Lessons Learned from the Boston Marathon Bombing

The Boston 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. Of 243 injured, 152 patients presented to an emergency department within 24 h. Of these 152 patients, there were 66 suffering at least one extremity injury, with ages ranging from less than 15 to 71 years old. Of the 66 patients with extremity injuries, 4 had upper limbs affected, 56 lower limbs only, and 6 combined upper and lower limbs affected. There were 17 lower extremity traumatic amputations in 15 patients. Additionally, there were ten patients with 12 lower extremities suffering major vascular injuries. In total, 29 patients had recognized extremity exsanguination at the scene. Twenty-seven tourniquets were applied to these 29 patients: 16 of 17 traumatic amputations, 5 of 12 lower extremities with major vascular injuries, and six additional limbs with major soft tissue injury. All tourniquets were improvised and no commercial, purpose-designed tourniquets were applied or used. Although the mortality rate among the 243 injured was 0 %, 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.