Radiologic Imaging Helped Boston Marathon Bombing Victims

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Based on a study published in Arthritis Care and Research (AC&R), radiologic imaging of explosion injuries served a crucial role in an immediate emergency response to the Boston Marathon bombing. The discoveries highlighted pin-point timing and utilization of imaging systems and methods.

"In an era of terrorism, even clinicians serving non-military patients need to understand the spectrum of injuries caused by bomb explosions. Critically ill bomb-blast patients needed quick assessments of their injuries, which had the most devastating effects to the lower limbs,” said lead author and professor of radiology at Boston University School of Medicine in Massachusetts, Ali Guermazi, MD.

Rheumatologists who are not usually engaged in severe trauma care could possibly be employed as first responders in similar cases and could additionally treat victims at a later date, aiding them in their recovery process from difficult musculoskeletal injuries.

Guermazi and some of his peers who treated injured civilians of the April 15 Boston bombing sent in their article to AC&R, all on their own accord.

“AC&R was interested in the topic, given the long-term sequelae of traumatic joint and muscle injuries that often require treatment by rheumatologists, healthcare providers, nurses, and physical therapists who specialize in rheumatic diseases," said AC&R Editor-in-Chief Marian, senior scientist, Institute for Aging Research, and associate professor of medicine at Harvard Medical School in Boston, T. Hannan, DSc, MPH.

"As a Boston-area resident with many ties to Boston hospitals, I was personally concerned with the many persons involved in the Boston Marathon bombing incident. Any good that could come from this tragic event, such as the information contained in the article, will help overcome the overwhelming sense of loss and sadness."radiologic imaging boston marathon

Hannan also serves as co-director of musculoskeletal research at Hebrew SeniorLife in Boston.

As tightly compacted air from the explosion moves, it do significant harm to the lungs, bowel, and ears. In addition it also spawns a void, referred as the ‘blast wind,’ that draws wreckage back toward the explosion.

The Centers for Disease Control and Prevention believe that traumatic amputation takes place in up to 3 percent of bomb survivors with soft tissue and musculoskeletal blast injuries.

"This article highlights the important information that can help in any future situation with overwhelming trauma, both for immediate responders, emergency personnel, and those treating the trauma patients long-term, especially those requiring rehabilitation of lower extremity injuries. In any traumatic situation, there are insights to be gained for the medical community and those healthcare providers for long-term benefit and understanding for the trauma patients as long as we document the findings with an aim to improve future situations,” said Hannan.

Three deaths and 264 injured, including soft tissue damage, limb fractures, and amputations was the result of two pressure-cooker bombs that were detonated at the finish line during the Boston Marathon event. Those who were within closer proximity to the explosion sustained more acute injuries to their lower limbs as shrapnel such as metal, nails, among other materials, penetrated the skin.

"The level of response from the Boston area responders, both immediately at the scene and in the hospital settings, was key to the treatment success and the ability to minimize long-term damage to many of the Boston Marathon bombing patients," said Hannan.

Immediate imaging was vital for evaluating such injuries. Many patients were subjected to one or more operations, and rehabilitation from their injuries as many patients’ injuries were projected to long and difficult to cope with during the recovery process.

The study suggested thoroughly investigating each extremity for open wounds and musculoskeletal, neurological, and vascular injury; requiring them to be recorded and photographed. As recommended by prior studies, free use of radiography and computed tomography (CT) can locate alien objects, define basic penetration patterns, and evaluate bony and soft tissue damage.

Pressing surgical involvement is called for large foreign body removal, penetrating blood vessels, hemostasis, damaged tissue debridement, and amputation. When the patient is secure following surgery, radiography and more detailed imaging can commence.

Magnetic resonance imaging (MRI) and ultrasound are quite ineffective in the delicate condition because of their long processing times and the possible movement of entrenched metallic shrapnel. If vascular injury is determined, computed tomography angiography is the recommended course of action, as well as traditional angiography in some instances for vascular intervention under fluoroscopic guidance.

For the many lower extremity injuries from the Boston Marathon bombing, medical imaging and noting the elements of the soft tissue injuries were key aspects that should be highlighted for future treatments and understanding of the injuries and outcomes. There is also a tremendous impetus to gain the positive insights amidst the sadness and loss that prevail in many of these traumatic events, both for patients and their providers of rehabilitation,” said Hannan.

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