Disasters disrupt everyone’s lives


Boston Bombings: Response to Disaster MAUREEN HEMINGWAY, MHA, RN, CNOR; JOANNE FERGUSON, MSN, RN


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


� 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.

278 j AORN Journal

February 2014 Vol 99 No 2 HEMINGWAYdFERGUSON



times. At 2 PM, the evening resource nurse and the

OR nursing leader assessed the afternoon staffing

situation and reported that it looked good: patients

were being cared for on time and team members were

not anticipating the need to work overtime hours.


Just before 3 PM, the hospital environment

changed dramatically. Social media provided the

initial information that a bomb had exploded at the

Boston Marathon finish line. The first responders at

the finish line began to care for the casualties by

converting the runners’ medical tent to an emer-

gency triage unit. From there, members of the

Boston Emergency Medical Services (EMS) tri-

aged and transported patients to trauma centers

across the city. Initially, the MGH emergency

preparedness leadership team did not know the

number of patients nor the types of injuries to

expect. Overhead paging alerted OR leaders to

check at the control OR desk.

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