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 By all accounts, Boston's hospitals performed well after the
attacks on April 15, 2013. While many of the wounded lost limbs and
a large amount of blood, all who made it to a hospital survived.
Looking back, a year after their hospitals were packed with blast
victims, Boston officials have tweaked how they prepare for a
disaster, now requiring city emergency medical personnel to carry
tourniquets and developing a standard method for one city agency to
track disaster victims in hospitals.
The new techniques will be in place by this year's race, set for
April 21, with 36,000 runners taking part and tens of thousands of
spectators expected to line the 26.2 mile course.
"This was worth more than 1,000 drills," said Dr. Eric Goralnick,
medical director of emergency preparedness at Brigham and Women's
Hospital, which received more than two dozen bombing victims. "A
real event highlights real shortfalls and real successes like no
other. And, after the marathon, every health-care provider became a
champion of emergency preparedness."
A variety of factors contributed to the survival rate last year.
Hundreds of police and medical personnel were working the race,
allowing for a quick response. Hospitals hold disaster scenario
drills dozens of times a year, making sure teams are able to work
quickly and fluidly in a crisis.
The city's compact size made for speedy transport to its six
level-one trauma centers, where doctors and nurses stabilized
victims, set bones, and performed necessary amputations.
A key element, experts said, was the use of tourniquets, sometimes
improvised from clothing. They stopped excessive bleeding from
wounds to victims' feet and lower legs caused when the nail-filled
pressure-cooker bombs exploded at ground level.
The wars in Iraq and Afghanistan, where U.S. soldiers have often
encountered improvised explosive devices, illustrate the value of
tourniquets. City officials are applying that knowledge more widely
as tourniquets become standard equipment for Emergency Medical
Services staff.
"Every clerk, cook and trombone player has a tourniquet and if we'd
had more that day, patients would have gotten to us in better
physiological shape," said Joseph Blansfield, trauma program manager
at Boston Medical Center who served as a combat nurse in Iraq. "Some
were on their last drops of blood."
KEEPING TRACK
The throngs of patients who arrived with no identification
underscored flaws in electronic tracking systems where the victims'
strings of identifying numbers started to look alike.
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 On the day of the bombing, the biggest weakness, however, was in
pushing information to one central agency responsible for tracking
all data from all hospitals to help reunite families.
The most vivid illustration of that occurred when relatives of
Krystle Campbell, who was killed, were initially told she had
survived, only to later learn it was her friend who was alive.
Staff from Boston's hospitals have since created a new single-page
disaster record, including a checklist to capture specific aspects
of care that might be missed in a disaster and record identifying
features like hair color, tattoos and piercings.
"It is important that we ID people better and push that to the next
level quickly," said Maureen McMahon, director of emergency
management at Boston Medical Center. "It was hard to look people in
the eye and say we don't know where your loved one is."
PROSTHETICS PROJECT
As victims slowly adjust to life without limbs, a ballroom dance
instructor's story inspired a Massachusetts Institute of Technology
biophysicist who is a double amputee to return her to the dance
floor with a specially designed bionic leg.
"It was 3.5 seconds between the blasts that took Adrianne
Haslet-Davis off the dance floor, but within 200 days we brought her
back," said Hugh Herr, head of the Biomechatronics research group at
MIT's Media Lab. Last month, Haslet-Davis performed a 30-second
rumba onstage at a conference where Herr was speaking.
Cautioning that the dancing leg is still in research and not yet a
product, Herr said bionic limbs are far better than conventional
prosthetics in returning victims to everyday activities.
This month he launched the No Barriers Boston Fund
(https://www.indiegogo.com/projects/no-barriers-boston-fund/x/6919991) to raise money to pay for Boston Marathon bombing survivors to
receive bionic limbs designed for athletic use that are often not
covered by regular insurance.
(Reporting by Svea Herbst-Bayliss; editing by Scott Malone and Gunna
Dickson)
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