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Prepared for Trauma, Overwhelmed by Carnage
Date:4/18/2013

ypically suffered by soldiers in Iraq and Afghanistan.

As ambulances started arriving at the hospitals, the disaster plans were playing out for real.

At Boston Medical Center, Dr. Andrew Ulrich said the shrapnel in victims "could be described as buckshot," the Boston Globe reported.

"We are used to a lot of chaos, but this was extraordinary," said Ulrich, who learned about the bombings just after starting his shift in the emergency department, the newspaper reported. "Within minutes eight or 10 patients arrived."

At Boston Medical Center, at least two patients had to have both legs amputated, the Globe reported.

At Massachusetts General Hospital, the wounds to the legs of some patients were so severe that they were considered "almost automatic amputees," said trauma chief Dr. George Velmahos. In those cases, "we finished what the bomb started," he told the Globe.

One of the first and biggest challenges facing physicians and nurses on the front lines: "Sorting out the people who are really sick from those who have life-threatening injuries," said Dr. William Durkin, president of the American Academy of Emergency Medicine, and an emergency physician in Alexandria, Va.

In a disaster like the Boston bombings, a hospital's entire emergency response team is in full action mode. The emergency department is kept updated about the hospital's critical data: how many operating rooms are available at any given time, how many ICU beds and patient rooms, Durkin said. "Things are happening all at once at many levels," he explained.

Patients have to be quickly assessed and triaged, sent for X-rays, CT scans and other tests.

Keeping track of what tests and treatments each patient needs and gets can be daunting, said Loni Howard, emergency preparedness coordinator at Sutter Medical Center in Sacramento, Calif. "We have abbreviated paper disaster charts," she said. But, she added, it can be difficult becau
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