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Securing the Emergency Department During Terrorism Incidents: Lessons Learned From the Boston Marathon Bombings

  • Horacio Hojman (a1), Rishi Rattan (a2), Rob Osgood (a3), Mengdi Yao (a4) and Nikolay Bugaev (a1)...
  • Please note a correction has been issued for this article.


Terrorist incidents that target hospitals magnify morbidity and mortality. Before a real or perceived terrorist mass casualty incident threatens a hospital and its providers, it is essential to have protocols in place to minimize damage to the infrastructure, morbidity, and mortality. In the years following the Boston Marathon bombings, much has been written about the heroic efforts of survivors and responders. Far less has been published about near misses due to lack of experience responding to a mass casualty incident resulting from terrorism. After an extensive review of the medical literature and published media in English, Spanish, and Hebrew, we were unable to identify a similar event. To the best of our knowledge, this is the first reported experience of a bomb threat caused evacuation of an emergency department in the United States while actively responding to multiple casualty terrorist incidents. We summarized the chronology of the events that led to a bomb threat being identified and the subsequent evacuation of the emergency department. We then reviewed the problematic nature of our response and described evidence-based policy changes based on data from health care, law enforcement, and counterterrorism. (Disaster Med Public Health Preparedness. 2019;13:791–798)


Corresponding author

Correspondence and reprint requests to Dr Nikolay Bugaev, Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., #4488, Boston, MA 02111 (e-mail:


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A previous error in this article has since been corrected. Please see 10.1017/dmp.2019.51



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Securing the Emergency Department During Terrorism Incidents: Lessons Learned From the Boston Marathon Bombings

  • Horacio Hojman (a1), Rishi Rattan (a2), Rob Osgood (a3), Mengdi Yao (a4) and Nikolay Bugaev (a1)...
  • Please note a correction has been issued for this article.


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