Boston Bombings Responseto DisasterMAUREEN HEMINGWAY, MHA

Boston Bombings: Response
to Disaster
MAUREEN HEMINGWAY, MHA, RN, CNOR; JOANNE
FERGUSON, MSN, RN
ABSTRACT
Disasters disrupt everyone’s lives, and they can disrupt the flow
and function of
an OR as well as affect personnel on a professional and personal
level even
though perioperative departments and their personnel are used
to caring for
trauma patients and coping with surprises. The Boston Marathon
bombing was a
new experience for personnel at Massachusetts General
Hospital, Boston. This
article discusses the incidents surrounding the bombing and how
personnel at
this hospital met the challenge of caring for patients and the
changes we made
after the experience to be better prepared in the event a
response to a similar
incident is needed. AORN J 99 (February 2014) 277-288. �

AORN, Inc, 2014.
http://dx.doi.org/10.1016/j.aorn.2013.07.019
Key words: perioperative disaster care, OR triage, terrorist
bombings, Boston
Marathon, shelter in care, city lockdown.
M
assachusetts General Hospital (MGH),
Boston, is a level I trauma teaching
hospital where patients receive care for
all surgical specialties. Personnel have the capacity
and ability to care for a large number of patients
with varying acuity levels. There are 907 beds and
61 functional ORs located on one campus. In 2005,
MGH received designation as a Magnet� hospital,
and, in 2008 and 2012, the American Nurses Cre-
dentialing Center renewed this designation. The
hospital’s perioperative nursing team cares for
approximately 36,000 patients per year and pro-
vides perioperative care, on average, for 150 pa-
tients per day. The ORs are located on three levels

across five different buildings. The OR personnel
comprise 235 RNs, 92 surgical technologists, 27
equipment technicians, 115 OR assistants, and 17
operations assistants.
The environment in the OR can change very
quickly during the course of any day. Perioperative
nurses who work in the OR are aware that the daily
schedule may be disrupted by unscheduled events,
such as the arrival of trauma patients, transplan-
tation recipients or donors, patients who need to
return to surgery, or equipment or facility failures.
When terrorist bombs exploded at the annual
Boston Marathon, the resources and disaster plans
at MGH were put to the test. This article discusses
the response of personnel and the outcome and
changes made as a result of this experience.
APRIL 15, 2013
It had been a typical “marathon Monday,” with an

atmosphere of excitement in the city that was felt in
the hospital and OR environment. The Boston
Marathon is a long-standing tradition for many
people who participate either as runners, volun-
teers, or bystanders.
1
Notably, this third Monday in
April is Patriot’s Day, a state holiday for many,
which coincides with the public school system’s
� AORN, Inc, 2014 February 2014 Vol 99 No 2 � AORN
Journal j 277
vacation week. However, it is one of the few state
holidays not observed at MGH.
This marathon Monday began no differently
than many others already past. The OR had pro-
cedures scheduled in 51 rooms that morning,
compared with the usual 61 rooms, and periopera-

tive leaders were projecting that there would be
fewer than 40 rooms running by 3 PM. That
morning, 135 nursing team members arrived for
the 7 AM shift, with more personnel scheduled to
arrive for the 11 AM and 3 PM shifts. The surgical
schedule included a variety of cardiac, vascular,
neurosurgical, and spinal fusion procedures, all
starting at 8 AM. In the early afternoon, the elite
marathon runners’ race results started filtering
in through people’s social media connections.
Although our ORs are mainly situated on one floor,
they do extend through multiple buildings (Figure 1),
and it has become necessary for personnel to
communicate by using cell phones with texting
capability. Operating room leadership personnel,
such as the resource nurse and the anesthesia staff
administrator, communicate with perioperative
personnel through hospital cell phones. Additionally,

in an effort to decrease overhead paging, employees
are allowed to carry personal cell phones; however,
these cell phones are not to be used in the presence of
patients, and they need to be kept in silent mode at all
Figure 1. Aerial photograph of the locations of the perioperative
services department at Massachusetts General
Hospital.
278 j AORN Journal
February 2014 Vol 99 No 2 HEMINGWAYdFERGUSON
times. At 2 PM, the evening resource nurse and the
OR nursing leader assessed the afternoon staffing
situation and reported that it looked good: patients
were being cared for on time and team members were
not anticipating the need to work overtime hours.
DISASTER DECLARATION AND RESPONSE
Just before 3 PM, the hospital environment
changed dramatically. Social media provided the
initial information that a bomb had exploded at the

Boston Marathon finish line. The first responders at
the finish line began to care for the casualties by
converting the runners’ medical tent to an emer-
gency triage unit. From there, members of the
Boston Emergency Medical Services (EMS) tri-
aged and transported patients to trauma centers
across the city. Initially, the MGH emergency
preparedness leadership team did not know the
number of patients nor the types of injuries to
expect. Overhead paging alerted OR leaders to
check at the control OR desk.
Massachusetts General Hospital uses an emer-
gency notification system (ENS) for critical com-
munications to varying levels of hospital leaders
when an emergency or a disaster is declared, which
is in accordance with the MGH Hospital Incident
Command System Pre-Marathon (Figure 2). At 3
PM, senior-level hospital leaders learned of the

terrorist events through the Boston EMS system
and the hospital leaders then used ENS to activate a
disaster declaration at 3:03 PM. The first MGH
patient arrived in the emergency department (ED)
at 3:04 PM, but this information was not immedi-
ately relayed to all perioperative administrative
leaders or clinical personnel. As a result of this
limited information, perioperative leaders and
team members relied primarily on information
from social media sites and newscasts. Periopera-
tive personnel began to prepare for the expected
influx of wounded patients based on their individ-
ual experiences caring for trauma patients. To
prepare for the expected influx of wounded pa-
tients, perioperative personnel immediately began
to assess perioperative staff resources and room
availability. At the same time, OR leaders required
all day-shift team members to remain on duty until

they could properly evaluate and understand the
situation.
Communication Compromised
The primary means of intradepartmental commu-
nication in the OR is by cell phone, either personal
or work assigned. Team members did not anticipate
that there would be issues with communication
technology as a result of the bombing; however,
law enforcement officials in the city of Boston
made a decision to shut down all cell phone towers,
which rendered all personnel cell phones inactive.
This decision was part of law enforcement’s
response to stop any further detonation of un-
known explosive devices and to ensure public
safety. The ability to communicate among
individual team members, however, became
compromised. In response, all MGH personnel
began to use landline telephones in each OR and

at the control desks, overhead paging, pager tech-
nology, and personal interactions.
Readiness to Respond
The emergency preparedness readiness team and
perioperative personnel referred to the MGH peri-
operative emergency preparedness plans to guide
initial assessment of their readiness to respond.
These plans guided personnel to take the follow-
ing actions:
n Determine the number of personnel available to
care for incoming patients as well as the patients
who were already undergoing scheduled pro-
cedures. Although team members were required
to stay on duty, they exhibited a mood of co-
operativeness, willingness, and understanding.
A sense of everyone wanting to help came
through loud and clear.
n Identify a list of all available nursing per-

sonnel, surgeons, anesthesia professionals,
AORN Journal j 279
RESPONSE TO THE BOSTON BOMBINGS
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and nonclinical support (eg, OR nursing and
medical, materials management, central sterile
processing departments) by skills and roles.
n Determine the current status of OR availability.
The nursing management team members began
this assessment by reporting the number of ORs
with procedures currently in progress, the
number of patients who were waiting for an OR,
and the number of rooms in which perioperative
teams were close to finishing scheduled surgical
procedures. This was an essential part of the
assessment plan to communicate and maintain
patient flow from the ED. At 3 PM, 32 pro-

cedures were still in progress, which left 26
ORs available for incoming patients. With this
report, the OR leadership team determined that
Figure 2. Massachusetts General Hospital’s incident command
system before and after the Boston Marathon
bombing. Adapted and printed with permission from
Massachusetts General Hospital, Boston.
280 j AORN Journal
the number of empty ORs and the rooms
finishing were sufficient to care for the antici-
pated initial influx of patients.
n Prepare for a wide range of patients with trau-
matic injuries by obtaining and readying spe-
cialty supplies and instrumentation. Initially,
team leaders planned for the arrival of patients
with abdominal, cardiac, and neurologic in-
juries. Very quickly, however, team members
understood that many of the injuries would be to

patients’ lower limbs and would be similar to
war zone or blast injuries. Although MGH
personnel frequently care for trauma patients,
blast injuries are not routinely seen.
In the 20 minutes between initiation of the di-
saster code and arrival of the first surgical patient,
members of the perioperative administrative team
decided to continue the surgical procedures on
schedule and for waiting patients. In addition, after
assessing staff member availability and skill level,
perioperative nursing leaders determined that each
new trauma patient would be cared for by two RNs
and one surgical technician (ie, the usual staffing
model for trauma patients admitted to MGH) and
that the resources available at that time were suf-
ficient to staff in that manner.
Emergency Care
The ED personnel, in the MGH ED, began ad-

ministering emergency care to the severely trau-
matized patients, where they assessed patient
injuries and then transferred patients emergently to
the OR. Through landlines and verbal communi-
cation with the ED, OR team leaders learned
that the bombing patients arriving at MGH had
traumatic lower limb amputations and shrapnel
injuries.
At 3:24 PM, the first severely injured patient
arrived in the OR at MGH. Five more patients
arrived in the OR within the next 20 minutes.
Perioperative personnel were preparing for a sev-
enth patient when the trauma triage surgeon in the
ED reported that the individual did not require
emergent surgical care. Team members from the
materials management and central sterile pro-
cessing departments were key in coordinating
orthopedic and trauma instrumentation. These

resources were critical to the perioperative
workflow during this disaster response.
Because the bombing patients had sustained
massive injuries, additional surgical nurses were
needed to assist with patient identification, identify
and obtain blood products, count procedures, pro-
cure supplies that were not readily available, and
oversee postoperative patient care assignments. All
staff RNs, surgical technicians, surgeons, and
anesthesia professionals who were not currently
assigned to an OR were asked to check in with
the staffing resource coordinator by name and role
group (eg, nurse, anesthesia professional), accord-
ing to the hospital’s emergency preparedness pro-
tocol. This master list was helpful when dealing
with injuries that required specialized care (eg,
patients with vascular compromise who would need
intraoperative imaging technology). In retaining the

day shift staff, we had 180 nursing team members
available at 3:30 PM, compared with the 88 who
had been projected before the code disaster.
By 5 PM, the city was in chaos, and the uncer-
tainty of whether additional bombings might follow
contributed to a sense of unease. As the late after-
noon progressed, we received word through the
ED personnel that we did not have any additional
emergent surgical patients. The influx of surgical
patients to the OR subsided approximately 4:30 PM
but the conflicting reports that we were receiving
from multiple sources necessitated retaining per-
sonnel until we were sure that care had been pro-
vided for all trauma patients. Nursing leaders
assessed the evening staffing numbers at this time
and began to let people leave at 5:30 PM. Not
knowing whether there would be a further need
for staff members during the night, the leaders

wanted to ensure that staff members were rested
and available.
The day had transitioned from a celebration
of patriotic freedom and athleticism to a day of
AORN Journal j 281
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heartbreaking terror. Our clinicians stated that they
“just wanted to help,” and in the end, personnel at
MGH cared for a total of 32 patients, including the
seven emergent surgical patients. Of the seven
surgical patients who were admitted, all seven un-
derwent amputation procedures and returned to the
OR for additional procedures on subsequent days.
APRIL 19, 2013
Marathon Monday was an emotionally draining day
for many clinicians at MGH. Later that week,

however, on Friday, April 19, 2013, the city of
Boston went into lockdown status (ie, shelter in
place), an event that proved even more difficult
than responding to the bombings. That Friday
morning, after clinical team members and same-
day surgical patients had arrived at the hospital,
Massachusetts governor Deval Patrick issued an
order for regional lockdown to accommodate a
manhunt for the main suspect in the bombings,
which resulted in a shelter-in-place order for Bos-
ton and its surrounding communities.
2
The uncer-
tainty of the immediate future brought the day’s
surgical schedule to a halt. The perioperative
leadership team members’ immediate concerns
were as follows:
n Personnel and patient safetydPatients were
arriving at the hospital, surprisingly even during

the lockdown period, for their scheduled sur-
gical procedures, but patients who had been
treated could not be discharged because of the
shelter-in-place order. Additionally, members
of the night staff had to remain at the hospital.
Personnel concerns around child care and other
personal obligations became issues that needed
to be addressed. We addressed the need for our
night shift personnel to sleep by reserving call
rooms for them for the day. Those staff mem-
bers with child care issues, although few in
number, were more problematic. However,
most were able to have their neighbors and
extended family to step in to care for the
children.
n High occupancy ratedOur normally high
medical/surgical occupancy rate of 90% com-
bined with the shelter-in-place order affected

our ability to admit patients even as more
continued to arrive at the hospital for their
scheduled admissions.
n Future developmentsdThe potential for a large
number of mass casualties was a concern and
caused hospital and perioperative leaders to put
all elective surgical scheduled cases on hold.
n Management of a temporarily idle teamd
Because of the halted surgical procedures, the
clinical nurse managers and clinical nurse spe-
cialists decided to offer education sessions on a
variety of subjects, such as the new surgical
robot and cardiopulmonary resuscitation recer-
tification and training, to nursing team mem-
bers. This action helped to alleviate team
member anxiety by providing an opportunity to
focus on internal matters instead of the constant
stream of external information. Taking advan-

tage of this valuable and unexpected education
time proved beneficial to all.
The reason the shelter-in-place situation was
more difficult than the response to the bombings is
that caring for patients with traumatic injuries is
what personnel at MGH are trained to do. However,
to have patients and personnel waiting for the
surgical schedule to proceed was especially chal-
lenging because it put the hospital personnel in a
holding pattern that did not permit them to provide
care and was combined with the anxiety that
everyone was feeling related to the terrifying
situation in the communities surrounding Boston.
Perioperative leaders made the decision mid-
morning to allow surgeries to begin based on two
factors: patient acuity, and for same-day surgical
patients, the discharge destination. The patient’s
discharge destination was important because pa-

tients could not be released into any location within
a wide, geographic area of Boston. This affected
the perioperative team’s ability to start proce-
dures, because the admission process at MGH is
282 j AORN Journal
dependent on inpatients being discharged to ac-
commodate same-day admission patients who need
postoperative beds. Because of the shelter-in-place
order, hospital staff members were unable to dis-
charge patients, which meant that postoperative beds
were no longer available. Additionally, any team mem-
ber who had arrived at the hospital was not allowed
to leave until the shelter-in-place order was lifted.
During the morning, staff members had several
emergent cases that needed to be started regardless
of the outside situation. Proceeding with patients

who were very ill and undergoing surgically com-
plex procedures later in the day and without a full
off-shift of staff members proved very challenging.
For example, leaders made the decision to proceed
with a patient scheduled for a thoracoabdominal
aneurysm repair at 10 AM, and that surgery con-
tinued late into the evening. Many team members
did not arrive at the hospital for their scheduled
shift because of the lockdown, which in turn chal-
lenged the evening staffing plans. Personnel cared
for a total of 52 patients of the 147 patients who
were originally scheduled for surgical procedures.
Our perioperative preadmission colleagues accom-
modated the surgical patients who had arrived at
the hospital that day but did not undergo surgery
and could not leave.
By the time Governor Patrick lifted the shelter-in
place order around 6 PM, and the crisis had passed,

members of the day shift who had not been allowed
to leave had been at the hospital for their regularly
scheduled 10- to 12-hour shifts, and some of our
afternoon and evening shift team members still had
not been able to arrive to relieve them. Team
members who had put in a full shift had to fill in
and care for patients of those team members who
were prevented from arriving. Members of the
evening shift began to arrive soon after the shelter-
in-place order was lifted, and OR nursing leaders
were able to release other personnel. However,
personnel began to hear media reports of gunfire,
which raised everyone’s anxiety and stress, and
further complicated operational issues. It remained
problematic to allow team members or patients to
leave the hospital’s safe environment and venture
into a situation in which gunfire was heard and
everyone wondered where the next terrorist activ-

ity would occur. To help address those external
concerns and to be prepared, MGH perioperative
leaders decided to keep four OR teams and four
ORs ready as trauma rooms in case emergent care
was needed for any casualties.
Despite the anxiety felt by personnel, the eve-
ning progressed without additional terrorist attacks
or incidents. After MGH personnel learned that the
suspect had been captured, the four standby ORs
and teams were released. There were still surgical
patients to care for that evening, and, by 8 PM, two
surgical procedures were in progress and ORs were
being prepared for procedures the next day.
PROCESS FOR CHANGE
An important exercise that leaders and staff mem-
bers at MGH use quite regularly is the debriefing
session. When an incident occurs, whether it is
related to patient care or to technical, operational,

or interpersonal issues, perioperative leaders
schedule a team debrief so that all the details of the
incident may be presented and reviewed. Debrief-
ing has become a valuable forum for our multi-
disciplinary teams to develop a comprehensive
understanding of an incident. During debriefing
sessions, team members consider events that led to
the incident, issues that occurred during the inci-
dent, and lessons learned. They also identify op-
portunities for change in areas of practice, work
flows, and communication. From there, recom-
mendations are made for appropriate changes in
practice and policy.
Before the bombing victims had even left the OR
that Monday evening, a debriefing session was
scheduled for the perioperative leadership team.
Similarly, the evening of the lockdown that Friday,
the associate chief nurse and the medical director

invited the perioperative leadership team members
who had helped during the day to a debriefing
session the next morning, so we could begin to
understand our response challenges, limitations,
AORN Journal j 283
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and successes. At the debriefing, all the participants
dincluding the nursing director of operational
planning and environment of care, associate chief
nurse, clinical nurse specialists, nursing clinical
managers, and other perioperative leadership team
membersdspoke in detail about what went well
during the events and identified potential opportu-
nities for improvement.
Members of the perioperative leadership team
agreed to support the formation of a small task

force whose mission would be to review existing
MGH policies, procedures, and communication
technologies, and then to make recommendations
for developing a more robust perioperative disaster
response plan. Members of the task force included
the director of operational planning and environ-
ment of care, who served as the project manager
and facilitator; clinical nurse specialists; the asso-
ciate medical director of perioperative services
departments of anesthesia, critical care, and pain
medicine; and the environment of care project
manager, who meet weekly. At the time of publi-
cation of this article, this task force is still in effect.
The task force began by developing a project
charter (Figure 3). Project charters have become an
integral part of the perioperative leadership team’s
work during the past few years because these
documents are important to keep the work on

target. The charter identifies short- and long-term
goals, a timeline, and resources necessary to ensure
success. The task force began meeting within one
week of the Boston bombing events. The first
weekly meeting included time for team members to
reflect on their individual experiences. After that
initial meeting, members of the task force began
work to revise and develop additional perioperative
roles and the corresponding job action sheets. They
also have worked to consolidate all necessary
supplies, including binders with job action sheets
and emergency vests to identify leadership per-
sonnel during a disaster event, into an accessible,
centrally located cabinet.
LESSONS LEARNED
The Joint Commission requires all hospitals to have
an emergency preparedness plan in place, and the
plan must meet certain standards.

3
The MGH pre-
paredness plan meets all of The Joint Commission
standards, yet perioperative leaders found room for
improvement. One of the lessons that the periop-
erative leadership team learned was that using the
processes outlined in the MGH emergency pre-
paredness plan resulted in unexpected challenges.
Many aspects of the emergency preparedness
response to the bombings and to the patient care
and outcomes were excellent; however, through
debriefing and subsequent conversations, leaders
identified opportunities for improvement that
included emergency notification, staff member
identification, traffic control, communication, and
development of a new plan.
Emergency Notification
In emergencies, senior MGH leaders activate the
hospital ENS. On that Monday, they sent the initial

ENS only to the highest tier of leadership, and, for
the OR, that was our associate chief nurse and
executive medical director. They immediately
responded to the senior leaders and received an
update on the situation. However, the ENS sent by
senior leaders did not go to the clinical managers or
to the anesthesia staff administrator for the day.
Initially, cell phone alerts from news stations pro-
vided information to the front-line perioperative
personnel and leaders, which led to some confusion
about what to expect and how to plan. These un-
confirmed reports and rumors made it difficult for
personnel to manage the existing schedule and
patient flow. Planning for staffing, equipment,
supplies, and instrumentation for the expected
influx of trauma patients also was very challenging
to personnel who found it difficult to separate fact
from fiction in reports and coverage of the event.

During the response, nursing leaders decided to add
a perioperative nurse to act as a liaison between the
284 j AORN Journal
ED and the OR to address communication chal-
lenges. This liaison role was invaluable to response
efforts and decisions about emergency care because
that nurse was able to discern the information that
perioperative nurses needed to care for specific
patients.
Figure 3. Massachusetts General Hospital’s project charter.
Adapted and printed with permission from
Massachusetts General Hospital, Boston.
AORN Journal j 285
www.aornjournal.org
Identifying Staff Members

Role identification was an issue for those per-
sonnel outside of the immediate central desk area.
As part of the MGH emergency preparedness
plan, leaders assign team members specific roles
to centralize operations and resources. But it was
difficult for perioperative team members to iden-
tify those individuals. For example, many well-
meaning individuals went about gathering sup-
plies without direction and without knowing for
which patient. These actions contributed to sup-
plies being depleted from central storage spaces.
One of the revisions to the emergency prepared-
ness plan has been to formalize resource coordi-
nator roles to manage the flow of supplies and
instruments rather than relying on individuals to
work independently.
Traffic Control
Traffic control for perioperative clinical and sup-

port personnel became a significant issue for the
team at the control desk who managed the OR
schedule and led the disaster response. There was
no doubt that everyone wanted to help the patients
and one another, but that desire to help and the
hovering around the central desk that ensued was
an ongoing challenge. Despite repeated appeals
from perioperative leaders that all personnel vacate
the desk area, individuals wanted to hear informa-
tion firsthand at that central location, and the area
became very noisy and crowded. It seemed as if
one group of people would disperse only for
another to form. Team member intentions were
good, but crowd control became a skill that needed
to be repeatedly deployed. An additional staffing
role that the task force members have since for-
malized is the traffic control officer. This individual
will be responsible for dispersing clinicians to a

central area and conveying information directly
from the perioperative disaster leaders.
Communication
Communication technology became a challenge
after cell phones no longer had coverage.
Communication was also a challenge within the
perioperative area. A contributing factor was the
location of the entire perioperative services de-
partment, which in 2011 moved into a building
adjacent to the MGH campus that is separate from
the control OR desk. The perioperative emergency
preparedness plan states that the main control OR
desk will be the emergency operations center for
the OR. Perioperative leaders had not accounted
for communications being required between the
control desks on the three levels of the ORs in the
adjacent Lunder Building, which houses neuro-
surgery, vascular, and orthopedic surgery. In this

building, there also was not a process for local
perioperative leaders such as the nursing and anes-
thesia professional team leaders to provide floor-to-
floor status updates or updates to the control OR
desk. Hospital leaders are considering the use of
walkie-talkie communication and having hand-held
communication devices ready for emergencies.
New Plan
Although many of the challenges noted above
are addressed in the existing MGH emergency
preparedness plan, leaders found that further rein-
forcement of multidisciplinary team members was
needed. The goal was to develop a more robust
education plan for all personnel, one that
n covers the emergency preparedness operations
and roles,
n accounts for the ongoing transition in personnel
that occurs in a large academic medical center,

and
n speaks to a broad range of disaster scenarios
that may occur at any time, day or night.
The task force identified managing roles during
the debriefing sessions that will be added to the
emergency plan. These new roles will be critical to
managing the large number of perioperative team
members at MGH and the sizable physical area that
the ORs encompass. Members of the task force
revised the job actions sheets for each emergency
preparedness plan role to be more role specific and
286 j AORN Journal
detailed (see Supplementary Figures 1-3 at http://
www.aornjournal.org). Their goal was to provide
any individual assigned to a described role the tools
and information necessary to successfully support

the emergency preparedness plan, regardless of
whether the role is typically within his or her scope
of practice.
During a disaster, ongoing updates are of sig-
nificant interest to everyone at the hospital. The
primary source of updates for the perioperative
team members during the bombings incident was
the media. Some of this information was accurate,
and some was not. It was a very real need for team
members, while they cared for patients and were
thinking of their family members and friends, to
know what was going on outside of MGH. The
shelter-in-place order was unprecedented in
Boston.
2
The hospital incident center provided
personnel with regular updates from the law
enforcement agencies, but team members needed
more information that would be specific to patient

care, such as numbers of patients and the specific
injuries. Hospital leaders are working with the
MGH public affairs office to determine the most
effective way to disseminate information to per-
sonnel and patients alike. The task force also will
be looking at the best way to increase accessibility
to news updates when the public at the hospital and
in the surrounding geographic areas are at risk for
attack or violence. For the perioperative environ-
ment, leaders intend to use strategically placed
monitor displays to update clinical team members
with real-time hospital updates and communica-
tion. This approach will require adding an addi-
tional communication role to our emergency
preparedness workflow.
CONCLUSION
Every process in any environment can be im-
proved, particularly with experience. It was only

through honest personal and professional insight
that leaders at MGH realized the hospital’s emer-
gency preparedness plan needed revision. In re-
flecting on the lessons that were learned during the
Boston Marathon bombing and the subsequent
shelter-in-place order that was issued, MGH leaders
are developing an updated plan that will help team
members respond to any event and situation. This
plan will be a broad, general roadmap with prin-
ciples to effectively guide team members and
leaders during an emergency. The critical lessons
learned during the 2013 event have reminded ev-
eryone that emergency preparedness plans need to
be updated on a regular basis. Team members and
leaders at MGH believe that emergency preparedness
plan updates must reflect the changing types of di-
sasters, changing communication technologies, and
the changing workforce. Although it is certainly

our hope that emergency preparedness plans will
not be needed, MGH personnel and our colleagues
across the country may have to implement an emer-
gency preparedness plan in the future. Certainly,
events such as the mass shooting in Newtown,
Connecticut,
4
Hurricane Sandy on the East Coast,
5
and the devastating tornado in Moore, Oklahoma,
6
testify to the need for hospital emergency planning.
Taking care of patients is a rewarding occupa-
tion, and, in situations such as those described in
this article, it is almost the easiest part of handling
the disaster. Preparing and caring for victims of a
mass casualty brings out the goodness in people.
Standing at the central desk, the repeated phrase
that could be heard was, “Tell me what to do, I just

want to help.” The days and weeks that followed
brought multiple opportunities for each individual
at MGH to reflect on and gain understanding from
experiencing this terrible event. One difficult con-
sequence of the bombings is that there are many
difficult and painful stories from the many survi-
vors and their caretakers, but a wonderful aspect of
this experience has been, and continues to be, that
there are so many individuals at MGH and in the
nursing community who are ready to listen.
SUPPLEMENTARY DATA
The supplementary figures associated with this
article can be found in the online version at http://
dx.doi.org/10.1016/j.aorn.2013.07.019.
AORN Journal j 287
www.aornjournal.org

Editor’s note: Magnet is a trademark of the
American Nurses Credentialing Center, Silver
Spring, MD.
References
1. The Beginning of a Boston Tradition. Boston.com Sports.
http://www.boston.com/zope_homepage/sports/marathon_
archive/history/1897.shtml. Accessed October 8, 2013.
2. DeLuca M. Boston transit shut down, nearly 1 million
sheltering in place amid terror hunt. US News on NBCNews
.com. http://usnews.nbcnews.com/_news/2013/04/19/1782
2687-boston-transit-shut-down-nearly-1-million-sheltering
-in-place-amid-terror-hunt?lite. Accessed October 8, 2013.
3. EM.02.01.01: The hospital has an emergency operations
plan. In: Hospital Accreditation Standards 2013. Oak-
brook Terrace, IL: Joint Commission on Resources; 2013.
4. Candiotti S, Botelho G, Watkins T. Newtown shooting
details revealed in newly released documents. CNN. http://

www.cnn.com/2013/03/28/us/connecticut-shooting
-documents/index.html. Accessed October 8, 2013.
5. Hurricane Sandy 2012. Huffington Post. http://www
.huffingtonpost.com/news/hurricane-sandy-2012/.
Accessed October 8, 2013.
6. Tornado devastates Moore Oklahoma. CNN US. http://
www.cnn.com/interactive/2013/05/us/moore-oklahoma-
tornado/. Accessed October 8, 2013.
Maureen Hemingway, MHA, RN, CNOR, is a
clinical nurse specialist at Massachusetts Gen-
eral Hospital, Boston. Ms Hemingway has no
declared affiliation that could be perceived as
posing a potential conflict of interest in the
publication of this article.
Joanne Ferguson, MSN, RN, is the nursing
director of operational planning and environ-
ment of care, Perioperative Services, at Massa-
chusetts General Hospital, Boston. Ms Ferguson

has no declared affiliation that could be per-
ceived as posing a potential conflict of interest
in the publication of this article.
288 j AORN Journal
http://www.boston.com/zope_homepage/sports/marathon_archiv
e/history/1897.shtml
http://www.boston.com/zope_homepage/sports/marathon_archiv
e/history/1897.shtml
http://NBCNews.com
http://NBCNews.com
http://usnews.nbcnews.com/_news/2013/04/19/17822687-
boston-transit-shut-down-nearly-1-million-sheltering-in-place-
amid-terror-hunt?lite
http://usnews.nbcnews.com/_news/2013/04/19/17822687-
http://usnews.nbcnews.com/_news/2013/04/19/17822 687-
http://www.cnn.com/2013/03/28/us/connecticut-shooting-
documents/index.html
http://www.huffingtonpost.com/news/hurricane-sandy-2012/
http://www.huffingtonpost.com/news/hurricane-sandy-2012/
http://www.cnn.com/interactive/2013/05/us/moore-oklahoma-
tornado/

tornado/
tornado/
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