The bombings that took place in Boston this week are a stark reminder of the importance of planning for the worst.
Images of bloodstained streets, dazed victims and chaos at the scene of the explosions filled the airwaves. But amid the turmoil, there was a high degree of co-ordination among emergency responders. The fact that disaster-management plans were implemented quickly meant victims were treated faster, and possibly lives were saved. Across Canada, trauma centres and emergency responders are taking stock of how well they would be able to respond to such an event.
"From what I can tell, they seemed to be doing a tremendous job against terrible obstacles," said Najma Ahmed, assistant trauma director at Toronto's St. Michael's Hospital. "I think that in the absence of a well-organized mass casualty response, the loss of life would have been much greater."
Bystanders who made makeshift tourniquets out of their own clothes and applied pressure to help stop bleeding made a difference in the immediate moments after the bombs went off. But what came next was critical, and without proper planning, could have been a logistical disaster. Emergency workers had to triage patients, stabilize them and take them to hospitals that were ready and able to accept multiple patients who all required surgery at once. For instance, Ahmed said one of the first things Boston hospitals would have done would be to cancel the majority of planned surgeries. Atul Gawande, a surgeon at Boston's Brigham and Women's Hospital, wrote in The New Yorker how nurses at the hospital stayed on after their shifts ended, gathered equipment trays for surgery and quickly prepped as many operating rooms as possible before patients arrived.
The medical community refers to events like the one that unfolded in Boston as "mass casualty incidents" and they undergo training and drills to ensure operating rooms are cleared, extra blood can be delivered and emergency-response workers can get people into hospitals as quickly as possible. The Wall Street Journal reported this week that two years ago, Boston police, fire, hospital and emergency workers participated in a mock exercise to react to a bombing in the city.
"You prepare the best that you can," Ahmed said. "Given the nature of the incident, there's only so much preparation you can do."
However, the events in Boston raise questions over Canada's preparedness for a similar disaster. A 2011 survey of Canadian trauma centres published in the Canadian Journal of Surgery found major gaps in their disaster plans. For instance, less than half of the trauma centres had done a disaster drill in the previous two years and many hospitals did not have the medical directors of trauma on their emergency-preparedness committees.
The authors note that in Canada, much of the focus has been on preparing for pandemics or chemical, biological, radiological and nuclear disasters. Acts of terrorism and other "mass casualty incidents" are wrongly put on the back burner, which could have disastrous consequences in case such an event ever occurs here, the report says.
"Motivation to plan for [mass casualty incidents] should not only arise in the aftermath of one of these events," wrote the authors.
Tarek Razek, director of trauma services at the Montreal General Hospital, said the survey served as a wake-up call and that things have improved since then. Increasing attention is being paid to the possibility of bombings, industrial accidents or large-scale car crashes, he said. Last year, a large mock disaster was staged in Montreal to test the city's preparedness, and across Canada, regional trauma centres have been set up to respond to large-scale emergencies. Events, such as the one that occurred in Boston, serve as a reminder why those exercises are so important, said Razek.
"It shakes us out of our complacency. It's easy to think it's not going to happen to you," he said.
Razek added that the trauma community around the world is very close and that the trauma team from Boston will likely share their experience with colleagues around the world to help them learn from their successes and mistakes.
"We all learn from each other," he said. "I think we're better prepared than ever before, but never as prepared as we need to be."
Carly Weeks