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Boston Marathon Bombing Yields Lessons for Hospitals

Tinker Ready, for HealthLeaders Media, April 17, 2014

For example, when unidentified patients arrive at the ED, they are assigned numbers. With so many on race day, it was easy to confuse patients with a single keystroke, Goralnick said. Now, they are assigned an M or F for male and female and a state or city name, and a color.

"We would love to think about how we can optimize electronic health systems so they can function during an MCI," Dr. Eric Goralnick said. "The goal is to have reliable system that you can rely on every day."

In the meantime, they plan to use paper records with wristbands and presigned orders to respond to the next mass casualty event.

At BIDMC, the EHR system—which was designed in house and already uses a text-based naming system—worked more efficiently. The hospital's ED dashboard was written by emergency physicians. Patient can be "micro-registered" in a few seconds by any nurse by entering a name, date of birth and gender, according to Dr. Larry Nathanson, ED's director of emergency medical informatics.

Registration staff follows up to gather the rest of the data. For patients who are too critical even for this, there are dozens of binders with patient information pre-registered as "EU CRITICAL, ADAM", "EU CRITICAL, BRAD", "EU CRITICAL, CHARLIE", etc. Nathanson writes in an email. "We just grab a binder and start treating the patient with zero delay."

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