Eric Feins, a 32-year-old surgical resident at Massachusetts General Hospital, had been excited to spend his day off taking in the Boston Marathon from a roof party along the route where he had gathered with four fellow residents. But after the group witnessed the explosion and the smoke began to clear, they quickly came to the grim realization that their skills might soon be in short supply. They reported to their emergency room with a simple question: How can we help?
Before long, they had set up a makeshift triage center in the lobby of the ER and began to treat the incoming — sewing up victims’ wounds and sending those with more-serious injuries through to be admitted. “We were prepared for waves of victims,” Feins told TIME, still wearing his scrubs outside his apartment near the hospital. “In the end, we worked on six people. Four had small lacerations, and we sewed them up.” Two other patients who had been in close proximity to the explosions complained of abdominal pain — a warning sign to Feins, who had been trained during his residency that explosive shock waves can cause internal trauma even if no shrapnel is present.
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“In the end, we only saw a few minor injuries,” Feins says, “But I have a feeling that some patients were taken straight from the ambulances to the operating theater. I was told we had four, very busy operating theaters today.” Another man in scrubs outside the hospital who identified himself as an emergency-room physician confirmed Fein’s suspicion in a brief interview. When asked whether the hospital had treated one of the three reported fatalities from the explosions (multiple news organizations were confirming Monday night that an 8-year-old child was among the dead), the physician nodded. “It hasn’t been a good day,” he said. CNN later reported that there had been at least 10 amputations as a result of the Boston attack.
Since the last terrorist attack on U.S. soil in 2001, the United States has spent billions of dollars to train emergency responders like Feins and build and maintain an enormous apparatus designed to respond to events like Monday’s. That apparatus is usually invisible to Americans. Not today. As a journalist for TIME, I have witnessed the emergency response to terrorist attacks. I arrived at Glasgow Airport shortly after the 2007 terrorist attack; I was in Stockholm in 2010 when a suicide bomber detonated in a central shopping area. But nothing could prepare me for the enormity of the emergency response in Boston this afternoon.
Ambulances, fire trucks and dozens of marked and unmarked police cars filled Boston’s streets; their sirens formed a pulsing, unrelenting, almost nauseating Doppler sound pattern. In Boston Common, the city’s main public park, squadrons of men in fatigues and berets lined up in formation with assault rifles on their shoulders, as helicopters swarmed overhead and an armored Humvee idled nearby — all assembled within 90 minutes of the explosions.
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Similarly at Mass General, Feins witnessed America’s first response protocols spring into action. Before the patients were even admitted into the hospital, he said, they were tested with elaborate detectors for hazardous residue in an effort to rule out a chemical or radiological attack — what he says is standard procedure following a suspected terrorist attack. “We have to make sure they don’t bring in to the hospital any materials that injure us or other patients,” Feins explained.
Even as Feins was addressing physical injuries, it was easy to see that other victims would be struggling with psychological scars. Across town, numerous bystanders shared the shocked, vacant stare of the depleted athletes around them. I have seen these faces before, in Glasgow and in Stockholm. I stopped one man, a runner, as he walked past Boston Common with a medal around his neck. He introduced himself as Jay Jelinek, from Denver. He was in the medical tent recovering from cramps when the explosions hit. Shortly after, the nursing staff vacated the tent to prepare to treat casualties on the scene. He had been walking the streets ever since; with cellphone service jammed and commuter lines suspended, he didn’t know what else to do. “This isn’t supposed to happen,” he said as a fire truck roared noisily by.