Pre-hospital Response to Boston Marathon Bombing

The Boston Marathon explosions of the year 2013 left three people dead and 260 others injured. There was a one percent mortality rate in the incident and this low number is attributed to the high preparedness levels that Boston hospitals had. The medical response to the bombing was organized in pre-hospital, hospital, and initial operation room reactions. The paper explains that before admission to medical facilities, the injured persons received aid in the field from bystanders through the application of tourniquets to arrest bleeding. Also, there was equitable distribution of patients to the various health facilities within Boston city. Hospitals in the city took several measures to make sure that patients were attended to properly. Members of staff within were organized in a way that they could handle high numbers of patients within a short time. Efficiency was key in saving lives during the incident as the medical teams offered prompt services to assist the affected people. In the initial operation room activities, doctors sought to first address life-threatening injuries. They first addressed issues such as amputation of limbs that were damaged in a way that they could not recover back to normalcy. The Boston Marathon bombing is a souvenir that terrorism is a global threat and it is important to stay vigilant of potential invasions. Medical preparedness highly contributed to the prompt responses that the incident received from hospitals in the city. Without such readiness, more people could have died as a result of the explosions. The paper looks into the manner in which medical responses were steered towards containing the effects of the explosions in Boston.

Boston Marathon Bombing

The bombing of Boston Marathon on April 15th, 2013 was a terrorist invasion. Two bombs went off 12 seconds apart nearby the finish-line of the marathon. The explosions slew three people and leaving more than 250 others injured. Investigations carried out by the Federal Bureau of Investigation department found that the Tsarnaev brother were the masterminds behind the attack in Boston. It was found that they had independently organized the terror invasion and they were not linked to any terror group such as Al Qaeda. Following the invasion, there was a prompt reaction from the state departments in terms of health care for the affected persons. The incursion caused a high number of fatalities that could potentially overwhelm the area healthcare institutions and surpass capacity to treat the casualties. Comprehensive reaction plans and prior training enabled Boston hospital members of the staff handle the high number of patients and avoid exceeding their capability of treating those in need of urgent care.

Past attacks such as the Colorado shooting and 9/11 attack led hospital officials to consider the preparation of mass casualty incidents (MCI). In a bid to conduct an effective reaction effort in case of MCI, Boston hospitals created and enhanced their response plans. Strategizing for an MCI integrates a comprehensive methodology of taking into account different scenarios and includes a comprehensive evaluation of local circumstances of direction with different communal stakeholders (Gates et al., 2014). The response plan adopted by Boston hospital familiarized its members of staff with their duties and responsibilities when an MCI materializes. Some on-scene responders received and treated a sudden flow of patients who sustained life-threatening injuries.

Pre-Hospital Response

Airway control, appropriate placement of tourniquets, and needle decompression of tension pneumothorax were needed after the explosions in a bid to conduct a safe evacuation of serious casualties. A majority of the wounded patients in the lower limit degree at 31 or 24.4 percent of all the fatalities with material confirmation for exsanguinating blood loss from the sores. 83 percent of the patients with exsanguinating minimal extreme injuries had bandages attached in the field (Gates et al., 2014). However, from the statistics, it was unclear whether applied tourniquets were suitable for use and if they were applied appropriately. Different bystanders took it to themselves to offer first aid services to the affected persons. The pre-hospital response also included the way in which decisions were made regarding patient allocation to hospitals.

There was an equitable dispersal of patients to trauma hubs with regard to total numbers. There lacked statistical variances since the numbers involved were negligible and could not meet the threshold of the complex data analysis. One of the trauma centers admitted six severely wounded patients while another one did not receive such casualties. The imbalance shows that the distribution ought to have been more justifiable. If a level I organization of care is over-stretched with mass victims, it is transformed from its current status to a dysfunctional with high mortality rates (Busch, 2014). Such a practice which should be avoided in a bid to save lives. Strict consideration of the aspect of even spreading of different casualties in the context of pre-hospital response is vital in the maintenance of a smooth running of the trauma hubs.

Pictures that were taken after the bombing show the critical role played by bystanders in first response to mass casualty incidents. Other than the medical teams, civilian individuals had a role to play in reacting to the Boston Marathon blasts. Rather than running away from the scene of the attack, runners tore their shirts and used them, either for direct pressure to regulate bleeding or bandages to cover up wounds (Osterweil, 2015). Other people pulled down racecourse barriers in a bid to ease access to victims and their fast rescue to the nearby trauma centers. Those of them with basic medical training began triaging victims, and hence they were the first responders to this attack. They were instrumental in aiding the healthcare practitioners in saving lives (Osterweil, 2015). It was a show of power in the manner in which the ordinary people could put their efforts in trying to salvage what they could and supplement the efforts made by hospitals.

Hospital Response

When the notification of an MCI was done during the Boston Marathon bombing, patients started to arrive in the hospital, and employees were effective and efficient in shifting from their daily procedures to the emergency response unit. It is a process that requires all the participant healthcare providers to make quick decisions and conduct different non-routine duties (Busch, 2014). Responding to the bombing of the marathon, Boston hospitals reacted in various ways as it is elaborated from the next paragraph.

In 18 minutes after the bombing, the Boston EMS had moved 30 severely injured patients to different infirmaries within Boston city. Some of the notable sanatoriums included the Massachusetts General, Boston Children’s Hospital, and Brigham and Women’s Hospital; some of the care institutions with high-quality medical providence around the world (Kellermann & Peleg, 2013). They were also notified about the MCI and their members of work beyond their shifts in a bid to handle severe and multiple cases arriving for prompt treatment.

The State Emergency Operation Center (SEOC) conducted consistent updates on hospices with information regarding the explosions as it came. The communication informed members of staff about the number of patients on the way in and the kinds of injuries that were expected in the hospitals. For this reason; the members of staff for the emergency unit in Boston sanatoria were able to pool equipment for the orthopedic and vascular processes that they expected to carry out (King, Larentzakis & Ramly, 2015). Also, hospitals used the WebEOC system for acquiring and offering real-time updates and data on equipment and availability of members of staff. Prompt WebEOC updates assisted in updating the medical care providers about matters concerning personnel availability to offer services and the resources required in treating the patients (King, Larentzakis & Ramly, 2015).

The Department of National Weather Service (NWS) forecast was supposed to establish the weather effects on the sporting event through the entire day. After the blasts, the department’s members of staff alerted its support team in a bid to confirm whether the detonations had hazardous chemicals or toxins (Gates et al., 2014). The process was done through an air dispersion model and establishing that there were no chemicals or toxins emitted when the explosions materialized. It was an effort of ensuring that there were high chances of survival among patients by mitigating detrimental impacts that are likely to be caused by the factor of toxin and potentially dangerous chemicals.

The hospital members of staff relocated regular patients in order to clear the emergency department, pre-positioned trauma teams, and prepared operating theatres. The incident commander in charge of the emergency unit organized the clearing of emergency rooms as well mobilization of equipment and staff members. The hospitals alerted their radiology departments to make sure that there is the accessibility of equipment such as x-ray units and CT scanners. Also, the hospitals’ management teams wanted to be sure that there is the readiness of technicians in these departments. The Massachusetts General Hospital suspended the normal CT scans to avail them to the bombing victims and requested technologists to be on standby with their portable imaging units (Gates et al., 2014). It is clear that before any technical and hands-on operation on patients, hospitals conducted thorough communication to set a stage for proper care for the victims.

The hospitals’ reaction plans included metrics to respond to radiation or chemical releases that come after an MCI. A majority of Boston hospitals members of staff are experienced in treating battlefield wounded individuals. Also, they are trained in handling cases where the possibility of chemical contamination or radiation is a source of major concern (Marcus, McNulty, Dorn & Goralnick, 2014). Such experiences have greatly impacted on the process of planning on such incidents of mass attacks.

Boston hospitals incorporated these concerns in their response plans during the bombing of the marathon in the year 2013. For instance, pursuant to the established response plan, once Brigham and Women’s Hospital started reacting to the Boston Marathon explosions, the members of staff prepared decontamination units (Gates et al., 2014). The efforts mitigated detrimental effects of possible chemical contamination and radiation. In this sense, hospitals were ready to avoid such preventable causes of mortality among the victims. Without such advanced reaction strategic plans, it is possible that the death toll in the Boston Marathon bombing would be more extensive over time since such reactions may take extended periods before their detrimental effects are manifested.

The response plans of hospitals accounted for the probability of an invasion of the sports facility, and added more security measures in a bid to prepare for such events. Healthcare providers reinforced security measures through instituting additional law implementation onsite and remained on high alert for potentially suspicious activities (Marcus, McNulty, Dorn & Goralnick, 2014). Other than reacting to only the medical aspects of the bombing attack, hospitals sought to create their security systems which will safeguard them against possible terror invasions.

Following the Boston Marathon bombs, the hospital security members of staff identified a suspicious package which prompted the emergency unit to shift to another group of the hospital. Law enforcement personnel carried out a sweep of the emergency unit and established that it was safe and patients could then re-enter the area. The marathon bombing scared the hospitals’ management teams and members of staff because it appeared they could as well be victims of terror attacks in the future (Marcus, McNulty, Dorn & Goralnick, 2014). The incident prompted them to install additional security metrics in their institutions in a bid to avoid possible vulnerability to such invasions.

Among the most significant life-saving factors after the Boston Marathon bombing was the short time between the times that the blasts happened to when they received medical care. For the people who suffered severe injuries, the fact that they received fast medical triage and care promptly after the explosions rapidly boosted their chances of surviving. At the medical tent, EMS had blood pressure monitors, IV bags, and tourniquets that were used to stabilize the victims (Marcus, McNulty, Dorn & Goralnick, 2014). After stabilization, the victims were boarded into ambulances and taken to the hospital trauma units. At this point, there was the quick application of tourniquets both in the field, and en-route to trauma centers, and this played a vital part in enhancing survival chances for the patients. Joseph Blansfield, a manager at the Trauma Program in the Boston Medical Center, believes that through applying tourniquets, it was possible to arrest bleeding and patients arrived in hospital in better physiologic statuse than it could have been the case without the application (Marcus, McNulty, Dorn & Goralnick, 2014).
Injuries that come as a result of IED blasts are extensive, and they call for a skilled and knowledgeable labor force that is well-equipped for purposes of trauma care. When patients arrived at trauma centers after the Boston Marathon explosions, the hospital members of staff carried outpatient evaluations to establish the correct course of action (Gates et al., 2014). The variability of sustained injuries ranged from burns, amputations, fractures, and shrapnel wounds that needed complicated procedures and cautionary coordination in all the surgical disciplines. A majority of these injuries required various and profound surgeries for complete healing. At Brigham and Women’s Hospital, after patient evaluations, the operation-room director took care of triage operations and established different operating rooms to allocate for the respective patients (Gates et al., 2014). The usual training that Boston hospitals carry out made sure that members of staff were prepared to offer trauma health care for the voluminous amounts of patients seeking treatment after the bombing.

Effective communication was instrumental in creating a conducive environment for treatment of a high number of patients. Through this connection, it was possible to lay down strategic plans that provided for a smooth flow of activities when going about the business of mass treatments in the hospitals (Osterweil, 2015). In particular, the keeping in touch between and with the different Boston hospitals assisted in establishing if an emergency unit was deficient in certain equipment that other institutions could offer. The hospitals kept in touch with coordination centers in a bid to pass important pieces of information during the outcome of the explosions (Osterweil, 2015). The coordination centers offered the various hospitals with information regarding the developments of the incident. Contrariwise, hospitals publicized patient identification details with the MIC for the location of families member so that they could be reunited with their loved ones.

Initial Operating Room Response

After the materialization of the explosions, the standard of care involved first damage control conducted through arresting bleeding, soft tissue debridement, the positioning of external fixators, and removal of foreign bodies. Also, the health care providers sought to complete amputations of limbs that were severely damaged in a manner that they could not be treated back to normalcy (Gates et al., 2014). In this sense, doctors were first interested in securing the most vulnerable types of wounds that could potentially result in preventable mortality among the victims.

A majority of the patients had sustained external injuries of skin from different secondary projectiles. The combinations of lacerations, abrasions, and subcutaneous hemorrhage have in the past been seen as a trait of cutaneous injury in the explosion casualties. After the explosions, hospital members of staff embarked on the removal of debris and addressing the delayed covering of the traumatic wounds which are mainstay therapy (Gates et al., 2014). It is clear that members of staff in Boston hospitals have high strategic plans of preparation for such incidents of mass casualties. It is the case because the trauma response in every hospital was coordinated through skill and efficiency, but not in a vacuum.

The Future

After the Boston Marathon explosions, there were 281 casualties in total; the ease with which the massive injuries took place serves as a reminder that terrorism is a potential menace for the entire world. Although it is impossible to forecast the nature and locality of future terrorist attacks, it is clear that terrorism is a current global threat. All the healthcare provides as well as concerned state, and government departments should conduct a gap analysis on the existing disaster plans to establish the next initiatives of minimizing mortality and morbidity in probable future mass casualty incidents (Osterweil, 2015). Minimal mortality rates in the Boston Marathon bombings are highly attributable to levels of preparedness in the healthcare sector.
The significance of preparation, training, and re-assessment was manifested in the manner in which the healthcare sector reacted to the Boston explosions in the year 2013. There is a need for continued collaboration in a bid to identify the best preparedness practices around the world (Osterweil, 2015). This will enhance medicinal reaction and help as the best method for efficacious results, till terror attacks are banished by global citizens, and such happenings are no longer threatening to regional and global security.

Conclusion

In response to the Boston Marathon explosions, health care personnel and hospitals at large illustrated the advantages of carrying out preparedness initiatives. Before the hospital response, it was important that there was the application of tourniquets on injured people to arrest bleeding and conducting an equitable distribution of severely wounded patients. In Boston area, hospitals managed to activate response plans when alerted and offered prompt care for the surging number of casualties. Among the primary factors that facilitated this success was the fact that the hospitals were in constant contact with operating centers and public departments in Boston. The real-time communication was instrumental in the activation of emergency reaction plans. Hospital emergency units depended on training and response plans when there was an increasing number of patients. Hospital members of staff were well-acquainted with their duties and obligations since they had gone through training sessions in readiness for such incidents. Hospitals established plans with initial responders, law enforcement agencies, and ambulance services for successful coordination of hospital response during the incident. Upon admission to the hospital, members of staff first sought to mitigate life-threatening injuries before proceeding to other minor wounds. For the entire process, communication was a key element in running a smooth response plan to avoid unnecessary deaths among the victims. In the future, it will be important for such response plans to be developed all around the world because terrorism is a global threat.

References

Busch, J. (2014). Boston Marathon Bombing Response Reaffirms Lessons. EMS World. Emsworld.com. Retrieved 20 December 2017, from https://www.emsworld.com/article/10960336/boston-marathon-bombing-response-reaffirms-lessons

Gates, J. D., Arabian, S., Biddinger, P., Blansfield, J., Burke, P., Chung, S. & Gupta, A. (2014). The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster. Annals of Surgery, 260(6), 960-966.

King, D. R., Larentzakis, A., & Ramly, E. P. (2015). Tourniquet use at the Boston Marathon bombing: Lost in translation. journal of Trauma and Acute Care Surgery, 78(3), 594-599.

Kellermann, A. L., & Peleg, K. (2013). Lessons from Boston. New England Journal of Medicine, 368(21), 1956-1957.

Marcus, L. J., McNulty, E., Dorn, B. C., & Goralnick, E. (2014). Crisis Meta-Leadership Lessons from the Boston Marathon Bombings Response: The Ingenuity of Swarm Intelligence. Boston, MA: National Preparedness Leadership Initiative.

Osterweil, N. (2015). World Class Emergency Response in Boston Marathon Bombing. Medscape. Retrieved 20 December 2017, from https://www.medscape.com/viewarticle/853394.