1. Erickson, Jeanette Ives DPN, RN, FAAN

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For the past 117 years in Massachusetts, the Boston Marathon has been run on Patriots Day. The event always brings large crowds to our city with more than 20000 runners and 500000 spectators. For more than 50 years, the Red Sox have played on Marathon Monday, and when the game ends, many of those 30000 spectators make their way to the finish line of the Marathon. As you can see, it's a tradition embraced by hundreds of thousands of people.

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I've been going to the Boston Marathon for 26 years. This year, my husband and I walked the city enjoying the brisk temperature, believing the day would be like every other Patriots Day, fun, uplifting, joyous. As the whole world now knows, that was not the case.


At 2:50 PM, a bomb went off close to the finish line not far from where we were standing. Eleven seconds later, another bomb exploded 2 blocks away. The smoke, smells, and screams filled my senses. My training kicked in. I called our incident commander at Massachusetts General Hospital (MGH) and told her, "I'm at the Marathon. Bombs are going off. I'm on my way to the hospital. This is going to be bad."


Immediately, the Boston hospital emergency notification system was activated. At 3:04 PM, MGH received its 1st patient. When I got to the hospital, I joined the emergency operations center. My role was operations chief, accountable for coordinating patient care and staff support.


Our emergency department (ED), which had been full, was emptied; ED patients were taken to inpatient units. Nurses and physicians rounded to discharge patients as soon as possible; the postanesthesia care unit kept postoperative patients in place instead of sending them to inpatient units. The operating room and trauma services mobilized quickly and reported to the ED. As our emergency management plan was implemented, response from staff was immediate and calm. MGH police and security secured the perimeter and sent additional officers to the ED, where 8 critical patients arrived in the 1st hour and a total of 31 by the end of the day.


Not knowing whether the 2 bombs were the extent of the threat, US, state, and city officials deployed armed patrols throughout the city, including Boston hospitals. Their presence was both comforting, in that they were there to ensure our safety, and unnerving, in that it underscored how our world had changed. In the days that followed, the MGH community cared for the injured, their loved ones, and each other.


But out in the city, those responsible for the bombings were still at large. On Friday, April 19, at 6:00 AM, the Governor of Massachusetts and the Mayor of Boston instructed the citizenry to "shelter in place" (remain in their homes or businesses) so tactical teams could pursue the suspects without fear of harming innocent people. The MGH incident command team had to make on-the-spot decisions to ensure uninterrupted operations in a rapidly changing, high-stress situation. Everyone knew their roles and remained calm as we prepared for any number of potential scenarios. Night-shift employees stayed on to cover day-shift employees who were instructed not to leave their homes or who were delayed when all public transportation was suspended by order of the Governor. Outpatient practices called patients to advise them to stay home. Discharges were delayed or canceled accordingly.


On the days of the bombings and throughout the shelter-in-place order, the following take-aways were key for me as a nurse executive:


* Preparation: Our participation in hospital, city, and state-wide drills prepared us to manage in this disaster. Involvement in regularly scheduled, disaster preparedness scenarios allowed the Boston hospital community to practice for just such an event. Debriefings after drills were critical in informing hospital-specific plans.


* The role of the chief nursing officer (CNO) in the hospital incident command system: As CNO, I was poised to mobilize hospital resources and to respond to staff, patient, and family needs as they arose. For example, during the shelter-in-place order, MGH was in lockdown. Many visitors and family members were on site and couldn't leave. I asked the patient care services leadership team to create a lounge in one of the lobbies where families could congregate when not visiting their loved ones.


* Communication: The involvement of public affairs and interhospital communication teams in all disaster command meetings helped expedite continuous messaging to staff throughout the network. Written updates were provided to patients on meal trays. We learned that being informed is critical in any emergency response. Information was flowing to staff via Twitter, the Internet, and various news outlets. It was imperative to dispel myths and provide sound information in a controlled and efficient manner.



In the weeks since the bombings, it has become clear that every member of the Boston community was touched by this event, directly or indirectly. Some of our employees were first responders, some cared for the injured, some were at the finish line, and many others were affected by the shelter-in-place order.


MGH has provided support, counseling, and guidance every step of the way. We offered formal prayer/healing services for the community, one-on-one pastoral/spiritual care, debriefings, music, healing sessions, mind-body interventions, counseling, and education materials (eg, how to talk to your children about tragic events).


At the time of this writing, all but 1 patient injured in the bombings have been discharged or transferred to rehabilitation facilities. But our work to promote healing continues. We are conducting a longitudinal evaluation to assess how members of the MGH community are integrating this tragedy into their lives, how they're moving forward, what resources they're using, how they've helped others, how they've returned to their work and life routines, what services or resources were most effective in helping them deal with this tragedy.


Based on the results of this evaluation, valuable information will be gained to inform decisions about allocating resources. We're committed to sharing the lessons we learned with the wider healthcare community to help craft a model for creating resilient communities in the face of devastating events. We remain Boston Strong, MGH proud.