Experts Discuss Boston Bomb Response Lessons

This article first appeared at EMSWorld.com on May 1, 2013.

Numerous public safety officials including Boston EMS Chief James Hooley participated Friday in a talk hosted by The Forum at Harvard School of Public Health titled, “THE BOSTON MARATHON BOMBINGS: Lessons Learned for Saving Lives.”

The presentation focused on the medical response and began with a rundown by Boston EMS Chief James Hooley.

“The day was unfolding like a lot of marathons in the past,” he said.

Just prior to the bombs going off, the main medical tent was at half-full capacity and the secondary tent was full, he said. His thoughts were, “Wow, we’re having an easy year.”

“Shortly after that we heard the first explosion,” he said. He didn’t know it was a bomb initially, and thought a vendor might have had an accidental explosion.

“Then we heard the second explosion, which left no doubt, and we started responding.”

He said they started getting reports back and put out a call for hospitals to be advised of a mass casualty situation.  With the help of volunteers, they quickly transitioned the marathon medical tent areas from things like cooling, heating and asthma treatment, to red, yellow and green triage areas.

Risks in Responding

Boston EMS Lt. Brian Pomodoro , who was serving as safety officer, was asked to speak from the forum’s live audience.

“I knew my personnel were going to be running to the scene – running into the smoke and haze – to grab victims as quickly as possible,” he said.

“We didn’t know if there would be more blasts to take out responders – that was primary on my mind at that point.”

He said responders did follow an order to get victims back to the tents as quickly as possible rather than stay outside. However, given the situation and lack of immediate information, he described the response as “more instinct than scene size-up.”

“You can’t turn your head to hurt people,” he said. “That’s why bystanders kicked in too.”

Hooley echoed that sentiment about secondary devices, and noted the same issue is faced around in the world in terrorism hot spots such as Israel. “It’s a calculated risk you’ve got to take and everyone does it,” he said.

Hospital Perspective

Paul Biddinger, Chief of the Division of Emergency Preparedness at Massachusetts General Hospital, said that when he got the mass casualty notification, he “didn’t believe it at first.”

“It was a whole-hospital response,” he said.  There was triage up front but the first 5-6 patients were no question, he said, and required simultaneous resuscitations and immediate surgeries.

They didn’t have the luxury of performing full ED patient evaluations – 30 people were sent to other floors within 20 minutes of arrival. By quickly moving patients upstairs, the ED maintained extra capacity that they could have used if they’d needed it.

“We spent a lot of time trying to find out if there were more coming or if there were more devices,” he said. “It wasn’t until about two hours later that we felt we could start to stand down.”

He said there was no question that it was life-saving that there had been so many medical personnel  out in the field, and volunteers providing tourniquets or just direct pressure on wounds.

“Had they not had those interventions they would have died.”

Conclusion

Toward the end of the presentation, Hooley was asked if he had advice for other EMS chiefs.

He said to cover the basics – train and equip personnel, and have enough ambulances. On top of that, one of the things that led to outstanding survival, he said, was that his staff has bought into the idea that you have to prepare, and be able to respond to something like an active shooter incident from muscle memory.

“You have to think that it’s going to happen – at the most innocuous place,” he said. “Be ready to imagine the unimaginable.”

The Presentation

WATCH THE ON-DEMAND WEBCAST FROM FRIDAY, APRIL 26, 2013 

Additional panelists included:

JudyAnn Bigby, Former Massachusetts Secretary of Health and Human Services

Leonard Marcus, Co-Director, National Preparedness Leadership Initiative

Don Boyce – Director of the Office of Emergency Management

Mary Clark – Mass. Dept. of Public Health