Marathon medical tent ‘transformed into trauma unit’

The medical tent at the Boston Marathon finish line minutes before the first explosion/Dr. Sushrut Jangi
The medical tent at the Boston Marathon finish line minutes before the first explosion/Dr. Sushrut Jangi

My friend and colleague, Dr. Jennifer Rosenberg, a family physician in Coolidge Corner, was attending to her patient when we heard two explosions – the second a few moments after the first. The medical tent was already packed with runners lying on cots for dehydration or hypothermia. We heard a calm voice from the center of the tent, belonging to John Andersen, one of our medical coordinators. “Stay calm, and stay with your patients,” he said, “while we figure out what’s happening.”

A few minutes later, physicians, nurses, and coordinators were called to the site of the explosion; EMS ran to the scene and returned with stories about dismembered limbs and pools of blood. Immediately, the medical tent was transformed into a trauma unit. A patient was wheeled in on a stretcher with legs missing at the end of her torso; another had severe burns on the left lower leg. The cots at the far end became beds for those with severe bleeding or leg injuries from the blasts. Although we were not equipped for trauma, we had bags of intravenous fluids hanging from four yellow ropes suspended down the middle, tourniquets, blood pressure monitors, defibrillators, and EKGs. We had medical personnel included internists, family physicians, cardiologists, emergency physicians, physical therapists, and social workers.

Many patients who had come in prior to the explosions continued to receive care, with Bair Huggers around those who were hypothermic or intravenous fluids flowing into the veins of those who were dehydrated. Some were anxious and crying. Andersen, every few moments, stepped to the microphone to direct IV bags to one cot or a pulse oximeter to another. He spoke patiently to the medical crew. “Doctors, nurses, stay relaxed,” he said. When I approached him to tell him how good a job he was doing keeping everyone calm, he said, “I’m glad to hear that. But to be honest, my heart rate is up to here.”

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Outside, smoke continued to drift from the site of the two explosions down Boylston Street. We heard a third explosion that was a controlled detonation by the bomb squad – an explosive had been found just a few meters away from our medical tent and could have affected rescue efforts had it gone off. Bomb-sniffing canines arrived while we escorted treated patients to their loved ones or to ambulances for transport to nearby hospitals. A few more of the injured arrived, most with lower leg injuries. I stayed beside the cots of earlier runners who were in shock at what they were seeing. Social services distributed cell phones so that many could call loved ones but the networks were jammed. A smell of smoke hung in the air.

Chris Troyanos, the medical coordinator of the Boston Marathon, sent messages to Andersen, systemically changing priorities as the situation required. Around 4 p.m., we began to evacuate the medical tent. Non-essential medical personnel were evacuated first. Doctors and nurses stayed back for a bit. But eventually, the injured stopped coming – most had been transported to hospitals. The runners had been diverted at Kenmore. In the last few minutes before leaving the tent, many physicians stood in a crowd unsure what to do. None of us wanted to leave because we wanted to help, but we weren’t sure what else we could do. A bomb-sniffing squad moved into the tent just as I left.

I’ve never been in any kind of tragedy like this – when 9/11 occurred, I saw it on television. Most of the doctors and nurses I spoke to hadn’t even been near such trauma before either. These events are not something the medical community generally prepares for – but medicine, by its very nature, is a process that evolves to meet its need. Hospitals are only now beginning to see the first of the injured patients in their emergency rooms; many medical staff will also see scenes they have only experienced in the media and never in their home city. One nurse I remember broke down and began to cry a few minutes after the first explosion; but just a moment later, she wiped her tears away and reached for an IV bag and brought it to an ailing patient. “I’m okay,” she said, “don’t worry.”

When I finally got outside the medical tent, a cop yelled at us to move to the sidewalks. The ambulance sirens echoed from every direction. That same morning, I remembered how beautiful a day it had been; now, Dartmouth Street was packed with SWAT trucks and a family stood on the median in tears. Behind me, the medical tent was closed as security moved in to lock it down and search the periphery. We joined everyone else, moving away from Copley Square, the familiar streets momentarily transformed into a city I could no longer recognize.

If you are trying to locate a family member who has been injured in this incident, but are not sure where they are being treated, call the Mayor’s Hotline at 617-635-4500.