Leadership During the Boston Marathon Bombings: A Qualitative After-Action Review

Abstract

Disasters provide a distinctive context in which to study the robustness and resilience of response systems. Therefore, in the aftermath of a large-scale crisis, every effort should be invested in forming a coalition and collecting critical lessons so they can be shared and incorporated into best practices and preparations. Novel communication strategies, flexible leadership structures, and improved information systems will be necessary to reduce morbidity and mortality during future events.

Review of alternatives to root cause analysis: developing a robust system for incident report analysis

“…This method of AAR can be a means to reflect on training, a work shift or IR 63 64. There are also examples of variations of AAR used after public health crises and mass casualty events 65–69. Sawyer et al suggest that AAR provides a structure to enhance team reflection, learning and enlightened action 61.…”

Enhancing Reporting of After Action Reviews of Public Health Emergencies to Strengthen Preparedness: A Literature Review and Methodology Appraisal

“…The reviews covered national and international responses to the 2009 A(H1N1) influenza pandemic (n = 8), [21][22][23][24][25][26][27][28] terrorist bombing incidents (n = 5), [29][30][31][32][33] industrial explosions (n = 6), [34][35][36][37][38][39] hurricanes (n = 2), 40 , 41 chemical contamination of drinking water (n = 1), 42 a heat wave (n = 1), 43 and largescale flooding (n = 1) (see Table 1). 44…”

Health and Medical Response to Active Shooter and Bombing Events

“…The simultaneous execution of a variety of activities according to standard operating procedures or job aids at the departmental level in the first 20 to 60 minutes often will determine whether the response succeeds or fails. Incident command and the hospital command center are needed to manage the less predictable, more dynamic response needs and issues that occur after the first 30 to 60 minutes (Goralnick et al, 2015).…”

“…Use of triage tags by the facility can help to maintain information flow until the patient information is entered into the electronic health record (EHR). A recurring theme among hospitals that receive multiple victims in a short period of time is that it is impossible to get the patients registered quickly enough and get information updated in the EHR to be useful, so that patients are often lost in the system for hours (Goralnick et al, 2015;Hick et al, 2008). With the potential for multiple unidentified victims, the hospital system for disaster registration should minimize the potential for confusion between different victims.…”