Physician leaders talk of day of trauma, shrapnel, and surgery

The first Boston Marathon attendees who arrived at Massachusetts General Hospital were among the worst injured, with damage to their legs severe enough in some to require amputation, surgeon Dr. Peter J. Fagenholz said outside the hospital late Monday evening.

“We had three in the first five or 10 minutes, and that’s when it became clear to us that it was going to be a busy day,” he said. “I’ve never seen this volume come this quickly.”

Physicians took a moment Monday night to speak to the press about a day of trauma, where their training for the worst was put to work. “This is what we prepared for,” said Dr. Ron Walls, chief of emergency medicine at Brigham and Women’s Hospital.

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As of about 10 p.m., Fagenholz said, the hospital had treated 29 people, eight of whom were in critical condition. Mass. General staff worked for a couple of hours to identify some patients or to locate family members, he said.

Fagenholz operated on six patients. The oldest he cared for was 71. Some will have repeat operations tomorrow, he said. Those who have bone, tissue, and vascular damage may require repairs done in a “step-wise fashion.”

Shrapnel injuries were common among the marathon-goers treated there.

“I just don’t think we can say if these were small bits of metal that were placed there intentionally [as part of the bomb] or if they were part of the environment,” he said.

Walls said the shrapnel appeared to be “street stuff”—shattered soda cans or pieces of other items that may have already been on the city street before the blast.

The Brigham treated 31 patients ranging in age from 16 to 62. Two were in critical condition and nine had been operated on.

Walls said incoming patients were tested for evidence of radiation or chemical contamination from the blasts, but none was found.

Both doctors said they have seen patients with eardrums shattered by the blasts. And each praised the quick work of doctors, nurses, and other hospital staff.

“All of these providers are people, and they are going to be affected by this, as everyone else is, as are the patients and their families,” Walls said.

He said the hospital will provide counseling and support to those providers who need it in the coming days, he said.