Boston hospital assesses emergency radiology operations in bombing aftermath

During the running of last year's Boston marathon two bombs exploded seconds apart from each other near the race's finish line, resulting in three deaths and hundreds of injuries--some of them life-threatening. An article published recently in the journal Radiology details how the emergency radiology staff at one of those facilities--Brigham and Women's Hospital--responded to the mass casualties that flooded into the hospital in the aftermath of the bombing, and describes the changes it made to some operations and procedures as a result of that experience.

Eight Boston hospitals, overall, ended up treating bombing victims.

Forty of the victims were transported to Brigham and Women's emergency department, 31 of whom ended up undergoing imaging. Thirty of those 31 underwent X-rays, while seven patients underwent CT scans.

During the emergency, additional staff was called into the hospital, including attending radiologists, radiology fellows and residents, and X-ray and CT technologists. In addition, imaging equipment (including two additional CT scanners and portable X-ray units) was brought in to supplement the emergency radiology equipment usually on hand.

Researchers studied the emergency radiology response by comparing turnaround times during the mass casualty event with routine emergency radiology turnaround times. They found that the average CT exam turnaround time during the event was 37 minutes, almost half that of the annual median of 72 minutes during routine emergency operations. They determined the turnaround time reduction was due to having three CT machines in operation and stationing a radiologist at each during the event.

"By having a radiologist stationed at each CT scanner, we could provide real-time protocols and preliminary interpretations of crucial results to help our trauma teams," lead researcher, John Brunner, M.D., an emergency radiology fellow at the department when the event occurred, said in an announcement.

However, X-ray turnaround times were more than 20 minutes longer than during routine operations. This was probably due to the number of patients who needed to be scanned and because conventional radiography portable X-ray machines relying on a single X-ray plate readout device were used, resulting in a bottleneck. According to the researchers, those units have now been replaced by digital radiography equipment with wireless image transfer, allowing for faster examinations and quicker image availability.

"Hospitals need to have emergency operations plans in place, and emergency radiology is a crucial component of that preparedness," senior author Aaron Sodickson, emergency radiology director at the hospital, said. "When an event occurs, it is important to direct a critical eye to the plan's operation in order to refine it for the future."

To learn more:
- see the article in Radiology
- read the announcement

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