title: Lessons From the Boston Marathon Bombing: An Orthopaedic Perspective on Preparing for High-Volume Trauma in an Urban Academic Center.
abstract: The 2013 Boston Marathon bombing resulted in a mass casualty event that tested the limits of Boston-area trauma centers. The explosions, 12 seconds apart, led to the rapid influx of 124 patients with primarily lower extremity injuries in 5 different adult level 1 trauma centers. This study aimed to examine the existing hospital systems in place for disaster scenarios at the time of the event and identify areas for improvement. Preparation before the Boston Marathon bombing included coordinating the delivery of patients to area facilities and creating a framework for response at an institutional level. These simulations, coupled with the fact that the explosions occurred at a nexus of medical facilities, helped provide impactful care preventing any fatalities in patients who arrived at a Boston hospital that day. The experience at our institution led to the implementation of a more robust communication infrastructure and reinforced the value of preparatory drills. Within the Orthopaedic Surgery Department, we developed a more robust organizational hierarchy for mass casualty events and implemented a multitrauma follow-up clinic. We believe that it is the responsibility of every hospital to have systems in place to handle the rapid arrival of patients with multiple-trauma, and we hope that others can learn from our experience.
authors.affiliation: *Harvard Combined Orthopaedic Residency Program, Boston, MA; and †Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tobert
authors.forename: Arvind
authors.initials: A
authors.lastname: von Keudell
authors.forename: Edward K
authors.initials: EK
authors.lastname: Rodriguez
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000328:Adult; D001753:Blast Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D054042:Bombs; D001900:Boston; D004189:Disaster Planning / Q000458:organization & administration; D005107:Explosions; D005260:Female; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents / Q000401:mortality / Q000517:prevention & control*; D008875:Middle Aged; D009985:Orthopedics / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D012420:Running; D016019:Survival Analysis; D023481:Terrorism / Q000517:prevention & control*; D014193:Trauma Centers / Q000458:organization & administration; D014218:Triage; D019037:Urban Health Services / Q000458:organization & administration; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D055815:Young Adult