title: The Boston Marathon bombing: after-action review of the Brigham and Women's Hospital emergency radiology response.
abstract: OBJECTIVE
  To analyze imaging utilization and emergency radiology process turnaround times in response to the April 15, 2013, Boston Marathon bombing in order to identify opportunities for improvement in the Brigham and Women's Hospital (BWH) emergency operations plan.
  
  
  METHODS
  Institutional review board approval was obtained with waivers of informed consent. Patient demographics, injuries, and outcomes were gathered, along with measures of emergency department (ED) imaging utilization and turnaround times, which were compared with operations from the preceding year by using the Wilcoxon rank sum test. Multivariate linear regression was used to assess contributors to examination cancellations.
  
  
  RESULTS
  Forty patients presented to BWH after the bombing; 16 were admitted and 24 were discharged home. There were no fatalities. Ten patients required emergent surgery. Blast injury types included 13 (33%) primary, 20 (51%) secondary, three (8%) tertiary, and 19 (49%) quaternary. Thirty-one patients (78%) underwent imaging in the ED; 57 radiographic examinations in 30 patients and 16 computed tomographic (CT) examinations in seven patients. Sixty-two radiographic and 14 CT orders were cancelled. Median time from blast to patient arrival was 97 minutes (interquartile range [IQR], 43-139 minutes), patient arrival to ED examination order, 24 minutes (IQR, 12-50 minutes), order to examination completion, 49 minutes (IQR, 26-70 minutes), and examination completion to available dictated text report, 75 minutes (IQR, 19-147 minutes). Examination completion turnaround times were significantly increased for radiography (52 minutes [IQR, 26-73 minutes] vs annual median, 31 minutes [IQR, 19-48 minutes]; P = .001) and decreased for CT (37 minutes [IQR, 26-50 minutes] vs annual median, 72 minutes [IQR, 40-129 minutes]; P = .001). There were no significant differences in report availability turnaround time (75 minutes [IQR, 19-147 minutes] vs annual median, 74 minutes [IQR, 35-127 minutes]; P = .34).
  
  
  CONCLUSIONS
  The surge in imaging utilization after the Boston Marathon bombing stressed emergency radiology operations. Process analysis enabled identification of successes and opportunities for improvement in ongoing emergency operations planning. © RSNA, 2014.
authors.affiliation: From the Department of Radiology, Emergency Radiology Section (J.B., T.C.R., A.A.C., A.S.), Department of Emergency Medicine (E.G., A.S.R.), and Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care (J.M.H.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.
authors.forename: John
authors.initials: J
authors.lastname: Brunner
authors.forename: Tatiana C
authors.initials: TC
authors.lastname: Rocha
authors.forename: Avni A
authors.initials: AA
authors.lastname: Chudgar
authors.forename: Eric
authors.initials: E
authors.lastname: Goralnick
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Havens
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.forename: Aaron
authors.initials: A
authors.lastname: Sodickson
mesh_terms: D000328:Adult; D000368:Aged; D001753:Blast Injuries / Q000175:diagnosis* / Q000601:surgery; D054042:Bombs; D001900:Boston; D003952:Diagnostic Imaging; D004189:Disaster Planning; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D009104:Multiple Trauma / Q000175:diagnosis* / Q000601:surgery; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000458:organization & administration*; D023481:Terrorism