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Keys to Managing a Medical Surge During Large-Scale Incidents

By Anthony Mangeri, American Military University

Just over four hours into the Boston Marathon there were two explosions within a few blocks of the finish line. Federal officials believe both devices were small and at least one device was placed in a trash container.

The explosions knocked runners and public safety professionals to the ground. Initial reports from several news outlets reported that at least three people were killed and more than 100 people were injured. Local hospitals are treating many of the wounded.

More than a terrorist incident, this attack was one of many mass casualty incidents that have occurred this year. Today’s special event contingency planning requires emergency planners to work extensively with local, state and federal emergency professionals to plan for mass causality contingencies. Hospitals were already on standby for marathon runners; doctors, nurses and emergency medical staff were also onsite to address the needs of the runners and spectators.

According to the Massachusetts Standing Committee on Multiple Casualty Incident Planning and Evaluation’s Emergency Medical Care Advisory Board, a multiple casualty incident (MCI) is defined as “one in which the number of people killed or injured in a single incident is large enough to strain or overwhelm the resources of local EMS providers.” In urban areas such as Boston, there are significant resources to address the day-to-day pre-hospital needs of the city. However, the added strain of special events, such as the Boston Marathon, can strain resources and personnel. It was clear from the media reports that Boston EMS, fire and law enforcement worked in harmony to respond effectively to those in need.

Contingency planning is essential for the worse-case scenario. All indications are that the response in Boston appeared well planned and well executed.  Police, fire, EMS and even the Massachusetts National Guard responded to and stabilized the incident quickly and decisively. This does not occur without well-developed policy, operational plans, and exercises to assure that responders understand their role and that agencies have the resources needed to execute plans quickly.

Each community must have a MCI plan that defines: incident leadership, the role and responsibilities of all first responders, the community’s capabilities, and mutual aid systems to address potential threats. Special permitted events must also be required to work with local officials to assure that there are contingencies plans in place to meet the potential needs based on a comprehensive risk analysis of the event, venue, and the host community.

It needs to also be noted that an overwhelming number of those who responded to the injured were spectators and bystanders. This attack reminds all in emergency management that large-scale incidents can occur anywhere at any time. Emergency planning must address the community’s needs based on available resources and work to integrate regional and state resources to address large-scale incidents.

About the Author: Anthony Mangeri has more than 30 years of experience in emergency management, response and recovery operations. During the attacks of September 11, 2001, Mangeri served as the Operations Chief at the N.J. Emergency Operations Center. He is a volunteer firefighter and emergency medical technician for more than 25 years. He earned the rank of Assistant Chief-Safety Officer. Currently, Mangeri is the Manager of Fire and Emergency Service Initiatives at American Public University System.  He is also an Assistant Professor in the School of Public Service and Health. Mangeri earned a Master of Public Administration from Rutgers University.


Leischen Kranick is a Managing Editor at AMU Edge. She has 15 years of experience writing articles and producing podcasts on topics relevant to law enforcement, fire services, emergency management, private security, and national security.

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