8.James Hooley — Direct

JAMES HOOLEY: My name is James Hooley, H-o-o-l-e-y.

JAMES HOOLEY: Good afternoon.

JAMES HOOLEY: Boston Emergency Medical Services.

JAMES HOOLEY: It was 36 years last June.

JAMES HOOLEY: We're the provider for emergency medical services for the city of Boston, the 911 prehospital provider.

JAMES HOOLEY: Well, it consists of field operations, which is ambulances, ALS, advanced life support, basic life support. We have a training division where we train and prepare personnel as well, and we have a dispatch operations and some administration staff.

JAMES HOOLEY: Yes, sir.

JAMES HOOLEY: I'm the chief of the department.

JAMES HOOLEY: To oversee the various bureaus at -- and departments at Boston EMS, the largest being field operations, but also dispatch operations, training, and some of our planning and budgetary responsibilities as well.

JAMES HOOLEY: Yes, EMS.

JAMES HOOLEY: Yes. In the incident -- in the action plan that day, I functioned as the EMS command for Boston.

JAMES HOOLEY: We had -- in addition to the 24 ambulances that we had in service for regular city service, we had deployed 13 ambulances for the final zones. We also had personnel assigned to medical tents. We had proceed-out teams on golf courts, John Deere Gators. We had EMTs and paramedics on bicycles. The total -- and also people in various command posts, communication posts. It was probably about 120 or so extra personnel on that day.

JAMES HOOLEY: Yes, sir.

JAMES HOOLEY: That's correct.

JAMES HOOLEY: Interspersed about the city providing coverage for our usual 911 calls. We do about 320 of those a day.

JAMES HOOLEY: I was at the rear of Alpha, or the main medical tent. I was standing outside at St. James Avenue on Dartmouth Street.

JAMES HOOLEY: It's probably 75 yards from the finish line. The front entrance -- it's right on Dartmouth Street. It's just past -- if you're running the race, you would go beyond the finish line, and the next intersection you come to is Dartmouth. And the tent takes the whole length of Dartmouth Street, down to St. James Avenue.

JAMES HOOLEY: There's a second medical tent. We call it Bravo, A and B. Bravo is down on Berkeley Street, St. James, adjacent to what is known as the family meeting area. It's where a lot of people get reunited afterwards. It's a little bit smaller tent, but it's also staffed with medical professionals, volunteers, EMS.

JAMES HOOLEY: Well, when I heard the explosions, I started heading towards the front of the tent, towards Boylston Street. Especially when you heard the second one, it didn't leave, you know, a whole lot of doubt that something bad had happened. And then our radios immediately picked up -- we had personnel on scene reporting that they just had two devices explode and many casualties. I went up to Boylston Street where we had folks forward deployed, and like everyone else in our department, we shifted into mass casualty mode.

JAMES HOOLEY: Well, we had a mass casualty situation. It's something that we, you know, train and prepare for whether it's a transportation accident or something like -- God forbid, something like this. We had -- this is -- the first thing we did is we notify all the area hospitals. Immediately it goes out simultaneously across radio network that there's a mass casualty in effect, and then we try to paint them a picture that we had in excess of at least 40 people seriously injured. That was the initial size-up. And that grew. About a minute or two after that, we notified the private ambulances that provide back-up support to Boston, should we need it, that we were establishing a staging area over on Huntington Avenue. But while this was going on, our EMTs and paramedics then began to triage, treat, and prioritize for transport, the patients.

JAMES HOOLEY: Thank you.

JAMES HOOLEY: So triage is to sort. So when you have a lot of people who are injured all at once, you want to do the most good for the most number of people. So we begin our system of prioritizing by checking for vital signs, various symptoms. There are three categories that we use. Basically, they're color-coded. We use red, yellow, green. And we deploy or employ triage tags with those colors on them to help us start to prioritize who's going to get out first and then second, then third.

JAMES HOOLEY: Red is immediate or critical. Red where personnel who would -- I'm sorry, patients who would have a high likelihood of succumbing to their injuries if they weren't treated very quickly, certainly within the hour; people with life-threatening trauma; people who may not just need an emergency room, but they likely need an operating room.

JAMES HOOLEY: Our initial -- 30 people were tagged red.

JAMES HOOLEY: Initially, yup.

JAMES HOOLEY: I don't believe so. It was -- 30 is the count that I remember from that day.

JAMES HOOLEY: Yellow is the next level down in acuity. It's delayed, some would call it. It just means that those will be the folks that you would -- or the patients that you would move out next. They might still have some serious injuries, but they're not injuries that you would deem to be life threatening, maybe could be a burn, could be a broken ankle, could be somebody who fell and they'll -- but they're not as injured as the first group.

JAMES HOOLEY: Twenty-five.

JAMES HOOLEY: Green is what we commonly refer to as walking wounded. If you have a lot of people who can either be assisted or are able to assist themselves, even though they may have some visible injury, their vital signs are okay. Their pulse is good. They're up. They're walking. They're breathing. They're awake. So you can more or less corral them in a treatment area and hold them while you evacuate the higher priority patients out.

JAMES HOOLEY: Thirty-five.

JAMES HOOLEY: Yes, sir.

JAMES HOOLEY: Yeah. Those -- the 90 patients were transported by hospitals [sic] and then -- later, after that, we also identified -- we had a total of 118 that were transported by ambulance.

JAMES HOOLEY: Yeah, Boylston Street or from the events, yeah. Some people we encountered on Newbury Street or two or three blocks over, but they all reported that their injuries came from Boylston Street.

JAMES HOOLEY: Yes, I am.

JAMES HOOLEY: Yes. This was actually a chart that we put together some time back so that we could account for what happened on that day. And there's two pie charts on there. One was -- represented the ambulances involved. For example, the one --

JAMES HOOLEY: You can't see it. I'm sorry.

JAMES HOOLEY: That represents the number of patients and how -- what agency transported them. There were 76 patients transported by Boston EMS ambulances, and then the other figures on there show some other private companies, for example, EasCare, Fallon, LifeLine. I won't read them all unless you want me to. And it shows you the number of patients that they accounted for each.

JAMES HOOLEY: That's a chart of -- I think it's nine of the Boston hospitals, and it shows what the patient distribution was, where the patients were brought to by Boston EMS.

JAMES HOOLEY: Yes.

JAMES HOOLEY: Twenty-three patients.

JAMES HOOLEY: Correct.

JAMES HOOLEY: Nineteen.

JAMES HOOLEY: Sixteen patients went to Mass. General.

JAMES HOOLEY: Yeah, potentially, yes.

JAMES HOOLEY: Well, what we try to teach our people, these are priorities. We want to get somebody to definitive care within the hour.

JAMES HOOLEY: Fortunately, most of these hospitals were within a two-mile radius, I believe, and so the -- once we were able to load patients, the travel time wasn't long. It was probably four or five minutes.

JAMES HOOLEY: Yes, yes. About 30-plus minutes was the last time we had a patient -- when we're transporting patients, if I may, we -- when it's a mass casualty, the units in the field aren't supposed to make a decision where to go when it's multiple patients. You're supposed to come on -- either a loading officer makes that determination, who's speaking with -- it's called Boston CMED. It's up in our dispatch center. They're trying to make an attempt to distribute patients. If you're at loading, if you've made it to loading, they will say, I have Boston Paramedic 2. We have two red patients or three yellow patients. CMED will tell them, Go to Brigham, go to Tufts, go to whatever. Then that way we try to distribute the patients so that no one hospital gets overwhelmed.

JAMES HOOLEY: Yes. I certainly suspect that's the case. I know at least one patient that was transported by -- in our Boston police wagon, I understand, went to Mass. General. And other people self-presented at the hospital, walked in either later that day or even hours later. And, you know, reportedly, some patients went as far away as South Shore Hospital. They just went there later for some minor complaints.

JAMES HOOLEY: Yes, sir.