Thoughts from Boston and reflections from Day 1 - Alan Cohen

Some Thoughts from Bostonand Reflections from Day 1Alan Cohen

15/04/2023

The Winter of 2014 – 15

in Boston

• New record (#1) – 108.6 inches of snow (most since records first kept in 1872)

• #2 – 107.6 inches (1995 – 96)• #3 – 96.3 inches (1993 – 94)• #5 – 86.6 inches (2004 – 05)• #7 – 83.9 inches (1992 – 93)• #8 – 81.0 inches (2010 – 11)

SOURCE: http://www.bostonglobe.com/metro/2015/02/03/new-website-lets-boston-residents-track-status-snow-plowing-their-street/DkcvnntnCN3YYkiqvZNU0N/story.html

SOURCE: http://www.bostonglobe.com/metro/2015/02/03/new-website-lets-boston-residents-track-status-snow-plowing-their-street/DkcvnntnCN3YYkiqvZNU0N/story.html

SOURCE: http://mashable.com/2015/02/07/boston-record-snowstorm/

The View from My Front Door

Hope Springs Eternal

The Boston Marathon

April 15, 2013

Recent Events

• The Trial of Dzhokhar Tsarnaev, accused Marathon

bomber In the first (“guilt”) phase, Tsarnaev was convicted on all

30 counts of crimes for which he was charged• 17 carried the death penalty

Massachusetts does not have the death penalty, but the

trial was held in federal court (which does)

In the second (“sentencing”) phase, Tsarnaev was

sentenced to death on all 17 counts

Now awaiting appeal

April 15, 2013

• The Marathon >26,000 runners >500,000 spectators

• The Incident 2:49 PM: 1st explosion 2:50 PM: 2nd explosion (12 seconds later)

• Near the Finish Line 17,000 had completed the run 9,000 still running

v

"My first reaction was to run toward the people.

There was so much commotion and a lot of people running away. I

was one of the first to help people and God protected

me. It was horrific.“

-Carlos Arredondo

• He used part of his clothing to make a tourniquet to slow the blood loss from the man's severed artery.

The Immediate Aftermath: Destruction and Carnage

• 3 people dead

• 264 people injured

• The cause: 2 pressure-cooker bombs placed near the finish line

SOURCE: http://www.cnn.com/2013/04/16/us/boston-marathon-victims-profiles/

Young Lives Lost

• Krystle Campbell, 29

• Lingzi Lu, 23, BU

graduate student

• Martin Richard, 8

SOURCE: http://www.cnn.com/2013/04/16/us/boston-marathon-victims-profiles/

Medical personnel manning the runners’ first-aid tent swiftly

converted it into a mass-casualty triage unit

Medical Tent A

• Care for the wounded began at the scene of the blasts

• Patients had severe eye damage, deep flesh wounds,

and ruptured internal organs Similar to trauma seen in serious car accidents

• The medical tent had been set up to treat running

injuries, e.g., dehydration, hypothermia, and cardiac

arrest

• But doctors improvised The critically wounded were triaged to the back of the tent

Routine ailments were treated in the front

Reactions of Clinicians

SOURCE: https://www.llis.dhs.gov/sites/default/files/Boston%20Marathon%20Bombings%20Hospital%20Readiness%20and%20Response.pdf

“There were victims coming in with both legs blown off. I had never seen anything like that.”

- Dr. Sushrut Jangi, Internist at Beth Israel Deaconess Medical Center

Dr. Richard Wolfe, Chief of the Emergency Department at Beth Israel Deaconess, said that in his 14 years at the hospital, “nothing

comes close” to what he witnessed.

Initial Response

SOURCE: https://delvalle.bphc.org/mod/page/view.php?id=610

Emergency medical teams mobilized from around the city and transferred the victims to 9 different hospitals in minutes,

despite the chaos.

Patient Transports in the First 60 Minutes



166 Patients Treatedat Six Level 1 Trauma Centers

SOURCE: https://www.llis.dhs.gov/sites/default/files/Boston%20Marathon%20Bombings%20Hospital%20Readiness%20and%20Response.pdf, Mary Devine, Presentation at Conference of Boston Teaching Hospitals; & http://www.bostonglobe.com/lifestyle/health-wellness/2013/04/15/boston-hospitals-treat-injured-with-wounds-more-often-seen-war-zones/MczjJJkkdLvjzqR9MK407N/story.html

Hospital Patients

Massachusetts General Hospital 37 (4 ER amputations)

Brigham & Women’s Hospital 38 (20 ER surgeries)

Boston Medical Center 29

Beth Israel Deaconess Medical Center

24 (17 ER surgeries)

Boston Children’s Hospital 10 (children ages 2-12)

Tufts Medical Center 28

https://www.llis.dhs.gov/sites/default/files/Boston%20Marathon%20Bombings%20Hospital%20Readiness%20and%20Response.pdf

Brigham and Women’s Hospital• 38 victims received; 28 with significant injuries

• 3:00 pm: Change of nursing shift Immediately notified day shift to stay on

No one wanted to leave, anyway

• 3:08 pm: 7 patients arrived nearly at once All required emergency surgery

• The rest followed, spaced by just one minute each

• 3:25 pm: 1st patient surgery A patient in shock, hemorrhaging profusely, with inadequate

breathing and a near-completely severed leg

• 20 underwent surgery that day Mostly vascular and orthopedic procedures

Why Boston Was Ready

“Boston's health care providers reacted the way they did

because they knew what they were supposed to do. Those

who did not were smart enough to follow the lead of those

who did. That's how a ‘ritualized’ disaster plan works.”

– Arthur Kellermann, Dean of the F. Edward Hébert School of Medicine

at the Uniformed Services University of the Health Sciences

“We all know each other. That connectivity is one big piece of why things went so well.”– Meg Femino, Director of Emergency Management at Beth Israel

Deaconess Medical Center


SOURCE: BUSPH PH712 Boston Marathon Bombing Case Study, NEJM Perspective May 2013 “Be Prepared — The Boston Marathon and Mass-CasualtyEvents” http://www.nejm.org/doi/full/10.1056/NEJMp1305480

“The fact that the response was so well executed wasn’t an accident—it was a result of years of planning and coordination.”– Richard Serino, FEMA Deputy Administrator


Planning and practice make the difference1. Partnerships are key

2. Social media can be effective

3. Volunteers and spectators can contribute

4. Improved resource allocation and information sharing

5. Respect for survivors and victims

6. Recovery is ongoing—especially mental health

SOURCE: BUSPH PH712 Boston Marathon Bombing Case Study, NEJM Perspective May 2013 “Be Prepared — The Boston Marathon and Mass-CasualtyEvents” http://www.nejm.org/doi/full/10.1056/NEJMp1305480

Medical Intelligence Center (MIC)

• 1 minute after the first explosion, an EMS staff member in a marathon medical tent alerted the center

• Within 10 minutes, an alert was sent to all area hospitals – EMS radio dispatches: “Explosion near Medical Tent A. EMS will be using red wristbands for

patients. Multiple casualties reported.”

SOURCE: http://www.bostonglobe.com/lifestyle/health-wellness/2013/05/23/medical-intelligence-center-key-player-marathon-bombing-response-marks-anniversary/bVemZLR8CCvdBbIfKfGUkL/story.html

• Only one of its kind in the U.S.• Based out of the Boston Public

Health Commission Operates with money from city,

state, and federal governments Operates on certain days

• Marathon• New Year’s Eve• July 4th

• Weather and other emergencies

Coordination by MIC• 7:00 PM: MIC briefing reported that 110 patients were known

to be injured 1 hospital experienced a shortage of amputation kits and was

looking for more

• 2 days after the bombings: Seaport World Trade Center

donated space for victims and families to meet privately with

law enforcement author ities

• >120 teams of grief counselors were deployed by MIC to help

1,500 traumatized people Marathon volunteers, first responders, staff working in stores in the

Boylston Street area, and health care providers treating victims

SOURCE: http://www.bostonglobe.com/lifestyle/health-wellness/2013/05/23/medical-intelligence-center-key-player-marathon-bombing-response-marks-anniversary/bVemZLR8CCvdBbIfKfGUkL/story.html



What Saved Boston…It Could Have Been Worse

• 6 Level 1 trauma centers within one mile

• Blasts occurred 10 minutes before the 3:00 pm shift change at area hospitals Double staff were available to help

• Emergency response preparedness 2002: Operation Prometheus – a multi-day exercise that

simulated the explosion of a dirty bomb; over 50 agencies and 10 hospitals participated

2011: Operation Falcon II – a functional exercise that tested hospital response plans and their ability to handle a surge of patients


• Aid to Victims Established to help those most affected by the

bombings

$61 million collected and distributed in 75 days to 230

victims and survivors 100% of donations dispersed; no overhead expenses

2014 – additional $18.5 million in gifts distributed 200,000 individual donations from 50 states & 60 countries

$1.5 million to establish One Fund Center in Massachusetts

General HospitalSOURCE: https://secure.onefundboston.org/pages/about

The Boston Marathon2013 - 2015

• 2013 Winner – Men’s Division

Lelisa Desisa of Ethiopia – donated his medal to the City of Boston


Meb Keflezighi – first American man to win the marathon since 1983


Lelisa Desisa of Ethiopia – got to keep his medal this time


Reflections from Day 1

Healthcare

Thoughts from Boston and reflections from Day 1 - Alan Cohen