Out front, social workers dealt with others who were arriving at the hospital. Registration was "very focused on getting real names so that we wouldn’t lose any patients to mistaken identity," he said. Patients were quickly assessed as they arrived, then flowed rapidly to the next stage of care, whether it was operating room or intensive care."
At Brigham and Women’s, the emergency department received a total of 35 patients, 28 of whom arrived in an hour.
"When this started, we had a pretty full ED," said Dr. Walls, professor of medicine at Harvard Medical School. "We decompressed by moving some of the patients out of the ED or into inpatient units. We created a lot of capacity in a short period of time. At the same time, we had alerted the OR, and it happened to be shift change, so we froze the staff, resulting in double staffing. And it was Monday afternoon on a holiday, so the ORs’ slate was lighter. Those two things allowed us to create seven open, staffed, ready ORs in a very short period of time.
"Within the ED, we deployed [emergency physicians] and surgeons and nurses into a number of trauma teams. At one point we had more than 10 teams, and they were all ready to receive patients, which turned out to be very important," Dr. Walls said.
At press time, none of more than 170 patients who were admitted to Boston area hospitals after the marathon had died, and physicians attribute this to great prehospital care, and lots of practice, preparation, and collaboration.
"It’s times like this that bring out the best in everybody," Dr. Wolfe said. "People are willing to help, they’re willing to collaborate. Egos dissipate and people tend to work together the way you just don’t see on a regular basis, which is absolutely lovely. From my standpoint, watching how well the teams worked, sort of was a validation of what emergency medicine is all about, and what emergency medicine training is."
"This was an amazing example for me, not that I really needed one, on how valuable every single person in the emergency department is," Dr. Walls said. "It’s the physicians and nurses, but it is also the aides, and the registration people and the housekeepers and everybody in the ED who have to do their jobs magnificently to make this work. And on that day, they all did."
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