Patient identification, communication failed in Boston bombing

Lessons learned from the April 15 Boston Marathon bombing are changing how six Boston trauma centers manage mass-casualty emergencies, the Boston Globe reported.

The hospitals will share what they learned in a joint analysis to be presented at the American College of Surgeons meeting in Washington, D.C., this fall, according to the newspaper.

Several hospitals had problems identifying unconscious patients who weren't carrying wallets or purses and had been separated from family members in the confusion, the article said. Additionally, so many patients arrived so quickly that staff couldn't always register them all in the computerized system.

In one case, rescuers picked up the purse of a woman who was killed, thinking it belonged to her friend, who was admitted to Massachusetts General Hospital. The family of the dead woman was initially told she was alive in the hospital, the Globe reported, and were shocked when they went to what they thought was her room.

At Brigham and Women's Hospital patients were assigned six-digit numbers, but staff found the identification system confusing and worried they were mixing up test results and medications, Dr. Eric Goralnick, medical director of emergency preparedness, told the paper.

With patients spread out across six hospitals, family members were frequently separated without knowing where their loved ones were being treated, according to the article. At Boston Medical Center, hospital President Kate Walsh personally called other hospitals until she located the son of a distraught woman at Beth Israel Medical Center.

Among lessons learned so far, according to the Boston Globe:

  • Hospitals need to use social media more effectively to prepare their trauma teams more quickly. Six minutes passed before public health officials alerted emergency departments to expect casualties.
  • Hospitals need to better organize and utilize the employees who show up to help to avoid making EDs even more chaotic.
  • Hospitals need better strategies to identify patients and reunite them with their families. The city is working on a plan for hospitals to communicate with a central office that will reunite families separated in emergencies.

Hospitals already have made some improvements to how they communicate internally and with families, the Globe reported, with more studies underway. Some also are looking at how they staff emergencies or respond to public safety threats.

It can be difficult to know how different disasters will test hospital preparedness. In San Francisco, for example, hospitals treating patients from the Asiana Airlines crash relied heavily on interpreters to communicate with Chinese- and Korean-speaking patients, along with patients speaking a host of other languages.

And hospitals in Moore, Okla., this summer and Joplin, Mo., in 2011 had their own crises to deal with when their facilities took direct hits from tornados.

For more:
- here's the Globe article