Marathon Bombings: An EM Physician's First-Hand Account

Marrecca Fiore

April 22, 2013

Parveen Parmar, MD, was barely 3 hours into her shift at Brigham and Women's Hospital in Boston, Massachusetts, on April 15, when her emergency department (ED) was notified that a blast had occurred at the Boston Marathon.

"The blast happened at 2:50 and very shortly afterwards we got notification from EMS that the blast had occurred and we should expect several patients," said Dr. Parmar, a physician and instructor of medicine in the hospital's ED.

The ED immediately called a Code Amber, a term it uses to describe an external incident that may result in an influx of patients to hospital.

"We had no idea how many patients to expect," she told Medscape Medical News. "We had to clear space, so the first order of business was that anyone in the emergency department had to be moved up to an inpatient unit. We did that immediately and the patients came in very quickly, within minutes."

Thirty-one patients came into the ED on that Monday afternoon following the blasts. A few more patients were sent to the hospital the next day, resulting in a total of 36 bombing victims treated at Brigham and Women's.

Dr. Parveen Parmar

"I had worked in humanitarian response and disaster preparedness internationally, but I hadn't ever been part of this type of mass casualty event. This was a very different experience," Dr. Parmar said.

"You saw a lot of what you would expect with these types of blast injuries," she continued. "There were a lot of soft tissue injuries and broken bones, as well as ruptured eardrums and burns. A lot of the injuries were to the lower extremities where shrapnel was found."

The youngest patient to come into the ED was aged 3 years, Dr. Parmar said. That child was immediately stabilized and sent to nearby Children's Hospital. The remaining patients were aged 16 years and older.

"Fifteen needed admission to the hospital, 9 were taken to the [operating room], and 5 were in critical condition," Dr. Parmar explained.

Lessons Learned

As of April 22, 10 patients remain at Brigham and Women's and none are in critical condition.

In the week since the bombings, Dr. Parmar said, the hospital's staff has spent some time going over its disaster management plan.

"There's been a lot of discussion and thankfully what we're really seeing is that the plan really worked well this time, which is a nice thing to realize," Dr. Parmar said. "We were able to clear the ED very quickly. We had teams of trauma and orthopedic surgeons standing by, and we had not only ED physicians, but also internal medicine physicians standing by and ready to help. I think the response went really well from our standpoint, but we will continue to evaluate it going forward."

The hospital and the community are helping both medical personnel and others process the events of April 15.

"At the time everybody goes into work mode, and people were all very efficient and professional for our patients, and that's continued over the subsequent days as patients required ongoing treatment," Dr. Parmar added. "But definitely something like this not only affects the staff but the city as a whole, and we've been having discussions about how to best address those needs. And there are programs that hospital has made available to help those who were affected by the scale of this type of emergency."

The hospital planned to hold a moment of silence today at 2:50 PM to remember the victims.

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