Boston hospitals say that overall they did well in their response to the bombings because, as crazy as it sounds, they got lucky on April 15.
Dr. Richard Wolfe, chief of emergency medicine at Beth Israel Deaconess Medical Center, says hospitals were fortunate with both the location and timing of the bombs that stunned the city.
Scores of emergency staff were already on scene for the marathon. There was a medical tent just yards away from the bombing site, and there were six Level 1 trauma centers within a mile or two, which were at shift change and had double the staff available to help. But still, Wolfe says, mistakes and near misses were made as hospitals dealt with mass casualties they would have expected in battlefields, not city streets.
"We did learn a number of new things through this experience that allowed us in some ways to rewrite the playbook about how we should handle these things going forward," says Wolfe.
Identifying Patients
Patient identification is one of the big ones. Massachusetts General Hospital learned the hard way, through a tragic mix-up. A woman who was rolled in with a handbag was identified by the driver's license inside, but it turns out the handbag belonged to a different woman.
"They looked roughly the same, and so, in the hurry of the moment, we said, 'Oh, she must be this person.' And that was incorrect," says Dr. Alasdair Conn, Mass General's chief of emergency medicine.
He says the mistake was only discovered when the woman's relatives rushed to her bedside, and were stunned to find a stranger. Eventually, they learned that their loved one had actually died at the scene.
"That's devastating, and we shouldn't do that. But it's challenging; it's very challenging," Conn says.
Higher Security, More Support
Hospitals say the marathon also underscored the need to beef up security, so that in the worst-case scenario, they don't become a secondary target. At Tufts Medical Center, trauma chief Dr. Reuven Rabinovici says a suspicious bag was discovered, and the emergency room had to be evacuated.
"We had to roll all the patients out of the emergency room, in the middle of caring for these patients," he says. "Police came with bomb-sniffing dogs, and they pretty much locked the hospital down."
The ER wound up in the front lobby. Rabinovici says hospitals need to be better prepared.
"You have to identify an alternative place which has a minimum amount of glass, of course, if there is an explosion, and make sure that the flow continues uninterrupted," he says.
Hospitals also say they learned that no matter how much emotional support is offered to providers dealing with mass casualties, it's not enough. And no matter how much training they do, there will always be curveballs.
When Dzhokhar Tsarnaev was arrested days after the bombing, he was taken to Beth Israel, upsetting many victims who were at the same hospital. But Beth Israel's Richard Wolfe says that might be more about changing mindsets than policies.
"I don't know what you do differently," Wolfe says. "I mean, you can't be selective about who you care for. That's the way it works. It works like that in Israel, where you have Palestinian bombers side by side with victims. What we do is we try to maintain our humanity, even if perpetrators do not."
The Value Of Social Media
One other lesson from the marathon bombing is the value of social media. Mass General got an early indication of trouble when an ER doctor saw a tweet from a friend at the finish line, just about a minute after the blast. That prompted the ER to hold off on surgeries that were about to begin, saving precious time and space for the victims that would flood in.
Conn says hospitals can't ignore social media, even if they can't completely trust them either.
"We're trying to wrestle with that, because obviously initial tweets might not be as accurate," he says, "And to implement the disaster plan — which means the whole institution grinds to a halt and redirects itself — that's a million-dollar decision, and we need to make quite sure we get it right."
In some ways, hospitals say, the biggest lesson from the marathon is the need to share — but sadly, nothing teaches like experience.
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