Why Boston’s Hospitals Were Ready
The New Yorker

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.

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