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.