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After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations

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After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations OFFICE OF PUBLIC HEALTH PREPAREDNESS Planning & Operations Preparedness & Coordination Training & Outreach 2013 Boston Marathon Emergency Support Function 8 (ESF-8) Public Health and Medical Planning, Response, and Recovery Operations (April 15 – April 26) Final After-Action Report / Improvement Plan December 20th, 2013 FOR OFFICIAL USE ONLY FOR OFFICIAL USE ONLY Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations This page is intentionally blank. FOR OFFICIAL USE ONLY FOR OFFICIAL USE ONLY Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations TABLE OF CONTENTS ADMINISTRATIVE HANDLING INSTRUCTIONS ...............................................................4 EXECUTIVE SUMMARY ..............................................................................................8 PHP & HPP CAPABILITY 1: COMMUNITY & HEALTHCARE SYSTEM PREPAREDNESS 22 PHP & HPP CAPABILITY 2: COMMUNITY & HEALTHCARE SYSTEM RECOVERY........ 33 PHP & HPP CAPABILITY 3: EMERGENCY OPERATIONS COORDINATION .................. 42 PHP CAPABILITY 4: EMERGENCY PUBLIC INFORMATION & WARNING ..................... 58 PHP & HPP CAPABILITY 6: INFORMATION SHARING .............................................. 73 PHP CAPABILITY 7: MASS CARE ........................................................................... 86 PHP & HPP CAPABILITY 10: MEDICAL SURGE .................................................... 106 PHP CAPABILITY 13: PUBLIC HEALTH SURVEILLANCE ......................................... 123 PHP & HPP CAPABILITY 14: RESPONDER SAFETY & HEALTH ............................. 128 PHP & HPP CAPABILITY 15: VOLUNTEER MANAGEMENT ..................................... 135 APPENDIX A: PARTICIPATING ORGANIZATIONS ..................................................... 145 APPENDIX B: CAPABILITY & FUNCTION DEFINITIONS ............................................ 146 APPENDIX C: INCIDENT EVENTS SUMMARY TABLE ............................................... 169 APPENDIX D: IMPROVEMENT PLAN ....................................................................... 214 FOR OFFICIAL USE ONLY FOR OFFICIAL USE ONLY Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations ADMINISTRATIVE HANDLING INSTRUCTIONS 1. The title of this document is 2013 Boston Marathon ESF-8 Health & Medical Planning, Response, & Recovery Operations After-Action Report/Improvement Plan (AAR/IP). 2. The information gathered in this AAR/IP is classified as For Official Use Only (FOUO) and should be handled as sensitive information not to be disclosed. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives. Reproduction of this document, in whole or in part, without prior approval from the Office of Public Health Preparedness, Boston Public Health Commission is prohibited. 3. Points of Contact: Lead Author: Michael Colanti, MBA, CEM, CBCP Associate Director, Office of Public Health Preparedness Boston Public Health Commission 785 Albany Street, 6th Floor Boston, MA 02118 617-343-6923 (office) [email protected] Editors: Nick Martin S. Atyia Martin Director of Communications Director, Office of Public Health Boston Public Health Commission Preparedness 1010 Massachusetts Ave. Boston Public Health Commission Boston, MA 02118 785 Albany Street, 6th Floor 617-534-2821 (office) Boston, MA 02118 [email protected] 617-343-1373 (office) [email protected] Executive Summary FOR OFFICIAL USE ONLY OPHP 4 FOR OFFICIAL USE ONLY Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations This page is intentionally blank Executive Summary FOR OFFICIAL USE ONLY OPHP 5 FOR OFFICIAL USE ONLY Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations INCIDENT OVERVIEW Incident Name 2013 Boston Marathon Incident Dates Monday, April 15th – Friday, April 26th, 2013 This was a real-world series of events that fully tested the response Scope capabilities of regional public health and healthcare agencies. Mission Area(s) Prevention, Protection, Mitigation, Response, and Recovery Community & Healthcare System Preparedness Community & Healthcare System Recovery Emergency Operations Coordination Emergency Public Information & Warning PHP & HPP Information Sharing Capabilities Mass Care Medical Surge Public Health Surveillance Responder Safety & Health Volunteer Management Threat or Terrorism / Improvised Explosive Devices Hazard The explosions at the finish line of the Boston Marathon on April 15th, and the subsequent manhunt and shelter in place request issued on April 19th, had Scenario significant impacts on the healthcare system within the Boston area. The consequences of the Boston bombings to the Boston area healthcare system are explored in depth in this report. Sponsor Boston Public Health Commission (BPHC) Executive Summary FOR OFFICIAL USE ONLY 6 FOR OFFICIAL USE ONLY Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations Local, state, and federal government agencies are represented in this report, Participating as well as numerous public and private public health and healthcare partners. Organizations A full list can be found in Appendix A: Participating Organizations. Executive Summary FOR OFFICIAL USE ONLY 7 FOR OFFICIAL USE ONLY Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations EXECUTIVE SUMMARY At 2:49pm on Monday, April 15th, two explosions occurred 13 seconds apart on Boylston Street near the finish line of the 117th Boston Marathon. It became the first successfully executed terrorist attack on American soil since September 11, 2001 and was instantly breaking international news. In the end, three individuals lost their lives as a result of the bombings. 282 people were injured. One officer was killed in the line of duty. And an entire region of Massachusetts was significantly impacted as law enforcement searched for suspects. First responders, healthcare institutions, volunteers, civilians, and countless others who responded in the moments, hours, days and weeks that followed the tragic events worked tirelessly, and provided the community, Commonwealth, and nation with a sense of reassurance in the face of a horrific act. The response efforts on scene by members of Boston EMS, Boston Police, Boston Fire, National Guard soldiers, trained volunteers, and bystanders were extraordinary. The rapid evacuation of patients and distribution to area Photo by Darren McCollester, Getty Images hospitals did not happen by accident. The fact that every patient transported from the scene that day survived is a testament to the years of coordinated operational response planning of many agencies across disciplines and jurisdictions. This planning is the reason there were pre-deployed resources, an integrated public health and healthcare response infrastructure, and human services coordination in the aftermath of the bombings. This After Action Report extends beyond the immediate response, and focuses on the collective public health and healthcare planning leading up to the Boston Marathon and coordination after Executive Summary FOR OFFICIAL USE ONLY 8 FOR OFFICIAL USE ONLY Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan 2013 Boston Marathon (AAR/IP) ESF-8 Health & Medical Operations the bombings. While the coordination is ongoing to support the survivors and their families, this report focuses primarily on the initial weeks following the bombings. Purpose The purpose of this report is to provide a comprehensive overview and analysis of the Emergency Support Function 8 (ESF-8) Public Health and Medical Services response and recovery efforts, which includes human services operations for the 2013 Boston Marathon and the subsequent Boston bombings. The entirety of the ESF-8 response was analyzed. Strengths and areas for improvement were identified and corrective actions are recommended. Scope The Boston Marathon is a large-scale real-world event that requires analysis on an annual basis. This year, the marathon turned into a full-scale tactical operational response to a bombing event. The response included not only the initial mass casualty incident response to those injured by the explosions at the finish line, but the subsequent investigation and manhunt that was being conducted in parallel to ongoing response and recovery efforts, which were further complicated during a shelter in place request on Friday April 19th. This report focuses on the public health, healthcare, and human services response to the entirety of the incident, in alignment with ESF-8, with a particular emphasis on the recovery efforts and public health’s role as it relates to mass care and human service efforts within Emergency Support Function 6 (ESF-6). It addresses the associated response operations of the Boston Public Health Commission (BPHC) as the public health authority for the City of Boston, BPHC’s Office of Public Health Preparedness (OPHP)
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