Boston Marathon Bombings: An Emergency Department Responds

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

Disclosures

April 24, 2013

In This Article

The Aftermath

Medscape: How are your 14 patients doing? Have you been able to follow up in any way?

Julia Compton: I believe that some of them have been discharged, and one of our surgical floors still has about 6 or 7 patients. What's remarkable is that they're from all different walks of life. But a lot of them are college kids, and they're almost upset that they're being waived from their finals because that would be some sort of normalcy for them. There has been a lot of extra social work and counseling support on the unit -- not just for the patients but for the staff as well. While the ED staff saw the victims for sometimes only 40 minutes, these nurses are taking care of them for days at a time.

Medscape: How is your staff coping? I know you prepare for situations like this, but I doubt that you've experienced anything similar.

Julia Compton: Once the staff members knew that their family members were okay, they knew what they had to do. They did their job in "synchronized harmony" -- that is the best way I could describe it. Obviously, when you have that many people in a trauma room, it gets really hot. I kept looking at the nurses and they were just dripping with sweat. I said, "Okay, we need to cycle the nurses in and out." Because we had everything set up for the marathon, we had extra Gatorade and water iced down. So I just kept throwing stuff in the rooms when there was a break and said, "Chug the Gatorade. Do you want to come out?" The nurses who were in the room said, "No, we're okay. Give us another one -- let's go." By the end of it all, when we knew that we probably weren't getting anybody else, the medical director and I had a quick debriefing in the trauma room. But nobody really wanted to talk. None of the staff really wanted to say anything. I don't think they had really understood what had happened. I mean, they did, but...

Medscape: And then, this past Friday, all of Boston was suddenly "locked down," leading to another unexpected obstacle for you. How did you cope with this upsetting situation?

Julia Compton: Our ability to cope was worse in some ways. It was worse because I don't live very close to the hospital. On a normal day it takes me about 35-40 minutes to get here. One of my colleagues called me at about 4:30 AM. She lives in Watertown, and she said, "There are helicopters. There are snipers going through my backyard." I thought she was having a dream. But we turned on the news and saw that it was real.

So, some of us got to work early, before the lockdown happened, but the problem was that they had shut down the public transportation earlier. A lot of the staff takes public transportation because there's a T stop right across the street from us. So, it wasn't just the ED staff -- all of the hospital staff had problems. We had to keep the night shift over for a period of time. But we had meetings with the emergency management group probably every 1-2 hours and would get updates.

At about 5:00 in the afternoon, one of my staff members looked at me and said, "Do you need to go home? We're fine. You're allowed to be on the road now. You're fine and you've got a family that you need to take care of," which was awesome.

Medscape: I wonder how the staff felt about the suspect who was then admitted for hospital care. I know that he was sent to another Boston hospital, but I wonder how the professional staff would feel about caring for him, if it had come to that.

Julia Compton: Once the staff had gotten through the first 1 or 2 patients, they knew they could do it, and I think we would have been okay with caring for the suspect. It is the ultimate ethical dilemma. What do you do? You have to do the right thing. That's one of those cases that you're given in nursing school 101 and ethics.

Medscape: I have a final question for you. As the manager of the ED, what was most difficult for you personally?

Julia Compton: I guess I'm not really ever concerned about this department being prepared, because we have great staff and they pitch in and the hospital supports us. So, I don't have any doubt about that, especially now. We're a recently designated Level 1 trauma center. We've only been a Level 1 trauma center for a year. It was a tough, uphill battle, and they've done a remarkable job.

Most difficult for me right now is thinking about what else I could have done for the staff to support them. I am not thinking about medically, but emotionally. Could we have prepared any better? How can you wrap your head around something like this that is so crazy? I don't even know if you can prepare anybody. Even some people who go to war are unprepared. But now I just want to make sure to do anything else I can do in the days after to support everyone. How to best do that is what I'm left with as my biggest dilemma. We are starting with some simple things, like an open house in the department, where folks can just vent or even talk about the Red Sox -- whatever they need.

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