April 21 could be doubly challenging for the Boston Marathon medical team. Memories of bloodied runners and spectators are still fresh for some doctors and nurses. And now they must get ready to care for 36,000 registered runners, thousands of unofficial "bandits" and an expected spike in crowds along this year's route.
But as medical tent veterans reconvene for the first time since the bombings, the mood is resolute.
"It’s really good to see all of you," says Chris Troyanos from behind a podium at the Keefe Technical School in Framingham last Sunday morning. "It’s been a while since we have been together."
Troyanos, medical coordinator for the Boston Athletic Association (BAA), looks out at a sea of faces, many of whom he’s worked with for years. This is the first time Troyanos has spoken publicly about the bombings that tested years of preparation and training.
"We’re obviously facing some new challenges," he continues. "That’s OK. This team always meets them, and you’ve become, in my opinion and in the opinion of many, the best marathon medical team in the world."
To respond to a possible record number of runners, there will be 1,900 volunteers, up from 1,400 last year. Troyanos said he had to turn away 600-800 people and only took, for the most part, volunteers with prior Boston Marathon experience.
Many tents along the route will double in size. There will also be more cots and medical staff. Both of the two white, glistening tents at the finish line will be bigger, with one as long as a football field.
"That’s a big tent," Troyanos said. "Everything we’re doing on the course, and in Boston, is to increase our cot size to make sure we can handle the need."
Family members will not be allowed into any medical tent this year, except in the case of a parent accompanying a child. The BAA says this is both a security change and an effort to avoid overcrowding.
A team of volunteers will carry messages and updates between loved ones behind barricades and runners or spectators inside a tent.
"It’s all about communication," said runner/family relations team leader Kathleen Horvath. "I do think family and loved ones - they’re going to be very understanding, probably less demanding this year about getting inside the tent."
Tighter security at this year’s race means changes for everyone on the medical team. At the training session, Troyanos took dozens of questions. Some volunteers worried about getting through or over metal barriers that will line the course from Newton to the finish line. Doctors and nurses are hoping their bags of meds, tools and supplies will get advance clearance. And ham radio operators are wondering if they can pack batteries and cables into vests with many pockets since they won't be allowed to carry bags.
Troyanos answered some questions and took notes on others.
"I don’t have all of it worked out. These are great questions that I’m writing down to just circle back on," he told several people. "We've got a month to kind of figure it out, so I apologize if I don't have it all buttoned up. Trust me when I tell you, every day it changes."
Troyanos and his team leaders began looking for ways to improve the marathon's medical response shortly after last year’s race. They anticipated an important need: mental health counseling. So a team of 60 licensed professionals will be at the race expo, at the start and finish lines and along the 26.2 miles.
"The plan right now is that they’ll have navy blue vests on that say 'Psych' and should be quite easy to recognize," said Dr. Jeff Brown, the BAA’s team psychologist.
Brown has helped organize support programs throughout the year and webinars for volunteers and runners who live outside the Boston area. The Schwartz Center is hosting three more confidential sessions for hospital staff, first responders and medical tent volunteers. Many volunteers have formed Facebook groups and arranged informal gatherings on their own.
Brown himself had trouble with loud noises after the bombings and says he fell apart once when a toilet flushed near his seat on an airplane.
"That’s our brain, being in protection mode and being in overdrive," Brown said. "That fades for some people, others may feel fatigue, like it takes more emotional energy" to be at this year's marathon. "That’s why we will have lots of support."
Brown and many others at the training said they are not afraid to volunteer again, in part because they feel prepared. Roz Puleo, a nurse practitioner from Somerville, was in one of the finish line tents last year.
"I have a lot of faith in the course medical directors," Puleo said. "I have a lot of faith in the BAA in general. I have a lot of faith in the city of Boston and all the cities along the course, and what they’re putting together. I’m really not nervous."
Her husband, Greg Robidoux, is a little more on edge. He remembers getting a text from Puleo, saying she thought a bomb had gone off.
"I couldn’t stay at work. I excused myself and left," Robidoux said. He began to cry. "It was a harder day for me than I tell her," Robidoux said, nodding at Puleo.
Robidoux will be on the course, near his wife this year.
As she turned to leave, Puleo laughed and said there is one event that she does not want to face on April 21 ... the delivering of a baby. That possibility came up during the training.
Most years, there’s a runner with an unusual health condition who seeks advice or clearance from the BAA medical team. Dr. Pierre d’Hemecourt, one of the marathon’s medical directors, says this year it’s a pregnant woman who is due on race day.
"The recommendation," d'Hemecourt said, "was that we didn’t think it was a very good idea, but that she really needed to clear this through her obstetrician."
A delivery along the course fits the general advice to volunteers: prepare for the unexpected. That may include moving teams of medical personnel to the site of any disturbance. Whatever happens, Troyanos wants to see the race through. Last year, the medical team had to evacuate the finish line an hour after the bombings.
"It wasn’t a normal close for us, it wasn’t really completed last year," said Troyanos. "So that’s what I’m hoping for and that’s what I think all these people want too."