Boston Marathon Bombings: An Emergency Department Responds

Susan Yox, RN, EdD; Julia L. Compton, RN, BSN

Disclosures

April 24, 2013

In This Article

The Explosions

Julia Compton: We were just kind of waiting -- the waiting game. It was unusually quiet; we had treated only 1 person from the marathon so far. Then the disaster radio went off in the ED, saying that there was an explosion that happened around 2:50 or 2:51 PM. In my head I'm thinking, "Why would they be doing a drill during the marathon? That's so weird." Then they followed it up by asking, "How many people can you take?" and we realized it was real.

So, we responded like we should. I called everybody together -- nurses, doctors, and technicians. I said, "I used to work down the street at Boston Medical Center, and I remember that when I was in charge during difficult days, my emergency manager always said, 'Make sure that your staff contacts their family to be sure they are safe, because you really can't care for anybody else unless you know that your own family is okay.' I asked them not to go into detail about what was going on [when they contacted their families] because we really didn't know what was going on. I thought it was important that the staff made sure their families were safe before patients began arriving, because a lot of them had family members either in the marathon or on the scene.

Medscape: What happened next?

Julia Compton: We called the trauma team down to the ED and we alerted them to what was going on. They got 4 different teams assembled at the different trauma beds in the rooms. We made sure that we had an attending physician at each bed. We had 2 nurses, a technician, and a resident at each bed as well and then we went over what everyone's role was.

Medscape: Did you have any idea about what to expect?

Julia Compton: Well, we just knew that we were going to be getting mass casualties. Obviously, things are going to be chaotic, and the more information the staff has about what their duties are, the more they will feel in control of an uncontrolled situation. So, I wanted to give as much information as possible to my staff and the people in the department. We quickly planned for frequent "roundups," where we just quickly stop everything in the department for 20 seconds and say, "This is what's going on now" and then 20 minutes later we do the same thing. That way, people know where they are supposed to go and what to do, because things change so rapidly.

That worked out well. Everybody knew what their duties were and they could get reassigned if they didn't feel like they were being useful. Of course, we also had extra staff from the rest of the hospital there by then, and they were asking what they could do. I just had this gut feeling that I didn't know what was going on in the front of the ED, meaning the waiting room. I wanted to ensure that if there were patients in the waiting room that they were safe and that security knew to watch every single entrance, so I sent some of the nurses from upstairs out there, for crowd control and to monitor what was going on.

Medscape: How quickly did patients start arriving, and in what condition?

Julia Compton: I think we got about 14 patients within 20 minutes, and 4 of them went upstairs to the operating room within 25 or 40 minutes of arrival. All of the victims were conscious, and what was very eerie was that they were all very calm. I think that must have been the shock, but I also specifically remember saying out loud, "This person has an open tib-fib and a question of a femur fracture" and "This person has circumferential burns of the abdominal area," for example. And then I just kind of sent them to where they were supposed to go. And I thought to myself, "Nobody does this on a normal basis -- indicate the findings out loud, in front of the patients. This isn't what comes out of your mouth on a day-to-day basis," you know what I mean?

Burn patients went up to the operating room pretty emergently. Then there were people with open mangled lower extremity fractures; they went up to the operating room right away as well. But we did not get any of the people who had amputations, although our orthopedic surgeons and trauma surgeons were expecting them. Sometimes, from the healthcare professional's perspective, it is harder to manage the patients with open mangled fractures, because further down the line they're still going to have many issues.

Medscape: How many of the patients were runners?

Julia Compton: We had only 4 marathon runners. Everybody else was a bystander.

Medscape: Were most of the patients admitted alone, without their family or friends?

Compton: Yes. Eventually they were all connected, however. I don't know how all that happened -- I truly don't -- but eventually everybody met up with their family members, in a rather quick manner -- almost quicker than on a regular marathon day, which I thought was surprising. But I think it's because most of our patients weren't marathon runners. They were bystanders who were with their family.

What was just as amazing was how everyone was so calm and so appreciative. You'd think that they'd be hysterical. Perhaps it was the absolute horror or the shock of what had happened.

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