Mass casualty preparedness

Once again, a senseless act of violence has upended any notion that the war on terror will someday end and a sense of normalcy will return to national life.

As of this writing, we still don't know who planted the homemade bomb that took three innocent lives and injured more than 175 spectators gathered near the finish line of the Boston Marathon. But does it really matter? Since the mid-1990s, the country has been repeatedly rocked by terrorist acts perpetrated by hate-filled individuals or small groups both foreign and domestic.

Oklahoma City, Atlanta, New York, Washington, D.C., now Boston—the number of major American cities targeted by terrorists has grown depressingly long. And then there's the equally long list of places that suffered tragic mass killings at the hands of individual gunmen: Columbine, Virginia Tech, the Aurora, Colo., theater shooting and, most recently, Newtown.

The lesson for healthcare providers everywhere is simple: Be prepared. We live in a world where powerless people with all manner of grievances—or simply noises in their head—can easily obtain the guns, bullets, pellets, nitrates (Isn't it ironic that another mass casualty event took place last week at a fertilizer factory in Texas?) to wreak untold havoc on innocent people. When mass casualties occur, somebody has to rush to the scene, care for the wounded and deal—for decades—with the physical and emotional aftershocks.

Since 9/11, the nation has spent a lot of money trying to ready local public health officials and healthcare facilities for horrific events with mass casualties. Grants have been given. The Centers for Disease Control and Prevention has prepared planning documents with sense-dulling titles such as “Preparedness and Response to a Mass Casualty Event Resulting from Terrorist Use of Explosives.”

And the reports from Boston seem to suggest all the attention paid off. The number who died was surprisingly low given the density of the crowd and its proximity to the blast. The speediness of the response and the brilliance of the surgical teams that saved lives and limbs were justifiably celebrated in the national media.

And what can now be done for those who lost limbs—the estimates are that at least 13 patients in Boston had one or both legs removed because of the extent of their injuries—has also won plaudits. It is a medical miracle courtesy of the extensive experience caring for the 1,600 soldiers who lost limbs in Iraq and Afghanistan. People are running in the Olympics and climbing mountains with the new prosthetic limbs developed by leading-edge medical device firms. The growing awareness about the lifelong impact of post-traumatic stress disorder has also given mental health its proper role in the overall preparedness scheme.

But let's not lose sight of the fact that there were many unique aspects to the Boston response. The marathon organizers were already prepared for mass casualties—among the runners. There was a large medical tent and dozens of mobilized emergency medical personnel standing by to deal with dehydration, heart attacks and other injuries.

Boston also benefits from having an oversized medical sector with high levels of expertise in almost every specialty of relevance in a mass casualty event. Places such as Massachusetts General and Brigham and Women's Hospital with their ties to Harvard Medical School have resources and skills that most communities can only envy and could not easily replicate if they were hit by something similar.

In the wake of 9/11, the federal government earmarked nearly a half billion dollars annually for hospital preparedness training. Over the past decade, spending fell 30% from its peak, with the Obama administration calling for another $100 million cut in its proposed budget. In the wake of this new Boston Massacre, that complacency is misplaced.

Merrill Goozner, Editor