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Disaster Response After the Boston Marathon

+ Kari Kohn

Atul Gawande, an American surgeon, professor, and journalist with an expertise on the interplay of rules and technologies in the medical field, has written an interesting piece for the New Yorker on the Boston Marathon explosions.  He states the following:

More than a hundred and seventy people were injured. They had their limbs blown off, vital arteries severed, bones fractured, flesh torn open by shrapnel or scorched by the blasts’ heat.  Yet it now appears that every one of the wounded alive when rescuers reached them will survive.

The possibility for a 100% survival rate for the wounded due to the response of the Boston medical community is amazing.  Here, an incident commander at a Boston hospital, describes how the staff organized itself:

“I mostly let people do their jobs,” he said. He never needed to call anyone. Around a hundred nurses, doctors, X-ray staff, transport staff, you name it showed up as soon as they heard the news. They wanted to help, and they knew how. As one colleague put it, they did on a large scale what they knew how to do on a small scale. They broke up into teams of six or so people, one trauma team for each patient. A senior nurse and physician stood at the door to the ambulance bay triaging the patients going to the teams. The operating-room director handled triage to, and communication with, the operating rooms. Another staff member saw the need for a traffic cop and began shooing extra clinicians into the waiting room, where they could stand by to be called upon.

Gawande suggests that the events of 9/11 were the catalyst for a shift in culture that has changed how we organize ourselves when dealing with tragedies.

Talking to people about that day, I was struck by how ready and almost rehearsed they were for this event. A decade earlier, nothing approaching their level of collaboration and efficiency would have occurred. We have, as one colleague put it to me, replaced our pre-9/11 naïveté with post-9/11 sobriety. Where before we’d have been struck dumb with shock about such events, now we are almost calculating about them. … Everyone’s imaginations have come to encompass these once unimaginable events.

And, after 9/11, Gawande explains that education, experience, and copying the best practices of others has made us better prepared.

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. Cities and towns have conducted disaster drills, including one in Boston I was involved in that played out the scenario of a dirty-bomb explosion at Logan Airport on an airliner from France. The Massachusetts General Hospital brought in Israeli physicians to help revamp their disaster-response planning. Richard Wolfe at the Beth Israel Deaconess recalled an emergency physician’s presentation of the medical response required after the Aurora, Colorado, movie-theatre shooting of seventy people last summer. From 9/11 to Newtown, we’ve all watched with not only horror but also grave attention the myriad ways in which the sociopathy of killers has combined with the technology of inflicting mass casualty.
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