A city whose hospitals and physicians are renowned for research and cutting-edge surgical innovations faced a starkly different challenge Monday, treating scores of injuries more commonly found in a war zone.
Patients arrived at Boston hospitals with limbs blown off, shrapnel wounds, burns, gruesome fractures, and perforated eardrums from the shock wave of two explosions near the Boston Marathon finish line shortly before 3 p.m.
“For many, many people in emergency medicine who are practicing domestically and not in the military, these are once-in-a-lifetime events,” said Dr. Ron Walls, chairman of the Department of Emergency Medicine at Brigham and Women’s Hospital.
Runners and spectators alike were rushed to hospitals, where doctors said that the injuries individually were not extraordinary, but that the volume was unprecedented.
In all, eight Boston hospitals reported treating at least 144 patients, many in critical condition. The injured included at least 10 children. Many of the hospitals activated long-held emergency plans, some calling in extra staff, and others placed their facilities temporarily on lock-down, not allowing visitors and searching anyone who entered, as a precaution because of the uncertainty.
Local, state, and federal law enforcement officials, some armed with automatic weapons, surrounded the hospitals, and interviewed patients, families, and friends about what they had seen.
At the Brigham, the staff treated 31 patients, ranging in age from 16 to 62, with a spectrum of injuries, including people who lost large amounts of tissue from their legs or had broken bones in multiple places.
“The two things that struck me the most were the incredible calm of the victims, even though they were obviously experiencing something no human being should ever have to experience,” Walls said. “Incredibly calm and able to help us take care of them.”
Care for the wounded began at the scene of the blasts. Within minutes, patients were carried into a nearby medical tent traditionally set up by the finish line to treat running injuries, such as dehydration and hypothermia.
Dr. Sushrut Jangi, an internist at Beth Israel Deaconess Medical Center, was shaken by what he witnessed. “There were victims coming in with both legs blown off,” Jangi said. “I had never seen anything like that.”
The tent was equipped with intravenous fluid bags, tourniquets, and defibrillators, and doctors improvised, arranging an area in the back of the tent for the critically wounded while treating runners with more routine ailments up front.
“Obviously we were not anticipating a scene of trauma,” said Jangi. “I just held hands and talked to patients to try to bring down their anxieties,” he said. “The patients who were severely injured didn’t stay in the tent too long; the priority was to stabilize them and get them to hospitals.”
At least 21 of the injured were taken to Beth Israel Deaconess, where about 100 additional physicians, nurses, and other personnel descended on emergency rooms to help out the 25 or so typically there during a Monday afternoon.
Dr. Richard Wolfe, chief of the emergency department, said that in his 14 years at the hospital, “nothing comes close” to what he witnessed Monday. Of the 21 people brought into the emergency room, at least seven had life-threatening injuries. He said one patient had both legs amputated and one person had one leg removed in the operating room. One or two patients were in a very “dicey” situation, Wolfe said, in their ability to survive their injuries.
Patients had severe eye damage, deep flesh wounds, and ruptured internal organs.
ER staff at the hospital are trained to handle the kinds of critical injuries they handled Monday — many were similar to the trauma seen in serious car accidents — but by around 6:30 p.m., when most patients had been transferred out of the emergency room and into other parts of the hospital, many staff members could not contain their suppressed emotions any longer. Several openly wept at memories of the initial hours of the blast, Wolfe said.
“Some people were quite traumatized,” he said.
Beyond the horrific wounds, hospital staff across the city were dealing with heightened tensions about potentially more explosions. Wolfe said police directed his hospital to go into lock-down, severely restricting access and requiring pat-downs of anyone who entered. Police told him that they worried that additional bombs might have been placed at other locations where police and crowds were expected, including hospitals.
At Boston Medical Center, which treated 23 patients, heavily armed SWAT-team officers arrived and held the perimeter for about 15 minutes around 5:30 p.m., before fanning out to check inside the hospital. Three officials wearing FBI jackets and eight wearing jackets from the Bureau of Alcohol, Tobacco, and Firearms were also seen at the facility.
At Massachusetts General Hospital, which received 29 patients, including at least four who lost limbs, Dr. Peter J. Fagenholz said, “We had three in the first five or 10 minutes. . . . I’ve never seen this volume come this quickly.”
About five years ago, administrators said, they realized they needed to upgrade disaster-response training. “We obviously have a limited experience with explosions in an urban area,” said Dr. Alasdair Conn, Mass. General’s chief of emergency services.
“The Israelis, unfortunately, have this several times a year, and we asked their disaster-
response teams to come and help us upgrade our disaster response,” Conn said. “And I’m very pleased that we went through that orientation and additional training.”
Boston Children’s Hospital treated eight patients: seven children — ranging in age from a 2-year-old with a head injury to a 12-year-old with a broken leg — and one child’s parent.