Transcript: Mass General Hospital press briefing on the Boston Marathon bombing victims – April 15, 2013

Partial transcript of remarks by Dr. Peter Fagenholz on the Boston Marathon bombing victims treated at Massachusetts General Hospital. The press briefing was held on the evening of April 15, 2013:

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Obviously, it’s upsetting to see so many people come in so quickly with bad injuries like that.

Question:
…8 are now in critical condition, including some in very critical condition?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
That’s correct. There have been 29 patients seen here total. 8 are in critical condition and many of those are very seriously ill.

Question:
What kind of injuries are we talking about?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
There’s a variety of injuries. Probably the most common serious injuries are combined lower extremity injuries – combined meaning bone injuries, soft tissue injuries, and vascular injuries to their lower extremities.

Question:
Are you seeing shrapel-type injuries?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Yup.

Question:
Can you describe…?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
So we’re seeing a lot of shrapnel injuries. Many of those involve, again, predominately lower extremities. But shrapnel injuries can affect the entire body.

Question:
Please describe the scene when people are coming in?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
The patient who came in was probably the most severe. We had 3 of the most critically ill patients come in about the first 15 minutes. You know, at that point, we didn’t know if that was – that did turn out to be the tip of the iceberg – if that was going to be the tip of the huge iceberg or not. I think actually everybody were prepared for that type of situation so the hospital activated its incident command system and within about 5 to 10 minutes, we had everything pretty much up and running.

Question:
What are the ages of the victims?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
I don’t have that information precisely.

Question:
Were there amputations?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Yes, we have performed several.

Question:
How many?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
I can’t tell you the total.

Question:
Could you tell us how many patients you personally have treated and I think we’re all interested to hear have any of them been able to communicate with you what they saw, what they witnessed, what they went through?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
So a number of patients have been able to talk. Most of them we’ve kept it business only, to be honest. So in terms of what affects their clinical condition precisely. So you probably know more than I do about what happened at the scene at this point.

Question:
How many have you been able to treat?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Well, the hospital’s treated 29. I have operated on 6 so far today.

Question:
Five patients were unidentified earlier. Have you identified all of the patients?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
I don’t know if we’ve identified everyone. Some of the patients who came in unidentified have now been identified.

Question:
How many remain in the hospital?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
I don’t know.

Question:
There have been a lot of questions, doctor, about family trying to reach their loved ones any difficulties they may be having. Have you had any indication from the patients that you’ve seen that they’ve been able to reach their loved ones their family members to be able to find them at Mass General at least?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Some of them we have. Some of them we haven’t. Some who were initially unidentified – it took at least a couple of hours. I know some of the patients I personally treated it took a couple of hours to find family. I don’t know if the 29 total or particularly the 11 who are – I’m sorry, 8 who are in critical condition if we’ve been able to reach everybody.

Question:
[Inaudible]

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Again, I’m not sure. I am not taking care of any runners. But of the 29 people there certainly may have been some runners.

Question:
[Inaudible]

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
No. There’s a lot of small metal debris. Some people have asked already about whether these were BBs or they were parts of the bombs and I just don’t think we’re able to say whether these are small bits of metals that were placed there intentionally or whether they were just part of the environment that were involved in the blast.

Question:
Do you think the people who are in critical condition at this point are things looking okay for them or…?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Well, they’re not looking okay because that’s not what critical condition means unfortunately. It’s really too early to say how everybody is going to do.

Question:
How long will this process continue with the 8 critical? Are we talking about hours?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
A number of patients require repeat operations tomorrow and serial operations over the next couple of days. So as I mentioned a lot of the injuries are combined – they’re combined bone and soft tissue and vascular injuries, and they have to be approached oftentimes in kind of a step-wise fashion.

Question:
How about their eardrums? Are you seeing any shattered eardrums?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Yeah, we have seen at least one, which is not uncommon with blast injury. One of the things on the to do list for tonight for me and the residents is actually to go right back around. It can be hard sometimes, particularly if people are being rushed to the operating room, to get a good exam and repeat all of those exams because that’s obviously something you don’t want to miss.

Question:
Can you give us an age range?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
There were no pediatric patients. Here we define that as somebody under 18. So that’s actually all I can tell you. The oldest patient I took care of personally is 71. I think that’s the oldest patient…

Question:
What was the most horrific thing you saw?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
I mean it’s just depressing that, you know – we take care of accidents all the time and it’s just depressing that it’s intentional.

Question:
Have you ever seen anything like this?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
You know, the injuries are not other-worldly but no I can’t say I’ve ever seen this volume of patients come this quickly with this type of injury.

Question:
Can you elaborate on what you mean by not other-worldly? Some of the initial reports that you’ve heard of appears that these devices may have been IED-like or crude in nature…

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Any traumatic amputation is a gruesome injury but it’s something that we do see from time-to-time in the course of daily life even outside of this type of event.

Question:
Do you think about much about what was happening or does it kick in automatically?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
No, I mean, this is just – this is work. So when this happens we just go to work.

Question:
The patients in critical condition – can you elaborate on their injuries?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
I’m hesitant to give you kind of a run-down of each of the 8 – one by one by one. Again, the dominant injury have been combined, complex lower extremity injuries involving blood vessels, bones, and soft tissue.

Question:
…combat medical experience…?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
One of my partners actually has been deployed to Iraq and Afghanistan and I think has the most personal experience with these types of injuries. He’s been here most of the night. But I haven’t talked to him directly about how does this compare to what you see in the field.

Question:
Did any of them say something that gave you a sense of what this was like for them?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
No. No. I mean, people – they want help in this kind of situation and my experience today is not unlike, I guess, other similar circumstances. I mean, people – they’re pretty brave, you know? It’s a terrible thing and I think most patient’s attitude is just do what you have to do and try to make me better.

Question:
[Inaudible]

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
Some conscious, some unconscious.

Question:
Can you describe a little about the scene in the ER when this first happened?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
We just got a series of patients on stretchers. Actually, none of them with the first wave – even some that were very seriously injured. None of the first few had breathing tubes so they were able to talk even if they were in and out a little bit. When it kicked off, the most severe injuries were really these lower extremity injuries and so we had about 3 in the first 5 or 10 minutes. And that’s when it became clear to us that it was going to be a busy day.

Question:
…you were all trained by Israeli disaster first responders? How did that help today?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
I was not trained by Israeli disaster first responders.

Question:
…Have you seen any of those bright signs in all of this horror?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
What I can say is within the hospital certainly. Everybody rose to the occasion. I mean, we had people who were out of town who flew back in here and somehow made it back in within hours from nursing staff to ancillary staff to operating room staff to specialists and really all of the different disciplines. We have as much or more manpower or people power than we can use. I can’t speak to the larger scenario. Although I was asked by the hospital to mention to anyone who’s willing to donate blood specifically that it’s appreciated, that right now we’re okay. If they can not forget that sentiment over the coming days to weeks – we are going to use a lot of blood with this incident and it will need to be replenished.

Question:
…bio hazard residue – how is that processed?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
No. To my knowledge they have not been. They were not quarantined in the emergency department.

Question:
We heard that at the hospital that all non-elective surgeries were being put on hold because of the number of patients coming in. What’s the status of that…?

Dr. Peter Fagenholz, Trauma Surgeon at Mass. General Hospital:
I can’t tell you that. I would be surprised if all non-elective surgeries. I can tell you that for our general and emergency service, we did cancel our scheduled cases for tomorrow and we’re just going to have to sort them out for the next couple of days.

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