Advertisement

Damage Control Surgery and the Boston Marathon Bombing

  • David R. King
Chapter

Abstract

The practice of trauma surgery in the aftermath of the Boston Marathon bombing took place within the walls of the multiple Boston Level I trauma centers, as well as several adjacent community hospitals. The approach to these patients reflected the general philosophy of rapid damage control, abbreviated surgery, frequent returns to the operating room in a staged fashion, and high-ratio blood transfusions. The real lesson for surgeons, however, is learned from careful examination of the prehospital treatment of the injuries resulting from the two improvised explosive devices detonated on Boylston Street during the running of the 117th Boston Marathon at 14:49 on April 15, 2013: damage control starts at the point of wounding.

References

  1. 1.
    Welling DR, McKay PL, Rasmussen TE, Rich NMA. Brief history of the tourniquet. J Vasc Surg. 2012;55(1):286–90.CrossRefPubMedGoogle Scholar
  2. 2.
    Kragh JF Jr, Swan KG, Smith DC, Mabry RL, Blackbourne LH. Historical review of emergency tourniquet use to stop bleeding. Am J Surg. 2012;203(2):242–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Kragh JF Jr, O’Neill ML, Walters TJ, Dubick MA, Baer DG, Wade CE, Holcomb JB, Blackbourne LH. Minor morbidity with emergency tourniquet use to stop bleeding in severe limb trauma: research, history, and reconciling advocates and abolitionists. Mil Med. 2011;176(7):817–23.CrossRefPubMedGoogle Scholar
  4. 4.
    King DR, van der Wilden G, Kragh JF Jr, Blackbourne LH. Forward assessment of 79 prehospital battlefield tourniquets used in the current war. J Spec Oper Med. 2012;12(4):33–8.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Beekley AC, Sebesta JA, Blackbourne LH, Herbert GS, Kauvar DS, Baer DG, Walters TJ, Mullenix PS, Holcomb JB, 31st Combat Support Hospital Research Group. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008;64(2 Suppl):S28–37.CrossRefPubMedGoogle Scholar
  6. 6.
    Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009;249(1):1–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Kragh JF Jr, Littrel ML, Jones JA, Walters TJ, Baer DG, Wade CE, Holcomb JB. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, Ben-Abraham R. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma. 2003;54(5 Suppl):S221–5.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Kapur GB, Hutson HR, Davis MA, Rice PL. The United States twenty-year experience with bombing incidents: implications for terrorism preparedness and medical response. J Trauma. 2005;59(6):1436–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Gates JD, Arabian S, Biddinger P, Blansfield J, Burke P, Chung S, Fischer J, Friedman F, Gervasini A, Goralnick E, Gupta A, Larentzakis A, McMahon M, Mella J, Michaud Y, Mooney D, Rabinovici R, Sweet D, Ulrich A, Velmahos G, Weber C, Yaffe MB. The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster. Ann Surg. 2014;260(6):960–6.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    King DR, Larentzakis A, Ramly EP. Tourniquet use at the Boston Marathon bombing: lost in translation. Boston Trauma Collaborative. J Trauma Acute Care Surg. 2015;78(3):594–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Kalish J, Burke P, Feldman J, Agarwal S, Glantz A, Moyer P, Serino R, Hirsch E. The return of tourniquets. Original research evaluates the effectiveness of prehospital tourniquets for civilian penetrating extremity injuries. JEMS. 2008;33(8):44–6. 49-50, 52, 54.CrossRefPubMedGoogle Scholar
  13. 13.
    D’Alleyrand JCG, Dutton RP, Pollak AN. Extrapolation of battlefield resuscitative care to the civilian setting. J Surg Orthop Adv. 2010;19(1):62–9.PubMedGoogle Scholar
  14. 14.
    Evaluation of self-applied tourniquets for combat applications, second phase. 2013. http://archive.rubicon-foundation.org/xmlui/handle/123456789/6870?show=full. Accessed 19 Sep 2013.
  15. 15.
    Passos E, Dingley B, Smith A, Engels PT, Ball CG, Faidi S, Nathens A, Tien H, Canadian Trauma Trials Collaborative. Tourniquet use for peripheral vascular injuries in the civilian setting. Injury. 2014;45(3):573–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Duchesne JC, Islam TM, Stuke L, Timmer JR, Barbeau JM, Marr AB, Hunt JP, Dellavolpe JD, Wahl G, Greiffenstein P, Steeb GE, McGinness C, Baker CC, McSwain NE Jr. Hemostatic resuscitation during surgery improves survival in patients with traumatic-induced coagulopathy. J Trauma. 2009;67(1):33–7. discussion 37-9.CrossRefPubMedGoogle Scholar
  17. 17.
    Dorlac WC, DeBakey ME, Holcomb JB, Fagan SP, Kwong KL, Dorlac GR, Schreiber MA, Persse DE, Moore FA, Mattox KL. Mortality from isolated civilian penetrating extremity injury. J Trauma. 2005;59(1):217–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Wall PL, Duevel DC, Hassan MB, Welander JD, Sahr SM, Buising CM. Tourniquets and occlusion: the pressure of design. Mil Med. 2013;178(5):578–87.CrossRefPubMedGoogle Scholar
  19. 19.
    Wall PL, Welander JD, Singh A, Sidwell RA, Buising CM. Stretch and wrap style tourniquet effectiveness with minimal training. Mil Med. 2012;177(11):1366–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Ingalls N, Zonies D, Bailey JA, Martin KD, Iddins BO, Carlton PK, Hanseman D, Branson R, Dorlac W, Johannigman JA. review of the first 10 years of critical care aeromedical transport during Operation Iraqi Freedom and Operation Enduring Freedom: the importance of evacuation timing. JAMA Surg. 2014;149(8):807–13.CrossRefPubMedGoogle Scholar
  21. 21.
    Ball CG, Williams BH, Tallah C, Salomone JP, Feliciano DV. The impact of shorter prehospital transport times on outcomes in patients with abdominal vascular injuries. J Trauma Manag Outcomes. 2013;7(1):11.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Crandall M, Sharp D, Unger E, Straus D, Brasel K, Hsia R, Esposito T. Trauma deserts: distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago. Am J Public Health. 2013;103(6):1103–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bulger EM, Guffey D, Guyette FX, MacDonald RD, Brasel K, Kerby JD, Minei JP, Warden C, Rizoli S, Morrison LJ, Nichol G, Resuscitation Outcomes Consortium Investigators. Impact of prehospital mode of transport after severe injury: a multicenter evaluation from the Resuscitation Outcomes Consortium. J Trauma Acute Care Surg. 2012;72(3):567–73. discussion 573-5CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Jacobs LM, NE MS Jr, Rotondo MF, Wade D, Fabbri W, Eastman AL, Butler FK Jr, Sinclair J, Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events. Improving survival from active shooter events: the Hartford Consensus. J Trauma Acute Care Surg. 2013;74(6):1399–400.CrossRefPubMedGoogle Scholar
  25. 25.
    Bulger EM, Snyder D, Schoelles K, Gotschall C, Dawson D, Lang E, Sanddal ND, Butler FK, Fallat M, Taillac P, White L, Salomone JP, Seifarth W, Betzner MJ, Johannigman J, Mc Swain N Jr. An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014;18(2):163–73.CrossRefPubMedGoogle Scholar
  26. 26.
    Ramly E, Runyan G, King DR. The state of the union. J Trauma Acute Care Surg. 2016;80(5):787–91.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Trauma, Emergency Surgery, and Surgical Critical CareHarvard Medical SchoolBostonUSA
  2. 2.Massachusetts General Hospital and Harvard Medical SchoolBostonUSA

Personalised recommendations