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NLM Director’s Comments Transcript
Lessons from Boston’s Emergency Medical Response: 04/29/2013

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Greetings from the National Library of Medicine and

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

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The success of the emergency medical response after the Boston Marathon explosions stems from planning and unusual circumstances that should inspire others to prepare for future human and natural disasters, suggests a timely editorial recently published in the New England Journal of Medicine.

The editorial’s authors note the Boston Marathon explosions resulted in a mortality rate of less than one percent. Three died and 260 persons were injured as a result of the explosions. The editorial’s authors note there was (and we quote) ‘…(a) remarkably low mortality rate’ (end of quote).

The authors suggest the primary lesson from Boston is the effective emergency response on Patriot Day (April 15, 2013) resulted from prior preparation coupled with six special circumstances that helped offset the disaster’s potentially more devastating medical impact.

First, the authors note the bombings occurred at a major civic event where significant numbers of police, security, and emergency medical workers were on site.

Second, Patriot Day is a Massachusetts holiday. So, Boston’s operating rooms and clinical services were less crowded than usual but in a standby mode.

Third, the explosions occurred before the 3 pm change of shift within Boston area hospitals. As a result, one shift of health care professionals was still on duty and a second shift was about to report. The authors find the explosion’s timing resulted in the availability of two shifts of medical professionals and two shifts of administrative staff within the area’s medical facilities.

Fourth, the editorial’s authors explain the downtown Boston area is home to seven trauma centers and multiple high quality hospitals. Emergency medical workers (and we quote): ‘wisely distributed casualties among the area’s trauma centers, so each one received a manageable number’ (end of quote).

Fifth, the bombs exploded outdoors and did not cause the structural collapse of surrounding buildings. The latter often is associated with significant increases in mass casualties.

Sixth, the editorial’s authors explain Boston hosted a 2009 conference on medical response to terrorist attacks that drew experts from several nations and was locally well attended. Boston area hospitals also were the beneficiaries of some veteran military surgeons and emergency health care professionals who experienced mass casualty situations in Iraq and Afghanistan.

While the authors acknowledge Boston’s successful response partially stemmed from fortuitous circumstances, they note the primary lesson is good health care delivery execution, teamwork, and preparation provide the foundation to take advantage of circumstances regardless if they are favorable or unfavorable.

Conversely, the editorial’s authors warn some health care professionals and public health officials (and we quote): ‘may erroneously conclude that it doesn’t matter if emergency departments are crowded and if disaster plans and rigorous drills are lacking because their hospitals’ medical staff will simply rise to the occasion’ (end of quote).

The authors argue the latter inference generates inaction and complacency, which are not what health officials should glean from Boston.

Meanwhile,’s disaster preparation and recovery health topic page provides a resource to help you prepare for a human or natural disaster.

Specific information about prior preparation for explosions (provided by the U.S. Department of Homeland Security) is available in the ‘specific conditions’ section of’s disaster preparation and recovery health topic page.

Some information to help relief workers respond to disasters is provided by the Centers for Disease Controls and Prevention within the ‘related issues’ section of’s disaster preparation and recovery health topic page.

Healthy Roads Media also provides a video guide to help you shelter in place. The latter was mandated for Boston area residents four days after the Marathon explosions occurred. The guide is available in the ‘videos’ section of’s disaster preparation and recovery health topic page.’s disaster preparation and recovery health topic page contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the disaster preparation and recovery health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

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