Securing the Emergency Department During Terrorism Incidents: Lessons Learned From the Boston Marathon Bombings

Area of Science:

• Emergency Medicine
• Public Health Preparedness
• Disaster Response

Background:

• Terrorist attacks targeting healthcare facilities increase patient harm and mortality.
• Effective protocols are crucial for hospitals to mitigate damage during mass casualty incidents.
• Limited literature exists on near-misses in hospital responses to terrorism, particularly bomb threats during active events.

Purpose of the Study:

• To report the first documented instance of an emergency department evacuation in the U.S. due to a bomb threat during an active mass casualty terrorist incident.
• To analyze the response to this unprecedented event and identify areas for improvement.
• To propose evidence-based policy changes for enhanced hospital preparedness for terrorism-related incidents.

Main Methods:

• A comprehensive review of medical literature and media reports in English, Spanish, and Hebrew was conducted.
• The chronology of events leading to the bomb threat and subsequent evacuation was summarized.
• The response was critically reviewed, and data from healthcare, law enforcement, and counterterrorism sectors were analyzed.

Main Results:

• This is the first reported case of an emergency department evacuation in the U.S. prompted by a bomb threat during an active mass casualty terrorist event.
• The response highlighted significant challenges and near-misses due to a lack of specific experience.
• Analysis revealed critical areas for improvement in existing protocols.

Conclusions:

• Hospitals require robust, evidence-based protocols to effectively manage bomb threats during active mass casualty terrorist incidents.
• Interagency collaboration between healthcare, law enforcement, and counterterrorism is essential for optimal preparedness.
• This experience underscores the need for continuous evaluation and enhancement of disaster response plans for unique terrorist threats.