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3:54 pm
Thu September 19, 2013

Boston Hospitals Share Lessons From Marathon Bombing

Originally published on Mon September 23, 2013 9:10 am

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.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

AUDIE CORNISH, HOST:

In the months following the Boston Marathon bombing, area hospitals have been reviewing and rehashing how they managed treating victims of the deadly attack. By most measures, they did great. Every single patient who arrived at the hospital alive survived.

But as NPR's Tovia Smith reports, the experience also revealed room for improvement.

TOVIA SMITH, BYLINE: Boston hospitals say overall they did well with their response because, as crazy as it sounds, they got lucky on April 15th.

RICHARD WOLFE: Did it work well? Well, yeah, it did. It worked really well but it was more like hitting a softball.

SMITH: Dr. Richard Wolfe, Beth Israel Deaconess Medical Center's chief of emergency medicine, says hospitals were fortunate with both the when and where of the bombs...

(SOUNDBITE OF AN EXPLOSION)

SMITH: ...that stunned the city.

UNIDENTIFIED MAN #1: Zora 1, the UCC, what was that?

SMITH: Scores of emergency staff were already on scene for the marathon.

UNIDENTIFIED WOMAN: A33, something just exploded at the finish line

SMITH: There was a medical tent just yards away.

UNIDENTIFIED WOMAN: Prepare to receive patients at the alpha tent.

UNIDENTIFIED MAN #2: OK.

SMITH: And six Level 1 trauma centers within a mile or two, who were at shift change and had double the staff available to help. But still, Dr. Wolfe says mistakes and near misses were made, as hospitals dealt with mass casualties you'd expect in battlefields, not city streets.

WOLFE: We did learn a number of new things that allowed us in some ways to rewrite the playbook about how we should handle these going forward.

SMITH: One of the biggies, patient identification. Mass General 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.

ALASDAIR CONN: They looked roughly the same and so we, in the hurry of the moment, we said, oh, she must be this person. And that was incorrect.

SMITH: Mass General's chief of emergency medicine, Alasdair Conn 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.

CONN: That's devastating and we shouldn't do that. But it's challenging; it's very challenging.

SMITH: Hospitals say the marathon also underscored the need to beef up security, so they don't become a secondary target and also for worst case contingency plans. That became clear at Tufts Medical Center, where trauma chief Reuven Rabinovici says a suspicious bag was discovered and the ER had to be evacuated.

REUVEN RABINOVICI: We had to roll all the patients out of the emergency room, in the middle of caring for these patients. The police came, you know, with bomb-sniffing dogs, and they pretty much locked the hospital down.

SMITH: The ER wound up in the front lobby. Rabinovici says hospitals need to be better prepared.

RABINOVICI: 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.

SMITH: Others takeaways, hospitals 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.

UNIDENTIFIED MAN #3: Subject in custody. Subject in custody.

SMITH: When Dzhokhar Tsarnaev was arrested days after the bombing...

UNIDENTIFIED MAN #3: 961, get the ambulance down here now, please.

SMITH: 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.

WOLFE: I don't know what you do differently. 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 bombing victims. What we do is we try to maintain our humanity, even if the perpetrators do not.

SMITH: One other lesson of the marathon bombing is the value of social media. Mass General got an early indication of trouble when an ER doc 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.

Dr. Conn says hospitals can't ignore social media, even if they can't totally trust them either.

CONN: We're trying to wrestle with that, because obviously initial tweets might not be as accurate. 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.

SMITH: In some ways, hospitals say, the biggest lesson from the marathon is the need to share. Sadly, they say, nothing teaches like experience. Tovia Smith, NPR News, Boston. Transcript provided by NPR, Copyright NPR.

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