YALE- TULANE ESF-8 SPECIAL REPORT BOMBINGS AT BOSTON MARATHON 144* 3
YALE- TULANE ESF-8 SPECIAL REPORT BOMBINGS AT BOSTON MARATHON 144* 3 YALE- TULANE ESF-8 SPECIAL REPORT BOMBINGS AT BOSTON MARATHON 144* 3
AS OF 15 APRIL 2013 2015 HRS INJURED NUMBER NOT CONFIRMED YALE- TULANE ESF-8 SPECIAL REPORT BOMBINGS AT BOSTON MARATHON DEAD 144* 3 SITUATION SITUATION MAP RESPONSE TYPE OF INJURIES HOSPITALIZATION AND TREATMENT SURGE CAPACITY IN A TERRORIST BOMBING STRESS If you information on the terror attack, police as that you call Boston Bomb Tipline: 1-800-494-TIPS AS OF 2300 HRS EDT 15 APRIL 2013 MASSACHUSETTS Massachusetts Emergency Management Agency Twitter | Facebook Boston Boston Office of Emergency Management Twitter - Alert Boston | Facebook FEDERAL GOVERNMENT FEMA Twitter | Facebook | YouTube | Blog Ready. gov DHS FBI HHS Public Health Emergency – ASPR Twitter | Facebook CDC Twitter | Facebook DOD NORTHCOM Twitter | Facebook ARMY NORTH Twitter | Facebook ORGANIZATION American Red Cross Family members looking for info relative to individuals injured during the incident are encouraged to call (617) 635- 4500.
- Page 2 and 3: WHERE: 671 Boylston Street. Boston,
- Page 4 and 5: LOCAL • There is heightened secur
- Page 6 and 7: TYPE OF INJURIES LIKELY TO BE SEEN
- Page 8 and 9: SURGE CAPACITY IN A TERRORIST BOMBI
AS OF 15 APRIL 2013 2015 HRS<br />
INJURED<br />
NUMBER NOT CONFIRMED<br />
<strong>YALE</strong>- <strong>TULANE</strong> <strong>ESF</strong>-8 <strong>SPECIAL</strong> <strong>REPORT</strong><br />
<strong>BOMBINGS</strong> <strong>AT</strong> <strong>BOSTON</strong> MAR<strong>AT</strong>HON<br />
DEAD<br />
<strong>144*</strong> 3<br />
SITU<strong>AT</strong>ION<br />
SITU<strong>AT</strong>ION MAP<br />
RESPONSE<br />
TYPE OF INJURIES<br />
HOSPITALIZ<strong>AT</strong>ION AND TRE<strong>AT</strong>MENT<br />
SURGE CAPACITY IN A<br />
TERRORIST BOMBING<br />
STRESS<br />
If you information on the<br />
terror attack, police as that<br />
you call Boston Bomb Tipline:<br />
1-800-494-TIPS<br />
AS OF 2300 HRS EDT<br />
15 APRIL 2013<br />
MASSACHUSETTS<br />
Massachusetts Emergency Management Agency<br />
Twitter | Facebook<br />
Boston<br />
Boston Office of Emergency Management<br />
Twitter - Alert Boston | Facebook<br />
FEDERAL GOVERNMENT<br />
FEMA<br />
Twitter | Facebook | YouTube | Blog<br />
Ready. gov<br />
DHS<br />
FBI<br />
HHS<br />
Public Health Emergency – ASPR<br />
Twitter | Facebook<br />
CDC<br />
Twitter | Facebook<br />
DOD<br />
NORTHCOM<br />
Twitter | Facebook<br />
ARMY NORTH<br />
Twitter | Facebook<br />
ORGANIZ<strong>AT</strong>ION<br />
American Red Cross<br />
Family members looking for info<br />
relative to individuals injured<br />
during the incident are<br />
encouraged to call (617) 635-<br />
4500.
WHERE: 671 Boylston Street. Boston, Massachusetts<br />
WHEN: 1450 HRS EDT, 15 APRIL 2013<br />
EVENT: Boston Marathon<br />
SITU<strong>AT</strong>ION: <strong>BOMBINGS</strong><br />
• Two explosions , a primary the a secondary explosion, occurred<br />
near the Boston Marathon finish line at approximately 2:50<br />
p.m.<br />
• The bombs appear to be crude devices that were hidden in<br />
trash cans<br />
• Shrapnel was incorporated into these explosive devices most<br />
likely to increase fragmentation and maximize the number of<br />
casualties.<br />
• The race was diverted before being halted as police and fire<br />
crews swept the area.<br />
• Another explosive device was found, which was purposely<br />
detonated by Boston Police at Boylston Street.<br />
DEAD AND INJURED:<br />
• 3 confirmed dead - including an 8 year old boy<br />
• Hospitals have treated more than 124 victims - including 8<br />
children. At least 17 are in critical condition, 25 are in serious<br />
condition<br />
INVESTIG<strong>AT</strong>ION: On going . Currently there is no one under arrest<br />
and no groups have claimed responsibility<br />
SITU<strong>AT</strong>ION
SECOND EXPLOSION<br />
FIRST EXPLOSION<br />
SOURCE: NEW YORK TIME<br />
SITU<strong>AT</strong>ION MAP<br />
Officials said that a suspicious package was found<br />
and destroyed by police at the Mandarin Hotel<br />
Runners approached from the west.<br />
Second explosion went off about 10 seconds<br />
after the first one.<br />
The two explosions were about 550 feet<br />
apart<br />
First explosion occurred about 3 p.m. on the<br />
north side of Boylston Street, just before the<br />
bridge that marks the finish line.<br />
2 MILES<br />
FINISH<br />
LINE<br />
<strong>BOSTON</strong><br />
EAST<br />
<strong>BOSTON</strong><br />
SOUTH<br />
<strong>BOSTON</strong><br />
JFK<br />
LIBREARY
LOCAL<br />
• There is heightened security at local hospitals and<br />
critical infrastructure sites<br />
• The Red Cross sent additional blood products to<br />
Boston hospitals<br />
• Hospital throughout Boston responded to Mass<br />
Casualty incident.<br />
• Criminal investigation is on going<br />
• The area around Copley Square where the<br />
incident took placed is closed and is considered a<br />
crime scene<br />
ST<strong>AT</strong>E<br />
• The Massachusetts Emergency Management<br />
Agency suggested people trying to contact those<br />
in the vicinity use text messaging because of<br />
crowded phone lines<br />
• Troops from the Massachusetts National Guard<br />
assisted police in emergency response<br />
• The office of the Attorney for the District of<br />
Massachusetts is coordinating responses from law<br />
enforcement agencies<br />
References: http://rt.com/usa/boston-marathon-explosions-updates-911/ ,<br />
http://www.cnn.com/2013/04/15/us/boston-marathon-response/index.html,<br />
http://www.govexec.com/defense/2013/04/federal-authorities-responding-bostonmarathon-explosions/62536/,http://www.cnn.com/2013/04/15/us/boston-marathonexplosions/index.html?hpt=hp_t1<br />
RESPONSE<br />
FEDERAL<br />
• Federal agents have been dispatched to crowded<br />
hospitals<br />
• Officials from the Justice Department and the<br />
Bureau of Alcohol, Tobacco, and Firearms are<br />
being deployed to investigate the explosions<br />
• Homeland Security Secretary Janet Napolitano<br />
ordered the department to provide “whatever<br />
assistance is necessary”
ON GOING INVESTIG<strong>AT</strong>ION<br />
• A multi-agency response including state and federal<br />
law enforcement agencies has been activated and<br />
is investigating the cause of the explosions along<br />
the Boston Marathon route and elsewhere.<br />
• Forensics analysis is on going.<br />
• The FBI’s Boston Division stands with the Boston<br />
Police Department (BPD) and remains on-scene.<br />
• The situation remains fluid, and it remains too early<br />
to establish the cause and motivation.<br />
• The FBI declared federal jurisdiction over the<br />
matter through the Boston Joint Terrorism Task<br />
Force.<br />
The Navy has sent one of its bomb-disposal units to<br />
Boston to assist local authorities as needed. The<br />
three-member explosive ordnance disposal team<br />
based at Naval Station Newport, R.I., was sent to<br />
Massachusetts after state officials asked for help.<br />
<strong>BOSTON</strong> FBI PRESS RELEASE<br />
http://www.whitehouse.gov/<br />
RESPONSE<br />
President Barack Obama said he ordered the "full<br />
resources" of the federal government to respond<br />
to the Boston bombings on Monday, and that he<br />
also called for increased security around the<br />
United States as necessary.
TYPE OF INJURIES LIKELY TO BE SEEN<br />
PRIMARY BLAST INJURIES<br />
• Most post-explosion injuries involve blunt and<br />
penetrating trauma<br />
• The initial blast may cause abdominal bleeding<br />
and perforation, concussion (possibly without<br />
physical signs of injury to the head), and<br />
rupture of the eardrum<br />
• Blast lung is the most common fatal injury<br />
among initial survivors<br />
‒ The blast wave may cause tearing,<br />
bleeding, and buildup of fluid in the lungs<br />
‒ Symptoms include shortness of breath,<br />
chest pain, and coughing up blood<br />
‒ Patients may also show signs of slowed<br />
breathing, cyanosis, and wheezing<br />
SECONDARY BLAST INJURIES<br />
• Flying debris and bomb fragments may cause<br />
penetrating trauma, fracture, or amputation<br />
References: http://www.bt.cdc.gov/masscasualties/blastinjuryfacts.asp,<br />
http://www.bt.cdc.gov/masscasualties/blastlunginjury.asp,<br />
http://www.bt.cdc.gov/masscasualties/explosions.asp,<br />
OTHER POSSIBLE INJURIES<br />
• Burns, crush injuries, and severe<br />
lacerations may be seen in victims<br />
• Blast may result in impaired vision and<br />
hearing<br />
• Exacerbation of chronic illness is possible<br />
NOTE: More of the injured seen have injuries to their lower<br />
extremities.
HOSPITALIZ<strong>AT</strong>ION AND TRE<strong>AT</strong>MENT<br />
HOSPITAL* NUMBER OF INJURED<br />
Brigham and Women's<br />
Hospital<br />
48<br />
Children’s Hospital 10<br />
Boston Medical Center 20<br />
Massachusetts General<br />
Hospital<br />
Tufts New England Medical<br />
Center<br />
29<br />
Beth Israel 23<br />
* This list is not complete and has not been confirmed.<br />
Numbers were gathered from press report.<br />
SOURCES:<br />
Marathon medical tent ‘transformed into trauma unit<br />
Mass General Press Conference - 15 APRIL 2013<br />
Hospitals treat carnage after Boston blasts<br />
9<br />
Medical personnel work<br />
outside medical tent in<br />
aftermath of bombing<br />
(AP Photo/Elise<br />
Amendola)<br />
• Eight hospitals report that they are treating at least 124 people. Of<br />
those, at least 15 are in critical condition.<br />
• The injuries ranged from cuts and bruises to amputations. Many victims<br />
suffered lower leg injuries and shrapnel wounds. Some suffered ruptured<br />
eardrums.<br />
• The medical tent at the finish lined was turned into triage center<br />
Although it was not equipped for trauma, they had bags of intravenous<br />
fluids hanging from four yellow ropes suspended down the middle,<br />
tourniquets, blood pressure monitors, defibrillators, and EKGs. Medical<br />
personnel included internists, family physicians, cardiologists, emergency<br />
physicians, physical therapists, and social workers.<br />
• Most of those seen had injuries to their lower limbs.<br />
• Patients were evacuated to hospitals throughout Boston.<br />
• Massachusetts General Hospital facility ICS was activated within 5<br />
minutes of notification. The hospital treated at least 29 victims, eight of<br />
whom were critically injured, including some with amputated legs.<br />
• Boston Children’s Hospital said the hospital treated eight children<br />
ranging in age from a 2-year-old boy with a head injury, to a 14-year-old<br />
boy also with a head injury. Two adults were also treated at the hospital.<br />
• The nine victims treated at New England Medical Center included victims<br />
with serious trauma and leg fractures, shrapnel wounds and ruptured<br />
eardrums
SURGE CAPACITY IN A TERRORIST BOMBING<br />
• Explosive devices are the most common weapons used by terrorists.<br />
• Explosions can produce instantaneous havoc, resulting in numerous<br />
casualties with complex, technically challenging injuries not commonly<br />
seen after natural disasters.<br />
• Because many patients self-evacuate after a terrorist attack and<br />
prehospital care may be difficult to coordinate, hospitals near the scene<br />
can expect to receive a large influx, or surge, of victims after a terrorist<br />
strike.<br />
• Health care and public health specialists should anticipate profound<br />
challenges in adequately caring for the surge of victims following a<br />
terrorist bombing.<br />
• CDC with a panel of experts produced “In a Moment’s Notice: Surge<br />
Capacity in Terrorist Bombings.” . It includes a description of systemwide<br />
and discipline-specific challenges as well as recommendations to<br />
address these issues.<br />
ADDITIONAL RESOURCES:<br />
• Blast Injury Fact Sheets<br />
• “Bombings: Injury Patterns and Care” poster and pocket card<br />
• “Interim Planning Guidance for Preparedness to Mass Casualty Events Resulting from Terrorist Use of Explosives” report<br />
• Blast Injuries: What You Need to Know Webcast<br />
• Blast Injuries: What Clinicians Need to Know (Podcast)<br />
• The Terrorism Injuries Information, Dissemination and Exchange (TIIDE) Project
SYMPTOMS OF STRESS<br />
Stress is a condition that is often characterized by symptoms of physical or emotional tension. It is a<br />
reaction to a situation where a person feels threatened or anxious. Stress can be positive (e.g., preparing<br />
for a wedding) or negative (e.g., dealing with a natural disaster).<br />
COMMON REACTIONS TO A STRESSFUL EVENT INCLUDE:<br />
• Physical or emotional tension are often signs of stress. They can be<br />
reactions to a situation that causes you to feel threatened or anxious.<br />
Stress can be positive (such as planning your wedding) or negative (such<br />
as dealing with the effects of a natural disaster).<br />
• Disbelief and shock<br />
• Tension and irritability<br />
• Fear and anxiety about the future<br />
• Difficulty making decisions<br />
• Being numb to one’s feelings<br />
• Loss of interest in normal activities<br />
• Loss of appetite<br />
• Nightmares and recurring thoughts about the event<br />
• Anger<br />
• Increased use of alcohol and drugs<br />
• Sadness and other symptoms of depression<br />
• Feeling powerless<br />
• Crying<br />
• Sleep problems<br />
• Headaches, back pains, and stomach problems<br />
• Trouble concentrating<br />
The Disaster Distress Helpline 1-800-985-5990 provides immediate<br />
crisis counseling to people affected by the tragedy in Boston. The<br />
helpline can also be accessed at<br />
http://disasterdistress.samhsa.gov/ and TTY for deaf and hearing<br />
impaired: 1-800-846-8517.<br />
THE BEST WAYS TO MANAGE STRESS IN HARD TIMES ARE THROUGH<br />
SELF-CARE:<br />
• Avoid drugs and alcohol. They may seem to be a temporary fix to feel<br />
better, but in the long run they can create more problems and add to your<br />
stress—instead of take it away.<br />
• Find support. Seek help from a partner, family member, friend, counselor,<br />
doctor, or clergyperson. Having a sympathetic, listening ear and sharing<br />
about your problems and stress really can lighten the burden.<br />
• Connect socially. After a stressful event, it is easy isolate yourself. Make sure<br />
that you are spending time with loved ones. Consider planning fun activities<br />
with your partner, children, or friends.<br />
• Take care of yourself.<br />
‒ Eat a healthy, well-balanced diet<br />
‒ Exercise regularly<br />
‒ Get plenty of sleep<br />
‒ Give yourself a break if you feel stressed out—for example, treat<br />
yourself to a therapeutic massage<br />
‒ Maintain a normal routine<br />
• Stay active. You can take your mind off your problems by giving— helping a<br />
neighbor, volunteering in the community, even taking the dog on a long<br />
walk. These can be positive ways to channel your feelings.<br />
SOURCE:<br />
http://www.samhsa.gov/newsroom/advisories/1304152649.aspx<br />
CDC – Coping with stress