Review of Boston bombing response offers lessons for emergency radiology

A review of emergency radiology response at Brigham and Women’s Hospital (BWH) following the Boston Marathon bombings last year highlighted the hospital staff’s efficiency at quickly turning around CT exams, though it also revealed areas for improvement.

“It’s important to analyze our response to events like the Boston Marathon bombing to identify opportunities for improvement in our institutional emergency operations plan,” according to senior author Aaron Sodickson MD, PhD, emergency radiology director at BWH. The review was published online July 15 in Radiology.

When two homemade pressure cooker bombs were detonated near the finish line of the Boston Marathon on April 15, 2013, dozens were injured by shrapnel. BWH, a Level 1 trauma center, received 40 of the wounded. Of those 40 patients, 31 underwent imaging, including 57 x-rays performed on 30 patients and 16 CT scans on seven patients.

To accommodate the mass casualty event, extra hospital staff were mobilized, including attending radiologists, fellows and residents, along with x-ray and CT technologists. Two additional CT scanners and additional portable x-ray units were used to supplement the existing emergency radiology equipment.

This extra equipment and personnel resulted in improved turnaround times for CT exams, reported Sodickson and colleagues. They compared the response following the marathon bombing to typical emergency radiology turnaround times, and found CT exams averaged 37 minutes following the bombing versus 72 minutes during routine operation.

X-ray turnaround times, however, went in the opposite direction. While routine operation had a median turnaround time of 31 minutes, x-rays following the bombing had a median turnaround time of 52 minutes. The authors explained this was likely due to a bottleneck created by the use of conventional radiography portable x-ray machines relying on a single x-ray plate readout device.

To remedy this issue, BWH replaced these portable x-ray units with digital radiography equipment featuring wireless image transfer that immediately sends images to the PACS.

Another adjustment made by BWH was the creation of a new system for handing unidentified patients. Following the bombings, 28 percent of the imaging orders were canceled because they were actually duplicate orders for the same patient made by different physicians. Rather than listing patients as unidentified, BWH devised a system in which a combination of a unique color, gender and a numeral—Crimson Male 12345, for example—is used to identify a patient.

While the bombings represent a nightmare scenario nobody wants to see repeated, the review from Sodickson and colleagues offers examples of how other radiology department can improve their preparedness for such mass casualty events.