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    Boston’s first-in-class first response

    The triumphant view of runners making their final strides toward the finish line of the celebrated Boston Marathon on April 15, gave way to smoke, disorientation, and panic. Cheering turned quickly into shouts and screams. And within minutes the world was grappling to make sense of what was unfolding. Just adjacent to the last segment of the marathon route, two bombs, 13 seconds apart, had been detonated on Boylston Street in downtown Boston, MA, USA. Three people were killed and over 170 runners and observers had sustained a ghastly array of injuries, many life-threatening.

    What followed, however, was a rapid, exceedingly well-orchestrated, and inspiring response. Immediately, medical and emergency personnel who were staffing the event swept in to treat the wounded and to secure the area, and the first wave of the injured were quickly transported to the network of hospitals nearby. In the context of such an emergency, the city of Boston is an unparalleled setting because of its great number of top-tier medical facilities and teaching hospitals.

    Ten hospitals, including Brigham and Women’s Hospital, Tufts Medical Center, and Massachusetts General Hospital, received and treated the injured. Importantly, they were at the ready. Upon being alerted of the explosions, local hospitals initiated a cascade of actions: emergency rooms were cleared, patients in less critical condition were diverted to increase capacity, and clinical teams were mobilised to aid in the triage of victims. All of the routine disaster rehearsals, coordinated training, and special awareness of the types of injuries they would be treating meant that clinical staff were poised to act. These well-practised plans undoubtedly served to minimise injuries and loss of life.

    We commend the commitment, bravery, and tireless efforts of Boston’s first responders. Moving forward, it is vital that the lessons learned here are shared within the global medical community. It is a sad truth that such horrific events happen all over the world and all too frequently, but Boston has set an excellent example that response efficacy and strength is built on planning and preparation. Emergency systems everywhere should aspire to be Boston strong.


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