Transcript: Mass General Hospital press briefing on Boston Marathon bombing victims – April 16, 2013

Partial transcript of remarks by Dr. George Velmahos, Chief of Trauma Surgery, and Dr. Alasdair Conn, Chief of Emergency Services, on the status of Boston Marathon bombing victims treated at Massachusetts General Hospital. The press briefing was held on April 16, 2013:

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
At this point, we have stabilized their vital signs and their hemodynamic situation is under control.

Question:
What are their injuries…? [Inaudible]

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:

Most of the injuries were, again, lower extremity, major injuries, and they bled a lot. We controlled the bleeding rather rapidly but certainly they lost a lot of blood, in fact, created a lot of physiologic problems.

Question:
…the nationalities of the people you treated?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
As far as I know, all of them are Americans.

Question:
Can you tell us about the age range of your patients?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
The younger patient so far was 28 years old and the older patient was 71 years old.

Question: [Inaudible]

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Most of the patients that are in the intensive care unit are still intubated, therefore they cannot be interviewed.

Question:
Can you tell us about their emotional state and that of their loved ones?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
It’s obviously an extremely sad day for all of us but even more so for the patients and for their relatives. I had the pleasure of interacting with many of the relatives and obviously they’re shattered by the events. We’re offering emotional support and we’ve pulled all our resources in order to support these patients not only for their disease but for their emotional status.

Question:
Has everyone been identified?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
At this point, everybody has been identified.

Question:
Doctor, you seem to talk a lot about injuries to the lower extremities. Is it unusual they have such a concentration of injuries to the lower extremities like that in a blast or would there be more multiple body – head – ?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
It’s not unusual. This bomb obviously was placed probably low on the ground and therefore lower extremity injuries are to be expected.

Question:
And there was no internal bleeding?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
There are on a few patients some internal problems that we still are working up and I don’t have further information on this one.

Question:
Are all patients conscious or are any unconscious still?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Most of the patients are conscious but we do have patients who are medically sedated in order to alleviate the pain at this point and therefore we don’t have a full evaluation of their mental status yet.

Question:
Did you screen for biological or radiation in these patients?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
It doesn’t appear that we have an issue with that at this point.

Question:
You mentioned that there are complications from the blood loss – what are those complications?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
The complications from the loss is that the heart may de-compensate and multiple other organs in the human body may be driven into failure because of the blood loss. But we were very rapid in replacing the lost blood and I think that for the most part we’ve saved the patients from these problems.

Question:
Can you give any estimation of percentages of patients who are runner or spectators?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
I don’t think any of them were runners. I think that they were all spectators. That’s correct, we did treat some runners but we have not included – those are the 3 patients that I said we received from the marathon but they were not traumatically injured and one was observed overnight and the others were treated and released.

Question:
Has anyone talked to you about what happened, what they saw?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Not to me in the Emergency Department. No, we haven’t had any more information. Unfortunately, the teams were extremely busy and concentrated on providing care. We try to focus on that and do nothing else but that.

Question:
As the investigators conduct their investigation, do they have to clear it with you before they can go and speak with the patients?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Well, we are always there by the patients and we make sure that they not suffer unnecessarily at this early point. So we are all in communication to make sure that the patients can talk only when they can really talk.

Question:
Can you tell us how many are medically sedated?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
I believe there must be 6 or 8 at this point. The last time that I saw the patients was about an hour ago and depending on what has happened to two of them, it’s between 6 and 8.

Question:
[Inaudible]

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
I think the prognosis will be probably okay. I think we stabilized these patients well. They have stopped bleeding. There are still things to be done but I really hope the outcome will be optimal.

Question:
[Inaudible]

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
I think the first patients may actually be ready to be released in a few days but this is too early to predict that.

Question:
[Inaudible] …have you ever seen something like this before?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
To that extent, no.

Question:
In terms of severity or quantity?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
In terms of quantity.

Question:
But the four amputations – those are four separate patients correct?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Yes, correct.

Question:
How is your staff doing? Are you well-staffed?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
We were very well-staffed and we were extremely proud of the resources that the hospital placed on this event. Quite frankly, it was one of the proudest moments in my life when we went there in the middle of this mayhem – I saw endless doctors coming from all over MGH to offer their help in a very, very organized fashion. So we absolutely have no problem with staffing.

Dr. Alasdair Conn, Chief of Emergency Services:
I would also add that the timing. Some of the physicians and nurses work from 7 to 3 and then 3 to 11 on the evening shift, and of course the day shift all volunteered and said “We’ll stay here as long as needed.” So that helped us out as well.

Question:
And of the amputees, how many were traumatically amputees versus amputees in the hospital?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Almost all of them had such severe trauma in the lower extremity that was beyond salvation, so I would consider them almost automatic amputees. We just completed what the bomb had done.

Question:
Doctor, would you just report back what the last 24 hours has been like for you and your staff?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
The experience is obviously overwhelming. We are all extremely sad. We are suffering emotionally for what happened to the people of Boston and many others. At the same time, we can’t feel but proud because the medical community here at Mass. General responded in an amazing way. Suffice it to say that some of the trauma group that happened to be outside the city jumped on planes immediately in order to come back and they did come back within hours. One of our physicians was actually running the marathon and dehydrated as he was he came back immediately after he finished the marathon to offer his help. So these difficult moments for all of us but at the same time we feel quite proud for what we’ve been able to offer and extremely appreciative for the opportunity to offer that to the people.

Question:
…the emotional toll – how did that manifest itself with some of your staff?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
We’re all trauma surgeons so we quite used in seeing unexpected events to a very large scale. So even if we are empathetic and we always stay by the side of the patient through the physical and the emotional disaster, we all know how to control our feelings and do what is best for the patient rather than focusing to ourselves.

Question:
How much do you think having all those first emergency workers on the scene, how much did that factor in the survival rate of the people you’re seeing now?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
I think it as an amazing response and as far as I understand, all this details are still not clear and mind you that I spent the larger part of last 15 hours taking care of patients and not learning the details. But I think it was an amazing response, and because of the rapid hospital response, life was able to be saved.

Question:
Is your team exhausted or are they getting rest? Or you able to just keep on pushing forward?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
We keep on pushing forward. Thank God, again, we have endless resources, and we’re able to keep on operating and providing care.

Question:
These extra materials that may have been packed into these bombs, how does that exacerbate the trauma?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Well, after a bomb, there is a number of traumatic injuries, and some of them is a direct effect of the bomb when the extremities are severely damaged or if there is internal bleeding, for example. But then there is secondary injury from the bomb blast – the wave of the bomb that can push people away, can throw them and hit them against walls. And there’s also another form of injury which is from the particles that are broken and embedded in people. So we’ve seen all three of them after this event.

Question:
…all of the shrapnels are environmental and none of it was intrinsic to the bomb…? How do we justify these two opinions?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
It is – I think we’re still getting details of all the events that happened and obviously, it’s very difficult to conclude based on initial impressions. I wouldn’t exclude completely the possibility that some of these fragments are environmental but my opinion is that most of them were in the bomb.

Question:
Doctor, what is the security like in there? Are there guards watching the patients?

Dr. Alasdair Conn, Chief of Emergency Services:
So the moment the intensive care unit obviously have restricted access. There is increased security around all the hospitals in the city and you can see some of the police around this campus. That is a precautionary measure. My understanding is that all of the major hospitals are being given the same protection.

Question:
[Inaudible]

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Because of the consistency of the fragments. Most of them are pellets. Some of them are nail-like. So I think it’s unlikely that they would be so consistent if they were pulled down from the environment.

…Nails. Or sharp objects. I can’t say what they are with certainty but that’s how they look like.

Question:
Do you know how many you’ve taken out?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
They are numerous. Numerous. There are people who have 10, 20, 30, 40 of them in their body or more.

Question:
[Inaudible]

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
We have – we’re working very closely with investigators and we handed them whatever evidence we can find.

Question:
What do you see in terms of resilience in these patients?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
I think that the patients responded really, really well. The patients that were able to talk when they first arrived and they were not immediately sedated and intubated for the purpose of an operation were amazingly resilient, were really pulling it together. And quite frankly because of the patients, our lives were made easier and we were able to provide better are. The patients were really amazing.

Question:
Can you give us some specifics about that?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
Most of the patients were calm. They were responding to our questions. They allowed us to examine them from top to bottom in detail. And they – when we had time to explain our decisions and the course of care that we intended to take, the patients agreed so it was a very, very calm and collected response by the patients.

Question:
Would you say that none of your patients are in danger of dying?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
It is too early to decide that but at this point, I’m extremely happy with how things are going.

Question:
Doctor, how do you tell someone that you might have to take their limb?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
It is a devastating thing. It is extremely difficult to come to this. But mind you, these patients who had amputations were the most severely ones – severely injured ones. And therefore quite frankly, these were the ones that were immediately intubated, immediately rolled into the operating room, and there was no real time to have a lengthy discussion. The focus was on saving their life from bleeding.

Question:
Are any of the patients related to each other?

Dr. George Velmahos, Chief of Trauma Surgery at Mass. General Hospital:
As far as I know, we don’t have any patient at MGH that is related to each other. I don’t know whether there are relatives of them that are transferred to other hospitals in Boston.

Dr. Alasdair Conn, Chief of Emergency Services:
And that is the case. We have patients here who have relatives who have been admitted to other Boston Hospitals.

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