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Leadership During the Boston Marathon Bombings: A Qualitative After-Action Review

Published online by Cambridge University Press:  22 June 2015

Eric Goralnick ,
Pinchas Halpern ,
Stephanie Loo ,
Jonathan Gates ,
Paul Biddinger ,
John Fisher ,
George Velmahos ,
Sarita Chung ,
David Mooney  and
Calvin Brown
...Show all authors
Eric Goralnick*
Affiliation:
Brigham and Women’s Hospital National Preparedness Leadership Initiative
Pinchas Halpern
Affiliation:
Sourasky Tel Aviv Medical Center
Stephanie Loo
Affiliation:
Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States;
Jonathan Gates
Affiliation:
Brigham and Women’s Hospital
Paul Biddinger
Affiliation:
Massachusetts General Hospital
John Fisher
Affiliation:
Beth Israel Deaconess Medical Center
George Velmahos
Affiliation:
Massachusetts General Hospital
Sarita Chung
Affiliation:
Boston Children’s Hospital
David Mooney
Affiliation:
Boston Children’s Hospital
Calvin Brown
Affiliation:
Brigham and Women’s Hospital Brigham and Women’s Faulkner Hospital, Jamaica Plain, Massachusetts, United States
Brien Barnewolt
Affiliation:
Tufts Medical Center
Peter Burke
Affiliation:
Boston Medical Center, Boston, Massachusetts, United States;
Alok Gupta
Affiliation:
Beth Israel Deaconess Medical Center
Andrew Ulrich
Affiliation:
Boston Medical Center, Boston, Massachusetts, United States;
Horacio Hojman
Affiliation:
Tufts Medical Center
Eric McNulty
Affiliation:
National Preparedness Leadership Initiative Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States;
Barry Dorn
Affiliation:
National Preparedness Leadership Initiative Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States;
Leonard Marcus
Affiliation:
National Preparedness Leadership Initiative Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States;
Kobi Peleg
Affiliation:
Tel Aviv University, Tel Aviv, Israel; The Gertner Institute for Health Policy, Tel Hashomer, Israel.
*
Correspondence and reprint requests to Eric Goralnick, MD, MS, Brigham and Women’s Hospital, Department of Emergency Medicine, 75 Francis Street, Boston, MA 02118 (e-mail: egoralnick@partners.org).
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Abstract

Objective

On April 15, 2013, two improvised explosive devices (IEDs) exploded at the Boston Marathon and 264 patients were treated at 26 hospitals in the aftermath. Despite the extent of injuries sustained by victims, there was no subsequent mortality for those treated in hospitals. Leadership decisions and actions in major trauma centers were a critical factor in this response.

Methods

The objective of this investigation was to describe and characterize organizational dynamics and leadership themes immediately after the bombings by utilizing a novel structured sequential qualitative approach consisting of a focus group followed by subsequent detailed interviews and combined expert analysis.

Results

Across physician leaders representing 7 hospitals, several leadership and management themes emerged from our analysis: communications and volunteer surges, flexibility, the challenge of technology, and command versus collaboration.

Conclusions

Disasters provide a distinctive context in which to study the robustness and resilience of response systems. Therefore, in the aftermath of a large-scale crisis, every effort should be invested in forming a coalition and collecting critical lessons so they can be shared and incorporated into best practices and preparations. Novel communication strategies, flexible leadership structures, and improved information systems will be necessary to reduce morbidity and mortality during future events. (Disaster Med Public Health Preparedness. 2015;9:489–495)

Keywords

bombsemergency medicinecommunicationdisaster medicinemass casualty incidents
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 9 , Supplement 5 , October 2015 , pp. 489 - 495
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

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