Beyond the ED, staff tackled a different issue—the parade of specialists who marched through patients' rooms every day. Instead of separate visits from the vascular surgeon, orthopedist, plastic surgeons and social worker, the hospitals formed teams that did rounds as a group.
Ultimately, Boston hospitals did well because those who responded knew what they were doing. Boston surgeon Atul Gawande wrote in The New Yorker that he was "struck by how ready and almost rehearsed they were for this event. A decade earlier, nothing approaching their level of collaboration and efficiency would have occurred."
'The Equivalent of 1,000 Drills'
In fact, they were rehearsed. In its report on the response, FEMA pointed to 2002 an exercise meant to simulate the explosion of a dirty bomb on an incoming airplane that involved over 50 agencies and 10 hospitals. In 2011, another exercise tested the ability of hospitals to handle a surge of patients from an explosion and building collapse.
"Members of the hospital staff were familiar with their roles and responsibilities because of the training and exercises they had previously conducted," according to the FEMA report. "Additionally, hospitals developed plans with first responders, ambulance services, and law enforcement to successfully coordinate a hospital response during an MCI."
Goralnick agrees that preparation and collaboration made a huge difference. But he said that, in terms of lessons learned, the Boston Marathon bombing was the equivalent of 1,000 drills: "We're going to learn from this event for a lifetime."