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Leadership During the Boston Marathon Bombings: A Qualitative After-Action Review

Published online by Cambridge University Press:  22 June 2015

Eric Goralnick ,
Pinchas Halpern ,
Stephanie Loo ,
Jonathan Gates ,
Paul Biddinger ,
John Fisher ,
George Velmahos ,
Sarita Chung ,
David Mooney  and
Calvin Brown
...Show all authors
Eric Goralnick*
Affiliation:
Brigham and Women’s Hospital National Preparedness Leadership Initiative
Pinchas Halpern
Affiliation:
Sourasky Tel Aviv Medical Center
Stephanie Loo
Affiliation:
Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States;
Jonathan Gates
Affiliation:
Brigham and Women’s Hospital
Paul Biddinger
Affiliation:
Massachusetts General Hospital
John Fisher
Affiliation:
Beth Israel Deaconess Medical Center
George Velmahos
Affiliation:
Massachusetts General Hospital
Sarita Chung
Affiliation:
Boston Children’s Hospital
David Mooney
Affiliation:
Boston Children’s Hospital
Calvin Brown
Affiliation:
Brigham and Women’s Hospital Brigham and Women’s Faulkner Hospital, Jamaica Plain, Massachusetts, United States
Brien Barnewolt
Affiliation:
Tufts Medical Center
Peter Burke
Affiliation:
Boston Medical Center, Boston, Massachusetts, United States;
Alok Gupta
Affiliation:
Beth Israel Deaconess Medical Center
Andrew Ulrich
Affiliation:
Boston Medical Center, Boston, Massachusetts, United States;
Horacio Hojman
Affiliation:
Tufts Medical Center
Eric McNulty
Affiliation:
National Preparedness Leadership Initiative Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States;
Barry Dorn
Affiliation:
National Preparedness Leadership Initiative Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States;
Leonard Marcus
Affiliation:
National Preparedness Leadership Initiative Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States;
Kobi Peleg
Affiliation:
Tel Aviv University, Tel Aviv, Israel; The Gertner Institute for Health Policy, Tel Hashomer, Israel.
*
Correspondence and reprint requests to Eric Goralnick, MD, MS, Brigham and Women’s Hospital, Department of Emergency Medicine, 75 Francis Street, Boston, MA 02118 (e-mail: [email protected]).
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Abstract

Objective

On April 15, 2013, two improvised explosive devices (IEDs) exploded at the Boston Marathon and 264 patients were treated at 26 hospitals in the aftermath. Despite the extent of injuries sustained by victims, there was no subsequent mortality for those treated in hospitals. Leadership decisions and actions in major trauma centers were a critical factor in this response.

Methods

The objective of this investigation was to describe and characterize organizational dynamics and leadership themes immediately after the bombings by utilizing a novel structured sequential qualitative approach consisting of a focus group followed by subsequent detailed interviews and combined expert analysis.

Results

Across physician leaders representing 7 hospitals, several leadership and management themes emerged from our analysis: communications and volunteer surges, flexibility, the challenge of technology, and command versus collaboration.

Conclusions

Disasters provide a distinctive context in which to study the robustness and resilience of response systems. Therefore, in the aftermath of a large-scale crisis, every effort should be invested in forming a coalition and collecting critical lessons so they can be shared and incorporated into best practices and preparations. Novel communication strategies, flexible leadership structures, and improved information systems will be necessary to reduce morbidity and mortality during future events. (Disaster Med Public Health Preparedness. 2015;9:489–495)

Keywords

bombsemergency medicinecommunicationdisaster medicinemass casualty incidents
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 9 , Supplement 5 , October 2015 , pp. 489 - 495
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

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References

1. Malone, S. Boston Marathon bombing injury total climbs to 264, officials say. 2013. Huffington Post. http://www.huffingtonpost.com/2013/04/23/boston-marathon-bombing-injury-total_n_3138159.html. Published April 23, 2013. Accessed March 23, 2014.Google Scholar
2. Walls, RM, Zinner, MJ. The Boston Marathon response: why did it work so well? JAMA. 2013;309(23):2441-2442.CrossRefGoogle Scholar
3. Kellermann, AL, Peleg, K. Lessons from Boston. N Engl J Med. 2013;368(21):1956-1957.CrossRefGoogle ScholarPubMed
4. Biddinger, PD, Baggish, A, Harrington, L, et al. Be prepared—the Boston Marathon and mass-casualty events. N Engl J Med. 2013;368(21):1958-1960.CrossRefGoogle ScholarPubMed
5. Goralnick, E, Gates, J. We fight like we train. N Engl J Med. 2013;368(21):1960-1961.CrossRefGoogle ScholarPubMed
6. , Boston’s first-in-class first response. Lancet. 2013;381(9876):1432.CrossRefGoogle Scholar
7. Bradt, DA, Aitken, P. Disaster medicine reporting: the need for new guidelines and the CONFIDE statement. Emerg Med Australas. 2010;22(6):483-487.CrossRefGoogle ScholarPubMed
8. Giacomini, MK, Cook, DJ. Users’ guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group. JAMA. 2000;284(4):478-482.Google Scholar
9. Malterud, K. The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet. 2001;358(9279):397-400.CrossRefGoogle ScholarPubMed
10. Stallins, R. Methods of Disaster Research. Bloomington, Indiana: Xlibris Corporation; 2003.Google Scholar
11. Scanlon, TJ. Disaster’s little known pioneer: Canada’s Samuel Henry Prince. Int J Mass Emerg Disasters. 1988;6(3):213-232.CrossRefGoogle Scholar
12. Waage, S, Poole, JC, Thorgersen, EB. Rural hospital mass casualty response to a terrorist shooting spree. Br J Surg. 2013;100(9):1198-1204.CrossRefGoogle ScholarPubMed
13. Sauer, LM, McCarthy, ML, Knebel, A, et al. Major influences on hospital emergency management and disaster preparedness. Disaster Med Public Health Prep. 2009;3(2 Suppl):S68-S73.CrossRefGoogle ScholarPubMed
14. Tami, G, Bruria, A, Fabiana, E, et al. An after-action review tool for EDs: learning from mass casualty incidents. Am J Emerg Med. 2013;31(5):798-802.CrossRefGoogle ScholarPubMed
15. Patton, M. Qualitative Research and Evaluation Methods. Thousand Oaks, California: Sage; 2002.Google Scholar
16. Adini, B, Peleg, K. On constant alert: lessons to be learned from Israel’s emergency response to mass-casualty terrorism incidents. Health Aff (Millwood). 2013;32(12):2179-2185.CrossRefGoogle ScholarPubMed
17. Glassberg, E, Lipsky, AM, Abramovich, A, et al. A dynamic mass casualty incident at sea: lessons learned from the Mavi Marmara. J Trauma Acute Care Surg. 2013;75(2):292-297.CrossRefGoogle ScholarPubMed
18. Wild, J, Maher, J, Frazee, RC, et al. The Fort Hood Massacre: lessons learned from a high profile mass casualty. J Trauma Acute Care Surg. 2012;72(6):1709-1713.Google Scholar
19. Mozingo, DW, Barillo, DJ, Holcomb, JB. The Pope Air Force Base aircraft crash and burn disaster. J Burn Care Rehabil. 2005;26(2):132-140.CrossRefGoogle ScholarPubMed
20. Lynn, M, Gurr, D, Memon, A, et al. Management of conventional mass casualty incidents: ten commandments for hospital planning. J Burn Care Res. 2006;27(5):649-658.CrossRefGoogle ScholarPubMed
21. Patton, MQ. Enhancing the quality and credibility of qualitative analysis. Health Serv Res. 1999;34(5 Pt 2):1189-1208.Google ScholarPubMed
22. Curry, LA, Nembhard, IM, Bradley, EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009;119(10):1442-1452.CrossRefGoogle ScholarPubMed
23. Cassa, CA, Chunara, R, Mandl, K, et al. Twitter as a sentinel in emergency situations: lessons from the Boston marathon explosions. PLoS Curr. 2013;5.Google ScholarPubMed
24. Davis, MEF, Alves, AA, Sklansky, DA. Social Media and Police Leadership: Lessons from Boston. Washington, D.C.: US Department of Justice, Office of Justice Programs, National Institute of Justice; 2014.Google Scholar
25. Roberts, KH, Stout, SK, Halpern, JJ. Decision Dynamics in two high reliability military organizations. Management Science. 1994;40(5):614-624.CrossRefGoogle Scholar
26. Roccaforte, JD. The World Trade Center attack. Observations from New York’s Bellevue Hospital. Crit Care. 2001;5(6):307-309.CrossRefGoogle ScholarPubMed
27. Hick, JL, Chipman, J, Loppnow, G, et al. Hospital response to a major freeway bridge collapse. Disaster Med Public Health Prep. 2008;2(Suppl 1):S11-S16.CrossRefGoogle Scholar
28. Hogan, DE, Waeckerle, JF, Dire, DJ, et al. Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med. 1999;34(2):160-167.CrossRefGoogle ScholarPubMed
29. Caro, D, Irving, M. The Old Bailey bomb explosion. Lancet. 1973;1(7817):1433-1435.CrossRefGoogle ScholarPubMed
30. Tucker, K, Lettin, A. The Tower of London bomb explosion. Br Med J. 1975;3(5978):287-290.CrossRefGoogle Scholar
31. Feliciano, DV, Anderson, GV, Rozycki, GS, et al. Management of casualties from the bombing at the centennial olympics. Am J Surg. 1998;176(6):538-543.CrossRefGoogle ScholarPubMed
32. Halpern, P, Tsai, MC, Arnold, JL, et al. Mass-casualty, terrorist bombings: implications for emergency department and hospital emergency response (Part II). Prehosp Disaster Med. 2003;18(3):235-241.CrossRefGoogle ScholarPubMed
33. Xiao, Y, Kim, YJ, Gardner, SD, et al. Communication technology in trauma centers: a national survey. J Emerg Med. 2006;30(1):21-28.CrossRefGoogle ScholarPubMed
34. Halpern, P, Goldberg, SA, Keng, JG, et al. Principles of Emergency Department facility design for optimal management of mass-casualty incidents. Prehosp Disaster Med. 2012;27(2):204-212.CrossRefGoogle ScholarPubMed
35. Bookman, K, Zane, R. Expedited electronic entry: a new way to manage mass-casualty radiology order workflow. Prehosp Disaster Med. 2013;28(4):391-392.CrossRefGoogle ScholarPubMed
36. Fry, EA, Lenert, LA. MASCAL: RFID tracking of patients, staff and equipment to enhance hospital response to mass casualty events. AMIA Annu Symp Proc. 2005:261-265.Google ScholarPubMed
37. Jokela, J, Simons, T, Kuronen, P, et al. Implementing RFID technology in a novel triage system during a simulated mass casualty situation. Int J Electron Healthc. 2008;4(1):105-118.CrossRefGoogle Scholar
38. Chan, TC, Griswold, WG, Buono, C, et al. Impact of wireless electronic medical record system on the quality of patient documentation by emergency field responders during a disaster mass-casualty exercise. Prehosp Disaster Med. 2011;26(4):268-275.CrossRefGoogle ScholarPubMed
39. Lenert, LA, Kirsh, D, Griswold, WG, et al. Design and evaluation of a wireless electronic health records system for field care in mass casualty settings. J Am Med Inform Assoc. 2011;18(6):842-852.CrossRefGoogle ScholarPubMed
40. Landman, A, Teich, JM, Pruitt, P, et al. The Boston Marathon Bombings mass casualty incident: one emergency department’s information systems challenges and opportunities. [In press.] Ann Emerg Med. 2014.Google ScholarPubMed
41. Klein, KJ, Ziegert, JC, Knight, AP, et al. A leadership system for emergency action teams: rigid hierarchy and dynamic flexibility. Acad Manage J. 2004;47(6):1-55.Google Scholar
42. Edmonson, AC. Teamwork on the fly. Harv Bus Rev. 2012;90(4):72-80.Google Scholar
43. Bigley, G, Roberts, K. The incident command system: high reliability organizing for complex and volatile task environments. Vol. 44.6. Acad Manage J 2001:1281-1299.Google Scholar
44. Roberts, KH, Stout, SK, Halpern, JJ. Decision dynamics in two high reliability military organizations. Manage Sci. 1994;40(5):614-624.CrossRefGoogle Scholar
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