How lessons from treating combat wounds helped save lives in Boston

A battery of surgical and even forensic skills came into play for surgeons and other providers treating victims of the Boston Marathon bombings.

Surgeons employed techniques their military counterparts learned from treating combat wounds, including blast injuries, The New York Times reported today.

Military surgeons learn to prioritize treatment of complex injuries that shatter bones, blood vessels and soft tissue, the Times reported. Urgent, life-threatening medical problems come first--in this case, stopping the bleeding from devastating wounds and full or partial amputations.

Vascular surgeons close torn blood vessels or, when possible, repair them to restore blood flow to extremities. Orthopedic surgeons use temporary measures such as pins and metal bars to stabilize shattered bones. Plastic surgeons clean soft-tissue wounds, removing nails, BBs and other embedded debris and saving them for investigators, the Times noted.

Debris collected during surgery is handled like a pathology specimen, Oscar Guillamondegui, M.D, of Vanderbilt Multidisciplinary Traumatic Brain Injury Clinic in Nashville, Tenn., told MedPage Today. It is bagged or containerized, sealed and documented to ensure chain of custody, he said. Pathologists turn the evidence over to law-enforcement authorities.

Foreign debris from wounds also is collected and saved in the emergency department, Louis Alarcon, M.D., medical director of trauma surgery at University of Pittsburgh Medical Center, told MedPage.

Emergency physicians at UPMC follow a standard evidence-collection process that outlines details such as whether to use plastic or metal instruments to pull objects from wounds, he said. The wrong instrument could damage, or "deform," the object. Record-keeping for collected items includes noting every person who comes in contact with the items, Alarcon added.

After they are stabilized, doctors observe patients for several days to better assess the extent of damage, according to the Times. Patients often undergo multiple surgeries in the ensuing days and weeks.

To learn more:
- read the Times article
- here's the MedPage Today article

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