????半年前，在4月15日那天,，在距離波士頓馬拉松賽終點(diǎn)線僅幾步之遙的地方,，兩個(gè)簡(jiǎn)易爆炸裝置在幾秒鐘內(nèi)相繼爆炸，當(dāng)場(chǎng)造成3人死亡,。值得注意的是,，在活著到達(dá)醫(yī)院的264名傷者中，沒(méi)有一個(gè)人死亡,。

????應(yīng)急準(zhǔn)備圈已經(jīng)從這一悲劇性事件中汲取了經(jīng)驗(yàn)教訓(xùn),。商界領(lǐng)袖也可以從爆炸發(fā)生后不知疲倦地工作的醫(yī)護(hù)人員身上獲得一些啟示。但更為寶貴的教益,，或許來(lái)自那些早在這場(chǎng)危機(jī)發(fā)生前就采取措施的有識(shí)之士,。

????簡(jiǎn)化組織

????醫(yī)院與公司并無(wú)多大不同：各種事件總是迅速且出人意料地發(fā)生。反應(yīng)需要及時(shí)且果敢,。你的組織能夠多么迅速地予以應(yīng)對(duì),？誰(shuí)有權(quán)做決定？誰(shuí)做這些決定,？誰(shuí)在事后承擔(dān)責(zé)任,？組織的指揮鏈清晰嗎,？每位重要參與者是否扮演一個(gè)明確且可管理的角色？

????就復(fù)雜性而言,，今天的醫(yī)療保健機(jī)構(gòu)完全可以跟大型企業(yè)相媲美,。醫(yī)療機(jī)構(gòu)通常由住院和門(mén)診部門(mén)構(gòu)成，其中或許包括多家醫(yī)院,、診所和健康中心,。醫(yī)生、護(hù)士,、管理人員,、技術(shù)支持人員、承包商,、供應(yīng)商,、患者和家庭皆是“利益攸關(guān)方”。這些復(fù)雜的組織擁有矩陣式管控結(jié)構(gòu),，其中往往包括為醫(yī)生,、護(hù)士和管理人員設(shè)置的獨(dú)立“筒倉(cāng)”。

????1970年9月,，圣安娜風(fēng)（Santa Ana Winds）引發(fā)的野火在加州四處蔓延,，席卷400平方英里。數(shù)百家消防部門(mén)按照各自的章程和組織結(jié)構(gòu)對(duì)抗這場(chǎng)大火,，但由于隸屬于不同管轄區(qū),，這些消防部門(mén)深受協(xié)調(diào)和溝通不暢之苦。

????這場(chǎng)大火之后,，七家加州消防部門(mén)開(kāi)發(fā)了一套突發(fā)事件指揮系統(tǒng)（ICS）,。它允許率先作出反應(yīng)的部門(mén)在事發(fā)現(xiàn)場(chǎng)成立一個(gè)臨時(shí)領(lǐng)導(dǎo)機(jī)構(gòu)，以鞏固和澄清指揮鏈,，無(wú)縫協(xié)調(diào)來(lái)自多個(gè)機(jī)構(gòu)或管轄區(qū)的救援人員,。隨后的30年間，全美各地的大多數(shù)消防部門(mén)和醫(yī)療急救隊(duì)都完善,、實(shí)施了ICS系統(tǒng),。1991年，奧蘭治縣緊急醫(yī)療服務(wù)隊(duì)和醫(yī)院一起開(kāi)發(fā)了一套適合醫(yī)院實(shí)際情況的ICS系統(tǒng),，這套系統(tǒng)最終被命名為醫(yī)院事故指揮系統(tǒng)（HICS）,。HICS系統(tǒng)建立了一個(gè)明確的指揮鏈、共同的術(shù)語(yǔ),、清晰的報(bào)告系統(tǒng)和角色職責(zé),，以及基于事件性質(zhì)迅速擴(kuò)大或收縮反應(yīng)規(guī)模的能力。HICS系統(tǒng)并不是一種臨時(shí)性活動(dòng),，它是相關(guān)部門(mén)堅(jiān)定地致力于計(jì)劃,、準(zhǔn)備和培訓(xùn)的結(jié)果,。波士頓馬拉松爆炸事件發(fā)生的愛(ài)國(guó)者日，波士頓的每家醫(yī)院都啟動(dòng)了HICS系統(tǒng),，一如它們?cè)诖饲暗恼鎸?shí)事件和演習(xí)期間進(jìn)行的操練,。這套系統(tǒng)實(shí)實(shí)在在地發(fā)揮了作用。

????災(zāi)害應(yīng)變是一項(xiàng)團(tuán)隊(duì)運(yùn)動(dòng)

????波士頓的成功醫(yī)療救助反應(yīng)建立在精心發(fā)展的跨部門(mén)關(guān)系之上：大醫(yī)院創(chuàng)傷中心,、醫(yī)療急救隊(duì),、消費(fèi)部門(mén)、地方和州執(zhí)法部門(mén),、公共醫(yī)療服務(wù)提供者,、波士頓田徑協(xié)會(huì)（Boston Athletic Association），以及地方和州政府,，以上僅僅是參與救援的一部分機(jī)構(gòu),。

????Six months ago, on April 15, two improvised explosive devices went off within seconds of each other, just steps away from the finish line of the Boston Marathon, killing three people almost instantly. Remarkably, of the 264 injured people that reached the hospital alive, not a single one died.

????The emergency preparedness community has already been cultivating the lessons learned from that tragic event. Business leaders, too, can gain insight from the experiences of the health care professionals who worked tirelessly in the wake of the bombing. Even more valuable lessons can come from those who acted long before the crisis took place.

????Streamline your organization

????A hospital isn't so different from a corporate workplace: Incidents occur quickly and unexpectedly. Responses need to be immediate and decisive. How rapidly can your organization respond? Who has the authority to make decisions? Who makes these decisions and who is accountable for them in the aftermath? Is your organization's chain of command clear? Does every key player have a defined and manageable role?

????Today's health care organizations rival large businesses in complexity. They include inpatient and outpatient components that may comprise multiple hospitals, clinics, and health centers. The "stakeholders" are physicians, nurses, administrators, support personnel, contractors, vendors, patients, and families. These complex organizations have matrix-style management control structures that often include separate silos for physicians, nursing, and administrators.

????In September 1970, wildfires sparked by Santa Ana Winds spread across 400 square miles of California. Hundreds of firefighting agencies struggled with coordination and communication across various jurisdictions as they fought the fires with their own protocols and organizational structures.

????In the aftermath, seven California firefighting agencies developed the Incident Command System (ICS), which allows first responders to establish a temporary leadership structure at the scene that consolidates and clarifies lines of command and seamlessly incorporates responders from multiple agencies or jurisdictions. Over the next 30 years, ICS was refined and implemented by most fire agencies and medical first responder agencies across the country. In 1991, The Orange County Emergency Medical Services and Hospital worked together to develop a hospital adaptation of ICS ultimately named HICS (Hospital Incident Command System). HICS establishes a clear chain of command, common nomenclature, clear reporting and clarity of roles, and the ability to quickly expand or contract a response based on the nature of the incident. HICS is not an ad hoc activity. It's the result of a determined commitment to plan, prepare, and train. On Patriot's Day, the day of the Boston Marathon bombing, every hospital in Boston utilized HICS, just as they had drilled during prior real-life events and exercises. And it worked.

????Disaster response is a team sport

????The successful medical response in Boston was predicated on well-developed relationships across disciplines: major hospital trauma centers, emergency medical services, fire services, local and state law enforcement, public health providers, the Boston Athletic Association, and local and state government, to name just a few.