Author(s): Jesse Roman. Published on March 2, 2015.

More Case Studies on Resiliency

AS DIRECTOR OF THE Massachusetts Emergency Management Agency, Kurt Schwartz oversees the state’s response to all types of disasters and emergencies. He was at the finish line of the 2013 Boston Marathon when two bombs exploded. Surrounded by terror, chaos, and carnage, Schwartz helped lead a successful public safety response to one of the most high-profile domestic terrorist attack in U.S. history. Schwartz also serves as undersecretary for homeland security and emergency management in the state’s Executive Office of Public Safety and Security (EOPSS), and as the state’s homeland security advisor and member of the Governors’ Homeland Security Advisors council.

In his own words, Schwartz explains how Boston’s tremendous resilience in the face of terror resulted from preparation, infrastructure, leadership and a little bit of luck.

On resilience: Resilience to me means the community bounced back quickly, quicker than might have been expected given the event. I think that is true in this case.

To me, when you look at the Boston Marathon bombings, public safety contributed to resilience in those first moments, because the response mitigated the extent of injuries and trauma. When those two bombs went off, three people died instantly and 260 were injured.  There were scores of people in critical condition. How is it that all 260 people survived? It’s not just that the gods were with us that day. You’ve got to be good and you’ve got to be lucky, and we were both.

On planning ahead: There were a number of exercise programs leading up to the 2013 marathon that very specifically helped responders effectively deal with a mass-casualty bombing incident. Operation Urban Shield is a full-scale exercise put on (every 12 to 18 months) within the city of Boston and eight surrounding communities. In 2012, the year before the bombings, our exercise scenario was a Mumbai style terrorist attack in the city of Boston, which included an Improvised Explosive Device (IED) on Boylston Street. These exercises are intended to exercise the emergency response capabilities of multiple agencies including police, fire, EMS, hospitals, and emergency managers all exercising together. We test communications, inter-operability, emergency operations, tactical teams on ground, HAZMAT, fire, SWAT, explosive ordinance disposal (EOD), lots of different components.

More on Marathon Bombings:

In addition, in the years leading up to the 2013 bombing we also conducted two different tabletop exercises that brought together local, regional, state and federal partners. Those exercises were focused around responses to terrorist incidents in the city. The same leadership that stood out on the street that day of the bombings in 2013, exercised together in these tabletop exercises, talking about just these issues. We asked questions like, “what if a terrorist attacks one location? Multiple locations? Who is responding? How would we work together? How would leadership teams work together? How would we make decisions?” No matter the situation, what is important are the systems in place. Whether you are responding to a lighting strike, a building collapse, a terrorist attack, or an active shooter, you have the same systems at work that you saw play out in Boston in 2013.

On the moments and hours after the bombs went off: After the second bomb went off, the overwhelming majority of the spectators did just what you’d want: they fled. And hundreds of first responders stayed in place and went to work.

Normally in a mass casualty event, first responders are dispatched, they arrive after the event and as they are arriving incident command is being stood up, and EMS triage is being set up—it didn’t happen that way (after the Marathon bombing). These bombs went off and the first responders were already there. We had hundreds of medical EMS professionals, hundreds of firefighters, police officers and other first responders on Boylston Street and in medical tent A (at the finish line) when the bombs went off. That meant they went to work before a real structure could stand up, to command and control their response.

Within about three minutes of my arrival on Boylston Street, I was with the police superintendent. The police commissioner showed up few minutes after that, as did the incident commander for state police, the superintendent of transit police, the chief of Boston EMS, and district fire chief from Boston fire. We stood up command fairly quickly in back of an ambulance, right on Boylston Street. That didn’t work very well for a number of reasons. I certainly suffered from tunnel vision, it was very hard to take a step back and have a broad view when you were seeing what you saw. The first person I encountered when came onto Boylston Street was a person who had lost both of their legs. It’s hard to focus, I think we all had tunnel vision.

Some of the incident commanders went right into rendering aid. I saw a lieutenant pull a chief off of a patient and say to the chief, “you can’t do this, you have to command, let us do the work.” There was a real drive to get in and provide care. It was just plain chaos. It’s hard to standup effective command amongst the chaos. Finally, the other big challenge was, as the 8,000 people at the finish line ran and fled, they all left their backpacks behind. There were hundreds of backpacks throughout the area and there was black powder on these bags and EOD detection dogs were flooding into the area. We are trying to standup command as EOD teams were screaming, literally screaming, that they found a bomb. Everybody would move and another dog would hit on another backpack. In those first minutes we still had patients being cared for on the street and a real belief there were other bombs on the street. It made command very difficult, which is why command very quickly moved two blocks away to the Westin hotel. We simply took over the ballroom in the hotel and that became the unified command for the next 36 hours.

On the EMS response: Normally, in mass casualty incidents, first responding units come in, and set up triage—all across country triage systems are somewhat similar—but that did not happen here for a number of reasons. First responders, including medical personnel, were on the scene already when the bombs went off. The Boston EMS chief made a decision within about two minutes and communicated it via radio, to do what was basically a combat medical approach to the trauma, which was to stabilize bleeding and begin rapid transport to trauma centers. That rapid transport of up to 260 people took many forms; some of them violated our own state guidelines and laws. We had about 30 ambulances staged when bombs went off; those 30 ambulances depleted in matter of minutes. A mutual aid call brought in another 60 ambulances within 15 minutes. Many of patients were transported in police cruisers; in at least one prisoner wagon; and at least one small bus was used. Many personal private vehicles were simply commandeered. The decision was made to move these people as quickly as possible, and it worked because the resources were there. The trauma doctors at the hospitals who received these patients said heroic work was done on the ground by the EMS, police, National Guard, and spectators— they saved scores of lives. People would have bled out without that quick intervention.

On coordination of hospitals: In Boston, we have seven level-one trauma centers within a couple miles of the bombing site. Contrast that with San Francisco, which has one level one trauma center. We also have something called the Boston Medical Intelligence Center, which is one of a kind in the country. For large preplanned events, this medical emergency operations center is stood up, and it was in place the day of the Boston Marathon bombing. The Medical Intelligence Center communicates with each of the city’s level-one trauma centers so they know each hospital’s capabilities, how many operating rooms are available, and things like that. When the bombs went off, it was this intelligence center that notified the hospitals of the mass casualty incident within three minutes. It was this center that managed the distribution of patients across the seven level-one trauma centers. And then after all 260 patients had been transported, the medical intelligence center then played a key role in the delivery of health and human services and social services when we went into a recovery phase hours after the bombings. This is where much of that coordination work was done.

We were lucky, too. The bombs went off at 2:50 p.m. Our hospitals all change shifts at 3 p.m. and they were all notified of mass casualty incident at 2:54 p.m. Each of the hospitals immediately held their day shifts, and since they all had their night shifts already in place, they each had double the number of staff. And, since the Boston Marathon is always run on the Patriots Day holiday, there was almost no elective surgeries scheduled that day, which meant that there were hundreds of available surgical rooms, and operating rooms available when the bombs went off.

On fortifying key infrastructure: We have a subway line that runs directly under Boylston Street. On this particular Monday, our mass transit system had moved about 1 million people into the city. We had to make a decision on whether to keep the transit system running or shut it down. That decision was made about 45 minutes into the event, just after we got to the Westin hotel. Transit police asked the unified command group—there were five of us—what we were going to do with the transit system. Standing protocol for a number of years has been if there is a terrorist attack or threat, we automatically shut down the transit system. But we had a quick conversation and made the decision that we needed to keep it up and operational. We knew we had terrorists in the city, but it seemed more important to us to get 1 million people out of the city. So the response was fortify the subway system and keep it open. The decision was to move tactical teams into the subway system, protect the system, but keep it open. Within a matter of an hour or so the National Guard fortified the subway and stayed there until Friday when the terrorists were killed or captured. The decision was also made in conjunction with the governor and mayor to keep city open but fortify the city: that included all of our critical infrastructure and any area that draws a high volume of people: hospitals, hotels, tourist attractions, skyscrapers, malls, all were just flooded with tactical teams for the next several days.

The National Guard played a huge role. We already had 400 soldiers on duty, providing law enforcement support in advance of the bombings. Boston police asked the National Guard to deploy in the city to help secure critical infrastructure and secure what was a huge crime scene. We deployed about 1,200 soldiers by the next day. We turned the city into a war zone. This could have been the green zone in Iraq by what it looked like the next day. The public welcomed it and supported it. We got no push back.

On communication: Within minutes of the bombings all cell phone service in the greater Boston area crashed from over saturation. That’s like tying one and a half arms behind your back if you’re on the incident command level and trying to make key decisions. Portable radios are only so good. Our phones all failed. People who had wireless priority service, (270 were available) were able to make phone calls. Portable radios worked. This was a preplanned event so we had a great interoperability system already in place. First responders were all talking to each other, we were all connected to the multi-agency coordination center. Portable radios worked, text messaging worked. Satellite phones worked. One issue was everybody came to work thinking they were on a 12-hour shift, so 24 hours in, all of our portables were going dead. That’s a huge issue you have to plan for. Fortunately Motorola brought down a truckload of batteries that they happened to have reasonably close. Cell phones were back in three hours after the event, but eight hours after that, almost every cell phone was dead, because the batteries died. You have to plan for that, too.

On the runners: We also had to deal with about 7,000 runners who were held up and stopped where they where on the race course when the bombs went off. We couldn’t let them run back into the city of Boston and it became a huge issue for us. We had good sheltering and emergency transportation plans in place, but we were slow to get that stood up. It took us a while in chaos to remember we had those 7,000 runners we had to take care of.

On crisis mental health assistance: We had 260 patients in hospitals within a matter of an hour. That left us with thousands and thousands of survivors, spectators, runners, first responders that all had just been witness to this horrific event. They needed support. We had 7,000 runners who were disconnected and not able to get back into the city where their cell phones were, their car keys were, their families were. We had thousands of people all over the world trying to figure out if their loved ones were dead or alive. We used the Red Cross “Safe and Well” website, which worked really well. Crisis counseling became a huge issue and remains an issue today. We have thousands of people who need psychological first aid. FEMA and the Massachusetts Health and Human Services agency were tremendous. They brought in federal crisis counseling teams to augment our local and state teams to treat, not just our first responders, but also the spectators, the family members, the runners, and the volunteers that were working on Boylston Street that day.

The aftermath: There were a number of after-action reviews done. Virtually every agency did its own comprehensive review, and my agency looked at the whole system. Best practices were identified, as were gaps that required improvements. We spent eight to nine months planning for the 2014 marathon to close all of those gaps. The organization and command structure for the 2014 marathon was in many ways quite different. The resources deployed in 2014 and the threats we deployed them against were different. On the ground in Boston, there was no multi-agency emergency operations center (EOC) working day of bombing; that was stood up after bombs went off. In 2014, that changed. In 2013, the unified command had no predesigned space to respond in case of an emergency; in 2014 we had a predetermined location several blocks away from the finish line that had phones ready for us if we needed them.

We learned some hard lessons in 2013. You can’t guard against every threat, but we built systems to guard against threats we deemed to have the have highest risks. Then we built better systems to respond to those events.

On leadership during the crisis: The scene was chaotic, but not without leadership. How do you bring some sense of order and structure to something that immediately causes chaos? How do you transition into a disciplined response instead of a chaotic response? Leadership came to bear on that scene quickly. We had great leadership from a tactical level all way to our elected leadership. A good crisis leader has to have the capability to think out of the box. Blindly following a written plan without taking into account the circumstances around you can be bad leadership. What we saw in the aftermath of the bombing was leaders making really good decisions in light of the circumstances facing them, even when written suggestions said to do something else.

It comes from experience, being in crisis situations and having experience. It’s education, it’s training, it’s exercising. Almost everyone of us at the executive level making decisions in 2013 bombing had taken courses at Harvard’s Kennedy School of Government in executive leadership. Some of it is innate.

Final reflections: There were many moving parts from first minute, to hours and days after the bombing, and so many things clicked and worked well together. If there are not several level one trauma centers close by, the outcome is going to be different and not for better. If you don’t have so many resources staged for the event and deployed within seconds, or if radio systems don’t work and we couldn’t coordinate a response, you have a much different outcome. There are so many instances where a slight difference in how things went would have made the outcome much different. The infrastructure and training were there and they worked.

I think lots of things about the bombing every single day. For those of us who were unfortunate enough to be there and see the horror of it, to think so many of the people we saw so grievously injured … yes, I still think about it all the time.

JESSE ROMAN is staff writer for NFPA Journal.