Will your hospital be “Boston strong” if a mass casualty happens?

January 12th, 2015

While others leave the site of terrorist activity or a disaster, healthcare providers get to work. I discovered this firsthand six years ago when I covered the tornado that hit the hospital in Americus, GA. As I talked to members of the staff, they shared how they had moved patients from one place in the hospital to another as the building became increasingly unstable. One staff member who was at home told me how she had weaved around downed streets lights and power lines and climbed over debris to reach the hospital.

chowdaheadz.com

The recent bombing in Boston had a similar response. Immediately after the bombing, healthcare providers working at the race and attending moved immediately to help the injured. Nurses at the Boston hospitals reported to the Associated Press having to put their fearful feelings aside as they cared for the patients who were screaming and crying. Nurses reassured patients by holding their hands and telling them “You’re safe with us.” ED staff mopped up blood, and security officers guarded the doors. Staff faced new challenges, including being told by law enforcement investigators initially to not wash wounds because they might wash evidence away. The investigators ended up working side-by-side with staff as they cleaned away the shrapnel and nails. (For more on what happened in the EDs, see Boston Marathon tragedy: Inside local ERs)

Hospital staffers say they’ve found strength by focusing on the progress of the injured. One nurse told AP, “They may have lost a limb, but they're ready to go on with their lives. They want to live. I don't know how they have the strength, but that's my reward: knowing they're getting better."

I ended up having a close-up view of the events surrounding the bombing. As executive editor of our Same-Day Surgery newsletter, I attended the Ambulatory Surgery Center Association meeting that started two days after the bombing at the Hynes Convention Center in Boston. I ventured over to the convention center for the opening reception and was met by an armored car and an armed SWAT team. The center overlooked the street where the bombings occurred. It resembled a movie set with stores, bicycles, and signs, but no people, except those donning hazmat suits to investigate the bombing sites. During one conference session on Friday, we all jumped when multiple phone alarms went off at the same time. It was an alert to stay where we were during the city’s lockdown, part of the effort to flush out the surviving suspect. That night over dinner, a nurse and I watched his capture unfold on television, and we joined the Boston residents in being grateful. When the conference was over, I ventured over to the memorial sites. It seemed that everyone, Boston residents and visitors, was united in stunned grief over the bombings and in our resilience to carry on.

Hospitals and communities have faced similar challenges from the shootings in Aurora, CO, and Newtown, CT, the fertilizer plant explosion near Waco, TX, and the destruction from Hurricane Sandy. “The past year seems to have delivered an unrelenting stream of massive, unthinkable human tragedies, along with countless others that differ only in their scale,” said Rich Umbdenstock, president and CEO of the American Hospital Association, in the April 19 AHA News Now. “In our heartbreak and confusion, Americans have been able to count on the strength and preparedness of the people of America’s hospitals, who have risen to the occasion time and time again as they’re tested in new ways.”

Hospitals aren’t on their own in preparing for mass casualty events. The CDC just issued an advisory with resources to help providers prepare for and respond to mass casualty events. The advisory includes links to CDC fact sheets, guidance and planning documents, data collection and planning tools, and training resources. Also, AHC Media, publisher of this blog, offers resources. We have two helpful webinar recordings:

• “Disaster Planning for Emergency Departments: Is Your Staff Prepared?”
• “Lessons from Aurora: Hospital and ED Response during Trauma Events.”

Also, disaster preparedness and response has been covered frequently in our ED Management newsletter.

If there’s one lesson that hospitals involved in these mass casualties would pass on, I’m sure it would be to be prepared – and do it before the eyes of the national media are on you. Your staff and patients will benefit, and so will your facility’s reputation.