Contemporary Case Study: Boston Marathon Bombing
Mass casualty incidents, if they are natural or man-made, remain a constant global threat and the adequate preparation and alignment of resources with immediate needs remain the key to optimal outcomes (Gates et al., 2014). On April 15, 2013, two improvised explosive devices (IEDs) were detonated closely after each other near the finish line of the Boston Marathon, in the middle of a densely packed crowd of thousands of runners and spectators (Biddinger et al., 2013, p. 1958). Overall, three people were killed and 264 were injured, with more than 20 sustaining critical injuries (Marcus, L. J., McNulty, E., Dorn, B. C., M.H.C.M. & Goralnick, E., 2014, p. 5).
According to the Emergency Medical Care Advisory Board’s Standing Committee on Mass Casualty Incident Planning and Evaluation in Massachusetts, a mass casualty incident is “one in which the number of people killed or injured in a single incident is large enough to strain or overwhelm the resources of local EMS providers” (Federal Emergency Management Agency, 2013, August 2). Since these were the first IEDs to cause mass injuries in the United States the response team did not expect this type of incident, but they demonstrated the benefits from advanced planning and exercising for large mass-gathering events (Federal Emergency Management Agency, 2013, August 2). The scale of this mass casualty incident required local, state, and federal partners to carry out a coordinated multi-agency response (Federal Emergency Management Agency, 2013, August 2).
In order to have an organized response to such an event there not only needs to be a preparation for a mass casualty incident, but also a quick and efficient response from police, medical and civilian teams. The response to the Boston Marathon Bombings in 2013 seemed to be successful because of the meticulous planning that took place beforehand and the emergency response executed after the bombings.
Event Preparedness
Following the 9/11 attacks, Massachusetts emergency management and response communities from multiple jurisdictions developed and enhanced plans to strengthen response capabilities (Federal Emergency Management Agency, 2013, August 2). In addition, local, state, and federal agencies, private-sector partners, and nongovernmental organizations in Boston developed plans to define roles and responsibilities during the Boston Marathon (Federal Emergency Management Agency, 2013, August 2). These agencies conducted exercises to test these plans, as well as communication and coordination during large-scale events (Federal Emergency Management Agency, 2013, August 2). This allowed for a quick response to the events that unfolded after the bombings.
Each year, Boston emergency management and response agencies conduct extensive medical planning to prepare for the Boston Marathon. In January 2013, the Massachusetts Emergency Management Agency convened a multi-agency, multidisciplinary team for three months to develop all the plans for the Marathon (Federal Emergency Management Agency, 2013, July 10). In addition, the Boston Athletic Association, Boston Emergency Medical Services, and the Boston health care community planned and drilled for mass casualty incidents for many years (Gates et al., 2014).
Particularly the medical preparation at the event allowed for an effective response to the incident. The goal of the medical coordinator for the Boston Athletic Association, Chris Troyanos, was to minimize the impact of the race on the local health care systems, especially hospital emergency departments (The Journal of Bone & Joint Surgery and the Journal of Orthopaedic & Sports Physical Therapy, 2014). The effective response was enabled by the medical community's prior efforts to build and sustain emergency-preparedness programs and to practice its response in exercises and drills (Biddinger et al., 2013, p. 1958). This included exercises where participants exercised multiple scenarios, one of which consisted of an IED incident during the Marathon (Federal Emergency Management Agency, 2013, August 2).
Using the previous year’s experiences, the Massachusetts Emergency Management Agency was able to improve their coordination of systems, relationships, and protocols in order to be prepared for any situation (The Journal of Bone & Joint Surgery and the Journal of Orthopaedic & Sports Physical Therapy, 2014). Especially since there had been high temperatures at the 2004 and 2012 Boston Marathon, a temporary medical tent had been put up at the finish line to provide care for up to 2500 runners (Gates et al., 2014). Additionally, Boston Emergency Medical Services crews were stationed at the tent to transport those approximately 200 to 250 runners in need of further medical attention to the Boston area hospitals (Gates et al., 2014). Since the Marathon is considered a planned mass casualty event, all the hospital stakeholders, including all 6 level 1 trauma centers in Boston, had their emergency systems activated on race day as well (The Journal of Bone & Joint Surgery and the Journal of Orthopaedic & Sports Physical Therapy, 2014).
Response Team
Moments after the explosions law enforcement and emergency medical services hurried quickly to those affected by the blast. At the same time Unified Command began to form when senior law enforcement and emergency management officials came together on Boylston Street and immediately began coordinating priorities (Massachusetts Emergency Management Agency, 2014). Less than 40 minutes following the explosions, the Unified Command shifted operations to a Unified Command Center established at the nearby Westin Hotel (Massachusetts Emergency Management Agency, 2014). The Unified Command made decisions on initial law enforcement response and investigation issues, including securing the crime scene, determining the extent of the ongoing threat, and protecting critical infrastructure, as well as managing the runners evacuated off the course (Massachusetts Emergency Management Agency, 2014). Local and state law enforcement worked with the FBI to secure and process the crime scene, respond to increased calls for suspicious activity and suspicious packages, and conduct the investigation (Massachusetts Emergency Management Agency, 2014).
Not only were the response teams prepared for any disaster but the organization of key leaders to quickly form a Unified Command and facilitate collaborative decision making ensured the success of the response (Massachusetts Emergency Management Agency, 2014). Describing the response efforts after the blasts at the Marathon, Kurtz Schwartz, Massachusetts Undersecretary of Public Safety, stated that “the cooperation and collaboration across agencies, disciplines, and jurisdictions was immediate and extraordinary. There was a unity of focus and unity of purpose at the command level and through the ranks all the way down to the first responders” (Federal Emergency Management Agency, 2013, August 2).
It is evident that despite the fact that there were key leaders in charge of the response, no one was in charge of the whole event (Marcus, L. J., McNulty, E., Dorn, B. C., M.H.C.M. & Goralnick, E., 2014, p. 8). This is termed as swarm intelligence, where no one is in charge yet decisions are made for the benefit of the whole including dynamic allocation of labor, evaluation of data input, and choosing among multiple options (Marcus, L. J., McNulty, E., Dorn, B. C., M.H.C.M. & Goralnick, E., 2014, p. 10). This allowed the key leaders to work together to come up with solutions without the typical issues that arise during large scale crises, such as bickering among political leaders and cross-jurisdictional conflict about who is in charge and who gets credit (Marcus, L. J., McNulty, E., Dorn, B. C., M.H.C.M. & Goralnick, E., 2014, p. 11).
Although the Unified Command Center worked together to coordinate messages and host press conferences, they did not utilize a Joint Information Center at any time during the week of the attack and search for the perpetrators (Massachusetts Emergency Management Agency, 2014). A Joint Information Center would have been able to support the management of the media requests necessitated by the constant news cycle (Massachusetts Emergency Management Agency, 2014). On the day of the bombing, the Unified Command Center was able to coordinate four formal press conferences to explain what public safety officials were doing in response to the bombings, and ultimately, request photographs or video from the public taken before, during or after the bombings (Massachusetts Emergency Management Agency, 2014). After the Unified Command Center stood down on Tuesday, public messages became less coordinated. Agencies and organization that provided public information ended up not coordinating their messages, which led to conflicting information in the media (Massachusetts Emergency Management Agency, 2014).
On the day of the bombings, medical personnel supporting the tent near the finish line immediately transitioned to a mass casualty response. They not only established a triage system and treatment groups but also designated the tent as a casualty collection point (Massachusetts Emergency Management Agency, 2014). Since the Boston Athletic Association put an all-hazards medical system in place for the day of the Marathon with the intent of taking pressure off the area hospital system by minimizing the number of patients who needed to be transported to hospitals, they were able to transport the injured immediately (Massachusetts Emergency Management Agency, 2014). All critically injured patients were transported to area hospitals within 50 minutes (Massachusetts Emergency Management Agency, 2014). Although many patients sustained grave injuries, every patient who was transported to area hospitals survived because of the rapid response of the medical team.
Conclusion: Learning Experience
The response that occurred in Boston followed a carefully crafted and practiced set of plans based on other mass casualty incident’s that were intentional attacks. The speed and coordination associated with the response is therefore attributable to the review of other cities experiences, adjusting the plan and training response teams in implementing those plans. Hence, the Boston Marathon Bombings can set an example of the things that worked and did not worked