Yale-Tulane ESF-8 Special Report: Bombings at Boston ... - NCDMPH
Yale-Tulane ESF-8 Special Report: Bombings at Boston ... - NCDMPH Yale-Tulane ESF-8 Special Report: Bombings at Boston ... - NCDMPH
YALE- TULANE ESF-8 SPECIAL REPORT BOMBINGS AT BOSTON MARATHON AS OF 15 APRIL 2013 2015 HRS INJURED DEAD 144* 3 NUMBER NOT CONFIRMED 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: SITUATION WHERE: 671 Boylston Stree
- Page 4 and 5: RESPONSE LOCAL • There is heighte
- Page 6 and 7: TYPE OF INJURIES LIKELY TO BE SEEN
- Page 8 and 9: SURGE CAPACITY IN A TERRORIST BOMBI
YALE- TULANE <strong>ESF</strong>-8 SPECIAL REPORT<br />
BOMBINGS AT BOSTON MARATHON<br />
AS OF 15 APRIL 2013 2015 HRS<br />
INJURED<br />
DEAD<br />
144* 3<br />
NUMBER NOT CONFIRMED<br />
SITUATION<br />
SITUATION MAP<br />
RESPONSE<br />
TYPE OF INJURIES<br />
HOSPITALIZATION AND TREATMENT<br />
SURGE CAPACITY IN A<br />
TERRORIST BOMBING<br />
STRESS<br />
If you inform<strong>at</strong>ion on the<br />
terror <strong>at</strong>tack, police as th<strong>at</strong><br />
you call <strong>Boston</strong> 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 />
<strong>Boston</strong><br />
<strong>Boston</strong> Office of Emergency Management<br />
Twitter - Alert <strong>Boston</strong> | 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 />
ORGANIZATION<br />
American Red Cross<br />
Family members looking for info<br />
rel<strong>at</strong>ive to individuals injured<br />
during the incident are<br />
encouraged to call (617) 635-<br />
4500.
SITUATION<br />
WHERE: 671 Boylston Street. <strong>Boston</strong>, Massachusetts<br />
WHEN: 1450 HRS EDT, 15 APRIL 2013<br />
EVENT: <strong>Boston</strong> Mar<strong>at</strong>hon<br />
SITUATION: BOMBINGS<br />
• Two explosions , a primary the a secondary explosion, occurred<br />
near the <strong>Boston</strong> Mar<strong>at</strong>hon finish line <strong>at</strong> approxim<strong>at</strong>ely 2:50<br />
p.m.<br />
• The bombs appear to be crude devices th<strong>at</strong> were hidden in<br />
trash cans<br />
• Shrapnel was incorpor<strong>at</strong>ed into these explosive devices most<br />
likely to increase fragment<strong>at</strong>ion 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 />
deton<strong>at</strong>ed by <strong>Boston</strong> Police <strong>at</strong> Boylston Street.<br />
DEAD AND INJURED:<br />
• 3 confirmed dead - including an 8 year old boy<br />
• Hospitals have tre<strong>at</strong>ed more than 124 victims - including 8<br />
children. At least 17 are in critical condition, 25 are in serious<br />
condition<br />
INVESTIGATION: On going . Currently there is no one under arrest<br />
and no groups have claimed responsibility
SITUATION MAP<br />
SECOND EXPLOSION<br />
Officials said th<strong>at</strong> a suspicious package was found<br />
and destroyed by police <strong>at</strong> 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<br />
First explosion occurred about 3 p.m. on the<br />
north side of Boylston Street, just before the<br />
bridge th<strong>at</strong> marks the finish line.<br />
2 MILES<br />
BOSTON<br />
EAST<br />
BOSTON<br />
FINISH<br />
LINE<br />
SOUTH<br />
BOSTON<br />
SOURCE: NEW YORK TIME<br />
JFK<br />
LIBREARY
RESPONSE<br />
LOCAL<br />
• There is heightened security <strong>at</strong> local hospitals and<br />
critical infrastructure sites<br />
• The Red Cross sent additional blood products to<br />
<strong>Boston</strong> hospitals<br />
• Hospital throughout <strong>Boston</strong> responded to Mass<br />
Casualty incident.<br />
• Criminal investig<strong>at</strong>ion 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 />
STATE<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 N<strong>at</strong>ional Guard<br />
assisted police in emergency response<br />
• The office of the Attorney for the District of<br />
Massachusetts is coordin<strong>at</strong>ing responses from law<br />
enforcement agencies<br />
FEDERAL<br />
• Federal agents have been disp<strong>at</strong>ched to crowded<br />
hospitals<br />
• Officials from the Justice Department and the<br />
Bureau of Alcohol, Tobacco, and Firearms are<br />
being deployed to investig<strong>at</strong>e the explosions<br />
• Homeland Security Secretary Janet Napolitano<br />
ordered the department to provide “wh<strong>at</strong>ever<br />
assistance is necessary”<br />
References: http://rt.com/usa/boston-mar<strong>at</strong>hon-explosions-upd<strong>at</strong>es-911/ ,<br />
http://www.cnn.com/2013/04/15/us/boston-mar<strong>at</strong>hon-response/index.html,<br />
http://www.govexec.com/defense/2013/04/federal-authorities-responding-bostonmar<strong>at</strong>hon-explosions/62536/,<br />
http://www.cnn.com/2013/04/15/us/boston-mar<strong>at</strong>honexplosions/index.html?hpt=hp_t1
RESPONSE<br />
ON GOING INVESTIGATION<br />
• A multi-agency response including st<strong>at</strong>e and federal<br />
law enforcement agencies has been activ<strong>at</strong>ed and<br />
is investig<strong>at</strong>ing the cause of the explosions along<br />
the <strong>Boston</strong> Mar<strong>at</strong>hon route and elsewhere.<br />
• Forensics analysis is on going.<br />
• The FBI’s <strong>Boston</strong> Division stands with the <strong>Boston</strong><br />
Police Department (BPD) and remains on-scene.<br />
• The situ<strong>at</strong>ion remains fluid, and it remains too early<br />
to establish the cause and motiv<strong>at</strong>ion.<br />
• The FBI declared federal jurisdiction over the<br />
m<strong>at</strong>ter through the <strong>Boston</strong> Joint Terrorism Task<br />
Force.<br />
The Navy has sent one of its bomb-disposal units to<br />
<strong>Boston</strong> to assist local authorities as needed. The<br />
three-member explosive ordnance disposal team<br />
based <strong>at</strong> Naval St<strong>at</strong>ion Newport, R.I., was sent to<br />
Massachusetts after st<strong>at</strong>e officials asked for help.<br />
President Barack Obama said he ordered the "full<br />
resources" of the federal government to respond<br />
to the <strong>Boston</strong> bombings on Monday, and th<strong>at</strong> he<br />
also called for increased security around the<br />
United St<strong>at</strong>es as necessary.<br />
BOSTON FBI PRESS RELEASE<br />
http://www.whitehouse.gov/
TYPE OF INJURIES LIKELY TO BE SEEN<br />
PRIMARY BLAST INJURIES<br />
• Most post-explosion injuries involve blunt and<br />
penetr<strong>at</strong>ing trauma<br />
• The initial blast may cause abdominal bleeding<br />
and perfor<strong>at</strong>ion, concussion (possibly without<br />
physical signs of injury to the head), and<br />
rupture of the eardrum<br />
• Blast lung is the most common f<strong>at</strong>al 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 bre<strong>at</strong>h,<br />
chest pain, and coughing up blood<br />
‒ P<strong>at</strong>ients may also show signs of slowed<br />
bre<strong>at</strong>hing, cyanosis, and wheezing<br />
OTHER POSSIBLE INJURIES<br />
• Burns, crush injuries, and severe<br />
lacer<strong>at</strong>ions may be seen in victims<br />
• Blast may result in impaired vision and<br />
hearing<br />
• Exacerb<strong>at</strong>ion of chronic illness is possible<br />
SECONDARY BLAST INJURIES<br />
• Flying debris and bomb fragments may cause<br />
penetr<strong>at</strong>ing trauma, fracture, or amput<strong>at</strong>ion<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 />
NOTE: More of the injured seen have injuries to their lower<br />
extremities.
HOSPITALIZATION AND TREATMENT<br />
HOSPITAL*<br />
Brigham and Women's<br />
Hospital<br />
NUMBER OF INJURED<br />
48<br />
Children’s Hospital 10<br />
<strong>Boston</strong> 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 g<strong>at</strong>hered from press report.<br />
SOURCES:<br />
Mar<strong>at</strong>hon medical tent ‘transformed into trauma unit<br />
Mass General Press Conference - 15 APRIL 2013<br />
Hospitals tre<strong>at</strong> carnage after <strong>Boston</strong> blasts<br />
9<br />
Medical personnel work<br />
outside medical tent in<br />
afterm<strong>at</strong>h of bombing<br />
(AP Photo/Elise<br />
Amendola)<br />
• Eight hospitals report th<strong>at</strong> they are tre<strong>at</strong>ing <strong>at</strong> least 124 people. Of<br />
those, <strong>at</strong> least 15 are in critical condition.<br />
• The injuries ranged from cuts and bruises to amput<strong>at</strong>ions. Many victims<br />
suffered lower leg injuries and shrapnel wounds. Some suffered ruptured<br />
eardrums.<br />
• The medical tent <strong>at</strong> 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, defibrill<strong>at</strong>ors, 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 />
• P<strong>at</strong>ients were evacu<strong>at</strong>ed to hospitals throughout <strong>Boston</strong>.<br />
• Massachusetts General Hospital facility ICS was activ<strong>at</strong>ed within 5<br />
minutes of notific<strong>at</strong>ion. The hospital tre<strong>at</strong>ed <strong>at</strong> least 29 victims, eight of<br />
whom were critically injured, including some with amput<strong>at</strong>ed legs.<br />
• <strong>Boston</strong> Children’s Hospital said the hospital tre<strong>at</strong>ed 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 tre<strong>at</strong>ed <strong>at</strong> the hospital.<br />
• The nine victims tre<strong>at</strong>ed <strong>at</strong> 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 n<strong>at</strong>ural disasters.<br />
• Because many p<strong>at</strong>ients self-evacu<strong>at</strong>e after a terrorist <strong>at</strong>tack and<br />
prehospital care may be difficult to coordin<strong>at</strong>e, 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 anticip<strong>at</strong>e profound<br />
challenges in adequ<strong>at</strong>ely 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 <strong>Bombings</strong>.” . It includes a description of systemwide<br />
and discipline-specific challenges as well as recommend<strong>at</strong>ions to<br />
address these issues.<br />
ADDITIONAL RESOURCES:<br />
• Blast Injury Fact Sheets<br />
• “<strong>Bombings</strong>: Injury P<strong>at</strong>terns 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: Wh<strong>at</strong> You Need to Know Webcast<br />
• Blast Injuries: Wh<strong>at</strong> Clinicians Need to Know (Podcast)<br />
• The Terrorism Injuries Inform<strong>at</strong>ion, Dissemin<strong>at</strong>ion and Exchange (TIIDE) Project
SYMPTOMS OF STRESS<br />
Stress is a condition th<strong>at</strong> is often characterized by symptoms of physical or emotional tension. It is a<br />
reaction to a situ<strong>at</strong>ion where a person feels thre<strong>at</strong>ened or anxious. Stress can be positive (e.g., preparing<br />
for a wedding) or neg<strong>at</strong>ive (e.g., dealing with a n<strong>at</strong>ural 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 situ<strong>at</strong>ion th<strong>at</strong> causes you to feel thre<strong>at</strong>ened or anxious.<br />
Stress can be positive (such as planning your wedding) or neg<strong>at</strong>ive (such<br />
as dealing with the effects of a n<strong>at</strong>ural 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 concentr<strong>at</strong>ing<br />
The Disaster Distress Helpline 1-800-985-5990 provides immedi<strong>at</strong>e<br />
crisis counseling to people affected by the tragedy in <strong>Boston</strong>. The<br />
helpline can also be accessed <strong>at</strong><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 cre<strong>at</strong>e 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 symp<strong>at</strong>hetic, 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 isol<strong>at</strong>e yourself. Make sure<br />
th<strong>at</strong> you are spending time with loved ones. Consider planning fun activities<br />
with your partner, children, or friends.<br />
• Take care of yourself.<br />
‒ E<strong>at</strong> 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, tre<strong>at</strong><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