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Boston Marathon Bombings Force Reevaluation of Emergency Radiology Procedures

By MedImaging International staff writers
Posted on 29 Jul 2014

A review of an emergency radiology response to the US Boston Marathon bombings emphasizes the vital role medical imaging plays in emergency circumstances and ways in which radiology departments can optimize their preparedness for mass casualty incidents.

The study’s findings were published online July 2014 in the journal Radiology. “It’s important to analyze our response to events like the Boston Marathon bombing to identify opportunities for improvement in our institutional emergency operations plan,” said senior author Aaron Sodickson MD, PhD, emergency radiology director at Brigham and Women’s Hospital (Boston, MA, USA).

Lead researcher John Brunner, MD, was an emergency radiology fellow working in the Brigham and Women’s emergency department on April 15, 2013, when two bombs exploded near the finish line of the Boston Marathon. As a level 1 trauma center, the hospital received 40 of the wounded patients, most within hours of the bombing. “Imaging is one of the best ways to decide who needs attention most quickly,” Dr. Brunner said. “The use of shrapnel-laden explosive devices resulted in extensive shrapnel injuries that required evaluation with X-ray and computed tomography, or CT.”

Of the 40 patients who arrived in the emergency department for care, 31 patients (78%) underwent imaging, including 57 X-rays performed on 30 patients and 16 CT scans of 7 patients. More personnel were rapidly mobilized, including attending radiologists, radiology fellows, and residents, and X-ray and CT technologists. Moreover, the typical emergency radiology imaging equipment (two portable x-ray machines and two fixed digital X-ray units, an ultrasound unit and a CT scanner) were supplemented with additional imaging units from elsewhere in the hospital, including two additional CT scanners and additional portable X-ray units.

The researchers studied the emergency radiology response by comparing turnaround times--or the amount of time taken to perform exams and to interpret the findings--from routine emergency radiology operations with those during the mass casualty event. CT exam turnaround time averaged 37 minutes during the mass casualty event, substantially lower than the yearly median of 72 minutes during routine operations. The researchers said the fast turnaround was likely the result of having access to three CT scanners and stationing a radiologist at each. “By having a radiologist stationed at each CT scanner, we could provide real-time protocols and preliminary interpretations of crucial results to help our trauma teams,” Dr. Brunner said.

By contrast, the researchers found the X-ray turnaround time (median, 52 minutes) was longer than during regular operations (31 minutes), in all probability due to a logjam created by the use of traditional radiography portable X-ray systems relying on a single X-ray plate readout device. To eliminate this technical logjam, these portable X-ray units have since been replaced by digital radiography equipment with wireless image transfer to enable faster scan completion and image availability. “Imaging plays a vital role in all emergent situations, from everyday emergency department visits and trauma to mass casualty events,” Dr. Sodickson said. “The surge in imaging utilization following the Boston Marathon bombing stressed emergency radiology operations but overall, things went smoothly in terms of patient care.”

The hospital’s system for naming unidentified patients during the mass casualty event contributed to a large number of duplication of imaging orders and has since been revamped. The new system, which includes a grouping of a unique color, gender, and numeral (e.g., Crimson Male 12345) should lessen confusion that accompanied the arrival of multiple patients following the Boston Marathon bombings.

“Hospitals need to have emergency operations plans in place, and emergency radiology is a crucial component of that preparedness,” Dr. Sodickson said. “When an event occurs, it is important to direct a critical eye to the plan’s operation in order to refine it for the future.”

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59 (!!!!! 3803.9684295654): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

60 (!!!!! 5949.0203857422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

61 (!!!!! 15290.975570679): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (!!!!! 13575.077056885): SELECT fid FROM jos_deeppockets WHERE id=294753712 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294753712 AND published='1' LIMIT 1

63 (!!!!! 11847.972869873): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

64 (!!!!! 6050.1098632812): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 5626.916885376): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 7599.8306274414): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 7951.9748687744): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 11838.912963867): SELECT fid FROM jos_deeppockets WHERE id=294753712 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294753712 AND published='1' LIMIT 1

69 (!!!!! 3860.9504699707): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (!!!!! 3338.098526001): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294753712 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 4677.0572662354): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294753712 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 5931.1389923096): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (!!!!! 5656.0039520264): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (!!!!! 6916.9998168945): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 6380.0811767578): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (!!!!! 1524.9252319336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 4786.9682312012): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (924.11041259766): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 1393.0797576904): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (828.02772521973): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (393.86749267578): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (777.00614929199): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1616.0011291504): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294753712 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (365.01884460449): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294753712 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (234.84230041504): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 2209.1865539551): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (812.05368041992): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (650.16746520996): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (320.9114074707): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (602.96058654785): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (115.15617370605): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (683.06922912598): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (895.97702026367): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (275.85029602051): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (454.18739318848): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4662.036895752): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

105 (982.99980163574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

106 (!!!!! 2099.9908447266): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294753712 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (936.03134155273): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294753712 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 5239.0098571777): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

109 (!!!!! 1544.9523925781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

110 (!!!!! 2790.9278869629): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294753712 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (792.9801940918): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294753712 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1775.0263214111): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 13743.877410889): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 4631.9961547852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

115 (!!!!! 3137.1116638184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

116 (839.9486541748): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

117 (225.06713867188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

118 (!!!!! 1034.0213775635): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

119 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

120 (665.90309143066): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

121 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

122 (705.00373840332): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 59982.061386108): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 7154.9415588379): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294753712 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294753712 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 8299.1123199463): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 7255.0773620605): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (!!!!! 5110.0254058838): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (!!!!! 1968.1453704834): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (!!!!! 2931.1180114746): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (!!!!! 3599.8821258545): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (!!!!! 1348.9723205566): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (150.91896057129): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (215.05355834961): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (!!!!! 5170.1068878174): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 3034.8300933838): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (400.06637573242): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (39.815902709961): SELECT name FROM jos_deeppockets WHERE id=211

138 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=211

139 (556.94580078125): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 3023.8628387451): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 1701.1165618896): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

142 (647.06802368164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

143 (!!!!! 15405.893325806): TRUNCATE TABLE jos_trademed_module

144 (164.03198242188): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294753712 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (134.94491577148): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294753712 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (731.9450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

149 (115.15617370605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

150 (!!!!! 9022.9511260986): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (!!!!! 2594.9478149414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

152 (!!!!! 1991.9872283936): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

153 (!!!!! 3321.8860626221): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294753712 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294753712 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (481.84394836426): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (!!!!! 4541.8739318848): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (628.23295593262): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (622.98774719238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

158 (!!!!! 2030.8494567871): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294753712 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294753712 AND published='1' LIMIT 1

159 (56.982040405273): select jos_twitters.link from jos_twitters where cat=10

160 (360.96572875977): select jos_facebook.link from jos_facebook where cat=10

161 (38.14697265625): select jos_google_plus.link from jos_google_plus where cat=10

162 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

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