WHY BOSTON’S HOSPITALS WERE READY

[DonViejo]

APRIL 17, 2013

POSTED BY ATUL GAWANDE

The bombs at the Boston Marathon were designed to maim and kill, and they did. Three people died within the first moments of the blast. More than a hundred and seventy people were injured. They had their limbs blown off, vital arteries severed, bones fractured, flesh torn open by shrapnel or scorched by the blasts’ heat. Yet it now appears that every one of the wounded alive when rescuers reached them will survive.

Medically speaking, this is no small accomplishment. We’ve seen bombs like this in the battlefields of the Middle East, but rarely in cities like Boston. In the past century of wartime conflict, explosive devices have escalated to become the predominant cause of military casualties. Among American personnel wounded in our wars in Iraq and Afghanistan, they have accounted for three-quarters of injuries; gunshot wounds for just twenty per cent. It has been an historic accomplishment for military medical units to bring case-fatality rates from such injuries down from twenty-five per cent in previous conflicts to ten per cent today. And according to data from the Israeli National Trauma Registry, explosives used in terror attacks have tended to be three times deadlier than those used in war—because civilians don’t have armor, because victims span a wider range of age and health, and because preparedness tends to be less systematic. Nonetheless, in Boston, they survived.

How did this happen? Something more significant occurred than professionals merely adhering to smart policies and procedures. What we saw unfold was the cultural legacy of the September 11th attacks and all that has followed in the decade-plus since. We are not innocents anymore.

The explosions took place at 2:50 P.M., twelve seconds apart. Medical personnel manning the runners’ first-aid tent swiftly converted it into a mass-casualty triage unit. Emergency medical teams mobilized en masse from around the city, resuscitated the injured, and somehow dispersed them to eight different hospitals in minutes, despite chaos and snarled traffic.

Full article:
http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html

[pinto]

1. Great piece.

Thanks for the post.

[WilliamPitt]

2. A week or so ago, there was an OP that asked, "What has America gained from wars?"

Sadly, this: incredible advances in triage and trauma surgery.

[SwissTony]

4. I've heard the question asked as:

which Doctor caused the greatest advances in wound surgery? And the answer given is Doctor Richard Gatling.

I don't know if it's true, but the invention of a machine gun has to be up there.

[WilliamPitt]

6. And the land mine. And the howitzer. And the grenade.

[Ilsa]

3. Being prepared takes training and practice

and money. I'm so glad they were ready. The payoff is lives saved and injuries treated well.

[Marrah_G]

5. Boston has amazing hospitals.

[justiceischeap]

7. I think there was an article out when Gabby Giffords was shot

about how so many of our surgeons have spent time as war trauma surgeons and that's why they were able to save her--because of their battlefield experience. Something we probably don't think about often is how many of our surgeons and doctors have spent time at war since 9/11 and the experience it's given them.

[magical thyme]

8. and an orthopedic surgeon who had completed the marathon just seconds

before the blasts ran straight to the medical triage tent and went straight to work. After running for how many hours nonstop? hitting the wall? Exhausted and drenched in sweat....

...another unsung hero, imo.

[FuzzyRabbit]

9. The hospital nurses

From the article: "The nurses put all scheduled surgery on hold and began readying eight rooms. They ordered equipment trays for vascular and orthopedic procedures to be brought up from stock supply. They called an orthopedics-manufacturer representative for extra hardware to be mobilized. They got in touch with the blood bank, which was already securing blood from other states. They communicated with other operating rooms around the city to make sure they had enough supplies of equipment, too."

The nurses did this without being told to. They did it on their own. They knew what to do. They have learned to do the best job possible for their patients.

Yet most hospital administrators making several million dollars per year, few of whom have any medical training at all, believe nurses deserve only minimum wage.

It isn't the millionaires that do good for other people, it is regular people who do good and sometimes heroic things every day.