Boston Marathon

June Physician Focus: Disaster Medicine

Posted in Boston Marathon, Disaster Preparedness, Physician Focus, Public Health, Uncategorized on May 29th, 2013 by MMS Communications – Comments Off on June Physician Focus: Disaster Medicine

The bombings at the Boston Marathon showed once again that disasters, whether man-made or natural, can happen at any time, with little or no warning, and that the key to successfully handling such events lies in the preparation.

The medical community’s response to the bombings, generally regarded as a model example of emergency response, provides the starting point for a discussion of emergency preparedness and the specialty of disaster medicine in the June edition of Physician Focus.

Paul Biddinger, M.D.,  (right, photo) Chief of the Division of Emergency Preparedness and Medical Director of Emergency Department Operations at Massachusetts General Hospital in Boston, and Mary-Elise Manuell, M.D., (center) Director of the Division of Disaster Medicine and Emergency Management at UMass Memorial Medical Center in Worcester, join host James Kenealy, M.D. (left) in describing the key elements to emergency preparedness and how disaster medicine is practiced.

Among a number of topics of conversation are the critical phase of planning and using a “whole community” approach to preparedness, the unique aspects of Boston that contributed to a successful response, how medical personnel and citizens can participate in response efforts, the contributions that battlefield experience in wars and cooperation with other countries have made to improved planning and response, and what smaller communities should consider in preparing for emergencies.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at www.massmed.org/physicianfocus, www.physicianfocus.org and on iTunes at www.massmed.org/itunes.

Commonwealth Sets Up Central Post-Marathon Web Resource Center

Posted in Boston Marathon on May 8th, 2013 by MMS – Comments Off on Commonwealth Sets Up Central Post-Marathon Web Resource Center

The Commonwealth of Massachusetts has established a single web portal to access resources for post-Marathon recovery.

These resources include:

  • Crisis counseling and support
  • Federal disaster distress helpline
  • In-person counseling support
  • Assistance to businesses or organizations
  • Home modification assistance
  • Assistance for veterans
  • Assistance for tax filers

Visit the Commonwealth’s website here.

Israel Trauma Coalition Workshops This Week

Posted in Boston Marathon, Disaster Preparedness, violence on May 6th, 2013 by MMS – Comments Off on Israel Trauma Coalition Workshops This Week

In the wake of the Boston Marathon bombing, the Israel Trauma Coalition (ITC) is arriving in Boston and offering two free workshops (on May 7, 9 and 10, as described below).  The number of available slots is limited, so Massachusetts physicians with an interest in participating should sign up right away.

These workshops are co-sponsored by the Massachusetts Department of Mental Health (DMH) and Department of Public Health (DPH) in collaboration with the Executive Office of Health and Human Services (EOHHS).

Psychological First Aid & Resilience in the Aftermath of Terrorism (Workshop #1)

Workshop Summary: This workshop will discuss the impacts of disaster on individuals and communities, techniques for working with impacted populations, and when to triage individuals to additional support.  Attendees will also learn the importance of self care and the importance of resilience both individually and for a community.  The Israel Trauma Coalition will incorporate their own response experience into the training.

Target Group: Licensed mental health clinicians or individuals who have served as crisis counselors in emergencies

Dates: May 7th or 10th (9am – 3pm)

May 7 – Location & Registration

May 10 – Location & Registration

  •  Boston Medical Intelligence Center.  This is located within Boston EMS Headquarters, Miranda-Creamer Building, 35 Northampton Street, Boston MA.  As you enter the garage there will be a large blue sign that reads Miranda-Creamer Elevators and a blue door on your far right. Exit the garage through that door and take elevator to the 6th floor. Once off the elevators, go through the double doors to your right. The Lawlor Regional Medical Intelligence Center is the fourth door on the right.
  • Register for May 10th at: http://psychologicalresilience2.eventbrite.com

Introduction to Disaster Behavioral Health & the Impact Of Disaster On Communities (Workshop #2)

Workshop Summary: This workshop will provide an introduction to the psychological impacts of disaster on the community and how community members can assist individuals who have been impacted. A particular focus of the workshop will be the impact of terrorist events on immigrant communities.

Target Group: Social service employees, healthcare professionals, clergy and other natural helpers and community leaders

Date: May 9th (1 – 4pm)

Please Note:

  • Though registration is required, trainings are free and open.
  • Lunch will not be provided at these events.
  • CME credit will not be offered.
  • Free on site parking is available at the Westborough workshop.  $5 garage parking is available at the Boston Medical Intelligence Center.  Attendees to the Lindeman Center trainings are strongly encouraged to take public transportation.  Paid parking and limited on street metered parking is available.

For further information contact Liam Seward (Director of Program Implementation and Emergency Management, DMH): Liam.Seward@State.MA.US (617) 626-8170

About ITC

The Israel Trauma Coalition (ITC) was created in 2001, on the initiative of the UJA-Federation of New York. Expanding from Direct Care to encompass Professional Training, Community-wide Interventions and emergency preparedness, ITC has consistently evolved its scope to address broader issues and needs.

The mission of the Israel Trauma Coalition (ITC) is to create a continuum of care in the trauma field, response and preparedness, by leveraging diverse resources to initiate, prioritize, and optimize services. The ITC provides a comprehensive view of the trauma field, whilst working towards strengthening community resilience and ensuring national emergency preparedness. The ITC harnesses the collective knowledge, expertise and experience of Israel’s leading NGO’s and government organizations- as no organization can do this work alone.

On the Front Lines of the Marathon Tragedy: A Physician’s Reflection

Posted in Boston Marathon on April 24th, 2013 by Erica Noonan – Comments Off on On the Front Lines of the Marathon Tragedy: A Physician’s Reflection

By Jacqueline DePasse, MD

As an internal medicine resident at Massachusetts General Hospital, many of my colleagues and friends were on the front lines. The following story comes from two co-workers who I spoke with as they tried to process the senselessness of these tragic events.

Dr. Zachary Landman, an orthopedics resident at Massachusetts General Hospital, had just finished examining a patient’s wound and was scribbling a note at the nursing station when he overheard rumors from the nursing staff of a bomb detonation at the Boston Marathon. He ducked into a call room and flipped on one of the rarely used televisions. After only a few seconds to take in the scene of smoke and chaos, he shut off the television and briskly walked towards the emergency department.

Dr. Elias Baedorf-Kassis sat in the Acute bay of the MGH emergency department. As a third year medicine resident on his ED triage rotation, his job that day was to evaluate patients in the emergency department and decide if they needed ICU level care, admission to an inpatient ward, or simply observation.

The day was fairly typical, and patients started to move from the ED to the inpatient units as the early afternoon wore on.  Suddenly the radio speaker crackled with an incoming report. Dr. Baedorf-Kassis expected to hear reports of an incoming med-flight or a cardiac arrest coming in via ambulance. Instead, over the speaker came reports of the attack. Everyone stopped what they were doing and listened. “At first we didn’t quite believe what we had heard,” he said.  “We weren’t sure if this was just a mistake…very quickly we realized that something serious was happening.” His thoughts flashed to his pregnant wife, who was one of the many spectators that day.

Dr. Landman had gowned up and was waiting by the ambulance door where he met the first wave of patients. “They just kept coming in through the door,” He estimates around twenty patients arrived in the first wave, the most critically injured among them. “The nature of the blast was such that it was a high temperature explosion and there was a lot of shrapnel. It’s difficult to quantify how many people came in, but I would estimate at least a dozen people had serious injuries and burns from the shrapnel.”

While Dr. Landman attended to the trauma victims, Dr. Baedorf-Kassis helped to coordinate staff members to clear the emergency department of any patients who were not involved with the trauma. Doctors began pouring into the emergency room. Some came from home wearing jeans and got straight to work assessing patients, sewing up lacerations, and getting beds cleared as quickly as possible. “We weren’t sure the extent of the casualties, if the first bomb was only the beginning, so we prepared for the worst possibility,” said Baedorf-Kassis.

As the ED was being cleared out by other specialties, the trauma surgeons and nurses organized themselves. In a typical day one or two trauma operating rooms may be running at a time. Now, there were six ORs open. A mass text page was sent out to all surgery residents to immediately stop any non-urgent work and come to the ED, where teams were formed with a junior and senior resident as well as an attending surgeon and nursing staff. “When an acute injury was found they would roll patients back to the OR and another team would step into place,” Landman recalls. Many residents repeatedly commented that the healthcare staff demonstrated incredible coordination and teamwork to safely and effectively treat the influx of patients.

The scene was described by anonymous residents as a “war zone” as patients with severed limbs and shrapnel injuries and horrific burns arrived to be treated. These injuries were unfamiliar to many staff members. The x-ray techs kept the machines constantly running to identify hidden shrapnel in patients’ bodies. Dozens of young, athletic runners and spectators appeared shell shocked, traumatized by what they had seen.

At this point there were overwhelming crowds in the ED. Police and security staff were placed at the entrance to the acute bay to only allow people in who were part of active trauma management. The internal medicine program director sent an email out to his residents to stem the influx of doctors, “Thanks to the many people who have already reached out to try and help. The current status is that the ED has more than enough doctors and is focusing on taking patients to the ORs and stabilizing people.  We appreciate the outpouring of support and hope everyone’s family and loved ones are safe.”

Dr. Baedorf-Kassis commented, “The medicine part was the easy part in a way. The harder thing about this experience was the fear of the unknown and the worry that your home was so vulnerable. Being able to focus on the medicine made things easier, we felt like we were being productive.” He breathed a sigh of relief when he found out that his wife was safely home.

With the crowds under control and most of the most critically ill patients in the operating room, the staff turned to the patients with lower acuity injuries. A significant number of patients were unable to hear because of the volume of the blast.  Many of the family members accompanying patients were also victims. As these patients were evaluated and treated, the ED began to return to normal, and by six o’clock thing had calmed down.

“There was a sense of teamwork and community…no jobs were below any member of the team.” Landman comments. “MGH had a huge influx of patients and two hours later the ED was empty with patients on the floors or in the operating room.”

It is challenging to see any silver lining in this horrific event. My colleagues and all of the members of the healthcare team rallied together in a phenomenal display of collaboration and teamwork. Though many were concerned about their own loved ones, they acted quickly in a professional and focused manner. I am incredibly proud to be working with many of the men and women at MGH who truly were heroes during this catastrophe.

Jacqueline DePasse, MD, is a first-year internal medicine resident at Massachusetts General Hospital. She has a B.A. from Stanford University and went to medical school at the University of California, San Francisco. Her professional interests include global health and technology, health policy, and writing. 

Listening First Aid

Posted in Boston Marathon, mental health, Physician Health, Steve Adelman, violence on April 23rd, 2013 by MMS – 1 Comment

By Steve Adelman, MD

In the past two days, I have had the privilege of participating in two large support sessions for volunteers who witnessed the horrors at the Boston Marathon finish line. The sessions were organized by the Boston Athletic Association, in conjunction with the Massachusetts Department of Public Health.

The purpose of these events was to give stressed and  traumatized volunteers an opportunity to come together, share their experiences, and to commence the process of regaining a sense of emotional well-being after having served a sudden and unexpected tour of duty in an urban war zone.

Sunday’s session took place at the Boston Sheraton on Boylston Street, not far from the finish line. Monday’s session took place at the offices of the Massachusetts Medical Society and Physician Health Services, in Waltham.

Many affected volunteers at each session expressed feelings that they wish they had done more. Virtually everybody at the scene was thrust into a chaotic and unpredictable situation, one that nobody anticipated. In the minutes after the blasts, most everyone at the scene of carnage experienced serious challenges to their sense of being competent and effective.

Although the results speak for themselves – many, many lives and limbs were saved by a superlative team effort – the members of the team are all feeling pretty bad. It’s as if they were saying, “I have no idea how our team won on Monday, because I certainly could have played better.”

Many of the survivors described awkward conversations in the community and the workplace:  “People call me a hero, but I don’t feel like a hero.” It’s very difficult to feel incompetent and to be told that you are a hero.

Several survivors have learned that people out there “just don’t know what to say.” After the manhunt ended on Friday, a common comment they heard was, “You must feel better now.” But they didn’t feel better – many of them felt worse.

Question: How do we talk to people who have recently endured extreme trauma?

Answer: Very little – better to listen than to talk.

Listen very carefully, and try to put yourself in their shoes. Ask open-ended questions and respect their answers and wishes. Follow the lead of the person you are listening to. Here are a few questions and comments to consider utilizing if you undertake a conversation with a traumatized person:

  • Do you feel like talking?
  • What would you like to talk about?
  • Tell me more.
  • What was that like?

Don’t assume that you know how the other person feels, and don’t assume that their experience of the trauma is what you imagine it to be. By asking gentle, empathic questions, you can help the trauma survivor to unburden himself or herself, but only if he or she wants to.

As an empathic listener, your job is to follow the other person’s lead, never to take the lead. If the survivor you are with prefers to remain silent, that’s okay. Just let them know that you’re ready to listen if they ever feel like talking.

Gregorio Billikopf Encina of the University of California Berkeley has referred to this form of “empathic listening” as “listening first aid.”

Now that the acute trauma of the Marathon explosions is beginning to subside, let’s approach our conversations with the survivors – in our communities and throughout the health care system – in a low-key, respectful, and empathic way. By applying “Listening First Aid,” we can promote healing by helping them to feel understood, by trying, as best we can, to see the fractured world through their eyes.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org.

The Next Focus: Mental Health

Posted in Boston Marathon, mental health, violence on April 19th, 2013 by MMS – Comments Off on The Next Focus: Mental Health

Following a week of terror and tragedy, there will likely be a greater focus on the mental health needs of the community: Victims, family members, medical clinicians, first responders, volunteers, and spectators.

Some of the most common symptoms of mental health issues are likely to be difficulty sleeping, becoming easily frustrated or angry, and a diminished ability to focus on daily tasks.

Physician Health Services is available to physicians, to provide support, and, when appropriate, referrals to mental health professionals and other resources. Support groups for physicians are also available. PHS can be reached at (781) 434-7404.

The Mass. Department of Public Health is coordinating mental health services for the public through its website.

The Massachusetts Department of Mental Health offers an excellent list of web resources on mental health issues.

The heroic work of physicians, first responders and other medical personnel was broadly documented in the news media. Here is a sample of the many reports:

Like all of you, we are grateful that this nightmare is over. Let us expend our energy and focus our resources to help all those involved recover from this ordeal – physically and emotionally.

“This Too Shall Pass”

Posted in Boston Marathon, Physician Health, Steve Adelman, violence on April 19th, 2013 by MMS – Comments Off on “This Too Shall Pass”

By Steve Adelman, MD

The surreal situation unfolding today in Greater Boston will surely pass. In the meantime, a tsunami of images, directives, theories and fears is flooding the hearts and brains of our entire community. In this kind of atmosphere, those who are emotionally vulnerable are being whipped into a frenzy of stress, anxiety, and, in some cases, panic.

As physicians, we are uniquely qualified to help our community maintain a sense of proportion. We know how to stay calm in times of stress and strain; we know that the “tincture of time” is sure to heal in aberrant situations like this one.

The public looks up to us.  Let’s do our best to communicate a sense of calm and reassurance to all. Let’s use our knowledge, experience and professional perspective to help people maintain, or regain, their composure.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org.

MMS and NEJM Offices Closed Today

Posted in Boston Marathon, MMS Building Information on April 19th, 2013 by MMS – Comments Off on MMS and NEJM Offices Closed Today

Because of the dangerous public safety situation in Waltham and other communities, the MMS and NEJM offices are closed today.

Employees: Further information will be provided today via the employee telephone hotline, the MMS Twitter feed, and this blog.

Please stay safe!

At Our Best When the Worst Happens

Posted in Boston Marathon, violence on April 16th, 2013 by MMS Communications – 1 Comment

By Richard Aghababian, MD
President, Massachusetts Medical Society

It is an axiom in the profession of medicine, perhaps too often left unstated, that physicians, nurses, and health care workers are at their best when others are at their worst.

We saw this all too clearly yesterday, Patriots Day 2013, when Boston was shaken by bombings at the Boston Marathon.

As an emergency physician, I understand the value of preparedness for incidents like this. The capability to meet disasters is preceded by hours of preparation, planning, drills, and a motivation to be ready when and if needed.

Boston is a city known around the globe for its medical care, and it has shared its expertise with others whenever and wherever needed: after Superstorm Sandy, in Louisiana following Hurricane Katrina, in Haiti after the earthquakes, in New York City after September 11.

Yesterday, disaster and terror struck at home, and Boston’s first responders, emergency medical personnel, physicians, and hospitals across the city showed just how prepared we are for the unexpected and how quickly we can meet a challenge. They can be proud of their actions, and we should take pride in how they responded.

On behalf of the Massachusetts Medical Society, I offer my thanks to all of them. We are fortunate to have such dedicated medical and law enforcement professionals among us.

We are All Patients, We are All Healers

Posted in Boston Marathon, Physician Health, Steve Adelman, violence on April 16th, 2013 by MMS – Comments Off on We are All Patients, We are All Healers

By Steve Adelman, MD

Terrorism is a vile disease, and when this disease strikes civilized society as it has in Boston, we are all afflicted. A sudden explosion turns all of us, immediately, into patients.

In times of crisis like this, we are all in pain. We suffer together. Each and every one of us has been violated. Innocents have been slaughtered and wounded; lives have been permanently damaged; a day of joy and celebration has been transformed into a day of mourning.

The disease of terror is not a fatal one. We New Englanders are fighters and we are helpers, and within seconds of the Marathon explosions we went into “healing mode.” A photographer at the finish line used one hand to shoot pictures while, with the other hand, he tore down barricades to get to the wounded . Momentarily stunned medical personnel immediately transformed the first aid tent into a field hospital. Friends and family rallied to assist and reassure one another, taking advantage of technology to reconnect and begin bouncing back.

Some bounce back faster than others. Here are some readily available resources that may be of assistance:

Coping with Disaster
FEMA – Ready.gov

Managing traumatic stress: Tips for recovering from disaster and other traumatic events
American Psychological Association

Recovering Emotionally
American Red Cross

Disaster Distress Helpline (24/7 phone and text)
Substance Abuse Mental Health Services Administration

Kevin Kennedy, Ph.D., is a Chief of Behavioral Health at Harvard Vanguard Medical Associates and a highly-regarded expert in parenting. I asked Dr. Kennedy to provide some practical parenting tips to guide us in talking to our children about the disaster in Copley Square. Here’s his advice:

“Events like the tragedy at the Boston Marathon cause children to feel vulnerable and unsafe. This is unavoidable. It is important that parents be realistic about the fact that some people do bad things but that most people are nice.

“Children are reassured by order and structure, so it helps to maintain the usual schedule of routines and activities in the family. In an environment of 24-hour news, parents can help children by limiting their exposure to excessive television coverage. Repetition of troubling videos can convey a disproportionate degree of danger.

“For much the same reason, parents should limit the amount of conversation about the tragedy in the presence of their children. Be sure to ask if the children have any questions and be alert to their concerns. Don’t be surprised if they want to remain close to home and need more than the usual attention or reassurance.

Above all, parents can assure children of their love and affection and their intention to take good care of them.”

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org.