The Cruel Irony Of Stellar Marathon Medical Planning

By Martha Bebinger
WBUR

In the medical world, the Boston Marathon has been known for years as a planned disaster, one of the largest planned mass casualties in the country.

Hundreds, sometimes thousands, of runners are treated every year by more than 1,000 doctors, nurses and other medical personnel who volunteer on race day.  Planning begins months before the marathons with doctors and nurses in charge of medical records, equipment, ambulances, water, short term triage, runner-family relations and a half dozen other specific tasks. Federal DMAT or Disaster Medical Assistance Teams are positioned along the route.  Tents at the finish line look like MASH units, with IVs dangling from dozens of cots.

"The marathon is a tremendous opportunity to test the plans that we (Boston) would use in an unplanned casualty event," said Mary Clark, the director of emergency preparedness at the Department of Public told me in 2009 for a story on marathon medical preparations.

But suddenly, last week, what was supposed to be a test turned into the real thing.

The monumental race that has become the model for Boston’s response to a disaster was, itself, attacked. And, though no one ever intended it this way, it turned into an acclaimed validation of the city's mass-casualty preparations.

Three spectators died at the scene: 23-year old Lu Lingzi, 29-year-old Krystal Campbell and 8 year-old Martin Richard, whose funeral was today.  But so far, all 55 patients taken to area hospitals with urgent or life-threatening injuries have survived; 15 have had amputations of one or both legs.

Praise for Boston's medical response continues to pour in.

"Boston has set an excellent example that response efficacy and strength is built on planning and preparation. Emergency systems everywhere should aspire to be Boston strong," says The Lancet in an editorial published online today.

Doctors, nurses and EMTs on Bolyston St. pulled off their belts or torn strips of cloth to stop the flow of blood from feet and legs. In hospitals, all available personnel ran to emergency rooms.

But in the marathon medical tent, despite careful planning and years of experience, many volunteers did not feel qualified to handle injured patients coming in off the street. Dr. Sushrut Jangi, writing in the New England Journal of Medicine, saw shredded arteries, veins, ragged tissue and muscle.

More victims followed: someone whose legs had been charred black, another man with a foot full of metal shrapnel, a third with white bone shining through the thigh. I watched in shock as the victims were rushed down the center aisle to ambulances at the far end of the tent. Many of us barely laid our hands on anyone. We had no trauma surgeons or supplies of blood products; tourniquets had already been applied; CPR had already been performed. Though some patients required bandages, sutures, and dressings, many of us watched these passing victims in a kind of idle horror, with no idea how to help.

"You try to tell yourself that is an opportunity to learn," says Boston EMS Chief James Hooley, his voice trailing off.

Hooley says Boston had a lot of factors in its favor in addition to planning.  The marathon is run on a holiday so hospitals had more operating rooms open than they would during a regular business day.  There are six level one trauma centers within a few miles of the explosions.  Marathon planning includes police and firefighters who rushed to assist victims on Boylston St.

"It's horrible beyond belief, but where it happened and the day it happened did lend us the best opportunity for good outcomes for people," says Hooley. "That's hard now for someone who's maimed for life," he continues, "and we have to be concerned about how we support those folks and those families going forward."

"Boston Strong" is the rallying cry for victims and supporters recovering from the marathon bombings.  In the medical world, many doctors, nurses and EMTs are adding,"Boston Ready."