While hospitals along the Boston Marathon route typically prepare for a surge of patients on race day, on April 15, 2013, these area hospitals were inundated with hundreds of patients with injuries more typical of war wounds than marathon injuries.
Two bombs detonated near the Boston Marathon finish line at approximately 3pm. The explosions caused three fatalities and hundreds of injuries. Most of the victims suffered lower-body injuries to bone, soft tissue and blood vessels. Doctors removed shrapnel, dealt with severed limbs and performed amputations on several victims.
In an instant, an explosion or blast can wreck havoc; producing numerous casualties with complex, technically challenging injuries not commonly seen after natural disasters such as floods or hurricanes.
To address this issue, Centers for Disease Control and Prevention (CDC), in collaboration with partners from the Terrorism Injuries Information, Dissemination and Exchange (TIIDE) Project, as well as other experts in the field, have developed fact sheets for health care providers that provide detailed information on the treatment of blast injuries.
The fact sheet addresses background, clinical presentation, diagnostic evaluation, management and disposition of blast injury topics.
Minutes after a terrorist attack killed three at the finish line of the Boston Marathon, doctors and nurses at the city’s hospitals faced severed limbs, burned bodies, shrapnel buried in skin.
For Boston doctors, the challenge presented by last week’s bombing was unprecedented — but they were prepared.
Many of the city’s hospitals have doctors with actual battlefield experience. Others have trauma experience from deployments on humanitarian missions, like the one that followed the Haitian earthquake, and have learned from presentations by veterans of other terror attacks like the one at a movie theater in Colorado.
But they have benefited as well from the expertise developed by Israeli physicians over decades of treating victims of terrorist attacks — expertise that Israel has shared with scores of doctors and hospitals around the world. Eight years ago, four Israeli doctors and a staff of nurses spent two days at Massachusetts General Hospital teaching hospital staff the methods pioneered in Israel.
Bright sunlight filtered through the awnings of the medical tent pitched in Copley Square, where I joined the many medical professionals caring for people who’d fallen ill from their 26.2-mile run. Some volunteers had been staffing the medical tent for years — one nurse had worked at the Boston Marathon more than 25 times.
Suddenly, there was a loud, sickening blast. My ears were ringing, and then — a long pause. Everyone in the tent stopped and looked up. A dehydrated woman grabbed my wrist. “What was that?” she cried. “Don’t leave.” I didn’t move. John Andersen, a medical coordinator, took the microphone. “Everybody stay with your patients,” he said, “and stay calm.” Then we smelled smoke — a dense stench of sulfur — and heard a second explosion, farther off but no less frightening. Despite the patient’s plea, I walked out the back of the tent and saw a crowd running from a cloud of smoke billowing around the finish line. “There are bombs,” a woman whispered. My hands began to shake.
The bombs at the Boston Marathon were designed to maim and kill, and they did. Three people died within the first moments of the blast. More than 170 people were injured.
Medical personnel manning the runners’ first-aid tent swiftly converted it into a mass-casualty triage unit. Emergency medical teams mobilized en masse from around the city, resuscitated the injured, and somehow dispersed them to eight different hospitals in minutes, despite chaos and snarled traffic.
Brigham and Women’s Hospital received thirty-one victims, twenty-eight of them with significant injuries. Seven arrived nearly at once, and all required emergency surgery. The first to go to surgery was on an operating table by 3:25 P.M., just thirty-five minutes after the blast. Twelve patients in all would undergo surgery—mostly vascular and orthopedic procedures.
This kind of orchestration happened all across the city. Massachusetts General Hospital also received thirty-one victims—at least four of whom required amputations.
There’s a way such events are supposed to work. Each hospital has an incident commander who coordinates the clearing of emergency bays and hospital beds to open capacity, the mobilization of clinical staff and medical equipment for treatment, and communication with the city’s emergency command center.
A decade earlier, nothing approaching this level of collaboration and efficiency would have occurred. We have replaced our pre-9/11 naïveté with post-9/11 sobriety. When ball bearings and nails were found in the wounds of the victims, everyone understood the bombs had been packed with them as projectiles. At every hospital, clinicians considered the possibility of chemical or radiation contamination, a second wave of attacks, or a direct attack on a hospital.
What prepared us? Ten years of war have brought details of attacks like these to our towns through news, images, and the soldiers who saw and encountered them. Almost every hospital has a surgeon or nurse or medic with battlefield experience, sometimes several. Many also had trauma personnel who deployed to Haiti after the earthquake, Banda Aceh after the tsunami, and elsewhere. Disaster response has become an area of wide interest and study.
BOSTON — For years, Dr. Michael J. Weaver, an orthopedic trauma surgeon, went to meetings of his professional society and heard surgeons from the military describe what they had learned treating blast injuries. Then he would return to his practice at Brigham and Women’s Hospital in Boston, where he mostly treated people injured in auto accidents or falls.
All that changed on Monday when victims of the bombings at the Boston Marathon arrived.
“We’ve seen similar injuries, but never of this magnitude,” Dr. Weaver said. “This is completely different.” The military experience, he added, “has been phenomenally helpful.”
It turns out to be an art — and a delicate balancing act — to treat people with blast injuries that can pulverize muscle and rip blood vessels, that can drive pieces of metal into soft flesh and shatter bones. Trauma surgeons call it damage control, and say the military experience showed how important it is.Read the full article
A city whose hospitals and physicians are renowned for research and cutting-edge surgical innovations faced a starkly different challenge Monday, treating scores of injuries more commonly found in a war zone.
Patients arrived at Boston hospitals with limbs blown off, shrapnel wounds, burns, gruesome fractures, and perforated eardrums from the shock wave of two explosions near the Boston Marathon finish line shortly before 3 p.m.
“For many, many people in emergency medicine who are practicing domestically and not in the military, these are once-in-a-lifetime events,” said Dr. Ron Walls, chairman of the Department of Emergency Medicine at Brigham and Women’s Hospital.
Runners and spectators alike were rushed to hospitals, where doctors said that the injuries individually were not extraordinary, but that the volume was unprecedented.
Dr. Richard Wolfe, chief of Emergency Medicine at Beth Israel Deaconess Medical Center, told CBS News that the hospital initially admitted 24 people; seven were released.
The injuries sustained in the bombing have been primarily shrapnel injury in the lower extremities, he said. “Some hand injuries, but mainly devastating injuries to limbs,” he said. “We have at least two amputations and a number of very serious wounds that require fairly aggressive care.”
At least eight hospitals in the Boston area treated more than 140 victims of the Boston Marathon explosions yesterday, which have left three people dead and many more critically injured.
The scope of injuries from the explosion resembled those of a war zone, according to a Boston Globe report, startling many medical providers who are not accustomed to such trauma. The severe injuries and influx of patients left the area’s hospitals mobilizing disaster plans and reinforcing emergency departments with extra staff and security.
At Boston Children’s Hospital, the list of the wounded included a 2-year-old boy with a head injury, a 9-year-old girl with leg trauma and six other children under the age of 15.
Over at Massachusetts General Hospital, which was caring for 29 victims, injuries ranged from cuts and bruises to serious shrapnel wounds. Trauma surgeons said they had performed several amputations by mid-evening on Monday.
In total, three people lost their lives and more than 100 were injured when two bombs ripped through the crowd on a resplendent Monday afternoon at the finish line of the Boston Marathon, creating a gruesome scene of panic and carnage.