In the wake of the Boston bombings, with over 140 people injured, we in the medical community must applaud the triaging and stabilizing care delivered by first responders.
Since these injuries are common in the war theater and are almost never seen in civilian life, it is incredible that medical volunteers at the Boston Marathon finish line were so versatile as to expertly care for wound victims; tourniqueting limbs, giving oxygen, providing intravenous fluids, and transitioning victims to hospitals as quickly as possible.
The bombs caused damage to lower limbs that resulted in more than twenty traumatic amputations, and decisions to amputate had to be made rapidly in order to minimize the risk of contamination and systemic infection.
Recovery from shrapnel wounds takes weeks, often multiple operations, and many victims will never be the same again. It is fortuitous that the Boston hospitals involved, including Massachusetts General Hospital, Boston Children’s Hospital, and Tufts Medical Center, are among the country’s best.
Trauma surgeons are trained in these kinds of injuries, and several Boston surgeons have experience in Iraq and Afghanistan that they can bring to bear.
An even greater risk for those in the vicinity is concussion, Traumatic Brain Injury (TBI), and Post-Traumatic Stress Disorder (PTSD).
Hundreds may be affected by these problems and not know it yet. Bystanders are sure to suffer from flashbacks, depersonalization, vivid dreams, as well as bouts of anxiety and depression for weeks and months afterward.
Those who fell and hit their heads may suffer from headaches and cognitive impairment. Those who were close to the bombs may suffer from burst eardrums, ringing in their ears, and headaches too.
According to the Veterans for Common Sense, almost 250,000 Iraq and Afghanistan veterans have been treated at a VA facility for PTSD. There have been at least the same number of veterans suffering from Traumatic Brain Injury.
Roadside bombs similar to the ones detonated yesterday at the finish line have led to more than a hundred times more instances of TBI and PTSD than have traumatic amputations.
For the rest of us glued to the TV screen watching the horrific images of explosions, and hearing over and over of flying limbs, there is the danger of voyeurism. Our empathy fully engaged, we may over-personalize the risk and it may interfere with our daily lives.
We need to go about business as usual, even as we continue to care. A loud noise shouldn’t startle us, it should only affect people who were there.
by Marc Siegel
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