Training Made the Difference in MGH Preparedness for Marathon Tragedy

While violently altering the course of hundreds of lives, the Boston Marathon© bombings on April 15 created a medical emergency of enormous and horrific proportions for Massachusetts General Hospital and other Boston-area medical institutions.

For Alasdair Conn, MD, Mass General’s chief of Emergency Services, the tragedy put a sharp focus on the critical importance of planning for the medical aspects of a disaster that can be expected. Elements of chance, such as the number of medical personnel already at the scene, helped keep Boston Marathon© bombing fatalities to a minimum. “But above all, it was the training and repeated disaster drills that made the difference,” says Dr. Conn, who is determined to help other hospitals and communities develop more detailed disaster-response plans of their own.

On the day of the Boston Marathon©, the benefits of preparedness drills emerged quickly at Mass General.

Dr. Conn got a call from Boston emergency authorities two minutes after the first bomb went off that afternoon. Within about 10 minutes, Mass General’s disaster response system had been activated and the ED had mobilized to treat the first of 39 bombing victims who would come to Mass General. The measures taken included dispatching triage specialists to meet arriving ambulances as they pulled up to systematically transfer patients already in the ED to make room for the incoming wounded.

Together as a Team

“We all came together as a team,” Dr. Conn says, “and together as a team, we saved lives.”

In the modern era, the recognition of Mass General’s leadership in responding to large medical emergencies dates to its treatment of scores of victims from the 1942 Cocoanut Grove nightclub fire in Boston, which killed nearly 500. MGH leadership undertook a detailed review of the hospital’s disaster-response procedures in the months following the terrorist attacks of Sept. 11, 2001.

“We all came together as a team,” Dr. Conn says, “and together as a team, we saved lives.”

Mass General sought outside advice and engaged in broad collaboration. Israeli emergency physicians came to Mass General to describe their procedures for responding to bus bombings and other incidents that required them to be able to manage up to 80 emergency patients at a time. Mass General and other Boston hospitals coordinated with Boston Emergency Medical Services officials in preparing for disaster scenarios that included a simulated building collapse and the detonation of a dirty bomb at Logan airport.

Internally, Mass General established a detailed hospital incident command system, or HICS, designed to bring military-like precision to decision making and operations after an emergency is declared. Mass General’s HICS also includes an intricate notification system designed to simultaneously alert dozens of key personnel to contact or go to the hospital as soon as an emergency has been declared. In addition to establishing a command post in a centralized location on the hospital campus, the Mass General HICS establishes procedures for everything from procuring additional equipment, such as ventilators, to providing the MGH incident commander with up-to-date intelligence about medical and emergency developments citywide.

Internally, Mass General established a detailed hospital incident command system, or HICS, designed to bring military-like precision to decision making and operations after an emergency is declared.

Sharpened Determination

Activated after the marathon bombings, the notification system has been the subject of repeated drills in recent years, including on weekends and late at night. “My home, office and cell phones ring,” Dr. Conn explains. “My email and pager go off.”

The MGH Emergency Response Fund.