In light of the events in Boston Marathon, the Yale-Tulane ESF #8 Planning and Response Program has produced a special report on Boston Marathon Bombing.The Yale-Tulane ESF #8 Program is a multi-disciplinary, multi-center, graduate-level, program designed to produce ESF #8 planners and responders with standardized skill sets that are consistent with evolving public policy, technologies, and best practices. The group that produced this summary and analysis of the current situation are graduate students from Yale and Tulane Universities. It was compiled entirely from open source materials.

1. SITUATION
AS OF 2300 HRS EDT
15 APRIL 2013
YALE- TULANE ESF-8 SPECIAL REPORT
BOMBINGS AT BOSTON MARATHON
SITUATION MAP
RESPONSE
FEDERAL GOVERNMENT
FEMA
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Ready. gov
DHS
FBI
HHS
Public Health Emergency – ASPR
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CDC
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DOD
NORTHCOM
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ARMY NORTH
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ORGANIZATION
American Red Cross
MASSACHUSETTS
Massachusetts Emergency Management Agency
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Boston
Boston Office of Emergency Management
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TYPE OF INJURIES
SURGE CAPACITY IN A
TERRORIST BOMBING
AS OF 15 APRIL 2013 2015 HRS
INJURED DEAD
144* 3
Family members looking for info
relative to individuals injured
during the incident are
encouraged to call (617) 635-
4500.
If you information on the
terror attack, police as that
you call Boston Bomb Tipline:
1-800-494-TIPS
STRESSNUMBER NOT CONFIRMED
HOSPITALIZATION AND TREATMENT

2. SITUATION
WHERE: 671 Boylston Street. Boston, Massachusetts
WHEN: 1450 HRS EDT, 15 APRIL 2013
EVENT: Boston Marathon
SITUATION: BOMBINGS
• Two explosions , a primary the a secondary explosion, occurred
near the Boston Marathon finish line at approximately 2:50
p.m.
• The bombs appear to be crude devices that were hidden in
trash cans
• Shrapnel was incorporated into these explosive devices most
likely to increase fragmentation and maximize the number of
casualties.
• The race was diverted before being halted as police and fire
crews swept the area.
• Another explosive device was found, which was purposely
detonated by Boston Police at Boylston Street.
DEAD AND INJURED:
• 3 confirmed dead - including an 8 year old boy
• Hospitals have treated more than 124 victims - including 8
children. At least 17 are in critical condition, 25 are in serious
condition
INVESTIGATION: On going . Currently there is no one under arrest
and no groups have claimed responsibility

3. SITUATION MAP
SOURCE: NEW YORK TIME
Officials said that a suspicious package was found
and destroyed by police at the Mandarin Hotel
Runners approached from the west.
Second explosion went off about 10 seconds
after the first one.
The two explosions were about 550 feet
apart
First explosion occurred about 3 p.m. on the
north side of Boylston Street, just before the
bridge that marks the finish line.
2 MILES
SECOND EXPLOSION
FIRST EXPLOSION
BOSTON
SOUTH
BOSTON
FINISH
LINE
EAST
BOSTON
JFK
LIBREARY

4. • There is heightened security at local hospitals and
critical infrastructure sites
• The Red Cross sent additional blood products to
Boston hospitals
• Hospital throughout Boston responded to Mass
Casualty incident.
• Criminal investigation is on going
• The area around Copley Square where the
incident took placed is closed and is considered a
crime scene
RESPONSE
LOCAL
STATE
FEDERAL
References: http://rt.com/usa/boston-marathon-explosions-updates-911/ ,
http://www.cnn.com/2013/04/15/us/boston-marathon-response/index.html,
http://www.govexec.com/defense/2013/04/federal-authorities-responding-boston-
marathon-explosions/62536/, http://www.cnn.com/2013/04/15/us/boston-marathon-
explosions/index.html?hpt=hp_t1
• The Massachusetts Emergency Management
Agency suggested people trying to contact those
in the vicinity use text messaging because of
crowded phone lines
• Troops from the Massachusetts National Guard
assisted police in emergency response
• The office of the Attorney for the District of
Massachusetts is coordinating responses from law
enforcement agencies
• Federal agents have been dispatched to crowded
hospitals
• Officials from the Justice Department and the
Bureau of Alcohol, Tobacco, and Firearms are
being deployed to investigate the explosions
• Homeland Security Secretary Janet Napolitano
ordered the department to provide “whatever
assistance is necessary”

5. ON GOING INVESTIGATION
• A multi-agency response including state and federal
law enforcement agencies has been activated and
is investigating the cause of the explosions along
the Boston Marathon route and elsewhere.
• Forensics analysis is on going.
• The FBI’s Boston Division stands with the Boston
Police Department (BPD) and remains on-scene.
• The situation remains fluid, and it remains too early
to establish the cause and motivation.
• The FBI declared federal jurisdiction over the
matter through the Boston Joint Terrorism Task
Force.
RESPONSE
BOSTON FBI PRESS RELEASE
http://www.whitehouse.gov/
President Barack Obama said he ordered the "full
resources" of the federal government to respond
to the Boston bombings on Monday, and that he
also called for increased security around the
United States as necessary.The Navy has sent one of its bomb-disposal units to
Boston to assist local authorities as needed. The
three-member explosive ordnance disposal team
based at Naval Station Newport, R.I., was sent to
Massachusetts after state officials asked for help.

6. TYPE OF INJURIES LIKELY TO BE SEEN
PRIMARY BLAST INJURIES
• Most post-explosion injuries involve blunt and
penetrating trauma
• The initial blast may cause abdominal bleeding
and perforation, concussion (possibly without
physical signs of injury to the head), and
rupture of the eardrum
• Blast lung is the most common fatal injury
among initial survivors
‒ The blast wave may cause tearing,
bleeding, and buildup of fluid in the lungs
‒ Symptoms include shortness of breath,
chest pain, and coughing up blood
‒ Patients may also show signs of slowed
breathing, cyanosis, and wheezing
SECONDARY BLAST INJURIES
• Flying debris and bomb fragments may cause
penetrating trauma, fracture, or amputation
OTHER POSSIBLE INJURIES
• Burns, crush injuries, and severe
lacerations may be seen in victims
• Blast may result in impaired vision and
hearing
• Exacerbation of chronic illness is possible
References: http://www.bt.cdc.gov/masscasualties/blastinjuryfacts.asp,
http://www.bt.cdc.gov/masscasualties/blastlunginjury.asp,
http://www.bt.cdc.gov/masscasualties/explosions.asp,
NOTE: More of the injured seen have injuries to their lower
extremities.

7. HOSPITALIZATION AND TREATMENT
HOSPITAL* NUMBER OF INJURED
Brigham and Women's
Hospital
48
Children’s Hospital 10
Boston Medical Center 20
Massachusetts General
Hospital
29
Tufts New England Medical
Center
9
Beth Israel 23
* This list is not complete and has not been confirmed.
Numbers were gathered from press report.
• Eight hospitals report that they are treating at least 124 people. Of
those, at least 15 are in critical condition.
• The injuries ranged from cuts and bruises to amputations. Many victims
suffered lower leg injuries and shrapnel wounds. Some suffered ruptured
eardrums.
• The medical tent at the finish lined was turned into triage center
Although it was not equipped for trauma, they had bags of intravenous
fluids hanging from four yellow ropes suspended down the middle,
tourniquets, blood pressure monitors, defibrillators, and EKGs. Medical
personnel included internists, family physicians, cardiologists, emergency
physicians, physical therapists, and social workers.
• Most of those seen had injuries to their lower limbs.
• Patients were evacuated to hospitals throughout Boston.
• Massachusetts General Hospital facility ICS was activated within 5
minutes of notification. The hospital treated at least 29 victims, eight of
whom were critically injured, including some with amputated legs.
• Boston Children’s Hospital said the hospital treated eight children
ranging in age from a 2-year-old boy with a head injury, to a 14-year-old
boy also with a head injury. Two adults were also treated at the hospital.
• The nine victims treated at New England Medical Center included victims
with serious trauma and leg fractures, shrapnel wounds and ruptured
eardrums
Medical personnel work
outside medical tent in
aftermath of bombing
(AP Photo/Elise
Amendola)
SOURCES:
Marathon medical tent ‘transformed into trauma unit
Mass General Press Conference - 15 APRIL 2013
Hospitals treat carnage after Boston blasts

8. SURGE CAPACITY IN A TERRORIST BOMBING
• Explosive devices are the most common weapons used by terrorists.
• Explosions can produce instantaneous havoc, resulting in numerous
casualties with complex, technically challenging injuries not commonly
seen after natural disasters.
• Because many patients self-evacuate after a terrorist attack and
prehospital care may be difficult to coordinate, hospitals near the scene
can expect to receive a large influx, or surge, of victims after a terrorist
strike.
• Health care and public health specialists should anticipate profound
challenges in adequately caring for the surge of victims following a
terrorist bombing.
• CDC with a panel of experts produced “In a Moment’s Notice: Surge
Capacity in Terrorist Bombings.” . It includes a description of system-
wide and discipline-specific challenges as well as recommendations to
address these issues.
ADDITIONAL RESOURCES:
• Blast Injury Fact Sheets
• “Bombings: Injury Patterns and Care” poster and pocket card
• “Interim Planning Guidance for Preparedness to Mass Casualty Events Resulting from Terrorist Use of Explosives” report
• Blast Injuries: What You Need to Know Webcast
• Blast Injuries: What Clinicians Need to Know (Podcast)
• The Terrorism Injuries Information, Dissemination and Exchange (TIIDE) Project

9. COMMON REACTIONS TO A STRESSFUL EVENT INCLUDE:
• Physical or emotional tension are often signs of stress. They can be
reactions to a situation that causes you to feel threatened or anxious.
Stress can be positive (such as planning your wedding) or negative (such
as dealing with the effects of a natural disaster).
• Disbelief and shock
• Tension and irritability
• Fear and anxiety about the future
• Difficulty making decisions
• Being numb to one’s feelings
• Loss of interest in normal activities
• Loss of appetite
• Nightmares and recurring thoughts about the event
• Anger
• Increased use of alcohol and drugs
• Sadness and other symptoms of depression
• Feeling powerless
• Crying
• Sleep problems
• Headaches, back pains, and stomach problems
• Trouble concentrating
THE BEST WAYS TO MANAGE STRESS IN HARD TIMES ARE THROUGH
SELF-CARE:
• Avoid drugs and alcohol. They may seem to be a temporary fix to feel
better, but in the long run they can create more problems and add to your
stress—instead of take it away.
• Find support. Seek help from a partner, family member, friend, counselor,
doctor, or clergyperson. Having a sympathetic, listening ear and sharing
about your problems and stress really can lighten the burden.
• Connect socially. After a stressful event, it is easy isolate yourself. Make sure
that you are spending time with loved ones. Consider planning fun activities
with your partner, children, or friends.
• Take care of yourself.
‒ Eat a healthy, well-balanced diet
‒ Exercise regularly
‒ Get plenty of sleep
‒ Give yourself a break if you feel stressed out—for example, treat
yourself to a therapeutic massage
‒ Maintain a normal routine
• Stay active. You can take your mind off your problems by giving— helping a
neighbor, volunteering in the community, even taking the dog on a long
walk. These can be positive ways to channel your feelings.The Disaster Distress Helpline 1-800-985-5990 provides immediate
crisis counseling to people affected by the tragedy in Boston. The
helpline can also be accessed at
http://disasterdistress.samhsa.gov/ and TTY for deaf and hearing
impaired: 1-800-846-8517. SOURCE:
http://www.samhsa.gov/newsroom/advisories/1304152649.aspx
CDC – Coping with stress
Stress is a condition that is often characterized by symptoms of physical or emotional tension. It is a
reaction to a situation where a person feels threatened or anxious. Stress can be positive (e.g., preparing
for a wedding) or negative (e.g., dealing with a natural disaster).
SYMPTOMS OF STRESS