Eric Thayer for The New York Times
A vigil at the Boston Common, near the site of the bomb blasts at the Boston Marathon finish. More Photos »
BOSTON — So many patients arrived at once, with variations of the same gruesome leg injuries. Shattered bones, shredded tissue, nails burrowed deep beneath the flesh. The decision had to be made, over and over, with little time to deliberate. Should this leg be amputated? What about this one?
"As an orthopedic surgeon, we see patients like this, with mangled extremities, but we don't see 16 of them at the same time, and we don't see patients from blast injuries," Dr. Peter Burke, the trauma surgery chief at Boston Medical Center, said.
The toll from the bombs Monday at the Boston Marathon, which killed at least three and injured more than 170, will long be felt by anyone involved with the city's iconic sporting event. For the victims, the physical legacy could be an especially cruel one for a group that was involved in the marathon: severe leg trauma and amputations.
"What we like to do is before we take off someone's leg — it's extremely hard to make that decision — is we often get two surgeons to agree," Dr. Tracey Dechert, a trauma surgeon at Boston Medical, said. "Am I right here? This can't be saved. So that way you feel better and know that you didn't take off someone's leg that you didn't have to take. All rooms had multiple surgeons so everyone could feel like we're doing what we need to be doing."
The widespread leg trauma was a result of bombs that seemed to deliver their most vicious blows within two feet off the ground. In an instant, doctors at hospitals throughout the city who had been preparing for ordinary marathon troubles — dehydration or hypothermia — now faced profound, life-changing decisions for runners and spectators of all ages.
Some victims arrived two to an ambulance, some with huge holes in their legs where skin and fat and muscle were ripped away by the bomb and with ball bearings or nails from the bombs embedded in their flesh. Others had severed arteries in their legs or multiple breaks in the bones of their legs and feet. The shock wave from the blast destroyed blood vessels, skin, muscle and fat. And at least nine patients — five at Boston Medical Center, three at Beth Israel Deaconess Hospital and one at Brigham and Women's Hospital — had legs or feet so mangled they would need to be amputated.
Some of the attendant medical professionals, said Julie Dunbar, a chaplain at Beth Israel, were faced with "more trauma than most ever see in a lifetime, more sadness, more loss."
There were only three fatalities, which doctors say was because the blast, low to the ground, mostly injured people's legs and feet instead of their abdomens, chests or heads. And tourniquets stopped what could have been fatal bleeding in many.
Dr. Allan Panter, 57, an emergency-room physician from Gainesville, Ga., was standing 10 yards from the blast near the finish line, waiting for his wife, Theresa, to complete her 16th Boston Marathon. Assisted by others, he said he used gauze wraps to apply tourniquets to several victims, including a man who appeared to be in his late 20s who lost both of his lower legs in the blast. He said he saw another six or seven victims with belts tied around their wounded legs.
Tourniquets, once discouraged because they were thought to cause damage to injuries, have returned to favor and have been used to treat wounds inflicted by explosive devices in the wars in Iraq and Afghanistan, Dr. Panter said.
"With blast injuries to the lower extremities that we're getting in the Middle East, you bleed out," he said. Tourniquets "can help save lives. I don't know if they helped in this situation, but it sure couldn't hurt."
While there was some initial chaos in a medical tent near the finish line, and some screaming and moaning by victims, it was generally an orderly scene, Dr. Panter said. He assisted others in wheeling in a female victim who died, he said. He described 20 to 30 cots in the tent with IV bags that had been intended for dehydrated runners.
At least eight doctors and what seemed to be 20 or more nurses were stationed in the tent. A man with a microphone stood in the center of the tent to coordinate medical care. Arriving victims were assessed and categorized as 1 for critical, 2 for intermediate, 3 for "can wait" and "black tag" for anyone who appeared to be dead, Dr. Panter said. An emergency medical technician outside the tent coordinated ambulance service to hospitals.
"All in all, it was a pretty controlled environment," said Dr. Panter, who has been an emergency-room physician for 30 years. "I've seen a lot worse. They were without question ready — not ready for those type of injuries, but they were prepared."
Jess Bidgood and Richard A. Oppel Jr. contributed reporting.
This article has been revised to reflect the following correction:
Correction: April 16, 2013
An earlier version of a photo caption in this story misspelled the surname of a physician who helped treat leg injuries at the Boston Marathon. It is Dr. Allan Panter, not Pantera.
Anda sedang membaca artikel tentang
Physical Legacy of Bomb Blasts Could Be Cruel for Boston Marathon Victims
Dengan url
http://healtybodyguard.blogspot.com/2013/04/physical-legacy-of-bomb-blasts-could-be.html
Anda boleh menyebar luaskannya atau mengcopy paste-nya
Physical Legacy of Bomb Blasts Could Be Cruel for Boston Marathon Victims
namun jangan lupa untuk meletakkan link
Physical Legacy of Bomb Blasts Could Be Cruel for Boston Marathon Victims
sebagai sumbernya
0 komentar:
Posting Komentar