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