CRISIS | RESPONSE CRISIS RESPONSE V O L : 8 | I S S U E : 4 | WWW.CRISIS-RESPONSE.COM J O U R N A L Darwinian terrorism; Azerbaijan; Typhoon Bopha; Waco explosion; Boston bombs; Security in Pakistan; Police training Rwanda; Cyber security; CBRN; Supply Chains; Nepal Police training Rwanda; explosion; Boston bombs; Security in Pakistan; Darwinian terrorism; Azerbaijan; Typhoon Bopha; Waco New: Greenline battery pump SPU 16 BC The fi rst pump you can use anywhere, for any rescue operation. 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Boston line shows that blast waves pushed spectators of large-scale, emergency response stages many large-scale events, some annual, away from the impact zone, but within seconds O– notably revealed in the US in the some unique – from a New Year’s Eve First they began to run back to render help. The response to both 9/11 in New York City and Night celebration, the July 4 Esplanade high density of the crowd contributed to the Hurricane Katrina – is the weak co-ordination concert and the arrival of Tall Ships, to parades large number of injuries – but it also meant of multiple first-response organisations and honouring national championship baseball, that there were many people immediately supporting agencies in the midst of crisis. football, basketball and hockey teams. available to render aid. The number of people But more than a decade of work to prepare A strong pattern of collaborative planning who climbed over barricades or tore them responders for major operations has begun to for such events has become routine, down to allow others to enter, and provided pay off. The Boston Marathon bombing and the reinforced by formal and informal efforts to aid with whatever means were available, massive effort to identify and apprehend the train responders for co-ordinated action, to shows a city and a society at its best – people terrorists this April, while not as massive a crisis exercise across agencies, jurisdictions, and spontaneously helping each other without as either 9/11 or Katrina, stands as a notable levels of government, and to build strong regard to culture, ethnicity, or nationality (the example of effective, co-operative first-response professional and personal relationships among bravery of responders at the scene ran contrary operations, as well as political collaboration. It commanders of law enforcement, firefighting, to training to beware of secondary attacks). demonstrates that at least some jurisdictions and emergency medical organisations. The medical response was also immediate in the US have made important progress in While planning and preparedness had and skilled. Trained responders at the scene, overcoming the difficulties of multi-institution been directed by senior management, the working with members of the public, placed co-ordination during large-scale operations. implementation of emergency actions did not tourniquets, held pressure, and transported The centralised planning for this event drew depend on centralised leadership. Significantly, survivors to medical tents and on to ambulances on a strong culture of preparing for large ‘fixed’ during the crisis in Boston, the response beyond. Then teams of doctors, nurses, and clinical staff at hospitals took over. A large As terrible as this attack was, we need to number of the grievous wounds from the recognise that it was nonetheless small- blast and shrapnel would, in almost any other circumstances have proved fatal, but it appears scale – by no means the largest mass-casualty that every person who was alive when definitive event that we may be called upon to address medical help was applied – in most cases, within minutes of the blast – is still alive today. events (for which time and location are known exhibited major elements of self-organising That success stems from several factors. well in advance) across multiple professional collaboration by small teams rather than Hundreds of medically-trained personnel disciplines (police, fire, EMS, National Guard). top-down command. This resulted from the were at the scene of the blast, the result of Although it took root earlier, this culture became structuring of response in common emergency detailed central planning and learning from much sturdier in the aftermath of 9/11. operating methods through the National Incident previous Boston Marathons and other events. When Boston faced the challenge of preparing Management System (NIMS), as well as Boston EMS and other local government for a National Special Security Event – the 2004 systematic development of organisational and and private emergency medical services Democratic Party’s National Convention – it personal ties among the diverse responders. had intensively trained and exercised, formed a multi-agency, multi-jurisdictional, Collaborative event planning, training, including with other responders, and had multi-level planning group that worked for exercising, and deployment at many large public frequently deployed to special events. more than a year developing security plans. events that have not suffered emergencies, In an ordinary Marathon year, thousands Many lessons for future collaboration were laid the groundwork for performance in crisis. of runners come off the course needing care learned from this, along with an emphasis Footage of the explosions near the finish for blisters, heatstroke or possible cardiac 18 CRISIS | RESPONSE+ VOL 8 ISSUE 4 incident analysis problems. While not deployed specifi cally to aid bomb victims, medical personnel stationed near the fi nish line were skilled and adaptable and could stabilise bomb survivors, who were then triaged and dispatched to medical facilities which, real-time communication indicated, had the capacity to handle their injuries. Fortunately, the bomb blasts did not directly degrade medical personnel and equipment positioned near the Marathon fi nish line – by contrast with the extensive loss in the Haiti earthquake of 2010. This suggests that future event planners should ensure that crucial resources are not concentrated in a single position and thus left vulnerable to attack. Moreover, signifi cant changes in treatment of blast and shrapnel trauma victims, developed on battlefi elds in Iraq and Afghanistan, had made their way into home-front trauma response. In particular, tourniquets, proven to staunch blood loss from major injuries to extremities, were deployed in the equipment of EMS personnel at the Marathon. Resourcefulness Boston has an extremely high concentration of the nation’s leading tertiary medical facilities, each with an emergency room, trauma unit, and advanced speciality medical services. Five of these six facilities are located within two miles of the bomb blast. This permitted defi nitive in-hospital care for critically-injured patients in less than a half hour – saving many who otherwise might have perished. In recent years, these medical facilities had extensively planned, practised, and trained for mass casualty events. While most preparation did not spotlight casualties from a bomb attack, Massachusetts General Hospital had recently consulted with experts from Israel about how to handle a sudden fl ow of blast and shrapnel survivors. The surge of patients facing hospitals in this incident, however, was beyond their experience, planning and normal capacity. Instead of being overwhelmed, they met the surge of patients with resourcefulness, clearing space occupied by less needy patients and improvising to accommodate unprecedented demands. Blast waves pushed spectators away from Notably, in the moments of crisis, the the impact zone, but within seconds they ran response by medical personnel, both at the site back to help others who had been injured of the blast and in the hospitals, was handled Rex Features nearly completely without central direction. EMTs and physicians at the scene, following pre-established protocols and improvising as necessary, were largely self-directed in caring for the injured. Doctors and nurses with relevant skills converged on emergency s rooms without having to be called. CRISIS | RESPONSE+ VOL 8 ISSUE 4 19 s As ambulances delivered patients to ordinated very effectively in responding to Law enforcement agencies, for example, hospitals, groups of clinicians self-organised this incident. They pieced together the nature sifted massive amounts of photographic into trauma teams. In one emergency room, of the attack; identified the two perpetrators’ evidence from public and private surveillance people who were not needed to provide direct images; responded to the perpetrators’ flight cameras, news media, and spectators to identify care realised that there was a congestion and engaged in a dramatic, but chaotic the principal suspects. This required both problem. They organised themselves in a shootout that killed one; and apprehended considerable labour and advanced technologies. side room from which they could be called the survivor after a massive manhunt.