Point-of-Care Ultrasonography in a Domestic Mass Casualty Incident: The Boston Marathon Experience

Abstract

Background: The role of Point-of-Care (POC) ultrasonography in domestic Mass Casualty
Incidents (MCI) has not been well established. On April 15th, 2013, two improvised explosive
devices were detonated near the finish line of the Boston Marathon injuring 264 patients and
killing 3. These patients were rapidly stabilized and transported to Boston area hospitals.
Objectives: To examine the role of POC ultrasonography during the Emergency Department
response to a large-scale domestic MCI, and to identify successful processes as well as barriers
to care delivery in order to best prepare for future events.
Methods: An online survey containing multiple-choice and open-response questions was distributed
to Emergency Medicine housestaff, physician assistants, fellows and attending physicians
in the Boston area Emergency Departments who cared for patients during the Boston
Marathon MCI.
Results: There were 50 respondents from 6 hospitals who were directly involved with patient
care. 23 respondents (46%) performed POC ultrasounds during the MCI, but only 8 of these
respondents (35%) documented findings in the usual fashion by saving images including patients
medical record numbers. Many respondents altered documentation patterns due to lack of
patient information/registration data and to time constraints. Focused assessment with sonography
in trauma (FAST) exams were reported as the most useful application (96%), followed by
lung sliding (36%), and soft tissue/foreign body exams (18%). Respondents noted that POC ultrasound
provided clinical information sooner then plain films and computed tomography (CT)
scans, as these traditional imaging resources were significantly overwhelmed. Many described
the value of POC ultrasound in resource allocation and triage once acute intra-abdominal and
thoracic injuries had been excluded. Respondents reported being hindered by too few ultrasound
systems or systems with long boot-up times and/or lack of battery power.
Conclusions: Though limited by our retrospective survey-based methodology, our findings indicate
that POC ultrasound was utilized in the hospital-based response to a large-scale domestic
MCI. POC ultrasound was especially useful given delays in traditional imaging. Our findings
highlight the difficulties with normal documentation patterns during such events, and suggest
that specific planning for POC ultrasound should be incorporated into future MCI preparedness