The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster.
OBJECTIVE
We discuss the strengths of the medical response to the Boston Marathon bombings that led to the excellent outcomes. Potential shortcomings were recognized, and lessons learned will provide a foundation for further improvements applicable to all institutions.


BACKGROUND
Multiple casualty incidents from natural or man-made incidents remain a constant global threat. Adequate preparation and the appropriate alignment of resources with immediate needs remain the key to optimal outcomes.


METHODS
A collaborative effort among Boston's trauma centers (2 level I adult, 3 combined level I adult/pediatric, 1 freestanding level I pediatric) examined the details and outcomes of the initial response. Each center entered its respective data into a central database (REDCap), and the data were analyzed to determine various prehospital and early in-hospital clinical and logistical parameters that collectively define the citywide medical response to the terrorist attack.


RESULTS
A total of 281 people were injured, and 127 patients received care at the participating trauma centers on that day. There were 3 (1%) immediate fatalities at the scene and no in-hospital mortality. A majority of the patients admitted (66.6%) suffered lower extremity soft tissue and bony injuries, and 31 had evidence for exsanguinating hemorrhage, with field tourniquets in place in 26 patients. Of the 75 patients admitted, 54 underwent urgent surgical intervention and 12 (22%) underwent amputation of a lower extremity.


CONCLUSIONS
Adequate preparation, rapid logistical response, short transport times, immediate access to operating rooms, methodical multidisciplinary care delivery, and good fortune contributed to excellent outcomes.
*Brigham and Women's Hospital †Tufts Medical Center ‡Massachusetts General Hospital §Boston Medical Center ¶Boston's Children's Hospital, and ‖Beth Israel Deaconess Medical Center, Boston, MA.
Jonathan D
JD
Gates
Sandra
S
Arabian
Paul
P
Biddinger
Joe
J
Blansfield
Peter
P
Burke
Sarita
S
Chung
Jonathan
J
Fischer
Franklin
F
Friedman
Alice
A
Gervasini
Eric
E
Goralnick
Alok
A
Gupta
Andreas
A
Larentzakis
Maria
M
McMahon
Juan
J
Mella
Yvonne
Y
Michaud
David
D
Mooney
Reuven
R
Rabinovici
Darlene
D
Sweet
Andrew
A
Ulrich
George
G
Velmahos
Cheryl
C
Weber
Michael B
MB
Yaffe
D000293:Adolescent; D000328:Adult; D054042:Bombs; D001900:Boston; D054597:Disaster Medicine / Q000458:organization & administration*; D004189:Disaster Planning / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000379:methods* / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D023481:Terrorism / Q000517:prevention & control*; D055815:Young Adult