On April 15th 2013 the unexpected happened near the finish line of the Boston Marathon. Two improvised explosive devices (IEDs) where detonated, at the feet of the spectators while they were cheering on the runners, in an interval of just seconds and a distance of approximately 200 feet. Three victims were pronounced dead on scene and there were close to threehundred injured. Luckily the Boston marathon was highly equipped and prepared for the worst and had a lot of first responders and medical personnel in close proximity to come to the victims’ aid very quickly.
This research paper will address how effectively the responders managed the incident, how they could improve in future incidents, the parts of the incident that went well and the parts that did not go so well, the organizations that were involved throughout the incident, whether they were prepared for such an event, whether they had received any prior training to prepare them for such an event and how this incident could affect a future responder. The Boston marathon is a yearly event held on Patriot’s day. An average of “23,000 runners” (Hoppel, 2013, p. 24]) come from all over the world to run in this 26. 2mile straight marathon. “Boston marathon differs from most other marathons in that it goes through various cities instead of being a circuit in just one city. The Boston marathon starts off in Hopkinton and travels through Ashland, Framingham, Natick, Wellesley, Newton, Brookline and Boston. ” (Massachusetts Emergency Management Agency, 2014, p. [3]). Every year, Boston Emergency Management prepare extensively for this event by organizing drills to make sure that everyone involved are well prepared for an emergency.
They are very well prepared for all sorts of medical issues that deal with the physical stress of a marathon on one’s body. In the past they have had multiple patients suffering from hyperthermia, dehydration, myocardial infarctions, hyponatremia, among other illnesses. As the bombs went off it came as a surprise to everyone, but the first responders, law enforcement, EMS, medical volunteers and civilian volunteers among others were extremely quick to realize what just happened and immediately assisted the wounded.
There was a barricade that caused some inconvenience to gain access to the casualties but military personnel, law enforcement and others managed to remove it some distance from the casualties to be able to gain access for emergency responders to get the casualties out of that location as soon as possible. Within seconds from the bombs law enforcement and EMS requested additional resources, there were already “16 ambulances prestaged, and 73 additional ambulances attended” (FEMA, 2013 p. [39]) and informed other units via radio of what had happened.
All of the responders work very effectively together and knew exactly what to do and how to do it. The management of the scene was very efficient and organized. EMS started to triage patients, sending the most critical directly into ambulances to be transported immediately to the closest appropriate facilities, other patients less critical would be triaged in the Alpha Medical Tent close to the finish line. In order to not overwhelm the hospitals Massachusetts Department of Public Health (MDPH) nd the Incident Commander were able to manage and determine how many patients could go to each of the five level 1 trauma facilities without sending too many patients to the same hospital by way of accessing Web EOC.
All of the hospital personnel and emergency responders that attend big community events have multiple drills throughout the year that help prepare, familiarize and become comfortable in mass casualty disasters, this was the main reason the response was such a success because all of the responders and medical personnel knew how to respond and communicate effectively with each other using the NIMS and ICS. 14 hospitals from Boston, as well as representatives from the city’s police, fire, and EMS departments, meet at least twice a month. And once a year with police, fire, EMS, folks at Logan Airport, the MBTA [Massachusetts Bay Transportation Authority] and the Department of Public Health”. (Hoppel, 2013, p. [23]). “NIMS provides a generic framework for leading a given incident, called “incident command,” and specifies the structure that such a command should have – including a designated incident commander who oversees the event as a whole, together with one operational and three support functions.
An operations chief directs the current operations. In support, the Plans, Logistics, and Administration/Finance groups undertake planning for the next operational cycle, organize the logistics necessary to support that plan, and keep track of the resources used and who is responsible for paying for them. ” (Leonard, Cole, Howitt, & Heymann, 2014, p. [5]). Everybody who responded and were involved in the Boston marathon bombing worked extremely well together. Every patient transported to a hospital lived. This was an extremely good outcome thanks to everyone involved and the quick transport times.
The hospitals were well staffed and prepared for the worst due to the marathon, they also planned to not schedule too many operations on that day considering that they may have casualties form the marathon. “Incident Command began to form moments after the explosions when senior law enforcement and emergency management officials came together on Boylston Street and immediately began coordinating priorities. Less than 40 minutes following the explosions, UC shifted operations to a Unified Command Center (UCC) established at the nearby Westin Hotel.
The UC would ultimately include the Governor, Mayo of Boston, Secretary of the Executive Office of Public Safety and Security (EOPSS), MEMA Director, Massachusetts State Police (MSP) Superintendent, BPD Commissioner, Boston Fire Department (BFD) Commissioner, Boston Emergency Medical Services (Boston EMS) Chief, Director of the Mayor’s Office of Emergency Management (OEM), MANG Adjutant General, Massachusetts Bay Transportation Authority (MBTA), Transit Police Department (Transit PD) Chief, and FBI Boston Special Agent in Charge (SAC). (Massachusetts Emergency Management Agency, 2014, p. [4]).
Some considerations that could have improved the incident management are that the triage tags were not used and should have been. This would have assisted in making a better and more effective triage both at the scene and at the hospitals as well as a better way for tracking patients and their conditions. One patient was erroneously identified due to somebody else’s handbag being transported with her. This mistake should have been avoided.
The responders were also short of tourniquets, therefore they took extra time coming up with alternative methods of stopping the patients bleeding, and some used their own clothes as tourniquets. For future incidents medical supplies such as tourniquets should be considered in more quantities. There was a lack of communication from the Hazmat team as to whether decontamination of the patients was supposed to happen or not, the hospitals assumed that due to the incident no news about it meant that it was not necessary but it should have been confirmed.
Another lack of communication incident happened when hospitals where put on lock-down in the following days, it was confusing for the employees to know how to react, they were not sure if the employees were allowed to have shift change and go home or not. Once the runners had past the first couple of cities of the marathon, busses that were provided for the runners were dismissed. A better strategy would have been to have them follow the runners so that that way they could have assisted in relocating the runners to a safe location.
There was lack of public announcement and communication to the runners throughout the route of the marathon, had there been some sort of multiple public microphones or intercoms throughout the entire route, the runners could have been informed adequately of what was occurring in a quicker and more effective manner, rather than multiple runners still running in a dangerous direction.
“The events in Boston have highlighted how close coordination among federal, state, and local officials is critical in the immediate aftermath and response to terrorist attack. (FEMA, 2013, p. [3]). The outcome would not have been the same without everyone coming together and working together so effectively. As a future responder all I could ask for is to be able to have a system and team that can work just as effectively as they did at the Boston marathon bombing. I would want my employer to prepare us just as well for any circumstance that way we can feel confident and know what to do when a mass casualty incident occurs.
I believe it is extremely important and makes all the difference to do multiple drills not only as an EMS team but as a bigger organization, to follow the NIMS and ICS with local, state and federal organizations so that one is familiar with how the organization and management should occur effectively with one another and to also get accustomed to working with each other and improve with every drill. Mass casualty incidents are extremely stressful, but the more you prepare for it the better the outcome will be for everyone.
There is a documentary that is interesting to watch, “Inside the Hunt for the Boston Bombers” but it focuses more on how they captured the bombers more so than how the different organizations worked together and how the medical response system worked as a whole. In conclusion, everyone not only responders but the general public should also be aware of the NIMS and ICS to become familiar not only with how to respond to an incident and be able to help but also for their own safety they should be aware of their surroundings.
