Boston Strong: The Role of Community Resilience

April marked the 1-year anniversary of the Boston Marathon Bombings, which brought our city to a standstill as we endured a terrorist attack, manhunt, and subsequent lockdown of the metropolitan area. Twin explosions near the marathon finish line, occurring just minutes apart, left 3 people dead and hundreds injured. In the hour that followed the bombing, the city of Boston and privately run ambulance crews, with the aid of first responders, bystanders, and trained volunteers, triaged and transported 118 patients to 9 different hospitals, including the city’s 7 major trauma centers, preventing what could have been a much higher death toll. In the ensuing disorder, families were separated, belongings misplaced, and hundreds of runners stopped before they could finish the race. As we have done every year since the 9/11 terror attacks, the Boston Public Health Commission, the city’s health department, had been working with other city agencies, the Boston Athletic Association, and state public safety officials for 12 months to plan for the annual marathon event. Our typical role during the marathon is to coordinate medical care for runners and spectators, ensure adequate numbers of emergency medical services crews and trained medical volunteers, and monitor the event for any unusual risks to the health of runners, which most often is inclement weather. On April 15, 2013, our role quickly shifted. Within 1 minute of the first explosion, crews in the medical tent at the finish line began treating those injured in the blast and radioed information about the bombings to the Medical Intelligence Center, the commission’s command center during a serious medical emergency. Within 3 minutes, the Medical Intelligence Center had notified all hospital emergency departments of the attack and warned them to prepare for an influx of badly injured patients. In the immediate hours after the bombing, we set up a family reunification center to enable runners and spectators to be reunited with their families, with injured patients who had