Public Health is … Emergency Preparedness for Boston Marathon

Written by Katrin Cox and Danielle Duong

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Photo Credit: The Associated Press

Two weeks ago, the world was sent into shock upon hearing that there were bombings at the Boston Marathon. As avid long-distance runners ourselves, these bombings hit particularly close to home, and we deeply feel the pain, fear, and shock of the victims and their families.

The Boston Marathon is the world’s oldest marathon and is considered to be one of the most prestigious races, since you can only sign up if you have met its stringent time-based qualifying standards. Many runners spend years training to qualify for Boston (one of the authors included!), but not all of them are able to do so.

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The Boston Marathon usually registers over 20,000 competitive runners and attracts over 500,000 eager spectators to the Greater Boston area, making it New England’s most popular sports event [1]. This year, the unexpected bomb attack turned Boston’s most inspirational event into a bloody battleground, throwing the city into complete chaos. The bombers had the intention of killing as many people as possible. The explosions left three dead and over 250 injured.

What went right on such a tragic day? Some say it’s a miracle that so many people survived. Others say they were lucky to be in a city with the nation’s best medical centers. But with a closer public health look, we realize Boston’s emergency preparedness and coordination plans made the real difference.

Within moments of the explosions, medical tents near the finish line were ready to stabilize injured runners and spectators [2]. Typically, volunteer medical personnel are prepared to address common runner conditions including dehydration, hyponatremia, muscle cramps, sunburn, and sprains and stress factors [3]. But Boston Marathon volunteers went beyond their expectations and took in patients who suffered life-threatening conditions while ambulances raced to the scene.

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Photo Credit: Charles Krupa / AP

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Photo Credit: David L. Ryan, The Boston Globe, Getty Images

Once ambulances arrived, patients were quickly loaded and transported to appropriate health centers. Prepared facilities include the nation’s finest: Massachusetts General Hospital, Boston Children’s Hospital, Tufts Medical Center, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center [4]. Trauma centers throughout Boston followed their emergency plans by calling in off-duty staff, bringing in physicians and nurses from other facilities, and assigning personnel to high priority cases.

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Boston’s response was extraordinary. But are other cities in the country as prepared?

Here at the UC Berkeley School of Public Health, we continually push the value of preparedness and prevention. How can we plan in advance for disasters and tragedies? What systems and structures need to be in place for quick and effective responses?  

“Nothing can really prepare one for the worst (all-hazards), but it’s what we train and plan for with steady precision, measured restraint, and commitment to do good in our communities and tailored to varying site specific venues,” says Michelle Heckle, Certified Healthcare Emergency Professional at Children’s Hospital & Research Center Oakland. Michelle’s role, as she describes it, is to plan the catastrophic demise of the organization and all of its people AND mitigate against it – and nobody can do this alone.

All hospitals in the US are required to have an Emergency Operations Plan (EOP) [5].  This plan is guided by the National Preparedness Goal [6], often based on The Joint Commission standards, and helps hospitals mitigate, prepare, plan, respond, and recover from emergency situations. In addition to the EOP, it is important that hospitals have a dynamic and strong incident command system (ICS) team. Heckle says that her team “consistently keeps a pulse on events occurring around the nation and learns to scale up or down quickly.”

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Now we can look to Boston as a model example. Boston’s healthcare system had been long prepared for this tragedy. In 2011, the city held an emergency drill that brought together Boston police, firefighters, hospitals, and emergency medical service workers [2] to respond to a mock situation. This effort reflects the city’s long-term commitment to developing response plans directing patient care and trauma and healthcare personnel to appropriate facilities. In the past decade, health centers and emergency personnel have been sharing resources, developing strategies, and detailing action plans as groundwork for an event like the bomb attack on the Boston Marathon [4].

However, emergency response isn’t just limited to physical trauma. Ana-Marie Jones, Executive Director of the Collaborating Agencies Responding to Disasters (CARD), writes in her upcoming article in the Oakland Business Review:

“Feed your employees a steady diet of helpful stress-reducing information. Many people have negative reactions just from watching coverage of tragic events. Provide information about stress and grief counseling, and make sure they know they can call 2-1-1, crisis hotlines, and other free and confidential resources. Encourage them to sign up for local alerts from the police department. Send reminders for people to stay hydrated and to breathe deeply.”[7]

While all physical injuries have been addressed, we must remember that the situation isn’t over yet: tragedies such as the Boston Marathon have very long-lasting effects on society that affect far more than those directly injured. “The public health continuum endures after initial treatment and response as a reflection of the whole community effort,” says Heckle. Those who were injured will endure months, if not years of physical therapy. Such tragedies also cause significant mental health issues, which sometimes remain unaddressed among the injured and their loved ones.  Aftermath plans must include institutional strategies to address mental health concerns that could linger for those who fell victim to the disaster.

While we were shocked to hear about the bombings in Boston, we are proud that our healthcare system, despite its flaws, was able to respond so quickly and take excellent care of the injured. Around the world runners have united to “run for Boston.” As committed runners, we are incredibly stubborn, and nothing, not even bombs, will stop us from doing what we love to do. As we look forward to lining up for our next race – which will hopefully one day be the Boston Marathon – we take comfort in knowing that in the event of a medical emergency, we will be prepared.

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[1] http://216.235.243.43/races/boston-marathon/boston-marathon-history/boston-marathon-facts.aspx

[2] http://online.wsj.com/article/SB10001424127887324345804578427250465921428.html

[3] http://walking.about.com/od/marathontraining/tp/marathoninjury.htm

[4] http://www.huffingtonpost.com/2013/04/16/emergency-plans-boston-hospitals_n_3094285.html

[5] www.calhospitalprepare.org

[6] www.fema.gov

[7] 5 Lessons for Oakland Businesses from the Boston Marathon Bombings by Ana-Marie Jones, Executive Director, CARD (to be published in May 2013 edition of Oakland Business Review)

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