Physicians on Scene at Boston Marathon

[wanderingmedic]

Two thoughts:

1) Our thoughts and prayers go out to those affected by the attacks.

I do not mean to criticize the job Boston's first responders did, many of them faced one of the most difficult days of their career yesterday. We stand behind them 110%

2) Why the did Boston deploy Physicians to the scene? What could a physician do at an MCI scene that a medic could not do? What was the benefit of deploying physicians / why is it worth deploying them with the risk of a secondary explosion targeting first responders?

 

[Aidey]

What makes you think they weren't already there? An even like the Boston Marathon will have a large medical presence, including nurses, doctors and midlevels to attend to the athletes. We have a couple of large outdoor sporting events in my city, and the local hospitals, sports med clinics, and orthopedic clinics always staff medical tents in addition to the EMS presence.

Since the doctors were already there, there is no reason they shouldn't be involved in the medical care of the wounded.

 

[Household6]

Maybe I'm not understand your question? But the physicians were already there tending to runners. Supposedly this happened right next to the medical tent where the MDs were working..

Right?

 

[wanderingmedic]

But the physicians were already there tending to runners. Supposedly this happened right next to the medical tent where the MDs were working..

Right?

ok, I assumed that they were deployed there as a part of Boston's MCI plan. They were wearing "Physician Vests" that the other first responders were wearing, and there seemed to be an abundance of them from the pictures on the news.

 

[AtlasFlyer]

My guess is that they were already there, as assistance to the runners if needed.

 

[mcdonl]

ok, I assumed that they were deployed there as a part of Boston's MCI plan. They were wearing "Physician Vests" that the other first responders were wearing, and there seemed to be an abundance of them from the pictures on the news.

They were wearing BAA Physicians Vests... Boston Atheltics Association... sponsors of the race.

 

[wanderingmedic]

They were wearing BAA Physicians Vests... Boston Atheltics Association... sponsors of the race.

ok, that makes sense. oops, never mind then.

 

[joshrunkle35]

I'm sure some of the runners and spectators were physicians, nurses, medics, etc too.

 

[STXmedic]

I know it was pointed out, but just for clarification/emphasis:

It's pretty standard to have physicians on site for major events like that. For example, we deploy our MMU (Mobile Medical Unit) during any major event- marathons, Fiesta, New Years Eve, etc. It's staffed with physicians, PAs, nurses, and paramedics. It's set up on site and utilized as a minor ER.

We do have DMAT teams ready for deployment, which do staff physicians as well. However, typically the field work is primarily done by medics, with the physicians and nurses primarily in the shelters.

 

[Meursault]

Everyone's pretty much already said this, but the Boston Athletic Association's medical team includes physicians with marathon-specific expertise and several medical tents at the finish line set up to treat runners, including i-STAT electrolytes, cooling tanks, etc. We got a ~10-page briefing book on marathon-related conditions and the treatment plan for each.

 

[silver]

Everyone's pretty much already said this, but the Boston Athletic Association's medical team includes physicians with marathon-specific expertise and several medical tents at the finish line set up to treat runners, including i-STAT electrolytes, cooling tanks, etc. We got a ~10-page briefing book on marathon-related conditions and the treatment plan for each.

Also to add, its set up like a controlled MCI. However, they don't generally expect the massive amount of trauma. That being said, the Boston EMS MCI trucks are right there and full of all the supplies needed for such injuries (AKA expect the unexpected).

 

[usalsfyre]

2) Why the did Boston deploy Physicians to the scene? What could a physician do at an MCI scene that a medic could not do?

I'm pretty sure things like surgical control of hemorrhage and open thoracostomy for pneumos, ect are useful for blast injuries. The UK, NZ and Aus have all proven physicians bring cards to the table medics don't. In addition if hospitals start to get overloaded they can begin dealing with the greens/yellows at the scene.

 

[Bullets]

I'm pretty sure things like surgical control of hemorrhage and open thoracostomy for pneumos, ect are useful for blast injuries. The UK, NZ and Aus have all proven physicians bring cards to the table medics don't. In addition if hospitals start to get overloaded they can begin dealing with the greens/yellows at the scene.

Do they actually bring that equipment out into the field? If they are expecting marathon related injuries are they bringing anything to deal with blast injuries? From the footage you see medics with bags and boards, but most of the physicians don't have anything

 

[Clipper1]

Do they actually bring that equipment out into the field? If they are expecting marathon related injuries are they bringing anything to deal with blast injuries? From the footage you see medics with bags and boards, but most of the physicians don't have anything

If there is an ALS truck nearby, a Physician can do a lot more with the equipment in that truck than the average Paramedic.

 

[usalsfyre]

Do they actually bring that equipment out into the field? If they are expecting marathon related injuries are they bringing anything to deal with blast injuries? From the footage you see medics with bags and boards, but most of the physicians don't have anything

Hemostats and sutures are enough to do hemorrhage control, a scalpel can do a thoracostomy (heck you can make a decent chest tube setup with a meconium aspirator and an ETT). A physician will also be able to provide a much better in depth assessment to decide who REALLY needs to be evaluated further and who doesn't.

Also....I'm not sold the medics having boards in a true MCI is a good thing....

 

[medicsb]

The assumption seems to be that the physicians present would know how to perform hemorrhage control via suturing, or thorocostomy or whatever, which is unlikely. I'm betting that most of the docs were residents and that there were plenty more FM than EM and very few surgeons. Besides, why suture when a TQ followed by rapid evacuation will work fine; or, perform a needle decompression instead of trying to macguyver a chest tube?

 

[usalsfyre]

The assumption seems to be that the physicians present would know how to perform hemorrhage control via suturing, or thorocostomy or whatever, which is unlikely. I'm betting that most of the docs were residents and that there were plenty more FM than EM and very few surgeons. Besides, why suture when a TQ followed by rapid evacuation will work fine; or, perform a needle decompression instead of trying to macguyver a chest tube?

Dangit why do you have to ruin an argument like that . FM residents would put a damper on things. That said...what are the surge capacity for the hospitals in the area? If I show up with 10 or 12 criticals at once will they be able to handle it? I honestly don't know...asking if anyone does.

 

[Clipper1]

The assumption seems to be that the physicians present would know how to perform hemorrhage control via suturing, or thorocostomy or whatever, which is unlikely. I'm betting that most of the docs were residents and that there were plenty more FM than EM and very few surgeons. Besides, why suture when a TQ followed by rapid evacuation will work fine; or, perform a needle decompression instead of trying to macguyver a chest tube?

You might be very surprised at what Physicians are trained and educated to do in emergencies.

The doctors associated with this event and those who responded are not just student doctors. The AMAA is a big sponsor in this event and the DMAT doctors are not newbies who have no clue about trauma. Responses are also going to be different depending on the area and resources. Have a city like Boston with several respected hospitals and trauma centers will make it easier. These are professional teams who are well prepared and don't enter situations "mcquyvering things. You can refer to another discussion here for Paramedic "mcguyvering".

With the AMAA, there were several doctors running and several more supporting them on the sidelines. Those managing these events have learned lessons from previous incidents which have included everything from cardiac arrests to shootings.

Were there any EMS associations which actively encouraged or supported their members in the Boston Marathon?

 

[JPINFV]

Were there any EMS associations which actively encouraged or supported their members in the Boston Marathon?

[not sure if serious.jpg]

I'm pretty sure that Boston EMS had a pretty big role.

 

[Clipper1]

[not sure if serious.jpg]

I'm pretty sure that Boston EMS had a pretty big role.

Did they have runners in the event? I think having teams from different professions supporting their members in athletics is a great idea to promote health and make them visible at these events. It would be great to get more in EMS involved in team events which promote their own health and reduce obesity. But, the fact that there was a diverse presence here in the race and at the sidelines taking care of the medical stations is pretty impressive. I believe all the medical associations that helped prepare before the event should be given some credit.

If you want to know more about what the doctors did at the finish line, there are several news stations now discussing this.

Paramedics are not the only health care professionals who know something about emergencies.