It was April 15, 2013, at the finish line of the 117th running of the Boston Marathon. Runners passed and spectators cheered, as they did every spring. Then two explosions rocked the narrow stretch of Boylston Street where the race ends, inflicting devastating injuries on those standing close by. Three people died and 140 sustained injuries, including many lower-limb amputations. On-scene medical personnel (on hand, as always, to give aid to runners), police, and spectators applied makeshift tourniquets to what remained of severed limbs and carried victims to medical tents, ambulances, and police cars.
Whether it was serendipity or fate, however, the city was ready: the weather was good; few operations had been scheduled throughout Boston because it was Patriots’ Day, a Massachusetts State holiday; EDs were already well staffed because of the marathon; medical personnel, ambulances, and police were already on hand at the finish line; the surrounding roads, which had been shut down for the runners, allowed ambulances speedy access to hospitals; and there were six level 1 trauma centers in close proximity.
Ambulances left the scene with victims, fanning out to the different EDs, and at each hospital, nurses were there. And nurses who weren't there supported those who were: some even sent flowers or pizzas from across the country. The support continued long after that day.
Out of that tragedy was born a kind of triumph, and the huge network of nurses working throughout the city played an integral part. Inpatient medical–surgical nurses facilitated rapid admission of emergency patients to make room for the incoming trauma patients they would come to know over the next days and weeks. Operating room nurses rapidly coordinated emergency surgery for patients transferred from the ED. And nurse managers coordinated patient care and family communications at the 14 hospitals involved. Below, we hear from four emergency nurses who were on duty that day. You can hear their full stories at http://links.lww.com/AJN/A57.—GailLenehan, EdD, MSN, RN, and Maryfran Hughes, MSN, RN
JAY O'REILLY, BSN, RN, BRIGHAM AND WOMEN'S HOSPITAL
Jay O'Reilly was in charge of the trauma room when the call came in:
Figure. Jay OReilly,...Image Tools
“‘There's been an explosion. Multiple explosions.’ Then one of our doctors got a call from hospital personnel at the finish line. She turned and said, ‘It's real and it's bad.’ That's all we needed to know. Not five minutes after getting the news, the patients started rolling in. Fourteen trauma bays filled within minutes.
“After the first wave, we'd be ready for the next wave. Some cases of water were brought from the cafeteria, but not one person would take [any]. So we opened the bottles and handed them to everyone, and only then did they drink. You don't think about yourself; I don't know if anyone took the time to go to the bathroom, [because we were] worried that [we'd] be needed.
“What we didn't think of, others did. I noticed that someone with a Geiger counter was checking readings on all the patients and the environment.”
O'Reilly described a particular area off the ED where the staff brought clothing and other evidence for the police. “Sadly, we had to look into shoes for body parts.”
KATIE MARENGHI, BSN, RN, MASSACHUSETTS GENERAL HOSPITAL
Katie Marenghi was working in the ED's acute area that day.
Figure. Katie Mareng...Image Tools
“We were incredibly busy already that morning when the disaster phone came on. ‘We're en route… patient with a right leg partial amputation… not responding… blood pressure dropping… not intubated yet. There may be more victims. ETA five minutes.’
“I thought, ‘Oh God,’ and told the ED attending and our resource nurse that it sounded like we needed to clear rooms out now. The inpatient-unit resource nurses began to call the ED to pull appropriate patients upstairs to help decompress the ED.
“My first patient rolled in. She had lost a lot of blood and was unresponsive. We applied tourniquets and pressure and rapidly transfused blood. She began to regain consciousness, barely arousable but tearful. I kept saying, ‘You're okay, you're safe. We're going to take away the pain. We're going to put you to sleep and get you to the OR.’ And I said what I always say to badly injured patients, my favorite thing: ‘We're going to take really good care of you.’ We medicated, intubated, and paralyzed her, readied her for travel, and the respiratory therapist and orthopedic surgeon quickly wheeled her into a waiting elevator and to the OR. By this time, there were more patients rolling in.
“I'll never forget that day and how everyone rose to the occasion. We were calling out, ‘Call the OR and tell them… ’ ‘Call the blood bank and tell them… ’ ‘Send a runner for… ’ ‘We need this, we need that.’ All the support staff, from transporters to unit coordinators, were fabulous. Every single thing we needed appeared.”
GRETTA MORRIS, RN, BOSTON MEDICAL CENTER
Gretta Morris had run the Boston Marathon four times herself and knew “metabolic madness” well—dehydration, hyperthermia, “labs” way off. But she would see no runners that day, only spectators.
Figure. Gretta Morri...Image Tools
“Someone said that there was a blast at the Copley [Hotel]—maybe fireworks. Then we heard it was a bomb; then the first victim rolled in—pale face, nothing below her knees, great loss of blood.
“And so it began, the controlled chaos—I can hear it in my head now. Very organized. ‘We have everything. We do constant drills,’ I told myself, and I began to triage the walking wounded, periodically going to the back to help get fluids and blood ready.”
Morris describes the amazing way everyone worked together. Physicians came running; nurses came in. Staff working at the [on-site first aid] tent came in.
“It was a horrible thing, but it ended up with so many people showing kindness to patients and to frantic families. So many positive things came out of it.
“We see a lot of trauma at Boston Medical Center. MedFlight comes in daily; we're ready for anything. But that day was different. There were just a couple hours of controlled chaos—treating patients, keeping track of patients, uniting them with family… and then calm descended on the ED. It all ended for us, but for those patients, their new [lives were] just beginning.”
JESSICA SEXTON, BSN, RN, BOSTON CHILDREN'S HOSPITAL
Jessica Sexton was off on Marathon Day, watching the race with friends. They heard the loud booms but thought it was cannons going off for Patriots’ Day.
Figure. Jessica Sext...Image Tools
“We left, saw the news, and I called the ED coordinator. I was there within 10 minutes. I wanted to be there; I needed to be there. Everyone did. It felt better to be at work.
“I saw some of the newer staff looking for guidance, and I encouraged them to focus on what they knew. We had a lot of people from other places—transport teams, the ICU—come down, and I helped orient them, and looked to see what could be done, even small tasks. With some victims, I just listened. As ED nurses, we want to fix problems, and there were things there that we couldn't fix. That was the challenge.
“During the day, I remember how calm it stayed and how focused [we were], even with all the chaos outside. [It wasn't] just patients from the bombing site; there were other patients as well. We still maintained a sense of calm for everyone there that day.
“I was so impressed by my colleagues. It wasn't one person, it was everyone. Didn't matter what their title or role was.”
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