By now, we have heard how brothers Tamerlan and Dzhokhar Tsarnaev constructed the bombs at the Boston Marathon with a pressure cooker and metal projectiles, and placed the bombs in backpacks on the ground. Due to the low positioning of the bombs, their blasts caused many lower extremity injuries and three deaths, including one child whose vital organs were closer to the ground. In total, more than 175 injuries occurred. It is unknown how many suffered amputations but a Boston Medical Center statement revealed that out of 23 patients treated there, five underwent amputations.
Podiatrists from around the country were present at the marathon. Some were running and others were staffing first aid stations. Those podiatrists stepped into action on April 15. Kirk Neustrom, DPM, from West Des Moines, IA, was working at a medical tent near the finish line. After the blasts, he ran toward the detonation zones and attended to patients with traumatic amputations.
Scott Aronson, DPM, from Easton, MA, and Howard Palamarchuk, DPM, from Philadelphia, PA, were also working at a medical tent and supervising students from the New York College of Podiatric Medicine (NYCPM) and the Temple University School of Podiatric Medicine (TUSPM). (For more about Dr. Palamarchuk’s story, see http://bit.ly/11Jia6U ). Dr. Aronson and students treated victims in the tents until all were transported to area hospitals. Carl Conui, DPM, from Reading, MA, witnessed a victim with both legs blown off.*
The circumstances of the Boston Marathon bombings led to more lower extremity injuries for which a podiatrist’s assistance could be invaluable. One should be prepared to act when disaster strikes. Many large cities have a mass casualty incident unit and doctors can sign up in advance to be activated in case of an emergency. In Los Angeles, I am a member of the Los Angeles County Surge Unit. The unit has regular drills and a paging system to summon medical personnel when needed.
For those who are interested in acquiring more skills for trauma preparedness, the American College of Surgeons offers courses in Advanced Trauma Life Support (ATLS). The Centers for Disease Control and Prevention (CDC) has valuable information on its website about the treatment of bomb victims (see http://www.bt.cdc.gov/masscasualties/essentialspro.asp ) and offers a primer for physicians on blast injuries (see http://www.bt.cdc.gov/masscasualties/explosions.asp ).
While bomb blast injuries may be a common occurrence for military physicians in wartime, the civilian physician may become overwhelmed by external stimuli such as smoke, smells, panic and mass injuries. Nothing can replace preparation. For situations like these, the GI Joe motto offers some perspective: “Knowing is half the battle.”
*Thank you to all our colleagues who acted to help bombing victims. Not all could be named.