From Olympic Park to the Boston Marathon to Texas
The New Yorker's Atul Gawande writes often and well about medicine. This week, he described how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:
.@artkellermanmd, who helped manage ER response to the 1996 Olympic Park bombing, wrote with 6 factors that aid a city ability to rescue.
— Atul Gawande (@Atul_Gawande) April 18, 2013
1. The explosion occurs at a big event with extra police and EMS pre-deployed.
— Atul Gawande (@Atul_Gawande) April 18, 2013
2. The explosion occurs when hospital ORs and other services are operating at less than full capacity due to the event.
— Atul Gawande (@Atul_Gawande) April 18, 2013
3. The explosion occurs during business hours so lots of staff are around.
— Atul Gawande (@Atul_Gawande) April 18, 2013
4. The explosion occurs at the city center, close to many hospitals and, ideally, multiple trauma centers.
— Atul Gawande (@Atul_Gawande) April 18, 2013
5. The explosion is detonated outside (lessening fatality count and blast severity) rather than inside.)
— Atul Gawande (@Atul_Gawande) April 18, 2013
6. The first responders and hospital providers have received advance training regarding the essentials of blast injury care.
— Atul Gawande (@Atul_Gawande) April 18, 2013
Atlanta had 5 of 6 of these factors in its favor. Boston had 6 of 6. Waco TX responders have 1 of 6 at best. Thoughts are with them.
— Atul Gawande (@Atul_Gawande) April 18, 2013
In his New Yorker piece, Gawande talked described how the years of post-September 11 training in hospitals led to the "orchestration" that happened after Monday's Boston Marathon explosions:
There’s a way such events are supposed to work. Each hospital has an incident commander who coördinates the clearing of emergency bays and hospital beds to open capacity, the mobilization of clinical staff and medical equipment for treatment, and communication with the city’s emergency command center. At my hospital, Stanley Ashley, a general surgeon and our chief medical officer, was that person. I talked to him after the event—I had been out of the city at the time of the explosions—and he told me that no sooner had he set up his command post and begun making phone calls then the first wave of victims arrived. Everything happened too fast for any ritualized plan to accommodate.
Even without the "ritualized plan," staff had been so thoroughly trained that one emergency department director told Gawande he didn't have to tell people much at all. “Everybody spontaneously knew the dance moves,” he said.