Marathon bombing was the first major, modern US terrorist event with multiple, severe lower extremity
injuries. First responders, including trained professionals and civilian bystanders, rushed to aid the injured. The purpose of this review was to determine how severely bleeding extremity
injuries were treated in the prehospital
setting in the aftermath of the Boston
A database was created and populated by all the Boston
Level I trauma centers following the Boston
Marathon bombing. Data regarding specific injuries, extremities affected, demographics, prehospital
interventions (including tourniquet
types), and outcomes were extracted.
Of 243 injured, 152 patients presented to the emergency department within 24 hours. Of these 152 patients, there were 66 (63.6% female) experiencing at least one extremity
injury, with age ranging from younger than 15 years to 71 years, and with a median Injury Severity Score (ISS) of 10 (range, 1–38). Of the 66 injured patients, 4 had upper limbs affected, 56 had injuries on the lower limbs only, and 6 had combined upper and lower limbs affected. The extremity
Abbreviated Injury Scale (AIS) scores had a median of 3 (range, 1–4). There were 17 lower extremity
traumatic amputations in 15 patients. In addition, there were 10 patients with 12 lower extremities experiencing major vascular injuries. Of 66 injured patients, 29 patients had recognized extremity
exsanguination at the scene. In total, 27 tourniquets were applied: 16 of 17 traumatic amputations, 5 of 12 lower extremities with major vascular injuries, and 6 additional limbs with major soft tissue injury. All tourniquets were improvised, and no commercial, purpose-designed tourniquets were identified. Among all 243 patients, mortality was 0%.
After the Boston
Marathon bombings, extremity
exsanguination at the point of injury was either left untreated or treated with an improvised tourniquet
in the prehospital
environment. An effective, prehospital extremity
hemorrhage control posture should be translated to all civilian first responders in the United States and should mirror the military’s posture toward extremity
bleeding control. The prehospital
response to extremity
exsanguination after the Boston
Marathon bombing demonstrates that our current practice is an approach, lost in translation, from the battlefield to the homeland.
LEVEL OF EVIDENCE
Epidemiologic study, level V.