Since the senseless attack on the Boston Marathon occurred on April 15, it has been a truly extraordinary time for Massachusetts and for our state's hospitals in particular. While so much has been said already from the president to our elected officials, about the stellar ways that our state's healthcare providers rose to meet the challenges of this horrific event, I wanted to share the overview of our hospital community's extraordinary response to this tragedy that appeared in MHA's Monday Report. The article truly captures some of the outstanding examples of our hospitals' outstanding work and the exceptional caliber of those healthcare professionals who showed us their best on the darkest of days. The text of the article is posted below:
UNPARALLED CARE IN THE FACE OF TRAGEDY
The horrible events that occurred on Patriots Day, April 15, 2013, during the annual Boston Marathon caused incalculable pain and suffering. But the loss of life and devastating injuries could have been worse. Because of the quick action of first-responders, the unselfish actions of bystanders, and the fact that the race was staffed by, and close to, some of the best medical talent on the globe many of the injured were able to receive immediate, lifesaving, coordinated care that reduced what could have been a more staggering fatality toll.
The Massachusetts healthcare system – from on-site caregivers who ran towards the blasts to help the injured, to the EMS officials who seamlessly triaged patients and directed ambulances, to the world-class hospitals staffed by remarkable surgeons, nurses, and others – all performed excellently, garnering the admiration and gratitude of the nation and world.
"… WE WILL CHOOSE TO SAVE AND TO COMFORT AND TO HEAL"
After speaking at an interfaith service at the Cathedral of the Holy Cross in Boston on Thursday, President Barack Obama visited Massachusetts General Hospital (shown below) where he met with patients injured in Monday's blasts and the hospital staff that is caring for them. First Lady Michelle Obama visited Brigham and Women's Hospital.
At the interfaith service, Obama said of Boston, "Year after year, you welcome the greatest talents in the arts and science, research -- you welcome them to your concert halls and your hospitals and your laboratories to exchange ideas and insights that draw this world together … You've shown us, Boston, that in the face of evil, Americans will lift up what's good. In the face of cruelty, we will choose compassion. In the face of those who would visit death upon innocents, we will choose to save and to comfort and to heal. We'll choose friendship. We'll choose love."
Photo: Pete Souza, White House
20 HOSPITALS; 219 PATIENTS
Following the explosions, the Boston Medical Intelligence Center was set up as the lead point of contact. It coordinated information sharing on family unification, and was the lead for assessing continuing needs, and available resources for medical-surgical and mental health services.
Hospitals were requested to provide information about patients to the Department of Public Health's Department Operations Center. As of Thursday afternoon, 219 patients associated with the blast were treated at the following 20 hospitals and one health center:
Beth Israel Deaconess Medical Center; Beth Israel Deaconess Hospital – Needham; Boston Medical Center; Brigham and Women's Hospital; Cambridge Health Alliance; Carney Hospital; Boston Children's Hospital; Emerson Hospital; Faulkner Hospital; Hallmark Health; Massachusetts General Hospital; Massachusetts Eye and Ear Infirmary; MetroWest Medical Center; Milford Regional Medical Center; Mount Auburn Hospital; Neponset Health Center; North Shore Medical Center; South Shore Hospital; St. Elizabeth's Hospital; Tufts Medical Center; and Winchester Hospital.
WHY WAS THE RESPONSE SO EFFECTIVE?
It wasn't luck that the medical response worked so effectively. Rather it was the result of a Massachusetts emergency response system that had planned, practiced, adapted, and evolved over the years, combined with the actions of so many people who performed extraordinarily under such dire circumstance.
On Monday, the large number of Emergency Medical Service (EMS) personnel on site was of great importance as they were able to triage and coordinate patient care quickly. The communications system that was in place between hospitals, the Central Medical Emergency Direction (CMED) Center, and Regional EMS – including use of the statewide WebEOC system that is managed by the Massachusetts Department of Public Health's Emergency Preparedness Bureau – all helped everyone communicate needs and resources. (WebEOC is a crisis information management system that provides real-time information sharing. MHA learned that all providers went into WebEOC within minutes to update important data such as bed and staffing availability; this was the central and most effective method for providers to know what was expected, what might be coming and where to turn for assistance.)
The explosion occurred in close proximity to many hospitals, including five Level 1 Trauma Centers, meaning they have the expertise to treat just about any injury that comes through their doors. These hospitals also have specially trained staff that helped write the national guidance and protocols on mass casualty, disaster planning, and trauma-level services.
An important factor that helped with the coordination was the elimination of ambulance diversions within Massachusetts a few years ago. With this change, hospitals learned how to coordinate patient-care needs hospital wide when their emergency departments were full with emergent and urgent situations. During Marathon Monday's tragedy, hospitals were able to coordinate/change operations quickly to meet patient need; many hospitals received 10 to 20 or more mass casualties in under an hour.
And because hospitals were well equipped with equipment and medical supplies they were able to provide emergency and trauma level services in a timely manner to all patients that came into their EDs.
Preparedness also played a key role. All hospitals have conducted city-wide and whole-hospital drills to help them develop internal procedures for how to respond to a mass casualty. As has happened in other serious situations, off-duty hospital staff (physicians, nurses, and ancillary workers) immediately left their homes and went to their hospitals to provide help to their on-duty colleagues. Staff also coordinated internally to ensure that there were enough caregivers to handle the patient flow. Hospitals checked availability and pulled staff from various departments or other local providers to help shifts as needed. It also became clear that numerous doctors, nurses and other medical personnel at Massachusetts hospitals had battlefield experience from serving overseas or had experience treating U.S. soldiers returning from war, which assisted them in dealing with bomb-related injuries.
The state, through the "HHAN" emergency communication network and DPH, provided guidance, and MHA was in constant communication with its membership.
All in all, the system worked when it was called upon to meet an unprecedented mass casualty situation. Governor Deval Patrick, in a moving speech before an interfaith gathering on Thursday, spoke of the many things for which he was grateful in the aftermath of the explosions, saying, "I’m thankful for the medical professionals -- from the doctors and trauma nurses to the housekeeping staff, to the surgeon who finished the marathon and kept on running to his operating room -- all of whom performed at their very best."
MHA's and COBTH's STATEMENT
MHA President & CEO Lynn Nicholas, FACHE, and the Executive Director of the Conference of Boston Teaching Hospitals John Erwin released the following statement following the Boston Marathon tragedy:
On behalf of our hospital community, MHA and COBTH would like to express our heartfelt sorrow and sympathy to the victims and families of yesterday's tragic events at the Boston Marathon. Our thoughts are with those families who lost loved ones, those who were injured and those indirectly affected. We want to commend the heroic efforts of hospitals, first responders, and the local, state and federal agencies that collaborated to ensure that the injured received care in the immediate aftermath of the event. Those on the frontline helped save lives, many without regard to their own personal safety.
In particular, we want to express our appreciation and admiration for the professional and dedicated efforts of all hospitals and their staff that worked to care for these patients under extraordinary conditions. Even as the care for victims who were gravely injured continues, hospitals are working together and collectively with the state to identify additional resources that can be extended to support the broader community both at this time and in the coming weeks
MENTAL HEALTH NEEDS NOT FORGOTTEN
Even as lives were being saved on Monday through timely triage and surgery, the mental healthcare system was moving into high gear. It became apparent early on that the patients, families, and public affected, as well as caregivers – especially first responders – grappling with unspeakable horror could be emotionally scarred by the experience. The U.S. Department of Health and Human Services immediately deployed 21 mental health professionals to assist throughout Boston. In a conference call between hospitals and state officials on Tuesday, the Boston Medical Intelligence Center requested that hospitals and other healthcare providers quickly provide not only the mental health resources they were able to offer but also the services that may be required for patients and staff. The Massachusetts Department of Mental Health attempted to coordinate mental healthcare resources from around the state and on Thursday posted these state and federal resources on its website.
POST ACUTES OFFER HELP
In the hours and days following the bombing, MHA received numerous calls from the post-acute community – long-term acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies. The discussions focused on one question: How can we help? During the crisis, the post acutes offered to take patients to relieve any congestion among the acute care hospitals. And as the extent of the injuries became clear – many amputations requiring extensive rehabilitation – the post acutes knew that their expertise would be required in the future.
BOSTON BLOOD SUPPLIES OK FOR NOW; BUT GIVE LATER
As the details of the tragedy became apparent, people from around the commonwealth obviously thought that the most important and appropriate offering they could make to those fighting traumatic injuries was the gift of blood. Fortunately, Massachusetts hospitals were well stocked during the tragedy and actually had to turn away donors. But blood donations will always be needed; it's just a matter of giving at the right time. The American Red Cross urged people to call 1-800-RED CROSS or click here to schedule an appointment to give blood in the days and weeks ahead.
THE ONE FUND
Massachusetts Governor Deval Patrick and Boston Mayor Tom Menino have announced the formation of The One Fund Boston, Inc. to help the people most affected by the tragic events that occurred in Boston on April 15, 2013. Find out more here.