On Monday, April 15 at 2:49 p.m., two improvised explosive devices made from pressure cookers detonated on the route of the Boston Marathon, killing three people and injuring 264. Thus began five days of chaos and panic that both directly and indirectly affected Boston’s hospitals.
Only about 10 minutes after the initial blast did patients start arriving. Many of them required amputations of their lower extremities and/or had open fractures, severe trauma and extreme blood loss. In all, Massachusetts General Hospital (MGH) treated 39 of the injured, six of them critical. Boston Medical Center (BMC) treated 31 victims, including five patients with seven amputated limbs.
Despite the severity of their injuries, not one bombing victim who arrived at any of the Boston hospitals that day lost their lives. This was due, in part, to the location of the city’s six trauma centers, which were in close proximity to the blasts. As a result, Boston EMS was able to distribute the patients among the medical centers so that no one facility would be too overwhelmed with victims. The impressive survival rate was also a testament to the outstanding medical care provided at the blast site and at the hospitals.
Extra Staff, Police Help With Patient Surge
In some ways, good fortune was smiling on MGH and BMC immediately after the bombings. BMC already had extra emergency department staff on hand because the center was expecting runners from the race who developed common medical conditions like dehydration, sprains and exhaustion during the marathon. Additionally, BMC had employees working in the medical tents at the marathon’s finish line. This enabled them to provide real-time information on the situation after the explosions (such as the nature of the victims’ injuries) so that BMC could prepare for the influx of patients.
MGH was in luck as well. The bombing happened during a shift change, so there were twice the normal number of staff members available to treat victims. Additionally, law enforcement was attending training at the hospital, so they were pulled out of class to help with security.
“If this had happened at 3 a.m., it would have been a different story in terms of security,” says Bonnie Michelman, who is MGH’s director of police, security and outside services.
All of this, as well as good planning by both organizations, enabled BMC and MGH to save patient lives, secure the premises and manage visitors as best as could be expected, considering the extremely challenging circumstances. Throngs of patients with various types of injuries were flooding into the hospitals. Family members were arriving, looking for their loved ones. Local law enforcement and SWAT teams were securing the campuses, and, of course, the media was covering everything. What made matters worse was no one knew if their hospitals might be targets. Was there another bomb? Were any of the patients the bombers? Was this a hazmat situation, and did they need to set up the decontamination tents?
Hospital Access, Visitors Closely Monitored
In light of these circumstances, access to the facilities and visitor management had to be managed effectively. With regard to going into lockdown, MGH officials determined this approach would not be appropriate for their situation on Monday. On Friday, however, they were ordered to lockdown.
“The decision to not let people in when you have the choice is, ‘What’s it going to accomplish?’” says Michelman. “If you really need to let people in who need to come in, such as visitors, families and patients, going into lockdown only creates severe delay, gridlock, anger and rage outside. It causes you to have to redeploy resources to places outside the campus rather than inside where you may need them the most. [Hospitals] do a lockdown and then people walk through the door, they provide an ID and they get a badge, but you still don’t know who is going into your facility. I think sometimes it’s an illusion of security.
“On the other hand, on Friday [April 19] when we needed to lockdown, we did that because the state asked us to. They encouraged people not to leave any facility or get on any roadway or walk around the city. For people trying to leave the facility, we explained the situation, asked them to stay, gave them a place where they would be safe and comfortable, but we didn’t mandate that. If people insisted on leaving, we let them leave. For people coming in, we made sure we knew who they were. When they were visitors, we asked them to go to a particular location where they were signed in and reunited with the person they wanted to see in a managed way.”
BMC Director of Public Safety and Control Center for Parking Services Constance Packard says her hospital went into what her organization calls “controlled access.”
“We were checking bags, checking IDs and only employees were getting in; no visits to the patients, except for patients in labor,” she says. “We shut down many buildings by card access that weren’t going to be in use so we could limit our vulnerabilities and we would have only two controlled points. Staffing had to be moved. Physical security systems had to be shut down. We activated our command center within the first 30 minutes.”
Investigation Unit Helps ID Bombs Used in Attack
Initially it was very difficult for MGH and BMC to identify all of the patients in their care. Even the following day, six bombing survivors at MGH remained unidentified.
