Some unrelated thoughts about the Boston Marathon bombings.
- It could have been worse. Sunday night and Monday morning I considered re-posting an oped I wrote five years ago on the “Marathon as dry-run disaster.” The underlying point of that piece being that the City of Boston and the surrounding communities through which the marathon is run are extremely prepared for terrorist attacks and other types of events, particularly on Patriots Day. The planning goes on all year, includes the possibility of non-marathon related incidents, and requires the deployment of an impressive amount of medical personnel. Emergency rooms add staff, Boston EMS is backstopped by private providers from around the region, and a medical tent at the finish line (a block or two from the explosions) is staffed by a score of volunteer doctors and nurses. Considering the types of injuries caused by the blasts, with many limbs later amputated in hospitals, lives were undoubtedly saved by the close proximity of such an array of medical resources that could begin to manage the victims.
- Bystander care is essential. Despite this being one of the most heavily first responder resourced events in the nation, with medics, doctors, and nurses steps away from the explosions, bystanders still played a critical role in the response. As a Washington Post profile explains:
In the aftermath of Monday’s explosions, much of the early lifesaving was performed by amateurs: Boston cops, marathon volunteers, plain old bystanders. They tied tourniquets and carried away the injured in wheelchairs or in arms.
On Tuesday, local hospitals said this work — along with the efforts of professional medics on the scene — probably saved lives.
“Tourniquets are a difference-maker. Tourniquets can save a life,” said Joseph Blansfield, a nurse practitioner and program manager at the Boston Medical Center trauma unit, which saw a large influx of patients from the scene. “They proved their value yesterday.”
The scene of the next terrorist attack or natural disaster is likely not to be so heavily staffed by medical personnel, so bystander care will play an even more vital role. Homeland security officials at all levels of government should think now how to better engage and train the public to provide immediate lifesaving treatment, and how to change the first responder community’s reluctance to take advantage of this resource.
- A teachable moment It is difficult to take the focus off Boston for even a moment, but it should be recognized that this attack represents a teachable moment for the rest of the nation. Whether due to a concern that these bombs represented the beginning of a campaign of attacks across the country, or that eventually it could happen in any town, responsible officials will be reviewing their community’s plans for a similar event. Fortunately, American medical professionals rarely have to treat victims of explosions. Before it happens again it might be wise to review and disseminate information such as that produced by the CDC on the treatment of blast injuries:
- Impossible to stop every attack. It was accepted conventional wisdom that there would eventually be another successful terrorist attack on U.S. soil. Few politicians commented on that fact, instead preferring to highlight efforts aimed at prevention. However, the Boston Marathon is just the type of highly visible soft target most vulnerable. Unlike the Superbowl or World Series, officials cannot restrict access to just a few points and check everyone’s bags. If the individual or group who planted the bombs did not share their plans with others, it may have been impossible for law enforcement or intelligence agencies to get tips about the plot. These agencies have greatly improved their capabilities since 9/11, but they are not omnipotent.
- Foreign or domestic? In the bigger picture of the lives directly impacted, who cares? Victims’ wounds would not have changed according to the ideology or citizenship of the bombers. However, if it is discovered that the perpetrators communicated their plans to like-minded colleagues beforehand, it may point to gaps in intelligence and policing. But at this point that remains a big if.
- Non-strategic. One thing to keep in mind is that as horrible as the bombings are for those directly hurt by the blasts and mentally shaken by events, this was a small attack. It will only become a strategic blow if we overreact and needlessly change our way of life. This is not the time for an “own goal” that will serve to only help further terrorists’ goals.
- Life didn’t stop. In the hours after the attack, friends in Boston replied to my text messages inquiring about their safety. The vast majority were at work (despite what you may have read the entire city does not get the day off) where they stayed. Not sheltering-in-place, but going about their daily jobs. One particular friend was in the midst of selling his condo. He has not put that on hold. Even in Boston, life did not come to a screeching halt for the majority of people.
- Cold or strong? On my way home from work that day I stopped at an upscale Italian restaurant for a cocktail and some news. Monday is not a particularly busy night, but there were still a number of people seated at the bar. I was the only one watching the television tuned to CNN. I realize that due to my work and interests that I have a strong appetite for stories about catastrophes. Yet it struck me, at first, that the other patrons seemed cold or callous, sipping their cocktails and nibbling on their olives unconcerned about a terrorist attack on U.S. soil. After a while I reconsidered. Perhaps we have become more resilient. Maybe we are not prone to overreaction. It might be that they already had heard the news and did not feel the need to stay glued to anchors repeating the same information over and over again. It could be that Tom Friedman, writing in today’s New York Times, got it right:
Fortunately, we don’t frighten easily anymore. You could feel it in the country on Tuesday morning. We’ve been through 9/11. We probably overreacted then, but never again. We tracked down Osama bin Laden with police and intelligence work, and we’ll do the same in this case.
- I have a feeling that next year the 118th Boston Marathon may be among the largest ever because as Boston author Dennis Lehane, writing in the same edition of the Times, put it:
Boston took a punch on Monday — two of them, actually — that left it staggering for a bit. Flesh proved vulnerable, as flesh is wont to do, but the spirit merely trembled before recasting itself into something stronger than any bomb or rage.