title: Leadership During the Boston Marathon Bombings: A Qualitative After-Action Review.
abstract: OBJECTIVE
  On April 15, 2013, two improvised explosive devices (IEDs) exploded at the Boston Marathon and 264 patients were treated at 26 hospitals in the aftermath. Despite the extent of injuries sustained by victims, there was no subsequent mortality for those treated in hospitals. Leadership decisions and actions in major trauma centers were a critical factor in this response.
  
  
  METHODS
  The objective of this investigation was to describe and characterize organizational dynamics and leadership themes immediately after the bombings by utilizing a novel structured sequential qualitative approach consisting of a focus group followed by subsequent detailed interviews and combined expert analysis.
  
  
  RESULTS
  Across physician leaders representing 7 hospitals, several leadership and management themes emerged from our analysis: communications and volunteer surges, flexibility, the challenge of technology, and command versus collaboration.
  
  
  CONCLUSIONS
  Disasters provide a distinctive context in which to study the robustness and resilience of response systems. Therefore, in the aftermath of a large-scale crisis, every effort should be invested in forming a coalition and collecting critical lessons so they can be shared and incorporated into best practices and preparations. Novel communication strategies, flexible leadership structures, and improved information systems will be necessary to reduce morbidity and mortality during future events.
authors.affiliation: 1Brigham and Women's Hospital.
authors.forename: Eric
authors.initials: E
authors.lastname: Goralnick
authors.affiliation: 9Sourasky Tel Aviv Medical Center.
authors.forename: Pinchas
authors.initials: P
authors.lastname: Halpern
authors.affiliation: 8Harvard T.H. Chan School of Public Health,Harvard University,Cambridge,Massachusetts,United States;
authors.forename: Stephanie
authors.initials: S
authors.lastname: Loo
authors.affiliation: 1Brigham and Women's Hospital.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gates
authors.affiliation: 2Massachusetts General Hospital.
authors.forename: Paul
authors.initials: P
authors.lastname: Biddinger
authors.affiliation: 3Beth Israel Deaconess Medical Center.
authors.forename: John
authors.initials: J
authors.lastname: Fisher
authors.affiliation: 2Massachusetts General Hospital.
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.affiliation: 4Boston Children's Hospital.
authors.forename: Sarita
authors.initials: S
authors.lastname: Chung
authors.affiliation: 4Boston Children's Hospital.
authors.forename: David
authors.initials: D
authors.lastname: Mooney
authors.affiliation: 1Brigham and Women's Hospital.
authors.forename: Calvin
authors.initials: C
authors.lastname: Brown
authors.affiliation: 5Tufts Medical Center.
authors.forename: Brien
authors.initials: B
authors.lastname: Barnewolt
authors.affiliation: 6Boston Medical Center,Boston,Massachusetts,United States;
authors.forename: Peter
authors.initials: P
authors.lastname: Burke
authors.affiliation: 3Beth Israel Deaconess Medical Center.
authors.forename: Alok
authors.initials: A
authors.lastname: Gupta
authors.affiliation: 6Boston Medical Center,Boston,Massachusetts,United States;
authors.forename: Andrew
authors.initials: A
authors.lastname: Ulrich
authors.affiliation: 5Tufts Medical Center.
authors.forename: Horacio
authors.initials: H
authors.lastname: Hojman
authors.affiliation: 7National Preparedness Leadership Initiative.
authors.forename: Eric
authors.initials: E
authors.lastname: McNulty
authors.affiliation: 7National Preparedness Leadership Initiative.
authors.forename: Barry
authors.initials: B
authors.lastname: Dorn
authors.affiliation: 7National Preparedness Leadership Initiative.
authors.forename: Leonard
authors.initials: L
authors.lastname: Marcus
authors.affiliation: 10Tel Aviv University,Tel Aviv,Israel;
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
mesh_terms: D001753:Blast Injuries / Q000628:therapy*; D054042:Bombs; D001900:Boston; D003142:Communication; D005107:Explosions / Q000706:statistics & numerical data; D006801:Humans; D007857:Leadership; D054527:Mass Casualty Incidents / Q000401:mortality*; D036301:Qualitative Research; D023481:Terrorism; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data
keywords: bombs; communication; disaster medicine; emergency medicine; mass casualty incidents