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041514-BIDMC.mp3

At 2:49 Tuesday afternoon, silence fell over the halls at Beth Israel Deaconess Medical Center, as the staff took a moment to honor the victims of the Marathon tragedy. It was a marked contrast to the scene one year ago.

"Almost simultaneously, someone knocked on my door and my phone rang, and said there was an explosion near the finish line," said Dan Nadworny, the clinical manager for the Emergency Departments at Beth Israel. "I said, 'OK.' Got up, started walking, I turned the scanner on and all I could hear was the chaos and the sounds of the Boston Police. And that was kind of the first sense that I had that this was something much more serious than an explosion."

Within 15 minutes, the first patient had arrived, a woman with makeshift tourniquets on both legs.

"Looking at her, and looking at the EMTs that were with her just put it all in place: This is going to be bad. This is real. And we can’t do anything but succeed."

The scope of that task quickly became apparent.

"The next patient came in and actually had a traumatic amputation of his leg." Nadworny said. "We had saved two of our larger rooms for the sicker trauma patients, and seeing him come in made me realize that they were all going to be sick trauma patients."

Over the next hour, twenty-four victims would come through the doors, fourteen of whom were critically injured, six of whom needed immediate emergency surgery.

"I was stationed as the so-called triage officer," said Dr. Carl Hauser, the trauma medical director at Beth Israel. "As people came in the door, my job was to look at them, and in about 10 seconds to 20 seconds per patient decide what their primary life-threatening problem is, and therefore who’s gonna take care of them."

As victim after victim came pouring out of the ambulances, Hauser kept in mind a lesson he’d learned during past mass-casualty crises — including a tornado in Mississippi and the riots in L.A. following the Rodney King verdict: Don’t try to do too much.

"You do sort of nuts-and-bolts stuff," Hauser said. "You save life first, you same limb second, you save function, and then you go on to other things."

For the patients who’d been stabilized, the staff went to work addressing another pressing need: emotional support.

"On that day, what struck the staff was the absolute quietness of the patients," said Lisa Hartwick, who runs the hospital’s Center for Violence and Recovery. "Really they were in shock, and not really able to completely take in what had just happened. Right at the beginning we are really empowering people we are attending to their emotional life, and it's so important because you cant regain that first interaction."

Hartwick’s staff helped patients connect with family, kept them informed, and simply listened. Just one part of what Nadworny says was a full-staff effort.

"Although there was a lot going on there was never chaos, there was people talking in a regular tone," Nadworny said. "People were talking on the radio, people were just walking very deliberately, their actions were very deliberate, but there was never yelling."

Nadworny stressed that there was a very important reason for the relative calm. While nothing like this had ever actually happened at Beth Israel, the hospital had spent countless hours preparing for it.

"We all just went to our plans," he said. "We have a great director of emergency preparedness here, Meg Femino, and she has a great saying: 'We develop muscle memory in the medical center.' And that’s what we started to do. We started to go to our plans, go to our programs that we’ve established over that past ten years plus. And we acted on them."

Reflecting back a year later, Nadworny says that Beth Israel is, in some ways, a different place. And that he is, in some ways, a different person.

"I think I have a greater respect for how a hospital works together than I ever did," he said. "And I think that did change me — for the better. And I think it will always be a little bit different, but in my mind, the differences need to be looked at as a positive. We now know what we can accomplish together and this hospital knows what it can accomplish together."