As elite athletes and everyday runners together complete the 26.2-mile physical feat of the Boston Marathon today, a logistical feat will also be achieved behind-the-scenes, near the race’s 16-mile mark. There, on the campus of Newton-Wellesley Hospital (NWH), all hands—from administrative to medical—will be on deck to ensure the safety and health of everyone involved in Marathon Monday.

To spectators and runners, the setup and operations visible at the intersection of Beacon and Washington Streets in Newton will have the appearance of a well-oiled machine. But ensuring that patients receive quality care, spectators stay safe, and everyone gets to where they need to be is the result of months of coordinated planning on many fronts. Pre-planning with the City of Newton’s and the Town of Wellesley’s police and fire departments and local EMS providers helps to ensure that the resources and on-the-ground infrastructure are in place to protect athletes and crowds, and ensure emergency vehicles can pass through the area. Those local law enforcement officials, in turn, collaborate with regional and national law enforcement, homeland security officials, and departments of public health to identify and plan for real-time threats—vigilance heightened since the Marathon bombing events of 2013.

In addition to managing the complexities that come with its position along the race route, the hospital must also ensure it is prepared to fulfill its mission: to provide medical care to all patients, whether or not they present with a Marathon-incited condition. At a baseline, hospital staff need to be prepared for a regular day’s work—making sure “typical” patients find their way in through multiple reception points across the NWH campus. Providers can also count on a range of standard Marathon-related concerns, such as foot injuries, hyponatremia—a sodium imbalance triggered by excessive water intake—and even alcohol-induced illness among Marathon revelers. The Emergency Department can see as many as 60-70 runners in a short period of time, requiring additional staffing. In the case of extreme weather, that number can quickly grow with cases of dehydration and heat exhaustion on warm days, or hypothermia in cold and wet conditions—and staffing models evolve accordingly based on the pre-race weather forecast.

To triage patients, NWH partners with the Boston Athletic Association’s (BAA) medical directors to staff up to 27 medical tents along the race route, educating BAA volunteers on the appropriate first aid protocols for patients and conditions they’re most likely to see. Back at the hospital, the Hospital Incident Command Center ensures that all stakeholders are briefed and updated as the day unfolds. Relying on a technical combination of the Partners HealthCare medical record system, Partners eCare, and the Boston EMS tracking system, hospital and race officials maintain a birds eye view of patient inflow and outflow, ensuring that all patients are accounted for—and family members informed—along the spectrum of care. 

The logistics behind Boston’s banner day are both essential to the Marathon’s success, and serve as a model for preparedness planning, for events both planned and unplanned—at NWH, in the Boston area, and beyond. “What we do to plan for the Marathon also helps us to prepare for other ‘mass casualty’ incidents, where we may see that same intense inflow of patients in a short period of time,” explains Charlotte Roy, MPS-HS, CEM, Safety Officer and Emergency Management Coordinator at NWH. “So these strategies and lessons-learned also serve us—and our patients—in a range of other situations as well.”

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