Preparing for Disaster: Tracey Dechert, MD, FACS and Joe Blansfield, NP share lessons learned from the Boston Marathon bombings

Preparing for disaster: Boston hospitals know the drill but keep practicing

By: Cynthia Saver, MS, RN published in OR Manager Vol. 30 No 2, Feb 2014

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Dr. Dechert gives an update on bombing victims at Boston Medical Center 

Photo courtesy globaltimes.cn, taken in April 2013

In the days after the Boston Marathon bombing on April 15, 2013, many praised the

way the city’s hospitals responded to the attack. But clinicians in those hospitals

aren’t resting on their laurels. They have examined what worked well (and not so

well) after the event and continue to plan for future mass casualty events and other

disasters.

The power of one

A simple, yet powerful, lesson learned from the Boston Marathon bombing is the importance

of a single point of contact for patient tracking. “You need one person who

knows who everyone is, where their medical records are, and where they are located

in the hospital,” says Tracey Dechert, MD, FACS, a trauma and acute care surgeon

at Boston Medical Center, who was on duty when the bombing occurred. “It sounds

like common sense, but on that day there was no master list of patients; it was hard

to find some people.” She says that not everyone arriving in the emergency department

that day had identification with them, and in 1 case a patient was temporarily

assigned 2 different identification numbers. The person in charge of tracking could

be an administrator, rather than taking a physician or nurse away from patient care,

Dr Dechert says.

Representatives from the media will be at the hospital on an ongoing basis to

cover the story, so there also needs to be a person to coordinate briefings. And someone

must coordinate visits from politicians and celebrities who want to visit patients

when such a high-profile event occurs.

Military resources

Joseph Blansfield, APRN, trauma program manager, says Boston Medical Center

incorporated reference material from the US Army Institute for Surgical Research

into physicians’ and staff’s clinical practice.

“There are 39 clinical practice guidelines that have been developed from the experiences

in Iraq and Afghanistan,” he says. “I was a colonel and the chief nurse of

a combat support hospital for a year in Iraq and had a hand in contributing to their

development, so we turned to them right after the bombing.”

The guidelines, which can be accessed at http://www.usaisr.amedd.army.mil/

clinical_practice_guidelines.html, provide specific suggestions for assessment and

clinical management. For example, the guideline on acoustic trauma includes indications

for referral to ear, nose, and throat specialists, and the guideline on infection

prevention related to blast injuries covers antibiotic treatment. The information

was integrated into policies and procedures at Boston Medical Center.

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