Critical Communications During the Boston Marathon

By Antonya English

Joseph O’Hare grew up in Boston, and as a young boy attended the Boston Marathon with his family, later watching as his own family made attending the event a ritual.

As a member of the City’s EMS Department for 37 years, he and his staff spent years preparing for a potential major disaster at the event, honestly never believing it would occur.

But when the unthinkable happened – a bombing at the finish line of the world-renowned race – the Boston EMS workers learned what they had thought all along: Preparedness can be the difference between life and death for many injured that day.

During a presentation entitled "Critical Communications During the Boston Marathon," O’Hare gave a riveting account of the hours and days that followed the attack two years ago that destroyed lives and briefly paralyzed a city. He reminded those in attendance of the critical role emergency services personnel have during a major disaster.

O’Hare said EMS personnel were helped by the fact that Boston has 10 hospitals, including five adult Level 1 Trauma Centers, three pediatric Level 1 trauma centers and two burn centers.

"We’re very fortunate and that proved to be true on that day," said O’Hare, now the deputy superintendent of Boston EMS.

The Boston Marathon is second only to the Super Bowl in terms of event management. The race included 27,000 registered runners, 5,000 bandit runners (unregistered), 550,000 spectators and 1,100 media members. About 100 EMS personnel on bicycles, golf carts and all-terrain vehicles were on duty.

The Boston EMS personnel transported 180 patients to area hospitals that day. The first explosion occurred at 2:49 p.m. By 2:58, the first ambulance was leaving the scene. By 3:05, the site of the first explosion had been cleared of patients. By 3:17, the second site was reported clear and by 4:06 patients had been transported to hospitals.

O’Hare said monthly emergency preparedness drills made a significant difference in the EMS response.

"We had a lot of practice at this stuff and it’s really important to do that," he said.

As part of his presentation, O’Hare produced a slide show complete with photos from that tragic day and audio from actual EMS personnel. The scenes were graphic, but they showed the resilience of the EMS personnel and staff. O’Hare said protocol is for EMS staff to stay away from the scene until told by supervisors through dispatch staff, but Boston’s EMS workers disobeyed those orders and rushed directly into the scene to help.

Interestingly, the primary dispatcher that day had been on the job just nine months.

"He handled it well," O’Hare said.

A bit of luck also helped: Many units were in the middle of a shift change, so the night shift was still on duty as the day shift was arriving, O’Hare said, allowing for extra help.

Some of the problems that EMS personnel had to deal with included loss of cellular service as thousands of people attempted to call family and friends. While texting services remained intact, Boston does not have Text-to-911 service.

Here are some of the lessons O’Hare said can be taken from the Boston Marathon bombing and its aftermath:

 

• Stick to strict radio protocol to minimize confusion.
• Use plain language.
• Make normal radio procedures a habit.
• Have EMS roles predefined – and utilize them.
• Early notification is critical: Time saves lives. Go for the basics – bleeding control and basic life-saving techniques, then transport.
• Peer support and debriefing – immediately and in the days and weeks afterward- is critical for EMS workers. "You need to take care of them," O’Hare said. "They need to talk."

Some areas that proved difficult were patient tracking in the days after the bombing. Many patients were transported to other hospitals, and some didn’t have triage tags from the scene. The problem was compounded by the fact that many had their clothes torn off or lost their personal possessions during the blast.

"Like every place, we’re not perfect, we always have something to learn," O’Hare said.

O’Hare said there are also five keys to preparedness:

 

• Planning
• Awareness
• Training
• Equipment
• Exercise

Ultimately, O’Hare told conference attendees to remember they are an important part of a major disaster no matter what job they hold.

"Folks, no matter where they are in the dispatch center, play a critical role," O’Hare said.