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Lessons for Information Technology from the Boston Marathon Bombings

Summary and Comment |
July 29, 2014

Lessons for Information Technology from the Boston Marathon Bombings

  1. Daniel J. Pallin, MD, MPH

Disaster drills are not just about teamwork and hazmat suits anymore.

  1. Daniel J. Pallin, MD, MPH

Investigators from Brigham and Women's Hospital in Boston conducted structured debriefings to learn from the experience of the hospital's response to the Boston Marathon bombings in April 2013. Debriefings included brief, informal sessions very early after the event, called “hot washes” after the military practice of quickly cleaning one's weapon immediately after use, and more structured formal analyses, called “after-action reviews” in standard disaster-preparedness parlance.

One component of this process was an analysis of what worked and what didn't work regarding emergency department and hospital information systems. Among the many lessons learned is that the naming conventions used for unidentified patients made it difficult to distinguish one patient from the next. Another is that the emergency department tracking system did not accommodate rapidly changing patient locations well. Based on this analysis, the hospital devised and implemented strategies to improve these systems.

Comment

This is a seminal paper. From this day forward, everyone responsible for designing and executing mass casualty response needs to include information technology systems in disaster preparation. Design of electronic systems should incorporate the speed, flexibility, and naming conventions to push performance to levels that might be 20 to 30 times more rapid and complex than those needed for business as usual. As a fail-safe, organized, paper-based systems should be ready to go as a substitute.

Dr. Pallin and NEJM Journal Watch Emergency Medicine Editor-in-Chief Dr. Ron M. Walls work in the same department as the authors but were not involved in the study.

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / Research support NIH Leadership positions in professional societies Society for Academic Emergency Medicine (Co-Chair, Scientific Subcommittee of Program Committee)

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