The 2013 Boston Marathon: Lessons in Emergency Planning

“The runners continued to pile-up at the barriers, and I was being crushed. When we heard the second explosion, all the police officers holding us back took off on foot towards the finish line - leaving the runners, their cruisers and motorcycles behind. We were left with no idea of what was happening.”
-    Anne Marie Winchester, Captain of South Shore Health’s Boston Marathon team

On April 15, 2013, the explosions caused by two unmarked backpacks echoed throughout Boylston Street in the Back Bay neighborhood of Boston. For many, time stood still. But emergency medical responders showed no hesitation in implementing their training to transport and stabilize over 200 victims. The response was by-the-book, but in the aftermath of the Boston Marathon bombings, public health officials also saw opportunity for improvement. For South Shore Health, it reshaped the way its EMS department evaluated and practiced its emergency response plan.

After the first explosion, the response by Boston EMS was instantaneous and well-coordinated as they began stabilizing and transporting victims. Training “helped mitigate a lot of issues and assisted in getting people to hospitals as quickly as possible,” said Paul Hughes, South Shore Health EMS Coordinator and a former member of the Boston EMS staff who was working the day of the race.

Before the Boston Marathon, “a lot of these plans (which outline the roles of municipalities and healthcare systems during an emergency medical response) were in a binder and sat on someone’s shelf, but now they’re a living document that we take down and exercise,” said Hughes. 

Those exercises, created through the Incident Command System (ICS) method of training, outline the roles of municipalities and healthcare systems.

“Training helps us work better as a team and to understand that this is my role and that is yours, and this is how we’ll progress through a disaster,” said Hughes.

In addition to improved organization, South Shore Health recognized the avenues and speed at which it distributes up-to-date emergency information to the public has changed. With improvements, it could alleviate the panic caused by untrustworthy information in a chaotic situation.

Following the April, 2013 incident, cell service in the city of Boston went dead and restricted the communication between runners, municipalities, and families -- creating panic and rumors. “All the phone lines were down, so that you couldn’t get any calls out.  I had to borrow a strangers phone to get a text off to my husband,” said Anne Marie Winchester, Captain of the South Shore Health Boston Marathon team.

As the largest healthcare provider on the South Shore, distributing trustworthy information to the community is an important aspect to its emergency response. “We needed to provide the public with information. To give some idea that things are going on and that we’re responding to them” said Joan Cooper-Zack, the manager for emergency preparedness at South Shore Health.

Additional lessons learned during the aftermath and stabilization of victims at the 2013 Boston Marathon, focused on patient tracking and severity identification cards. The tracking and armbands used at that time were intended to help the workflow, but the technology was unable to keep up with the fast-moving event.

“It sounded like a great idea at the time, but the upload and download time took about ninety seconds, and that’s an eternity in the mass casualty world. We had transport decisions to make, so we had to resort back to paper,” said Brian Pomodoro, South Shore Health’s disaster response educator.

“There is a stark difference between the technology we use now and six years ago,” said Pomodoro. 

Thousands of runners, who now participate yearly in the Boston Marathon, aren’t necessarily running for placement, but to commemorate those who died or were injured on April 15, 2013. 

“The most amazing thing is when you’re out on the course, and you see the victims of the Boston Marathon bombings running right beside you." 

"They’re running the marathon that almost killed them, and that is pretty spectacular,” said Winchester.