Boston Hospitals Lean on Sept. 11 Lessons in Swift Response to Bombs

Once a year, Boston hospitals work together to train for the unthinkable. When it happened during the Boston Marathon, they were ready.

With emergency teams already on hand because of the race, the city’s emergency rooms “went into auto-mode,” said Mark Pearlmutter, chief of emergency medicine at St. Elizabeth’s Hospital in Boston. Within minutes after the bombs went off, the wounded were parceled into five major trauma centers that took those with the worst injuries. Several other community centers handled the rest.

A key reason the triage went smoothly is the city’s program of training drills that date to the aftermath of the Sept. 11 terrorism attacks, doctors said.

“We had protocols, policies and work flows in place to do the best job possible,” Pearlmutter said.

The drills, now standard in most major U.S. cities, cover everything from plane crashes to natural disasters and dirty bombs, medical officials said. Each of the hospitals sends a team of 10 to 20 doctors and staff to the yearly drills, Pearlmutter said in a telephone interview. The teams are then asked to respond to each scenario and the responses are discussed in depth by the entire group, he said.

This helps create the area-wide plans that kick in when an actual emergency occurs.

A mass trauma like the Boston explosions, isn’t much different from a bomb blast scene in a war zone, doctors said.

The first step is to quickly determine which patients are most in danger of dying, no easy task in a bombing when hundreds of victims are covered in blood, some with life-threatening internal injuries and others with little more than superficial cuts.

Stephanie Kayden, an attending physician in the department of emergency medicine at Brigham & Women’s Hospital in Boston, said the biggest problem with blast injuries “is they can look a lot less severe than they actually are. The liver is just a hunk of fleshy material,” she said. “Although you may not see any damage on the outside, the liver itself can be broken into pieces and bleeding profusely.”

Brigham & Women’s emergency department treated 31 patients Tuesday, five of whom were still critically injured as of Tuesday afternoon, Kayden said.

Medical personnel were treating three primary groups of injuries: internal bleeding, those sustained when falling or thrown to the ground from the bomb’s shock wave and embedded debris from the bomb as well as flying glass, he said.

Said Paul Biddinger, medical director for emergency preparedness at Massachusetts General, “We’re proud we were able to limit the injury and illness, but it was a tragic event,” Biddinger said. “Everyone is going through sorrow and loss. It was a great system response, but it’s hard to celebrate given the reason for what went on.”

This article appeared in print on page 4 of the April 18th, 2013 edition of Hamodia.