This article first appeared in the St. Louis Beacon, April 23, 2013 - A week after the Boston Marathon bombing, one bright spot has been the hope following the horror as modern medicine helped to treat the wounded and reduce the casualty count, some local trauma surgeons say.
Drs. Grant Bochicchio of Washington University and Bradley Putty of Saint Louis University say that the lessons learned from years of traumatic injuries to soldiers in Afghanistan and Iraq have been put to good use in treating civilians injured by explosives at home.
In a matter of days, police identified two suspects, ethnic Chechen brothers from Russia, in the explosion. One, 26 years old, died Friday in a gunfight with police; the other brother, 19, was captured after suffering a gunshot wound to the throat, according to news reports. Three people were killed and more than 170 people were wounded in the bombing.
The local trauma surgeons say they were horrified by the incident but took comfort in their belief that more lives might have been lost in the absence of growing trauma-care expertise developed from treating victims of terror attacks on American and coalition forces in Afghanistan.
Bochicchio, chief of acute and critical care surgery/trauma, at Washington University School of Medicine, also conducts trauma care research for the Department of Defense. He says the injuries in a bombing like the one in Boston takes two forms. Some are associated with air pressure that causes or produces traumatic brain injury. Others are associated with IEDS or improvised explosive devises, such as pellets and other material growing out of a blast.
Though many people may recoil from knowledge that some of the victims in Boston suffered internal injuries from pellets from the bomb, Dr. Bochiccho says the pellets might not have been a major medical concern of trauma surgeons.
“If the pellets are causing bleeding, we actually treat the bleeding itself,” but, he says, surgeons don’t necessarily remove pellets lodged deep within body tissue. “They eventually may wiggle their way out on their own. If they cause infection, we may go after them. But what we’ve learned is, even with shotgun injuries where people receive hundreds of pellets, digging them out doesn’t do much to benefit to the patient.”
He says, “We’ve actually learned a lot,” adding that the conflict in Afghanistan “has actually been extremely beneficial” in helping surgeons and others develop medical products. Examples, he says, are medicines that can be applied to blast wounds to prevent victims from bleeding to death before medical attention is available.
One product, still to be studied, involves injecting a foam into the abdomen to stop internal bleeding until the victim can be cared for. “If somebody (like a medic) could inject this foam into your abdomen, it could save your life,” he says.
Other research holds promise for treating the consequences of air pressure from blasts that result in traumatic brain injury, he says. A product he is studying for that purpose is glyburide, now taken by mouth to treat type 2 diabetes. Bochicchio and colleagues have found that the drug works in reducing swelling and blood loss after an injury to the brain and spinal cord. He says soldiers and civilian blast victims might eventually be able to use the drug to ward off lethal swelling from traumatic brain injuries.
SLU is home to a unit of the Air Force’s Center for Sustainment of Trauma and Readiness Skills Program, also known as C-STARS. Putty, one of the SLU trauma surgeons affiliated with C-STARS, says the program offers plenty of experiences to help the military take care of a range of injuries stemming from blasts.
“These result from indirect fire from rocket-propelled grenades, for example, or from IEDS, improvised explosive devices, like the one that occurred in Boston.”
He says surgeons have learned to recognize the injury patterns, but the injuries continue to “present a challenge to rehabilitating the patient.” Even so, he says, “we’re actually much better in evacuating patients more quickly and giving them a high level of care. We are now able to save patients who probably would have died before reaching medical care" in the past.
He also took note of progress in prosthetics. Severe injuries meant limbs of some of the victims in Boston had to be amputated.
“There have been so many advances in prosthetics for those who have lost limbs,” he says. Victims undergo amputations nowadays, “and yet they are out there competing in cycling, wheelchair races, skiing and other activities. It’s very impressive.”
In the comments of these trauma surgeons, there is an implicit point that war has benefitted modern medicine. Putty even worries that the next generation may have less trauma-care expertise in the event no major U.S. conflict follows the war in Afghanistan, which is winding down.
The tendency, he says is to “learn (medical skills), try them in situations, then forget them later. One of the challenges for us as military health-care providers is to record and maintain the lessons so that the lessons needed can be used to train the next generation.”
Washington University has set into motion one system to share with surgeons around the world some of its knowledge of peripheral nerve injuries. The idea came from Dr. Ida Fox, a member of the medical school, who has started a website for sharing this medical expertise. The target audience, the university says, has been surgeons treating soldiers injured in Iraq and Afghanistan.
Trauma surgeons, who served overseas, have had to respond both emotionally and professionally to the carnage in Boston. It's disturbing to return to America and feel “you can’t go to a recreation activity without thinking this could happen,” Putty says.
He adds that if a domestic attack, however unfortunate, had to happen, he is "glad it happened in Boston where you have (C-STARS) colleagues who are part of a robust trauma system.”
Putty says he and colleagues who have used their trauma-care expertise in many hot spots are confident in dealing with attacks like the one in Boston. “They are the kinds of injury patterns you’ve seen before, so you have a lot of experience in taking care of the victims,” he said.
