Hostname: page-component-745bb68f8f-cphqk Total loading time: 0 Render date: 2025-01-24T07:37:00.015Z Has data issue: false hasContentIssue false
  • English
  • Français

Securing the Emergency Department During Terrorism Incidents: Lessons Learned From the Boston Marathon Bombings

Published online by Cambridge University Press:  12 March 2019

Horacio Hojman ,
Rishi Rattan ,
Rob Osgood ,
Mengdi Yao  and
Nikolay Bugaev
Horacio Hojman
Affiliation:
Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine. Boston, MA
Rishi Rattan
Affiliation:
Ryder Trauma Center, Department of Surgery, Miller School of Medicine, Universtiy of Miami, Miami, FL
Rob Osgood
Affiliation:
Tufts Medical Center, Boston, MA
Mengdi Yao
Affiliation:
Department of Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
Nikolay Bugaev*
Affiliation:
Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine. Boston, MA
*
Correspondence and reprint requests to Dr Nikolay Bugaev, Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., #4488, Boston, MA 02111 (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Terrorist incidents that target hospitals magnify morbidity and mortality. Before a real or perceived terrorist mass casualty incident threatens a hospital and its providers, it is essential to have protocols in place to minimize damage to the infrastructure, morbidity, and mortality. In the years following the Boston Marathon bombings, much has been written about the heroic efforts of survivors and responders. Far less has been published about near misses due to lack of experience responding to a mass casualty incident resulting from terrorism. After an extensive review of the medical literature and published media in English, Spanish, and Hebrew, we were unable to identify a similar event. To the best of our knowledge, this is the first reported experience of a bomb threat caused evacuation of an emergency department in the United States while actively responding to multiple casualty terrorist incidents. We summarized the chronology of the events that led to a bomb threat being identified and the subsequent evacuation of the emergency department. We then reviewed the problematic nature of our response and described evidence-based policy changes based on data from health care, law enforcement, and counterterrorism. (Disaster Med Public Health Preparedness. 2019;13:791–798)

Keywords

evacuationmass casualtiesterrorist attack
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 4 , August 2019 , pp. 791 - 798
Copyright
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

A previous error in this article has since been corrected. Please see 10.1017/dmp.2019.51

References

REFERENCES

Alexander, D. Terrorism, disasters, and security. Prehosp Disaster Med. 2003;18:165-169.CrossRefGoogle ScholarPubMed
Stein, M, Hirshberg, A. Medical consequences of terrorism. The conventional weapon threat. Surg Clin North Am. 1999;79:1537-1552.CrossRefGoogle ScholarPubMed
Halpern, P, Tsai, M-C, Arnold, JL, et al. Mass-casualty, terrorist bombings: implications for emergency department and hospital emergency response (part II). Prehosp Disaster Med. 2003;18:235-241.CrossRefGoogle Scholar
Adini, B, Peleg, K. On constant alert: lessons to be learned from Israel’s emergency response to mass-casualty terrorism incidents. Health Affairs. 2013;32:2179-2185.CrossRefGoogle ScholarPubMed
Leissner, KB, Ortega, R, Beattie, WS. Anesthesia implications of blast injury. J Cardiothorac Vasc Anesth. 2006;20:872-880.CrossRefGoogle ScholarPubMed
Kashuk, JL, Halperin, P, Caspi, G, et al. Bomb explosions in acts of terrorism: evil creativity challenges our trauma systems. J Am Coll Surg. 2009;209:134-140.CrossRefGoogle ScholarPubMed
Lucci, EB. Civilian preparedness and counter-terrorism: conventional weapons. Surg Clin North Am. 2006;86:579-600.CrossRefGoogle ScholarPubMed
The National Counterterrorism Center. Bomb threat stand-off distance chart – 2014 counterterrorism calendar.nctc.gov. 2014:1–2. https://www.dni.gov/index.php/search?q=bomb+threat+stand-off. Accessed April 21, 2014Google Scholar
Almogy, G, Rivkind, A-I. Terror in the 21st century: milestones and prospects – part I. Curr Probl Surg. 2007;44:496-554.CrossRefGoogle ScholarPubMed
Tucker, K, Lettin, A. The Tower of London bomb explosion. Br Med J. 1975;3:287-290.CrossRefGoogle Scholar
Ciraulo, DL, Frykberg, ER. The surgeon and acts of civilian terrorism: blast injuries. J Am Coll Surg. 2006;203:942-950.CrossRefGoogle ScholarPubMed
Mines, M, Thach, A, Mallonee, S, et al. Ocular injuries sustained by survivors of the Oklahoma City bombing. Ophthalmology. 2000;107:837-843.CrossRefGoogle ScholarPubMed
Thach, AB, Ward, TP, Hollifield, RD, et al. Eye injuries in a terrorist bombing: Dhahran, Saudi Arabia, June 25, 1996. Ophthalmology. 2000;107:844-847.CrossRefGoogle Scholar
Thach, AB. Eye injuries associated with terrorist bombings. Ophthalmic Care of the Combat Casualty. 2003rd ed. Office of The Surgeon General Department of the Army, United States of America; 2003:421-429.Google Scholar
Yonekawa, Y, Hacker, HD, Lehman, RE, et al. Ocular blast injuries in mass-casualty incidents. Ophthalmology. 2014;121:1670-1676.e1.CrossRefGoogle ScholarPubMed
Dorn, M. Back to lockdown basics. CampusSafety. Published June 30, 2007. http://www.campussafetymagazine.com/article/back-to-lockdown-basics. Accessed April 20, 2014.Google Scholar
Phelps, S, Russell, R, Doering, G. Model “code silver” internal lockdown policy in response to active shooters. Am J Disaster Med. 2007;2:143-150.CrossRefGoogle ScholarPubMed
ED managers react to threat against hospitals: here are security strategies. ED Manag. 2003;15:1-5Google Scholar
Feliciano, DV, Anderson, GV, Rozycki, GS, et al. Management of casualties from the bombing at the Centennial Olympics. Am J Surg. 1998;176:538-543.CrossRefGoogle ScholarPubMed
Occupational Safety and Health Administration. Emergency preparedness and response. Safety and health guides – secondary explosive devices guide. 2014:1–2. https://www.osha.gov/SLTC/emergencypreparedness/guides/secondary.html. Accessed April 21, 2014.Google Scholar
Paredes Zapata, GD. Terrorism in Colombia. Prehosp Disaster Med. 2003;18:80-87.CrossRefGoogle ScholarPubMed
Eckstein, M. The medical response to modern terrorism: why the “rules of engagement” have changed. Ann Emerg Med. 1999;34:219-221.CrossRefGoogle Scholar
Hogan, DE, Waeckerle, JF, Dire, DJ, Lillibridge, SR. Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med. 1999;34:160-167.CrossRefGoogle ScholarPubMed
Holt, GR. Making difficult ethical decision in patient care during natural disasters and other mass casualty events. Otolaryngol Head Neck Surg. 2008;139:181-186.CrossRefGoogle ScholarPubMed
Larkin, GL, Arnold, J. Ethical considerations in emergency planning, preparedness, and response to acts of terrorism. Prehosp Disaster Med. 2003;18:170-178.CrossRefGoogle ScholarPubMed
Pesik, N, Keim, ME, Iserson, KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001;37:642-646.CrossRefGoogle ScholarPubMed
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 ScholarPubMed
Xiao, Y, Kim, Y-J, Gardner, SD, et al. Communication technology in trauma centers: a national survey. J Emerg Med. 2006;30:21-28.CrossRefGoogle ScholarPubMed
Roccaforte, JD. The World Trade Center attack. Observations from New York’s Bellevue Hospital. Crit Care. 2001;5:307-309.CrossRefGoogle ScholarPubMed
Davis EF III, Alves AA, Sklansky DA. Social media and police leadership: lessons from Boston. New perspectives in policing. Washington, DC: National Institute of Justice; 2014.Google Scholar
Morley, B, Leslie, GD. Terrorist bombings: motives, methods and patterns of injuries. Australas Emerg Nurs J. 2007;10:5-12.CrossRefGoogle Scholar
Magyar, J, Theophilos, T. Review article: debriefing critical incidents in the emergency department. Emerg Med Australas. 2010;22:499-506.CrossRefGoogle ScholarPubMed
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;31:798-802.CrossRefGoogle ScholarPubMed
U.S. Fire Administration. Fire/Emergency Medical Services Department operational considerations and guide for active shooter and mass casualty incidents. Published September 2013. https://www.usfa.fema.gov/downloads/pdf/publications/active_shooter_guide.pdf. Accessed April 20, 2014.Google Scholar
The Scottish Executive Health Department. Hospital lockdown: a framework for NHSScotland. June 2010:1–57. http://www.sehd.scot.nhs.uk/EmergencyPlanning/Documents/FinalLockdownGuidanceforweb.pdf. Accessed April 20, 2014.Google Scholar
Almogy, G, Rivkind, A-I. Terror in the 21st century: milestones and prospects – part II. Curr Probl Surg. 2007;44(9):566-619.CrossRefGoogle ScholarPubMed
Halpern, P, Goldberg, SA, Keng, JG, Koenig, KL. Principles of emergency department facility design for optimal management of mass-casualty incidents. Prehosp Disaster Med. 2012;27:204-212.CrossRefGoogle ScholarPubMed
Hirshberg, A, Holcomb, JB, Mattox, KL. Hospital trauma care in multiple-casualty incidents: a critical view. Ann Emerg Med. 2001;37:647-652.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. In a moment’s notice: surge capacity for terrorist bombings. 2010:1-64. https://www.acep.org/globalassets/uploads/uploaded-files/acep/by-medical-focus/disaster/inamomentsnotice.pdf. Accessed April 20, 2014.Google Scholar