The Boston medical community’s response to last month’s marathon bombings has been widely praised and credited with limiting the number of fatalities. The effort was made possible by previous emergency-preparedness programs, response practice and attention to the lessons learned from other cities, according to an article published May 2 in the New England Journal of Medicine.

Emergency managers in Boston’s medical community have refined plans for mass-casualty events for more than a decade, hosting speakers from London, Madrid, Mumbai and Israel who shared their own harrowing experiences with mass attacks, according to Paul D. Biddinger, MD, of Massachusetts General Hospital (MGH) in Boston, and colleagues.

While emergency medical service (EMS) personnel infrequently use tourniquets on civilians, military experience with improvised explosive devices has shown they reduce combat death from blood loss, and Boston EMS began adapting concepts from combat casualty care strategies, according to the authors.

Boston emergency departments (EDs) were fortunate to have the foresight to address problems of overcrowding and have plans to deal with a large influx of critically injured patients. When the bombings occurred, the city’s operating-room schedules were booked and most EDs, including MGH, were full, according to Biddinger and colleagues. Pre-existing plans called for rapid transport of ED patients to inpatient floors, while pending OR cases were held and OR personnel were quickly mobilized. “In total, MGH received 31 patients in approximately 1 hour, but the hospital could have accommodated even more injured victims if necessary,” wrote the authors. “This response would not have been possible without prior institutional plans that anticipated these needs.”

While the events of that day remained tragic—three people lost their lives and 264 were injured—the emergency response surely saved many lives. Critically ill patients were “red-tagged” and the initial 30 red-tagged patients were triaged and transported within 18 minutes of the explosions, according to Biddinger and colleagues. The last injured patient was transported from the scene within 45 minutes, and nobody transported to a hospital died.

The response is a credit to the sound emergency preparedness strategy, which should continue to be built and refined. “We believe that the speed and coordination of the response is partially attributable to reviewing other cities' experiences, adjusting our plans, and repeatedly training staff in implementing those plans,” wrote the authors. “In this context, it seems especially unfortunate that U.S. health departments, hospitals, and EMS are facing severe budget constraints, owing to cuts in federal funding that will undermine planning, training, and practice activities that have been so important in building health emergency preparedness capabilities.”

For more on disaster preparedness, please read “Sandy’s Wake: Disaster planning revisited” in the March/April issue of Health Imaging.