Disaster MAUREEN HEMINGWAY
Boston Bombings: Response to Disaster MAUREEN HEMINGWAY, MHA, RN, CNOR; JOANNE FERGUSON, MSN, RN
ABSTRACT
Disasters disrupt everyone’s lives, and they can disrupt the flow and function of
an OR as well as affect personnel on a professional and personal level even
though perioperative departments and their personnel are used to caring for
trauma patients and coping with surprises. The Boston Marathon bombing was a
new experience for personnel at Massachusetts General Hospital, Boston. This
article discusses the incidents surrounding the bombing and how personnel at
this hospital met the challenge of caring for patients and the changes we made
after the experience to be better prepared in the event a response to a similar
incident is needed. AORN J 99 (February 2014) 277-288. � AORN, Inc, 2014. http://dx.doi.org/10.1016/j.aorn.2013.07.019
Key words: perioperative disaster care, OR triage, terrorist bombings, Boston
Marathon, shelter in care, city lockdown.
M assachusetts General Hospital (MGH),
Boston, is a level I trauma teaching
hospital where patients receive care for
all surgical specialties. Personnel have the capacity
and ability to care for a large number of patients
with varying acuity levels. There are 907 beds and
61 functional ORs located on one campus. In 2005,
MGH received designation as a Magnet� hospital, and, in 2008 and 2012, the American Nurses Cre-
dentialing Center renewed this designation. The
hospital’s perioperative nursing team cares for
approximately 36,000 patients per year and pro-
vides perioperative care, on average, for 150 pa-
tients per day. The ORs are located on three levels
across five different buildings. The OR personnel
comprise 235 RNs, 92 surgical technologists, 27
equipment technicians, 115 OR assistants, and 17
operations assistants.
The environment in the OR can change very
quickly during the course of any day. Perioperative
nurses who work in the OR are aware that the daily
schedule may be disrupted by unscheduled events,
such as the arrival of trauma patients, transplan-
tation recipients or donors, patients who need to
return to surgery, or equipment or facility failures.
When terrorist bombs exploded at the annual
Boston Marathon, the resources and disaster plans
at MGH were put to the test. This article discusses
the response of personnel and the outcome and
changes made as a result of this experience.
APRIL 15, 2013
It had been a typical “marathon Monday,” with an
atmosphere of excitement in the city that was felt in
the hospital and OR environment. The Boston
Marathon is a long-standing tradition for many
people who participate either as runners, volun-
teers, or bystanders. 1 Notably, this third Monday in
April is Patriot’s Day, a state holiday for many,
which coincides with the public school system’s
http://dx.doi.org/10.1016/j.aorn.2013.07.019
� AORN, Inc, 2014 February 2014 Vol 99 No 2 � AORN Journal j 277
vacation week. However, it is one of the few state
holidays not observed at MGH.
This marathon Monday began no differently
than many others already past. The OR had pro-
cedures scheduled in 51 rooms that morning,
compared with the usual 61 rooms, and periopera-
tive leaders were projecting that there would be
fewer than 40 rooms running by 3 PM. That
morning, 135 nursing team members arrived for
the 7 AM shift, with more personnel scheduled to
arrive for the 11 AM and 3 PM shifts. The surgical
schedule included a variety of cardiac, vascular,
neurosurgical, and spinal fusion procedures, all
starting at 8 AM. In the early afternoon, the elite
marathon runners’ race results started filtering
in through people’s social media connections.
Although our ORs are mainly situated on one floor,
they do extend through multiple buildings (Figure 1),
and it has become necessary for personnel to
communicate by using cell phones with texting
capability. Operating room leadership personnel,
such as the resource nurse and the anesthesia staff
administrator, communicate with perioperative
personnel through hospital cell phones. Additionally,
in an effort to decrease overhead paging, employees
are allowed to carry personal cell phones; however,
these cell phones are not to be used in the presence of
patients, and they need to be kept in silent mode at all
Figure 1. Aerial photograph of the locations of the perioperative services department at Massachusetts General Hospital.