Within minutes of the two explosions on Boylston Street, scores of victims in the attack at the Boston Marathon finish line were rushed the city's hospital emergency rooms with injuries more often seen in a war zone.
Was the person who planted these bombs one of the patients flooding the emergency rooms? SWAT teams armed with automatic weapons flanked hospital entrances. Across the city, everyone was on high alert.
See Also: In Wake of Bombings, How Hospitals Are Communicating
Leana Wen, MD, an emergency physician at Massachusetts General Hospital and Brigham & Women's Hospital in Boston, described that day on NPR. Two weeks later, those terrified moments still haunt her. "Life seems back to normal — except it's not… At work, I feel numb to my patients' suffering. At home, I break down and cry."
She isn't alone.
During an emotionally and physically exhausting week, three marathon spectators were killed, and hundreds were grievously injured. Hospital leaders give credit to their focused staff who carried out their professional duties while balancing their personal reactions to the bombing.
Communication starts at the top
In Boston, leadership at Partners HealthCare prioritized supporting staff and kept care teams focused with direct, immediate, and regular communication. The nonprofit health system's integrated employee assistance program was ready.
"It's a fine balance, as it always is, in healthcare. Jobs can be very demanding, but you have to make sure providers are present for patients as well as themselves," says Henrietta Menco, LICSW, CEAP, Quality Improvement Manager at Partners and the EAP liaison to Brigham and Women's Hospital.
"To help employees through a day like Marathon Monday, it's important to have direct and regular updates of information going on," adds Barry Wante, CEM, Director of Emergency Management at the health system.
Partners used an internal paging system to notify hospital staff and direct personnel to clear the ED and make room for a patient surge. And administration followed up immediately with an all-users email from the public affairs department, providing more detail about the explosions and city-wide response.
The emails continued regularly throughout the week, which ended dramatically, with a city-wide lockdown and manhunt. Through it all, the health system kept employees focused on their work with accurate, simple, and timely updates on a variety of channels, even social media, in order to stay out in front of any potential misinformation.
"Many messages went out that afternoon from leadership keeping people informed, but supportive messaging went out as well," says Menco. "Our executives discussed taking care of our patients, families, and each other. They also discussed compassion and resilience, which I think is wonderful for staff to see leadership making those types of statements. They also encouraged staff to utilize the EAP."
Deploy employee support services immediately
As soon as the information about the bombings reached Partners executives, those leaders were on the phone with the EAP. According to Andrea Piraino Stidsen, LICSW, CEAP, the founding director of the MGH Employee Assistance Program, determining where to deploy EAP resources was a priority.
The EAP at Partners is an internal program. Offices are located on hospital premises, so staff was able to respond immediately. Communication immediately went out to employees with opportunities for group discussion sessions or individual sessions with EAP social workers. They also made outreach phone calls directly to providers to offer support.
"We targeted workgroups that were affected first, like the emergency department, and offered our services to managers who set up a session or recommend that individual staff attend," said Menco.
"Most people after a traumatic event, in time, on their own they begin to do better. But maybe their symptoms are staying the same or getting worse, and it's then that their body is telling them to seek help."
Promote employee self care
To reach those workers who might be hesitant to slow down and address their emotional responses, Menco suggests appealing to their desire to provide good patient care.
"Healthcare providers are very conscientious people and want to do their best, so what might drive a healthcare provider to make sure they're providing good patient care is to emphasize that taking care of themselves is part of that care," says Menco.
Typical behaviors after a traumatic event can include anxiety, irritability, trouble concentrating, fatigue, discussing the event repetitively, and phobias. It's up to managers, human resources, and leadership to be on the lookout for employees who may be struggling and suggest EAP sessions to those who may benefit.
In EAP sessions, people have the opportunity to share their experiences. One of the major lessons is community. On Thursday and Friday last week, MGH put together a healing event with volunteers offering massages, meditation sessions, yoga, and other opportunities to help staff rejuvenate.
People came together and allowed themselves to breath, says Stidsen. They, along with their patients, are only just beginning to digest what happened.
By allowing them to take that time for themselves, leadership is giving staff the opportunity to heal.
Chelsea Rice is an associate editor for HealthLeaders Media.
