DOI: 10.1097/SLA.0000000000000987

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PMID: 25386863

Issn Print: 0003-4932

Publication Date: 2014/12/01


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The Danger of Complacency − Readiness and Preparedness = Effective Outcomes

Kobi Peleg

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Excerpt

It seems that most of the experts agree that the Boston health care system dealt with the Boston Marathon mass casualty incident (MCI) with a high level of effectiveness.1–4 The fact is more pronounced when taking into consideration that this was the first time in the last decade that Boston's health care system has had to deal with a real terror MCI. The questions are as follows: How did they succeed in being so effective? Was this a coincidence? If not, how can we promise that every city or area will be prepared like Boston?
Boston has a great history of preparedness for MCI. The Cocoanut Grove was the place to be in 1942. On November 28, 1942, at 10:15 PM, “a fireball of flame and toxic gas raced across the room toward the stairs.” A total of 490 dead and 166 injuries resulted from the MCI event. It is significant to note that even in 1942, Boston was prepared for MCI in advance. Two weeks before the huge fire in the Cocoanut Grove club in Boston, “In an interesting twist of fate, area hospitals had practiced a disaster drill the week before the fire.”5
Terror MCI is a situation that happens once in a while, usually, in another location such as Oklahoma, Madrid, New York, London, Boston, Bali, and other sites. It occurs once in a while, out of the blue, and so it is not easy to keep the whole system prepared 24/7 for an extended period of time for a situation that may or may not eventuate. This entails high costs, lots of attention, and resources such as, time, energy, space, manpower, equipment, and more from very busy personnel. To be ready, prepared, and effective, we have to carefully study the lessons learnt from the experience of others who have encountered terror MCI.6 They contain relevant lessons on the system and developed training and practices within the system accordingly. Oscar Wilde said, “Experience is one thing you can't get for nothing.”
So, what were the reasons for the success of the Boston health care system in this event? Boston was known to be one of the cities in which the health care system works very tirelessly to be prepared for such situations even before the Boston Marathon bombing. They organized international conferences to share experience and knowledge, workshops, setting up MCI system and Standard Operating Procedures, training sessions, tabletop exercises, and drills on MCIs and made a collaborative agreement with the CDC on this issue. The cooperative efforts have resulted in principles such as national standards for triage at the scene and other fundamentals.3 The outcomes were the results of conscientious efforts to be effective and involved deep thinking and intensive training. Undoubtedly, it is frustrating to prepare for something that does not happen and may never happen in your city, but Boston is a good example of how important it is to prepare and how many lives can be saved if the professional response is carried out correctly. In this case, none of the injured died in the hospitals.7
When we study the lessons learnt and are setting your system on the basis of the evidence gained from the experience of others, it seems simple and obvious, but actually it is not; we cannot take a system from one country and perform a cut and paste application to our system; no health care systems are identical. Hence, we are unable to build the same response system in any 2 countries. It can sometimes be similar but not identical.
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