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‘Everyone knew what … to do,’ doctor at Boston hospital says

BOSTON – As 3 o’clock neared on Monday afternoon, officials at Brigham and Women’s Hospital, one of Boston’s premier medical centers, expected this year’s marathon would be a nonevent.

“We were winding down,” said Barry Wante, the hospital’s emergency management director.

Then, the hospital’s radios suddenly crackled with reports from the finish line. Within minutes, the first ambulances arrived, and the emergency department, like others across the city, was flooded with critically wounded runners and spectators, some with missing and shredded limbs, many bleeding profusely.

“It was a horrible scene,” said Dr. Michael Zinner, the chief surgeon at Brigham and Women’s.

Authorities said Tuesday that 176 people were injured in the two back-to-back blasts.

On another day, in another city, Monday’s bombings may have overwhelmed local hospitals.

But Boston was fortunate to have six high-level trauma centers, including one for children, within a mile and a half of the bomb sites. All of the hospitals had extra staff on hand for the marathon. Several surgeons on duty had worked in military hospitals in Iraq or Afghanistan.

At the same time, health care workers, police officers, firefighters and other emergency officials had spent years training for just such an emergency, a legacy of the Sept. 11, 2001, terrorist attacks. That experience proved critical in distributing casualties equally among hospitals.

“Everyone knew what we had to do,” said Dr. Stephen K. Epstein, an emergency physician at Beth Israel Deaconess Medical Center.

But emergency physicians and surgeons said Tuesday that no amount of practice could replicate the reality of treating so many casualties.

“We have seen our fair share of young people missing an arm or leg from an accident,” said Dr. Andrew Ulrich, vice chairman of emergency medicine at Boston Medical Center, the city’s public hospital.

“But the scale of this was completely different. ... And there is something about the nature of the attack, the fact that someone set out to hurt people, that makes this more difficult emotionally.”

At Massachusetts General Hospital, doctors confronted multiple patients in need of amputations.

Amputating a leg can be one of the toughest decisions a surgeon faces, said Dr. George Velmahos, the hospital’s chief trauma surgeon. In this case, though, the decision was already made, he said.

“We just finished the job the bomb did. Their limbs were completely mangled, some hanging by a shred,” he said. “There was no question whether these limbs would remain alive.”

Dozens of people remained hospitalized Tuesday night, many in critical condition, some facing more surgeries as doctors try to save badly damaged limbs and prevent infections, a persistent threat in blast wounds that lodge debris in victims’ bodies.

At least five people’s limbs were amputated, with one at Mass General at risk of losing his other leg. Most victims suffered leg injuries. One patient at Brigham and Women’s had a severe head injury.

But the casualties could have been worse had emergency responders and hospitals not reacted so quickly, officials said. That allowed the most critically ill patients to move rapidly from the bombing sites through emergency departments into surgery.

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