By Debra Wood, RN, contributor
UPDATED April 18, 2013 - Most of the nurses and other medical staff who were working at the iconic Boston Marathon were expecting to treat patients for exhaustion, dehydration and perhaps even heart problems that can occur during the 26.2-mile endurance race. No one expected explosions and carnage. But when two bombs went off near the finish line, killing three people and injuring up to 170 or more, they jumped in and attended to victims. As word quickly spread, area hospitals rallied to respond and care for the injured.
Brigham and Women's Hospital received a call about an unconfirmed explosion and gave everyone in the emergency department a heads up, said Annmarie Chase, RN, MSN, shift supervisor for the ED. Soon after, the announcement came to expect multiple trauma victims. Fourteen arrived in rapid succession along with less severely injured people, 31 in total.
“We were blessed with the resources we have; people called in asking ‘Do you need me?'” Chase said. Intensive care nurses came down, a labor and delivery nurse pitched in, nurses on medical units came down and transferred patients who were boarding to other rooms to make space. The experienced trauma teams relied on their training and worked fast. Within an hour, patients were in the operating rooms.
“It was phenomenal to see the response,” Chase said. “No one complained. They just jumped in.”
President Barack Obama described the violence as an act of terrorism and praised the efforts of fellow runners, bystanders, first responders and healthcare professionals who came to the victims’ aid, including, “men and women treating the wounded at some of the best hospitals in the world.” He also noted that medical students and other staff members who were off shift hurried in to help as soon as they heard.
Two explosions occurred within moments of each other around 2:50 p.m. on Monday, April 15, 2013, near the race's finish line on Boylston Street.
Physicians, nurses and others were tending to runners receiving care for dehydration and hypothermia in the marathon’s medical tent when they heard the nearby blasts. After initially being told to stay with their patients, some were asked to go to the crime scene to help the victims, according to internist Sushrut Jangi, MD, in his blog at Boston.com.
Soon patients with horrific blast injuries were being wheeled into the tent. Clinicians with trauma experience monitored vital signs, applied tourniquets and administered IV fluids as they waited transfer to area hospitals.
Stephen Segatore, RN, a critical care nurse at Tufts Medical Center and volunteer at the medical tent, told CNN that he ran to help and saw people with missing legs and faces blown away. He tended to a patient whose abdomen had been torn open, but despite administering CPR, she died. He reported that nurses, doctors and EMTs on the scene worked in tandem, and he called it “the most amazing two hours of nursing in my life.”
Boston EMS transported 90 of the patients to Boston hospitals, according to Mayor Thomas M. Menino’s office. Boston Police tweeted that 176 patients sought care at area hospitals.
Massachusetts General Hospital saw 31 patients related to the explosions, with eight in critical condition. Ten patients had been released as of 11 a.m. Tuesday. Four remained in critical condition as of Wednesday. Injuries ranged from cuts and bruises to amputations. Peter Fagenholz, MD, a trauma surgeon at the Massachusetts General Hospital, told the London Telegraph that patients had combined lower extremity injuries.
George Velmahos, MD, chief of trauma surgery at Mass General, reported at a press conference that the patients’ wounds had small pellets and nails or pins, without heads. The pellets flew all over and were removed from patients’ abdomens, necks and lower extremities. He said the patients have been stabilized and bleeding is stopped. Four lost an extremity, and many also have burns.
“I’ve been moved and really amazed by the resolve of our patients,” Velmahos said. “Some of them woke up today with no leg and told me they were happy to be alive.”
Boston Medical Center received 23 patients, ages 5 to 78 years, and by mid-day on Thursday was still treating 19 patients, with seven in critical condition, six serious and six fair. One of them is a child. The majority of these patients will require further surgery over the next several days. Boston Children’s Hospital received 10 patients who were injured at the marathon scene.
Other hospitals reported to have received patients include Beth Israel Deaconess Medical Center and Tufts Medical Center.
Some of the local hospitals had staff members in the race; Massachusetts General and Brigham and Women’s Hospital had fielded teams. Ron Walls, MD, chairman of the emergency medicine department at Brigham and Women’s told CNN the local hospitals have prepared and drilled for a situation such as this.
Velmahos said the Mass General teams have experience treating similar wounds in battle and in other countries.
The same was true at Brigham and Women’s. Chase said the injuries were not that different from other trauma, but the volume was more than normal. As the hospital does whenever its ED and trauma staff deal with a major incident, leaders have held multiple debriefings and gave everyone involved the opportunity to talk about it and their feelings. An emergency psychiatrist in the department at the time of the trauma arrivals also talked with staff.
The dead include an 8-year-old boy, Martin Richard, of Boston, 29-year-old Krystle Campbell, of Medford, Mass., and Lu Lingzi, a Boston University student from China.
The Federal Bureau of Investigation (FBI) has taken the lead in the investigation through the Boston Joint Terrorism Task Force, along with state and local law enforcement agencies. Still unknown is who planned and carried out the attack, whether it was an individual or organization, or a motive.
“We will find whoever harmed our citizens, and we will bring them to justice,” Obama said. “The American people refuse to be terrorized. What the world saw yesterday in the aftermath of the explosions were stories of heroism, of kindness, of generosity and love.”
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