Posted By Prucia Buscell,
Tuesday, October 20, 2015
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Coordination, Leadership Flexibility, Saved Lives After Bombing
Flexible leadership, swam intelligence and smooth collaboration and coordination among members of the medical community, police and other city, state and federal agencies saved lives after the April 2013 explosion of two bombs at the Boston Marathon, according to new research.
Three people died at the scene, and 264 bombing victims, many with life threatening injuries, were taken to 27 area hospitals. A least 14 of the injured required immediate amputations but none of those taken to hospital died. One reason for that, researchers found, was the high level of flexibility and autonomous decision making among physician leaders.
The National Preparedness Leadership Initiative (NPLI) is a joint venture of the Harvard T.H. Chan School of Public Health's Division of Policy Translation and Leadership Development and the Harvard Kennedy School's Center for Public Leadership. Experts from the NPLI and colleagues from Boston hospitals and several Israeli institutions analyzed the role of organizational dynamics and leadership in the aftermath of the bombing. The NPLI focuses on training leaders for crisis and emergencies and has studied many disasters across the country, including the H1N1 outbreak in 2009, the 2010 Deepwater Horizon explosion and oil spill in 2012 and Hurricane Sandy in 2013. A Harvard news story by Karen Feldscher describes the NPLI Boston bombing study.
"We wanted to know what leaders were thinking, what they were doing and how they were working together because there was an extraordinary outcome in the wake of the bombing: coordination and collaboration were smoother and more seamless than we've seen in other events," said Eric McNulty, NPLI director of research and professional programs. NPLI researchers said the exceptional coordination was an example of swarm intelligence, in which individuals work together effectively toward a goal even when no one is in charge.
Researchers identified five principles that applied to leaders in fostering the kind swarm intelligence they saw at work: unity of purpose, with all intent on saving lives; generosity of spirit; people focused on their own jobs and helped others with theirs; no ego no blame; and a foundation of strong relationships. Though no one person was directing operations, those involved kept order and coordinated complex decisions and actions over the 102 hours between the explosions and the capture of suspects.
Resident physician helped clear emergency rooms by moving patients quickly into wards. When ell phone service was disrupted after the bombings, hospital staff improvised with runners, radio, social media and more face to face communications. Seriously injured patients needed medications, fluids, blood and often surgery. Hospital staffers found it hard to keep track of the names of large numbers of unknown patients who couldn't always speak and weren't carrying identification. To help with this problem in the future, Brigham and Women's Hospital (BWH) presented its findings to federal emergency preparedness officials for possible use in establishing a national naming convention.
Practice apparently helped. Eric Goralnick, medical director of emergency preparedness and assistant professor of emergency medicine at BWH and a faculty associate at NPLI, described past practice programs and the marathon bombing response at BWH in a New England Journal of Medicine article. He said in an eight year period, BWH activated its emergency response team on 78 occasions, boh for real events, and drills based on an assortment of scenarios, including chemical attacks, blizzards, train wrecks and building evacuations. "These drills have been departmental, hospital-wide, citywide and statewide," he wrote. "They taught us familiarity, comfort, trust and routines. On April 15 these routine saved lives."
With thanks to Sonali Vaid.
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