New takeaways from the Boston Marathon bombings
EXPERT ANALYSIS FROM EAST SCIENTIFIC ASSEMBLY 2014
Patients arrived in such rapid succession, however, that it slowed the electronic medical record system and forced staff to use sequential record numbers, which can be dangerous. Registration couldn’t keep up and orders couldn’t be put in fast enough with 43 patients arriving in roughly 35 minutes, Dr. King explained. Workarounds were often old-school, and reminiscent of his days as a green trauma surgeon serving at Ibn Sina Hospital, Baghdad, Iraq.
"In the midst of this entire event, I turned to my nurse practitioner and asked for x, y, z information on a particular patient," he said. "She didn’t turn to her tablet or desktop computer in the operating room. She pulled out a piece of paper where she’d written all the relevant information. At the end of the event, I looked down and realized I’d done the same thing. I was keeping track of my patients on my pants with a Sharpie."
King describes this as a failure of technology and translation from the battlefield, but noted that the hospital did use the military’s practice of reviewing a critical event. Once they’d finished in the operating room and achieved hemorrhage and contamination control, the entire trauma team was reassembled. They did detailed tertiary trauma surveys and went back through every single patient to determine what additional studies they needed, what injuries had been missed.
"It was remarkable the number of things that were missed," Dr. King said. "No one was bleeding to death, but tons and tons of [small, non–life threatening] missed injuries [like ruptured ear drums], and to me this was one of the more important events that surrounded our response to the entire bombing – sitting down after the dust had settled and carefully going over every patient’s medical record."
Dr. King reported having no financial disclosures.
