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Boston hospitals grapple with explosion aftermath

Monday April 15, 2013
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This story was updated Tuesday, April 16.

The mayhem of the bomb explosions Monday at the Boston Marathon had subsided a day later, but hospitals still faced urgent situations that tested clinical and stress management skills.

Medical personnel from various area hospitals conducted news conferences Tuesday and described the circumstances at their facilities.

The casualty count included three dead, 17 critically wounded and more than 150 others injured from the pair of explosions near the finish line Monday afternoon. The injured, almost all of whom were spectators, were taken to eight hospitals.

Some of most severely injured patients lost limbs. Others had organ damage, fractures, shrapnel wounds and ruptured eardrums. "These are very high-force, high-impact injuries so they cause a lot of damage to tissue and to bone," said Ron Walls, MD, chairman of the department of emergency medicine at Brigham and Women’s Hospital.

The shrapnel wounds were jarring for clinicians to see up close. Even trauma center staff rarely handle these kinds of injuries, certainly not on such a large scale. "One of the sickest things for me was just to see nails sticking out of a little girl’s body," said David Mooney, MD, MPH, director of the trauma center at Boston Children’s Hospital.

George Velmahos, MD, PhD, trauma chief at Massachusetts General Hospital, told reporters 20 to 30 pieces of shrapnel — nails or ball bearings, possibly items that were built into the bombs — were embedded in some patients. Debris lodged in body tissue may pose a significant risk of infection. (To read a previous Nurse.com article on treating injuries from explosions, see http://news.nurse.com/article/20070103/ED/70104008.)

Alasdair Conn, MD, chief of emergency services at Massachusetts General, which treated 35 patients ages 28 to 71, said the scene at the hospital was unprecedented in his 25 years with the facility. "This is what we [would] expect from war," he told reporters. Four patients at the hospital lost limbs, with two additional patients still in jeopardy of having to undergo amputation.

In all, eight patients at the hospital were in critical condition as of Tuesday afternoon, Velmahos said. He was confident all would survive, with staff having stabilized their vital signs and stopped the blood loss, but some faced the prospect of multiple substantial surgeries. He credited patients with remaining calm and responsive in the aftermath of the explosion.

Tracey Dechert, MD, a trauma surgeon at Boston Medical Center, said the majority of injuries to patients treated at the facility were to the lower extremities. BMC received 23 patients, five of whom needed either amputations or treatment for limbs that had been blown off. Another 11 patients underwent major operations and likely will need follow-up surgery. "We are used to a lot of chaos, but this was extraordinary," Dechert said.

Stephen Epstein, MD, MPP, attending physician in the ED at Beth Israel Deaconess Medical Center, said the hospital had treated 21 patients with morbidities ranging from ear damage to life-threatening injuries. In some of the most seriously injured patients, Epstein said, "the limbs are certainly mangled, [and] the question is can they be saved at all? We need to see what the surgeons can save."

Sushrut Jangi, MD, a resident at Beth Israel, was working in the marathon medical tent at the finish line when it was transformed into a makeshift trauma center.

In a first-person account for the Boston Globe, Jangi described a nurse who broke down crying soon after the explosions happened. But "just a moment later, she wiped her tears away and reached for an IV bag and brought it to an ailing patient," Jangi wrote. " 'I’m OK,’ she said, 'don’t worry.’ "

(For the latest news from USA Today on the bomb explosions, visit www.usatoday.com/story/news/nation/2013/04/16/boston-marathon-scene-healing/2087583/.)


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