“Boston Trauma” by Diane Schneidman describes the impressive way the medical community marshaled to handle the Boston Marathon bombing. In their own words, doctors explain what worked so well that day – and why.
Point #1: Boston was a city prepared:
Approximately 14 months after 9/11, the city of Boston, local EMS providers, and the 14 institutions that comprise the Conference of Boston Teaching Hospitals participated in a large-scale disaster drill called Operation Prometheus, which simulated the explosion of a dirty bomb on an inbound airplane, according to Drs. Zinner and Walls.
Since then, Boston-area trauma centers have been refining their plan for handling mass-casualty events. “For example, from 2006 to 2012, Brigham and Women’s Hospital conducted or participated in 73 separate exercises, events and disaster activations,” wrote Drs. Zinner and Walls. “In 2010, Operation Falcon, coordinated by Metro Boston Homeland Security, tested system-wide response to a mass casualty bombing, complementing previous exercises in 2007 and 2008.”
“Although the Boston hospitals had prepared, trained, and drilled for mass-casualty events, the challenge of receiving so many critically ill patients so rapidly at a single hospital had not been specifically addressed,” wrote Drs. Zinner and Walls. “To ensure that Boston hospitals would be ready for an onslaught of patients in the event of a mass-casualty event, additional incident command training, particularly for senior leaders, was identified, and efforts were initiated to move preparedness to a higher level.”
In addition, over the last two years, trauma surgery, emergency medicine and emergency nursing staff at area hospitals have worked together to provide team training for trauma team members using simulated disaster situations. These combined actions – the drills, the analysis of other mass-casualty events, the team training – “were waypoints along the path to readiness,” according to Drs. Zinner and Walls.
The plan that emerged from all of these initiatives “involves multiple levels, and we have practiced it incessantly, and this is exactly why when the real deal happened, we were totally prepared to do the right thing.”
Point #2: More Than Coincidence: Optimal Location, Optimal Time
Although preparation clearly was a deciding factor in the successful efforts carried out by these institutions, “we shouldn’t forget that within this tragedy, we got a little bit lucky because, if it had to happen, it happened in the optimal location, at the optimal time,” Dr. Velmahos said. First, the bombs were detonated near the finish line of the marathon where EMS has traditionally set up a fully staffed emergency care center for runners who might experience injury, dehydration, chest pains, or heat stroke. Ambulances are on standby to transport the more serious of these cases to area hospitals, and ERs increase their staffing to ensure that runners who are ill or injured can be treated promptly. Furthermore, Marathon Monday is also Patriots’ Day – a holiday in the Commonwealth of Massachusetts – so all of the hospitals are open, but their OR’s tend to have a light schedule. In addition, the blasts occurred right at change of shift at most of the hospitals, so the day shift was still on-site, while the evening shift was starting to check in, and happened in the afternoon when the ERs tend to be less full.
Furthermore, the bombs were only volatile enough to damage people’s legs, in most cases. “If these had been more powerful bombs that created trunk and head injuries, the situation would have been more challenging,” Dr. Mackey noted. “But, as tragic as the event was, we were very fortunate in terms of the readiness because it was Marathon Monday, because of the time of day it happened, because it was change of shift – all those things and the nature of the injuries conspired to create a very good outcome.”
Terrorists want to make the big splash. They certainly did that on Sept 11th. To maximize the carnage they hijacked planes that carried the most fuel. They wanted a big boom when those jets impacted their targets. They flew at the busiest time of day for air traffic, timing collision with the Towers to when they would be full of people.
How did they coordinate all this? They studied patterns. They flew their chosen flights on test runs. They knew how things worked.
Terrorists would have done their homework. They would likely have seen Boston as a city fortified and chosen another target. The Boston Marathon may be an iconic event, but it is far from the only one in the country.
Terrorists would have used more powerful bombs. They would not have been content to use weapons that would not cause a lot of fatalities. And they would have attended other marathons first, finding out where the medical personnel were stationed to ensure they were far away. They would have detonated the bombs where the runners would still be bunched together, not where they are coming in well-separated like we see at the finish line. They would not time the explosions to coincide with an increase in the number of hospital personnel available to treat the wounded at area hospitals due to overlapping shift changes.
Some may say this was all chance – or Providence. Maybe they would be right. Or maybe this is indication of experienced forces at work who took all their intricate knowledge of how the city of Boston had planned, practiced & carried out drills & used it to their advantage – before blaming it on two hapless brothers who didn’t seem to have a plan or a clue – judging by the events that unfolded after the bombing.
Dzhokhar was studying something in the months leading up to the marathon but I doubt it was shift changes at area hospitals & placement of medical personnel at the race.
Tamerlan was angry about a lot of things he saw as unjust in the world. He was zealous about his religious beliefs to a degree that would seem unhealthy to us. Yet after the bombing when the FBI called him saying he needed to come in and talk to them, he said only this “You know where to find me.”
“You know where to find me.”
Think about that.
Whoever planned and carried out bombing the Boston Marathon knew the extensive planning the city had gone through. They knew what the medical community could handle. They knew the optimal time of day, the optimal location for the blasts, the type of bombs that would cause the least harm.
Terrorists don’t think that way. Hatred shows no such consideration for those it wishes to destroy.
This is more likely the work of people with background knowledge of how the response system in Boston works and why it works that way – from all that training, all those drills.
On Patriots Day 2013, one final scenario had never been tested: coordination of a large-scale manhunt in a populated U.S. city by the various agencies of law enforcement, FBI & Homeland Security. And on Patriots Day 2013, the reaction and response from the citizenry affected by such a manhunt had never been studied because no American city had ever been put on lockdown before.
That drill has now been run, with mixed reviews and mixed results. We watched it on TVs across the country – with mixed reactions.
In our search to uncover the truth of who planned and carried out bombing the Boston Marathon, I think we can rule out terrorists and the brothers; this event has the fingerprints of government all over it.