First Aid Tent to MASH Unit: Saving Lives at Boston’s Finish Line

They expected no more than dehydration. Instead the medic-volunteers at the marathon got the equivalent of combat wounds. How they responded

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Firemen carry an injured person where two explosions occurred along the final stretch of the Boston Marathon on Boylston Street in Boston, Mass., on April 15, 2013.

Surgeons, as the saying goes, are like well-trained athletes. They prepare for years to be able to perform delicate and complex procedures under immense pressure, calm and collected in even the toughest of times.

When the Boston Marathon erupted a little over four hours into the race, Dr. Lyle Micheli, 72, director of sports medicine and an orthopedic surgeon at Boston Children’s Hospital, was standing near the finish line. A star rugby player for years, Micheli ran into the scrum to begin treating the wounded. Just a few feet away, Dr. Albert Pendleton, 33, one of Micheli’s orthopedic surgery fellows, hit the ground when the bomb exploded. A former state champion wrestler who went on to captain the Princeton team, Pendleton scrambled to his feet and evacuated bloodied bystanders.

The two doctors were part of a large team of volunteers–physicians, athletic trainers, EMTs and nurses–-who expected to be treating mostly dehydrated runners. Instead, they found themselves in a bloody mass casualty scene. “These were like military combat wounds,” says Micheli, who served as an Air Force doctor during the Vietnam War and helped treat soldiers who had been evacuated from the country after stepping on land mines and booby traps. “This is the kind of thing you don’t see very often.”

After tearing down the fencing separating them from the blast site, Micheli and others ran to a nearby building where about half a dozen people lay bleeding on the sidewalk. Micheli and an Army Special Forces soldier who had run in the race improvised a tourniquet from a running jacket, using a coat hanger as the windlass to tighten the device around a woman’s mangled leg. After working to get the bleeding under control, they helped rush her and others to the medical tent about a hundred yards away.

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Transporting patients to the medical tent was the first thing on Pendleton’s mind. After picking himself up he helped rush an injured man to the tent, then ran back to the scene of the blast. He saw 20 or 30 people who had their legs blown out from underneath them. Many had nothing from the knee down. “Once I got out there, it was ‘What can I do to help these folks?’” Pendleton says. “In my mind that was to get them to the hospital as fast as possible.”

For the next 20 minutes, he helped to get the wounded controlled and transported, loading people onto gurneys, wheelchairs and backboards. When firefighters yelled that they had to clear the area because they thought there might be another bomb, Pendleton and others packed up the last few critical patients and rushed them up Boylston Street.

The marathon’s medical tent had become a MASH unit. A member of the medical staff who would usually be calling for IV fluids to one side of the tent and basic bandages to another stood on a chair, directing the most critical patients to the back right corner and the more stable ones to the other side. Doctors and nurses cut off clothing to get a better look at the wounds and sent the most serious ones out the back door, where a fleet of ambulances stood waiting to carry the injured to hospitals around the city.

When the bomb exploded at the finish line, Dr. David Mooney, 53, was in his office talking to his wife. The director of the trauma center at Boston Children’s Hospital hung up the phone and went straight down to the emergency room. Because Monday was a holiday, much of the hospital only had a skeleton crew. “Within minutes, before the first kids even started to arrive, we just had a flood of hospital people coming in from home,” Mooney says. “From the chief of neurosurgery to clinical assistants to housekeepers to O.R. nurses, just a mob of people just came in the doors of the hospital to do whatever they could do to help.”

During his time at Children’s Hospital, Mooney estimates that he’s worked on about a thousand injured children. The majority of the time the kids are not as badly injured as described in the initial reports. Last Monday was different. “These kids were very badly hurt,” Mooney says. “They had soot on their faces from the flash, burned hair, burned eyebrows. Wounds all over their bodies, mainly on the legs, but just wounds everywhere.”

(MORE: Doctor: Metal in Boston Bomb Victim Leg Like Ball Bearings)

As Mooney was treating a little girl he saw a lump in her skin. “I felt this lump and I pulled it out and it was a nail that was head first sticking out of her flesh,” he says. Surgeons at several hospitals reported removing carpenter’s nails and ball bearings from wounds. The shrapnel was turned over to the FBI, a key piece of evidence in the ongoing investigation.

Mooney praised his trauma teams, and was quick to credit those who responded to the casualties at the scene. “Each of the two critically injured kids had their lives saved by the first responders,” he says. “Somebody at the scene put a tourniquet on their legs and stopped the bleeding, and I have no doubt they would have bled to death if the first responder hadn’t done that.”

About an hour and a half after the bombing as the chaos waned, Pendleton and other race medical volunteers worked to patch up the less critical injuries. He met his wife not far from the racecourse, and because the T subway line wasn’t running in the area near Copley Square, they walked the more than three miles back to their home.

Life has returned to its busy normalcy with clinics and surgeries, but two days after the bombing, Pendleton took a few hours off to attend the prayer service where President Obama spoke. For a crew used to seeing torn ACLs and concussions, the bomb attack was outside of the sports medicine group’s usual experience, but not their capabilities. “I’m really impressed with all my partners,” Pendleton says. “It was a pretty unbelievable effort.”

The trauma team at Children’s Hospital specializes in the controlled chaos of emergency care. “We’re the busiest trauma center in the northeast,” Mooney says. “That’s what I do–take care of kids who get hurt. The thing about this that was so striking was the intentional part of it. The fact that someone would actually do this to a kid was the kind of thing you don’t want to think about. It’s just hard to imagine.”

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