The Boston Marathon Bombing on April 15, 2013 brought together various disciplines from the healthcare spectrum to handle and triage wounded people at the actual bombing site downtown, and subsequently in the various admitting hospitals in the area. Physical Therapists were some of the key people who covered both the medical tents at the site, the hospital ERs, and the trauma floors including the ICU while entire hospitals went into triage mode.

Acute Care trained physical therapists also covered for nurses by stepping in to monitor vital signs and other physiological responses such as heart rate and rhythm, respiratory rate and oxygen saturation in trauma ICUs and other floors such as critical care where patients are unstable. 

Jim Smith, PT, DPT, president of the APTA’s Acute Care Section brought the point of acute care being a physiological state rather than a physical location where the patient is being treated. “Things that were ‘acute’ when I was a new PT and had to be handled in the hospital, we’re now routinely managing in home care, in rehab centers and even in outpatient clinics” he noted. (1) 

The Boston Marathon Bombing called attention to the role of this specialty in both the lay press and in several of our physical therapy magazines. Based on the latest research, The Acute Care specialty stresses early mobilization for complex medical patients now under circumstances of physiological instability, where years ago they would be left in bed or at best, in a chair. It became clear that the benefits of mobilization outweighed the risks so long as the physiological responses were monitored for safety, and to push the patients little by little to achieve optimal outcomes. In the case of the Boston Marathon Bombing victims, many of them were receiving physical therapy within a day or two to get them up, and for the amputees to start to teach them desensitization techniques to handle their pain.

(1). www.apta.org/PT inMotion/2013/9/Feature/LessonsfromBoston/ 

Since many of us are seeing acutely ill patients in many different practice settings (SNF, home care, rehab, OPD), let us know how you have adapted to early hospital discharges and if you have issues that are unresolved about this process. How do you facilitate communication across the continuum between settings and facilities with these quick transitions of care?