April 26, 2013 -- Dr. Paul Biddinger was at a medical station near the Boston Marathon's "Heartbreak Hill" on April 15 when his pager went off, notifying him of the bombs at the finish line, five miles away.
Biddinger, who directs emergency operations at Massachusetts General Hospital, was standing next to someone from Boston Emergency Medical Services and someone from the state health department as they got similar calls.
They'd drilled for this moment, using actors pretending to be patients, paint bullets and controlled explosions. Federal funding goes to Massachusetts hospitals and emergency teams to train medical personnel to respond to disasters such as the Boston Marathon bombing.
Fortunately, on April 15, within minutes, Biddinger and the other medical responders were headed to where they needed to be.
"I think, given the severity of the injuries of the first patients we received after the bombing, I am absolutely surprised there was not more loss of life," said Biddinger, who arrived at the hospital shortly after the first patients arrived.
But with the final 2013 budget still not settled, the programs that enabled doctors and EMTs to save lives on April 15 may face federal cuts.
Of the 264 patients injured in the twin blasts on Boylston Street at 2:50 p.m., there have been no deaths after the initial three. Although Boston area hospitals initially listed 38 patients in critical condition and 14 patients underwent amputations for their injuries, no one else died. Now, only one patient remains in critical condition.
Hospitals throughout Massachusetts have received funding from the Office of the Assistant Secretary for Preparedness and Response's Hospital Preparedness Program to perform emergency drills that include fake patients. (They also need to have a shadow staff that continues to treat real patients during the exercise.)
And since May 2010, the city has done two 24-hour disaster simulations as part of its annual Urban Shield exercises, which are funded by the Department of Homeland Security. The exercises involved police, EMS teams, SWAT teams and hospitals. In 2011, they prepared to encounter bombs and active shooters as part of an exercise intended to mimic the 2008 Mumbai massacre.
"The realism is heightened. It's not just walking to a garage with props set up," said Boston EMS Chief James "Jimmy" Hooley. "It's noisy. It's sweaty. They run it for 24 hours. It's meant to try to push stress levels a little bit."
But the drills could be in jeopardy. The Hospital Preparedness Program already faces a proposed $125 million dollar cut from the 2014 federal budget, after receiving $379 million in 2012. It's not yet clear what the final 2013 budget will be because of the sequestration.
The program began in 2002 with the Bioterrorism Act, but program director Dr. David Marcozzi said it shifted in 2012 toward building coalitions between hospitals that normally competed for patients and funding.
"No hospital stands alone," Marcozzi said.
That's why the Urban Shield drills involved hospitals as well as first responders and law enforcement, Hooley said.
"In Boston, we did not just invest in bomb robots or radios and stuff," he said. "They have been willing to invest in 'O.K., we need a way to make sure hospitals can work together and cooperate.'"
But that program saw a 30 or 40 percent cut in recent years, and it's not clear what funds will be available this year because of the sequestration, said Rene Fielding, who directs Boston's Office of Emergency management.
Still, the training helped teach teams to "think on the fly," which came in handy during the marathon bombing, she said.
Hooley said the patients first responders determined to be critical – or "red" -- had been rushed to hospitals within 15 minutes of the second blast. About three minutes after that, not a single patient was left on Boylston Street where the bomb went off.
By 3:42 p.m., less than an hour after the explosions, a radio announcement notified ambulances that they could return to regular city service.
"A lot of the training we do … fortunately, it kicked in," Hooley said. "When this did happen, everyone knows not just their roles but what their capabilities are. What you can and what you can't do."
For instance, EMS dispatchers couldn't overwhelm the nearby hospitals. They had to evenly spread the patients out, and know which hospitals were able to handle which patients.
The city emergency teams and hospitals studied what emergency responders learned from the 2005 London subway bombing, the 2004 Madrid train bombing and other mass casualty situations.
Biddinger said hospital employees were able to jump into action as soon as the disaster code was announced after the bombing.
"It's something we wouldn't have been able to do 10 years ago," Biddinger said. "The outcomes are a tremendous credit to all the preparation efforts going on, and I think also a tremendous argument for why those efforts need to continue."