatment, including patients at
Waco’s other hospital, Providence Health Center, where 68
patients had been seen.
Doctors had treated mostly skin and soft tissue injuries, lung
contusions, bruising, eye injuries from flying debris and burst
eardrums. No chemical-related injuries had been noted. Other
trauma surgeons were overwhelmed by the professionalism of other
caregivers and staffers during a hectic night and described it as
“controlled chaos.”
The types of injuries generally seen in blasts include traumatic
brain injuries, skull fractures, ruptured eyes, internal bruising
to the lung or other internal organs. There is also the potential
for broken arms and legs when people are flung through the air by
a blast.
The fertilizer plant explosion in West,Texas has forced area
hospitals to ramp up their crisis management plans.
Officials at several of the hospitals lauded the preparedness of
their staff members. Raj Gandhi, MD, medical director of trauma
services at JPS Health Network, said the area’s regional trauma
plan have helped save lives.
A large explosion at a Texas fertilizer plant left many dead and
180 wounded. Staff at area hospitals scrambled to treat
patients.
The explosion was the result of a small fire at West Fertilizer
in West, Texas. The fire apparently spread to tanks that
contained chemicals used which prompted a massive blast.
At Hillcrest Baptist Medical Center, the entire staff arrived at
the facility to help treat the wounded. The hospital received
more than 100 patients with lacerations, broken bones, and burn
injuries.
The bombs at the Boston Marathon were designed to maim and kill,
and they did. Three people died within the first moments of the
blast. More than 170 people were injured.
Medical personnel manning the runners’ first-aid tent swiftly
converted it into a mass-casualty triage unit. Emergency medical
teams mobilized en masse from around the city, resuscitated the
injured, and somehow dispersed them to eight different hospitals
in minutes, despite chaos and snarled traffic.
Brigham and Women’s Hospital received thirty-one victims,
twenty-eight of them with significant injuries. Seven arrived
nearly at once, and all required emergency surgery. The
first to go to surgery was on an operating table by 3:25 P.M.,
just thirty-five minutes after the blast. Twelve patients in all
would undergo surgery—mostly vascular and orthopedic procedures.
This kind of orchestration happened all across the city.
Massachusetts General Hospital also received thirty-one
victims—at least four of whom required amputations.
There’s a way such events are supposed to work. Each hospital has
an incident commander who coordinates the clearing of emergency
bays and hospital beds to open capacity, the mobilization of
clinical staff and medical equipment for treatment, and
communication with the city’s emergency command center.
A decade earlier, nothing approaching this level of collaboration
and efficiency would have occurred. We have replaced our pre-9/11
naïveté with post-9/11 sobriety. When ball bearings and
nails were found in the wounds of the victims, everyone
understood the bombs had been packed with them as projectiles. At
every hospital, clinicians considered the possibility of chemical
or radiation contamination, a second wave of attacks, or a direct
attack on a hospital.
What prepared us? Ten years of war have brought details of
attacks like these to our towns through news, images, and the
soldiers who saw and encountered them. Almost every hospital has
a surgeon or nurse or medic with battlefield experience,
sometimes several. Many also had trauma personnel who deployed to
Haiti after the earthquake, Banda Aceh after the tsunami, and
elsewhere. Disaster response has become an area of wide interest
and study.
A city whose hospitals and physicians are renowned for research
and cutting-edge surgical innovations faced a starkly different
challenge Monday, treating scores of injuries more commonly found
in a war zone.
Patients arrived at Boston hospitals with limbs blown off,
shrapnel wounds, burns, gruesome fractures, and perforated
eardrums from the shock wave of two explosions near the Boston
Marathon finish line shortly before 3 p.m.
“For many, many people in emergency medicine who are practicing
domestically and not in the military, these are
once-in-a-lifetime events,” said Dr. Ron Walls, chairman of the
Department of Emergency Medicine at Brigham and Women’s Hospital.
Runners and spectators alike were rushed to hospitals, where
doctors said that the injuries individually were not
extraordinary, but that the volume was unprecedented.
At least eight hospitals in the Boston area treated more than 140
victims of the Boston Marathon explosions yesterday, which have
left three people dead and many more critically
injured.
The scope of injuries from the explosion resembled those of a war
zone, according to a Boston Globe report, startling many medical
providers who are not accustomed to such trauma. The severe
injuries and influx of patients left the area’s hospitals
mobilizing disaster plans and reinforcing emergency departments
with extra staff and security.
In an instant, an explosion or blast can wreck havoc; producing
numerous casualties with complex, technically challenging
injuries not commonly seen after natural disasters such as floods
or hurricanes.
To address this issue, Centers for Disease Control and Prevention
(CDC), in collaboration with partners from the Terrorism Injuries
Information, Dissemination and Exchange (TIIDE) Project, as well
as other experts in the field, have developed fact sheets for
health care providers that provide detailed information on the
treatment of blast injuries.
The fact sheet addresses background, clinical presentation,
diagnostic evaluation, management and disposition of blast injury
topics.
The National Center for Disaster Medicine and Public Health has
gathered resources for health professionals in response to the
April 15th explosions in Boston to foster resilience through
learning.
The organization of the content is intended to facilitate
self-directed learning as well as provide materials for
educators.
The National Center encourages health professionals to process
the events of April 15th by educating themselves and others to
contribute to “a Nation of resilient communities.”
This Burn Resource Manual has been created as a tool for use by
the Emergency Departments in all Los Angeles County Hospitals.
The materials were developed and/or selected from the burn
literature by a Burn Task Force. This Burn Task Force was created
by the Los Angeles County Emergency Medical Services Agency. This
multi-disciplinary group included the Medical Directors and
Administrative Nurses from the three burn centers in Los Angeles
County, one center in Orange County and one center in San
Bernardino county and representatives of the Emergency Medical
Services Agency.
This Information Bulletin contains information gained from
federal, state and local public safety sources with expertise in
explosives and response to explosives incidents. As with any
public safety issue, local agencies must determine local policies
and procedures. Note that a subsequent Information Bulletin will
be issued, to include information for use when responding to a
suspected bomber, if the call is received prior to an actual
detonation.