Lessons learned in Afghanistan, Iraq may help Marathon bombing victims
By David Burge | El Paso Times, Texas | Published: April 17, 2013
EL PASO, Texas — The two bomb blasts that ripped through the finish line area at Monday's Boston Marathon have caused mayhem and injuries similar to those seen during the wars in Iraq and Afghanistan, Army medical experts said Tuesday.
But lessons learned during the past 10 years of war may also help the injured in Boston, they said.
The blasts killed three people and wounded more than 170. Injured runners and spectators sustained broken bones and head injuries. Some of the victims have had limbs amputated.
People who witnessed the blasts but escaped injury could also be affected by acute stress in the first few days and post-traumatic stress disorder in the long term, experts said.
"It's tragic," said Lt. Col. Brian Sonka, a surgeon and trauma medical director at William Beaumont Army Medical Center. "It sounds to me like the injuries may mirror the injuries we see overseas in the combat hospitals."
During the past decade, the Army has learned several important lessons during the wars in Iraq and Afghanistan, and those are being applied to the situation in Boston, Sonka said.
"In the past 10 years, there has been a revolution in the way we manage massive hemorrhaging," Sonka said.
It started with work done at the Ibn Sina hospital in Iraq and has now become common practice, Sonka said.
This new method is called hemostatic resuscitation.
Simply put, patients are given transfusions of clotting agents much earlier than they used to be, Sonka said.
"If you picked up textbooks even from 2005, they don't mention that stuff," Sonka said.
The Army has also learned that tourniquets, which developed a bad reputation during the Vietnam War, can also be a major help by preventing massive blood loss and shock, Sonka said.
Tourniquets "buy time" until victims can get to the hospital, Sonka said.
Lt. Col. Kenneth Nelson, an orthopedic trauma surgeon at Beaumont, called the situation in Boston "horrific."
"But they've got fabulous medical centers in Boston and great doctors," Nelson said. "I doubt they routinely take care of blast injuries, but they routinely take care of trauma like car accidents, falls from heights. There's a lot of similarities. They are also familiar with the research that's being done with war wounded."
Those who were injured in Boston are benefiting from all the research that's been done by the Army on pre-hospital care and "all the stuff we've done on how to take care of blast injuries," Nelson said.
"If you have to get blown up, it's better now than 10 years ago," Nelson said. "In the past 10 years, soldiers have started surviving blast injuries that were previously lethal. That's predominantly due to better body armor and vehicle design.
"But we also have a better casualty evacuation system, better equipment for combat medics and better training," he added.
All of that is available through research published by Walter Reed and Brooke Army medical centers, Nelson said.
Col. Dale Levandowski is a psychiatrist and chief of the Department of Behavioral Health at Beaumont.
The injuries sustained by runners and spectators at Boston are similar to what a small Army unit receives when soldiers are on patrol and run over an improvised explosive devise, or homemade bomb, or one is set off close to them, he said.
Levandowski has deployed twice — once to Iraq in 2005-06 and to Afghanistan in 2010.
The Army's ability to treat blast injuries has grown phenomenally in the past 10 years, Levandowski said.
"It's a very, very small percentage that die from blast injuries because we have such good care capabilities even in a deployed environment," he said. "However, the issue goes downstream in terms of rehabilitation and the quality of life for those who have suffered blast injuries."
People who have lost limbs, for instance, face the struggle to find new meaning in their lives, he added.
Those who witnessed the attack in person could also be at risk of developing what is called acute stress during the first month after such a traumatic experience, Levandowski said.
They have experienced "intense fear or horror," Levan dowski said.
Normal reactions in the initial days after witnessing such an event include having recurring thoughts of it, feeling like it's surreal or that it's detached from them and having nightmares.
"It's just our bodies' and heads' way of making sense out of something that is incredible and out of the normal range of experience," he said.
These are all normal psychological responses, and 75 to 80 percent of people see those symptoms diminish within a month, Levandowski said.
Fifteen to 20 percent may develop post-traumatic stress disorder. They may experience persistent nightmares, are hyper-vigilant against possible threats and avoid loud places that may remind them of the incident, he said.
But medicine and the Army have also made advances in dealing with post-traumatic stress disorder through a variety of therapies, Levandowski said.
These include methods for mastering emotions and thoughts associated with the trauma, he said.
Louisiana National Guard Staff Sgt. Steven W. Williams, 40, of Denham Springs, La., suffered a severe back injury while serving in Iraq and deals with post-traumatic stress disorder. He currently lives in El Paso and has been getting treatment through the Warrior Transition Battalion at Fort Bliss.
Like many other Americans, Williams said he had a hard time processing what he saw during the Boston Marathon.
"First thing I thought of, we train for those kind of situations," Williams said. "It was unique to see it on American soil. It's kind of a shock. We knew it would happen again (after 9/11) but we didn't know when, where or how."
Those who were wounded can expect their recovery to be slow and tedious, Williams said.
The injured and the emergency responders such as police and firemen also should seek some form of counseling sooner rather than later, Williams advised. That will lessen future problems, he said.