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Mass General Trauma Chief Talks Disaster Drills, Shrapnel Recovered in Surgery

April 16, 2013 at 12:00 AM EST
Hari Sreenivasan talks to Dr. Alasdair Conn, who heads Massachusetts General Hospital's department of emergency medicine, about the emergency medicine administered to victims of the Boston Marathon bombing, how his staff had prepared for such a disaster and an overview of the various serious injuries sustained.
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JEFFREY BROWN: Now a firsthand account of the emergency medicine administered to victims and the challenges they will be facing.

Patients were sent to seven hospitals across Boston yesterday, including Massachusetts General.

Dr. Alasdair Conn heads the hospital’s department of emergency medicine.

Hari spoke with him a short time ago.

HARI SREENIVASAN: Dr. Conn, thanks so much for joining us.

What can you tell us? What is the latest on the status of the patients that you have?

DR. ALASDAIR CONN, Massachusetts General Hospital: We have 12 patients that were admitted to the hospital yesterday following this explosion.

Last night, we listed eight as critical, and we’re now listing seven as critical, although we’re hoping that one will improve overnight, so that will leave us with six. Four of the patients, unfortunately, had an amputation of one of their lower extremities.

HARI SREENIVASAN: Now, what types of injuries are you seeing? We have heard so much about these lower extremities. In fact, one of your colleagues this morning said that you’re completing the job that the bomb began.

ALASDAIR CONN: That’s correct.

They were — when they arrived, they were virtually complete amputations. And it was very obvious in the emergency department and subsequently in the operating room that there was so much damage that these could not be reattached, if you like.

And so basically we were completing what the explosion had already done. The other injuries did require — there seemed to be a lot of metal fragments from the explosive device. And these caused a lot of damage to the musculature, and particularly in one patient to the blood vessels supplying the lower extremity.

We did have one of the vascular surgeons repair the blood vessels, so we’re hopeful that we will be able to salvage that limb. It’s still a little bit of early days, though.

HARI SREENIVASAN: So, what happens to some of that shrapnel? Is it going into the hands of federal investigators trying to piece together …

ALASDAIR CONN: Absolutely.

Any material that is going to help in this investigation was handed from the operating room to the appropriate authorities for them to obviously see what they can determine about the people who led to this tragedy.

HARI SREENIVASAN: And when you say metal objects, what does that mean? Are these sharp like nails? Are they round like BBs? What was in there?

ALASDAIR CONN: The one thing that impressed me first looking at the C.T. scans and the X-rays as soon as we had them developed was the number of small, like BBs that were in the wounds, not only the lower extremities, but in some patients elsewhere on the body.

And Dr. Velmahos, who did a lot of the surgery, was saying that some of the metal objects appeared to be like nails that, that the head had been cut off in some way. So, again, all of these were collected when we removed them from the patients and give them to the authorities from the operating room.

HARI SREENIVASAN: Now, you’re the chief of the department of emergency medicine. You train for something like this, but how different is it when this comes through your door?

ALASDAIR CONN: We train for it.

We’re very fortunate in Boston. We have gone through a lot of disaster drills. But this was the real thing. We certainly see horrific injuries, but it’s usually one patient at a time, and, yesterday, 12 patients in the course of less than an hour.

Fortunately, we were able to mobilize the resources. And within just a few minutes, we had five patients from the emergency department right up to the operating room. And those were obviously the most critical patients.

HARI SREENIVASAN: And so what’s next for these critical patients? What are you looking for and watching out for in the next 24-48 hours?

ALASDAIR CONN: What we do in the first operation is obviously salvage as much viable tissue as we can. The patients will be taken back to the operating room almost on a daily basis, and we will be cleaning out the wounds, eventually doing some tissue transfers to cover the wounds, skin grafts in other patients, and waiting until we can get complete coverage of the wounds.

We’re hopeful that the — no more patients will lose a lower extremity. That’s what we’re hoping for — and that the people who have lost their lower extremity ultimately will be able to be fitted with a prosthetic limb.

I will say, one of the orthopedic surgeons here has received calls from patients who he’s previously operated on calling up and saying, look, I have been living with my artificial leg. I have a full life. I can walk. I can run. I can jog. I would love to come in when the time is right and help people initiate their rehabilitation process.

HARI SREENIVASAN: I know you had sent some of your patients across for ear damage. Was that from the explosion?

ALASDAIR CONN: Yes, it was.

A blast injury, if they’re very close to the explosion, it can literally rupture the eardrum. And those patients, we sent across to the Massachusetts Eye and Ear Infirmary to have their ears more appropriately managed.

HARI SREENIVASAN: Are there dangers of concussion wounds for all of these patients, too?

ALASDAIR CONN: They were in danger, but after evaluation here, we felt comfortable that they didn’t have any severe concussion and that we wanted to get them examined to determine if there was any damage to their tympanic membranes and their hearing.

HARI SREENIVASAN: And what about things like blood pressure, considering the loss of blood and limbs and so forth? How do you regulate that?

ALASDAIR CONN: Well, certainly, one of the things that is gratifying was the way that EMS and all of the personnel on the scene brought the very severely injured patients to our emergency department and to other level one trauma centers within the city in a very fast manner.

One or two patients had very low blood pressure when they arrived. We gave them blood in the emergency department to bring up their blood pressure and then sent them immediately upstairs. And obviously the treatment is to stop the bleeding, control the hemorrhage, and then give them blood transfusions to bring their blood pressure up and normalize.

HARI SREENIVASAN: Dr. Conn, in an odd way, a doctor I spoke to yesterday says it couldn’t have happened in a better location. There was almost an entire medical hospital there at the finish line.

ALASDAIR CONN: That’s correct.

We had — we have — some of our physicians and nurses were manning some of the medical tents along the way. And, obviously, as these — this explosion occurred, things took a rather more serious turn. One of our trauma surgeons, an actual fact, ran the marathon and, when he finished, realized what was happening and came in to operate on some of the patients.

HARI SREENIVASAN: Wow.

Dr. Alasdair Conn, thanks so much for your time.

ALASDAIR CONN: Thank you.