EMERGENCY FIRST RESPONSE

[gmohan]

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.

G.MOHAN.

[Badri]

It is indeed a very efficient and well coordinated system that the local health administration in Boston will feel proud to have. I am sure we do have such systems in place here in UK. Perhaps doctors working in the A & E depts may be able to enlighten us.

[uamohammed]

This article has brought home the lesson that an alert and quick team can render yeomen service in times of need. Usually it is not so. The chaos seen not only at the site of accident but in emergency wing of the hospital too.
UA Mohammed

[amarendra]

Totally agree. That unfortunate incident during the Boston Marathon proved how the emergency response should be. The whole response and the Pre-Hospital medical help provided were excellent. There might have been minor delays, errors, etc identifiable only by those involved in the action but never will have contributed to any drastic failings in the operation. Most important is how the public co-operated and kept away and let the emergency services carry out their work. In UK undoubtedly the emergency service and the Emergency Medical care is again equally good and very well prepared for any unexpected events. During the terror attack on London Underground in July 2005, the emergency services response was brilliant. Ambulance, Fire service & Police force have performed superbly with equal quality of co-operation and help from Public. The secret of such unfailing preparedness is in the resources, training, team discipline, and of course public attitude. I am aware the emergency services are fast growing in India, but personally (happy to be corrected) I feel and being very optimistic it will take maybe another 5 to 10 years to come somewhere nearer to the gold standard service. The reason I feel in such fashion is because of quite a number of facts but to mention a few,

1) Public education… Public should be educated about management in Emergencies highlighting the Priorities for e.g., calling for help and also most important what NOT to do to an injured person. Many times some passing drivers won’t even bother stopping to check and call for help purely because of fear of being called for legal cases.
2) Traffic……In a city many times if any Political VIP car goes the whole Traffic comes to stop and just imagine an ambulance with seriously ill patient inside stuck in the traffic. Traffic can be made Thin Flow keeping it moving at the same time meeting the security requirements for VIPs journeys, as there is no need for Empty Roads. And there is an important need for Public education to give way for emergency services.
3) Emergency Personnel….Pre-Hospital Care Training and need to be repeated on regular intervals either annually or once in Two years
4) Hospitals for Secondary Care should have well established and equipped Emergency Department, with well trained and ATLS/ALS certified doctors and nurses.
5) Facilities & equipment --- Innovation, funding and support is required from the government.
6) Major Incident Mock Exercises to be carried once a year in all major cities
7) Regular once in six months screenings of Short documentaries on Basic Life Support techniques for public in Villages utilising the Cinema theaters or local school halls.
Being a graduate of Madras Medical College, it is quite natural for anyone like me to think about situation in Tamil Nadu. It only needs a team of few people with dedication and selfless effort to devise workable plans for development of the emergency services. I don’t think it will be a difficult task to gather like minded senior and experienced people from UK and USA to join hands and contribute their time and knowledge to develop the Emergency services with help from local doctors. It needs strong support and funding from Govt and most important is the acceptance from local medical fraternity to let NRIs to join and together to build a great Emergency service for our Tamil Nadu. I consider it will be a great privilege for me to be part of such group. - Amarendra.