Just before 3 pm April 15, 2013, two pressure cooker bombs exploded near the finish line of the Boston Marathon, killing three and wounding 264 runners, family members, and spectators. In an instant, medical personnel on the scene, who typically treat runners for conditions such as fatigue and dehydration, were triaging and caring for severely injured patients. Meanwhile, local hospitals, including Boston Medical Center (BMC), organized their staffs and emergency departments (EDs) into high-capacity treatment centers equipped to handle devastating injuries.
From treatment to triage at the finish line
Immediately after the explosions, BMC staff at the medical tent near the finish line worked to stabilize patients, many of whom suffered injuries to their lower extremities because the bombs detonated low to the ground. “We worked as we’ve never worked before,” says Elizabeth Mitchell, MD, a BMC physician in the tent that day. “We used scattered debris to splint legs that were barely hanging on. We rolled people onto boards.”
She notes that Boston Emergency Medical Services quickly provided stretchers and backboards, while Boston Athletic Association volunteers worked swiftly to evacuate patients. Staff from UMass Memorial Health Care, a member of America’s Essential Hospitals, also were stationed at the marathon’s medical tent and provided care to victims in the immediate aftermath.
On the frontline, BMC treats patients with precision
From the finish line, the injured were transported to various Boston-area hospitals. BMC, a level I trauma center, accepted 23 of those patients. “Patients were bloody, missing limbs, and in shock physiologically and psychologically,” says BMC Nurse Manager Joseph Bellabona, RN. “They had multiple shrapnel wounds and were being treated as though they had just been removed from the front lines of a war zone.”
Trauma surgeons tended to 16 patients in 10 operating rooms, while other available staff members responded to the ED to provide whatever additional assistance was needed.
“I’ve never been prouder to work here,” says Andrew Ulrich, MD, executive vice chair of the department of emergency medicine. “Some people were running (in) the marathon and they just left the course and came in to work. Others were watching the race, or enjoying a day off, and they all came in to do what they could.”
Meanwhile, the patient advocacy department established a Family Resource Center for victims’ family members and staffed it with social workers, chaplains, patient advocates, and other volunteers. Not only did the center serve as a liaison to the clinical teams caring for patients, but it also served food and beverages and provided computers, phone lines, and mobile phone chargers to those who needed them.
“The center was an incredible team effort under the most challenging of circumstances,” says Sheryl Katzanek, director, patient advocacy. “The families were an inspiration to all of us.”
Drills helped prepare for the worst
BMC regularly participates in disaster drills to prepare for mass casualty disasters like the marathon bombings on an organization- and citywide basis. Drills are held annually in Boston and cover events from plane crashes to natural disasters and dirty bombs. Each hospital sends a team of physicians and staff, who respond to different scenarios and discuss responses as a group.
“A combination of being ready and having practice, but also expert clinical and trauma care delivered with compassion and teamwork, really saved lives,” BMC President and CEO Kate Walsh told The Boston Globe in a recent interview. “I know it saved lives here, and I’m sure it saved lives at other hospitals around the city.”
Caring for staff
Following Marathon Monday’s events, BMC took extra steps to ensure the well-being of staff, who reported experiencing physical and emotional reactions, such as fatigue, exhaustion, and first-responder guilt about being spared in the bombings.
The psychiatry, social work, pastoral care, and human resources departments provided group and individual debriefing sessions, where hundreds of employees discussed tips on self-care for dealing with the stress of the bombings, strategies to reduce anxiety, how to discuss the incident with children, and how to cope with random acts of violence. The departments and senior leaders also rounded units caring for victims to offer counseling and additional resources.
“People in the medical profession who are used to taking care of others many times put themselves on the back burner,” says Claire Murphy, senior employee relations specialist, human resources. “Staff have expressed great appreciation for these sessions and the chance to process with their colleagues.”
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