Preparedness Key to Response

One Year Later

Paul Biddinger, M.D.: “We’re Continuing to Ask, ‘What If?’ ”

Paul Biddinger, MDBoston was praised for its medical response to the April 2013 marathon bombings, which resulted in three fatalities at the scene and 264 injuries. That response was the result of years of training in preparedness for natural and man-made disasters.

“We’ve worked very hard to be as prepared as we can be,” said Paul Biddinger, M.D., chair of the MMS Committee on Preparedness and chief of the Division of Emergency Preparedness at Massachusetts General Hospital, attributing a lot of the good outcomes in Boston to preparedness efforts. “No one who made it to the hospital died.”

Those efforts included meeting with professionals from Israel, London, and Madrid, which had experienced similar events, to ensure Boston’s plans were appropriate, Dr. Biddinger said, and working with local, state, and federal agencies.

In the two years prior to the event, hospitals in the Metro Boston Homeland Security Region had conducted exercises and evaluations of mass casualty response plans of Boston hospitals, community health centers, and emergency medical services.

And, just four months prior to the marathon, the region’s hospitals had conducted an annual 24-hour full-scale exercise of emergency personnel response to various scenarios involving more than 600 emergency responders from 50 agencies.

Dr. Biddinger, who has been involved in preparedness and response efforts to emergencies locally and around the world, was working at Heartbreak Hill during last year’s Boston Marathon. When he heard about the bombings at the finish line, he went immediately to MGH and took charge of the emergency department response.

Dr. Biddinger acknowledged luck played a role in preventing more casualties. The explosions occurred outdoors, equidistant from the city’s trauma centers, and during a shift change so that emergency departments and operating rooms had double staff.

Dr. Biddinger noted that departments beyond the ED were a very important part of MGH’s response. Some of the internal medicine physicians took over the care of the patients already in the ED when the bombs went off and transported some patients to other areas of the hospital, enabling the ED to treat the incoming blast victims.

“We’re not patting ourselves on the back,” he said. “We’re continuing to ask, ‘What if?’ and looking at any challenges we experienced that day.”

Communication Challenges

Communicating with hospital employees in the moment is difficult but important, Dr. Biddinger learned during the event. “They want to know what’s going on, if they’re needed, what the threats are. By pushing information out quickly, we can limit crowding in the ED of physicians and others.”

“People want to contribute; they just want to know how they can best help,” he added. “If they feel confident that they’ll be called quickly, they’re less likely to self-respond.”

Hospitals and local and state health authorities are trying to improve communication of accurate information across the system so that families can find where their loved ones are, said Dr. Biddinger.

Psychosocial Support Important

Biddinger commended the city and the hospitals for the psychosocial support they provided for medical responders.

“The most important lesson is that everyone is different and a one-size-fits-all strategy definitely doesn’t work,” he said, noting that a variety of approaches over time are necessary. Some people need one-on-one support, some want to share their experiences with others, some want no support, and some don’t realize they’ve been affected until weeks later, he said.

Anniversary Approaching

As the anniversary of the event approaches, some of those affected may have a significant amount of difficulty. “They may seem despondent, fearful, angry,” he said, recommending that physicians be vigilant, so they recognize if a patient, colleague or employee is having difficulty, and refer them to support.

“These events can happen anywhere at any time,” said Biddinger.

Dr. Biddinger recommends that all physicians associated with a hospital should know what the hospital emergency plan is, what his or her role is, and be prepared to help. Community physicians can join their local medical reserve corps, he said. “Everybody can be necessary, and sometimes you’re necessary in an unexpected way.”

—Robyn Alie 
MMS Public Health Manager
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