Medical professionals treating the victims of the Boston Marathon bombings have one advantage over first responders at the Oklahoma City bombing: the accumulated knowledge of treating blast injuries gained over a decade of war in Iraq and Afghanistan.
Thanks to quick action after the blasts, new damage control surgery protocols, aggressive treatment to prevent secondary infections and advances in prosthetics, many Boston bombing survivors will be facing a life of mobility and near-normalcy that wouldn’t have been likely 15 years ago.
The improvised explosive devices (IEDs) used at the Boston Marathon on April 15, which claimed three lives, seriously injured dozens—mostly with lower body injuries. “These patients are probably going to be treated in a way that benefits from the experience we’ve gained from the wars,” says Odette Harris, associate chief of staff of polytrauma at the Veterans Affairs Palo Alto Health Care System in California. “The resulting amputations and orthopedic injuries would be similar to what our polytrauma department would have experienced. It’s important to make that link and reassure people that these individuals have incredible resiliency, and the outcomes that are possible are extraordinary, given the extent of the injuries.”
In fact, a 2008 study co-authored by Colonel Todd Rasmussen, deputy commander of U.S. Army Institute of Surgical Research at Fort Sam Houston in San Antonio, described the surgical response in the first 72 hours after three IEDs exploded in Iraq for the purpose of conveying lessons applicable in civilian settings. “The Boston hospitals got a surgical surge that almost mirrors in volume the individual incidents that we outlined in Iraq in 2008,” Rasmussen says. “An unexpected value in return for civilians' investment in combat casualty care research is that nearly all of the life-saving lessons, knowledge and products that come from that investment translate right into the civilian trauma care system. Undoubtedly, elements of damage-control resuscitation and damage-control surgery as it pertains to mangled extremities, abdominal wounds and head injuries have been used extensively in the medical centers in Boston over the past number of days.”
According to a 2011 study in the British Journal of Surgery, amputation of traumatized lower limbs “has become the signature injury of the conflict in Afghanistan.” Amputations among U.S. soldiers more than doubled from 2009 to 2010 therein, and double-amputations tripled. This increase in injuries meant an increase in knowledge, experience and innovation in treating them. “In the face of adversity, that’s when the greatest innovations come out,” says Pawan Galhotra, the program director for the Polytrauma System of Care at VA Palo Alto. “We’ve had to be very creative in management of individuals with multiple limb loss.”
How IED injuries are different
Blasts from grenades and mines are nothing new in war, but IEDs differ both in terms of injury patterns and in the long-term risks of infection from their improvised design. Galhotra describes two basic injury patterns from “mounted” and “dismounted” IEDs. Mounted IEDs are those embedded in the sand or road that a vehicle rolls over, primarily leading to traumatic brain injury. Dismounted IEDs are those that detonate when a soldier is on foot, and are the ones more likely to cause multiple limb loss, head injury and other complications, such as burns, internal organ damage, spinal cord injuries and genital or urinary injuries.