Yale - Tulane ESF- 8 MOC Special Report - Boston Marathon Bombings - 15 April 2013

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In light of the events in Boston Marathon, the Yale-Tulane ESF #8 Planning and Response Program has produced a special report on Boston Marathon Bombing.The Yale-Tulane ESF #8 Program is a multi-disciplinary, multi-center, graduate-level, program designed to produce ESF #8 planners and responders with standardized skill sets that are consistent with evolving public policy, technologies, and best practices. The group that produced this summary and analysis of the current situation are graduate students from Yale and Tulane Universities.
It was compiled entirely from open source materials.

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Yale - Tulane ESF- 8 MOC Special Report - Boston Marathon Bombings - 15 April 2013

  1. 1. SITUATIONAS OF 2300 HRS EDT15 APRIL 2013YALE- TULANE ESF-8 SPECIAL REPORTBOMBINGS AT BOSTON MARATHONSITUATION MAPRESPONSEFEDERAL GOVERNMENTFEMATwitter | Facebook | YouTube | BlogReady. govDHSFBIHHSPublic Health Emergency – ASPRTwitter | FacebookCDCTwitter | FacebookDODNORTHCOMTwitter | FacebookARMY NORTHTwitter | FacebookORGANIZATIONAmerican Red CrossMASSACHUSETTSMassachusetts Emergency Management AgencyTwitter | FacebookBostonBoston Office of Emergency ManagementTwitter - Alert Boston | FacebookTYPE OF INJURIESSURGE CAPACITY IN ATERRORIST BOMBINGAS OF 15 APRIL 2013 2015 HRSINJURED DEAD144* 3Family members looking for inforelative to individuals injuredduring the incident areencouraged to call (617) 635-4500.If you information on theterror attack, police as thatyou call Boston Bomb Tipline:1-800-494-TIPSSTRESSNUMBER NOT CONFIRMEDHOSPITALIZATION AND TREATMENT
  2. 2. SITUATIONWHERE: 671 Boylston Street. Boston, MassachusettsWHEN: 1450 HRS EDT, 15 APRIL 2013EVENT: Boston MarathonSITUATION: BOMBINGS• Two explosions , a primary the a secondary explosion, occurrednear the Boston Marathon finish line at approximately 2:50p.m.• The bombs appear to be crude devices that were hidden intrash cans• Shrapnel was incorporated into these explosive devices mostlikely to increase fragmentation and maximize the number ofcasualties.• The race was diverted before being halted as police and firecrews swept the area.• Another explosive device was found, which was purposelydetonated by Boston Police at Boylston Street.DEAD AND INJURED:• 3 confirmed dead - including an 8 year old boy• Hospitals have treated more than 124 victims - including 8children. At least 17 are in critical condition, 25 are in seriousconditionINVESTIGATION: On going . Currently there is no one under arrestand no groups have claimed responsibility
  3. 3. SITUATION MAPSOURCE: NEW YORK TIMEOfficials said that a suspicious package was foundand destroyed by police at the Mandarin HotelRunners approached from the west.Second explosion went off about 10 secondsafter the first one.The two explosions were about 550 feetapartFirst explosion occurred about 3 p.m. on thenorth side of Boylston Street, just before thebridge that marks the finish line.2 MILESSECOND EXPLOSIONFIRST EXPLOSIONBOSTONSOUTHBOSTONFINISHLINEEASTBOSTONJFKLIBREARY
  4. 4. • There is heightened security at local hospitals andcritical infrastructure sites• The Red Cross sent additional blood products toBoston hospitals• Hospital throughout Boston responded to MassCasualty incident.• Criminal investigation is on going• The area around Copley Square where theincident took placed is closed and is considered acrime sceneRESPONSELOCALSTATEFEDERALReferences: http://rt.com/usa/boston-marathon-explosions-updates-911/ ,http://www.cnn.com/2013/04/15/us/boston-marathon-response/index.html,http://www.govexec.com/defense/2013/04/federal-authorities-responding-boston-marathon-explosions/62536/, http://www.cnn.com/2013/04/15/us/boston-marathon-explosions/index.html?hpt=hp_t1• The Massachusetts Emergency ManagementAgency suggested people trying to contact thosein the vicinity use text messaging because ofcrowded phone lines• Troops from the Massachusetts National Guardassisted police in emergency response• The office of the Attorney for the District ofMassachusetts is coordinating responses from lawenforcement agencies• Federal agents have been dispatched to crowdedhospitals• Officials from the Justice Department and theBureau of Alcohol, Tobacco, and Firearms arebeing deployed to investigate the explosions• Homeland Security Secretary Janet Napolitanoordered the department to provide “whateverassistance is necessary”
  5. 5. ON GOING INVESTIGATION• A multi-agency response including state and federallaw enforcement agencies has been activated andis investigating the cause of the explosions alongthe Boston Marathon route and elsewhere.• Forensics analysis is on going.• The FBI’s Boston Division stands with the BostonPolice Department (BPD) and remains on-scene.• The situation remains fluid, and it remains too earlyto establish the cause and motivation.• The FBI declared federal jurisdiction over thematter through the Boston Joint Terrorism TaskForce.RESPONSEBOSTON FBI PRESS RELEASEhttp://www.whitehouse.gov/President Barack Obama said he ordered the "fullresources" of the federal government to respondto the Boston bombings on Monday, and that healso called for increased security around theUnited States as necessary.The Navy has sent one of its bomb-disposal units toBoston to assist local authorities as needed. Thethree-member explosive ordnance disposal teambased at Naval Station Newport, R.I., was sent toMassachusetts after state officials asked for help.
  6. 6. TYPE OF INJURIES LIKELY TO BE SEENPRIMARY BLAST INJURIES• Most post-explosion injuries involve blunt andpenetrating trauma• The initial blast may cause abdominal bleedingand perforation, concussion (possibly withoutphysical signs of injury to the head), andrupture of the eardrum• Blast lung is the most common fatal injuryamong initial survivors‒ The blast wave may cause tearing,bleeding, and buildup of fluid in the lungs‒ Symptoms include shortness of breath,chest pain, and coughing up blood‒ Patients may also show signs of slowedbreathing, cyanosis, and wheezingSECONDARY BLAST INJURIES• Flying debris and bomb fragments may causepenetrating trauma, fracture, or amputationOTHER POSSIBLE INJURIES• Burns, crush injuries, and severelacerations may be seen in victims• Blast may result in impaired vision andhearing• Exacerbation of chronic illness is possibleReferences: http://www.bt.cdc.gov/masscasualties/blastinjuryfacts.asp,http://www.bt.cdc.gov/masscasualties/blastlunginjury.asp,http://www.bt.cdc.gov/masscasualties/explosions.asp,NOTE: More of the injured seen have injuries to their lowerextremities.
  7. 7. HOSPITALIZATION AND TREATMENTHOSPITAL* NUMBER OF INJUREDBrigham and WomensHospital48Children’s Hospital 10Boston Medical Center 20Massachusetts GeneralHospital29Tufts New England MedicalCenter9Beth Israel 23* This list is not complete and has not been confirmed.Numbers were gathered from press report.• Eight hospitals report that they are treating at least 124 people. Ofthose, at least 15 are in critical condition.• The injuries ranged from cuts and bruises to amputations. Many victimssuffered lower leg injuries and shrapnel wounds. Some suffered rupturedeardrums.• The medical tent at the finish lined was turned into triage centerAlthough it was not equipped for trauma, they had bags of intravenousfluids hanging from four yellow ropes suspended down the middle,tourniquets, blood pressure monitors, defibrillators, and EKGs. Medicalpersonnel included internists, family physicians, cardiologists, emergencyphysicians, physical therapists, and social workers.• Most of those seen had injuries to their lower limbs.• Patients were evacuated to hospitals throughout Boston.• Massachusetts General Hospital facility ICS was activated within 5minutes of notification. The hospital treated at least 29 victims, eight ofwhom were critically injured, including some with amputated legs.• Boston Children’s Hospital said the hospital treated eight childrenranging in age from a 2-year-old boy with a head injury, to a 14-year-oldboy also with a head injury. Two adults were also treated at the hospital.• The nine victims treated at New England Medical Center included victimswith serious trauma and leg fractures, shrapnel wounds and rupturedeardrumsMedical personnel workoutside medical tent inaftermath of bombing(AP Photo/EliseAmendola)SOURCES:Marathon medical tent ‘transformed into trauma unitMass General Press Conference - 15 APRIL 2013Hospitals treat carnage after Boston blasts
  8. 8. SURGE CAPACITY IN A TERRORIST BOMBING• Explosive devices are the most common weapons used by terrorists.• Explosions can produce instantaneous havoc, resulting in numerouscasualties with complex, technically challenging injuries not commonlyseen after natural disasters.• Because many patients self-evacuate after a terrorist attack andprehospital care may be difficult to coordinate, hospitals near the scenecan expect to receive a large influx, or surge, of victims after a terroriststrike.• Health care and public health specialists should anticipate profoundchallenges in adequately caring for the surge of victims following aterrorist bombing.• CDC with a panel of experts produced “In a Moment’s Notice: SurgeCapacity in Terrorist Bombings.” . It includes a description of system-wide and discipline-specific challenges as well as recommendations toaddress these issues.ADDITIONAL RESOURCES:• Blast Injury Fact Sheets• “Bombings: Injury Patterns and Care” poster and pocket card• “Interim Planning Guidance for Preparedness to Mass Casualty Events Resulting from Terrorist Use of Explosives” report• Blast Injuries: What You Need to Know Webcast• Blast Injuries: What Clinicians Need to Know (Podcast)• The Terrorism Injuries Information, Dissemination and Exchange (TIIDE) Project
  9. 9. COMMON REACTIONS TO A STRESSFUL EVENT INCLUDE:• Physical or emotional tension are often signs of stress. They can bereactions to a situation that causes you to feel threatened or anxious.Stress can be positive (such as planning your wedding) or negative (suchas dealing with the effects of a natural disaster).• Disbelief and shock• Tension and irritability• Fear and anxiety about the future• Difficulty making decisions• Being numb to one’s feelings• Loss of interest in normal activities• Loss of appetite• Nightmares and recurring thoughts about the event• Anger• Increased use of alcohol and drugs• Sadness and other symptoms of depression• Feeling powerless• Crying• Sleep problems• Headaches, back pains, and stomach problems• Trouble concentratingTHE BEST WAYS TO MANAGE STRESS IN HARD TIMES ARE THROUGHSELF-CARE:• Avoid drugs and alcohol. They may seem to be a temporary fix to feelbetter, but in the long run they can create more problems and add to yourstress—instead of take it away.• Find support. Seek help from a partner, family member, friend, counselor,doctor, or clergyperson. Having a sympathetic, listening ear and sharingabout your problems and stress really can lighten the burden.• Connect socially. After a stressful event, it is easy isolate yourself. Make surethat you are spending time with loved ones. Consider planning fun activitieswith your partner, children, or friends.• Take care of yourself.‒ Eat a healthy, well-balanced diet‒ Exercise regularly‒ Get plenty of sleep‒ Give yourself a break if you feel stressed out—for example, treatyourself to a therapeutic massage‒ Maintain a normal routine• Stay active. You can take your mind off your problems by giving— helping aneighbor, volunteering in the community, even taking the dog on a longwalk. These can be positive ways to channel your feelings.The Disaster Distress Helpline 1-800-985-5990 provides immediatecrisis counseling to people affected by the tragedy in Boston. Thehelpline can also be accessed athttp://disasterdistress.samhsa.gov/ and TTY for deaf and hearingimpaired: 1-800-846-8517. SOURCE:http://www.samhsa.gov/newsroom/advisories/1304152649.aspxCDC – Coping with stressStress is a condition that is often characterized by symptoms of physical or emotional tension. It is areaction to a situation where a person feels threatened or anxious. Stress can be positive (e.g., preparingfor a wedding) or negative (e.g., dealing with a natural disaster).SYMPTOMS OF STRESS

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