Tag: Boston Marathon

Boston Marathon, How They Saved So Many Lives

Cross posted from The Stars Hollow Gazette

Last week I wrote about the use of tourniquets in a pre-hospital emergency to save someone from bleeding to death. Tourniquets were used very effectively in Boston and were a key factor in getting so many to the hospital alive. At the finish line there were two medical tents with cots, blankets and IV fluids to treat dehydrated, hypothermic runners. Both were staffed with doctors and nurses. An emergency-room physician from Georgia, Dr. Allan Panter, was waiting at the finish line for his wife. He was just 10 yards a way from the first explosion. He assisted with victims and after went to the tents to assist. He described the events:

While there was some initial chaos in a medical tent near the finish line, and some screaming and moaning by victims, it was generally an orderly scene, Dr. Panter said. He assisted others in wheeling in a female victim who died, he said. He described 20 to 30 cots in the tent with IV bags that had been intended for dehydrated runners.

At least eight doctors and what seemed to be 20 or more nurses were stationed in the tent. A man with a microphone stood in the center of the tent to coordinate medical care. Arriving victims were assessed and categorized as 1 for critical, 2 for intermediate, 3 for “can wait” and “black tag” for anyone who appeared to be dead, Dr. Panter said. An emergency medical technician outside the tent coordinated ambulance service to hospitals.

“All in all, it was a pretty controlled environment,” said Dr. Panter, who has been an emergency-room physician for 30 years. “I’ve seen a lot worse. They were without question ready – not ready for those type of injuries, but they were prepared.”

There usually aren’t those provisions or medical staff on site and this still required the actions of bystanders to help control bleeding and move patients to the tents and ambulances. The night after the bombings on MSNBC’s “The Last Word,” host Lawrence O’Donnell spoke with Dr. Lyle Micheli, the head physician at the finish line and Massachusetts General Emergency Room Nurse Meghan McDonald about their experience:

But what happened in the hospitals was even more critical. It wasn’t like the ER’s were empty and waiting for these patients. As Nurse McDonald described in the interview Massachusetts General hospital had 90 patients being treated, waiting for admission or discharge when the explosions happened. The other four other ER’s that would receive the bulk of the casualties were in not much better shape. Luckily they all have similar disaster plans in place and have frequent drills to keep the staff prepared. Prepared they were. Of the initial 170 patients the five level one trauma centers received that day only one patient, who arrived in cardiac arrest, died. The other two fatalities were pronounced dead at the scene. That is a quite a feat and a testament to the training and skills of the doctors, nurses and other support staff. This article in the New York Times describes how Massachusetts General Hospital handled the disaster:

The first priority for those who were severely injured was to prevent them from dying, often from bleeding to death. Many had tourniquets on their legs when they arrived at the hospitals. But that was just a temporary measure to slow the bleeding. They needed immediate surgery to get their bleeding under control and prevent muscles and nerves from dying for lack of blood. [..]

That requires a vascular surgeon to repair the torn blood vessels and restore blood to legs and feet that may no longer have a blood supply. To do those repairs, surgeons often sew in part of a vein from the other leg, if it is uninjured, or from an arm. Or they use a synthetic tube.

Meanwhile, an orthopedic surgeon must stabilize a bone that might be flopping because it is fractured in several places. Surgeons do that with a temporary solution – they drill into the bone from outside the leg and attach pins that they screw into a metal bar also outside the leg.

Plastic surgeons clean the wound. In this case, blast victims had BBs or nails or debris embedded in their legs and feet. Everything the surgeons took out of the wounds was placed in plastic bags for the F.B.I., said Dr. Samuel J. Lin, a plastic surgeon at Beth Israel Deaconess Medical Center who helped care for blast victims.

“The crime scene extends to the hospital,” Dr. Lin said.

It’s definitely an art. It might appear chaotic to the casual beholder as everyone seems to be moving and talking at once. Each staff member has his or her job and is looking and listening so as not to miss details. Usually there is one coordinator, in situations like this there are some times more, as the ER is sectioned off into areas that depend on the patient’s status. Life threatening are first, then go back to treat and repair everything else. The decision to amputate a limb is not made lightly and is done most often to save a patient’s life. The other reason is that the bone, tissue and vascular damage is so severe there is no other option. The doctors in Boston had the luxury of having an immediate second opinion, it doesn’t always happen that way in combat zones or parts of the third world.

MSNBC’s Rachel Maddow saluted the thorough, professional and remarkably successful performance of the medical professionals who responded to the emergency injuries of the Boston Marathon Bombings and kept the public informed with honest straightforward briefings.

“Who ever came in alive, stayed alive.”

Dr. George Velmahous, Chief of Trauma Surgery, Massachusetts General Hospital

Thank you to all. Well done.

A Message From A Bostonian

Cross posted from The Stars Hollow Gazette

Charlie Pierce  is a sportswriter, author and political blogger. He is also lives very near Boston. He writes several article a day for Esquire at his Politics Blog. His writing about the bombing incident and his appearances on “All In with Chris Hayes” over the last week have kept many of us grounded in seeking the facts. He now has a request of the “gobshites” that are still spinning on their speculative tops: “Please, for the love of almighty god, shut the fk up.”

I mean, seriously, padlock the pieholes. We are fine. We are muddling through. We are carrying on. We are getting up this morning and going about the business of our lives. We are riding the T, or driving on the Pike, or walking along open paths along the Charles River. We are eating lunch at Donohues or shopping at the Target in the Watertown Mall. (OK, some of us are still doing some rubbernecking at the several crime scenes.) We are dealing with the fact that Copley Square, the center of practically everything, is still something of a crime scene. (We’re getting a little grumpy about it, but that’s what we do here.) Our kids are going back to school. And we are doing all these things without particularly needing the pity, concern, or the Very Deep Thoughts of a pack of Green Room school nurses seeking to coin what we’ve all been through into their own unique brand of banality. We are not children here, and neither are our children. [..]

Seriously, though, people. We’re really doing OK. It was nice having y’all around for a week. Hope you spent a little dough. Now go home, please. We have lives to live.

Thanks, Charlie, we sure hope they take your advice but we have our doubts.

Marathon Suspect in Custody, Not Mirandized

Cross posted from The Stars Hollow Gazette

The second suspect in the Boston Marathon bombing on Monday was taken into custody last night in Watertown, MA. Nineteen year old  Dzhokhar A. Tsarnaev, was found hiding in a tarp covered boat in a backyard shortly after the “stay in place” order was lifted. He was bleeding heavily from gunshot wounds to the neck and leg. He is listed in serious condition in  Beth Israel Deaconness Medical Center, the same hospital where several of the bombing victims are recovering and his brother, Tamerlan, died of his wounds.

Boston Police commissioner, Edward Davis, thanked all who had helped in the manhunt stating, “It’s a proud day to be a Boston police officer.” Crowds lined the streets near the site of the capture, cheering the officers and other first responders as they left the scene. Crowds of relieved Bostonians gathered in the Commons chanting “USA” and “Boston” and waving American flags.

This morning, there has been no further word on Dzhokhar’s condition. The FBI has stated that he has not been read his Miranda rights at this time, citing the so-called public safety exception. Dzhokhar is a naturalized American citizen from Chechnya. Sens. John McCain (R-Ariz.) and Lindsey Graham (R-S.C.) said Dzhokhar should not be read his Miranda rights and should be questioned for “intelligence purposes.”

“It is clear the events we have seen over the past few days in Boston were an attempt to kill American citizens and terrorize a major American city,” McCain and Graham said late Friday in a joint statement. “The accused perpetrators of these acts were not common criminals attempting to profit from a criminal enterprise, but terrorist trying to injure, maim, and kill innocent Americans.” [..]

“We need to know about any possible future attacks which could take additional American lives,” they said. “The least of our worries is a criminal trial which will likely be held years from now.”

Constitution? What Constitution? Joseph Stalin would have loved these two.

Constitutional lawyer and columnist for The Guardian, Glenn Greenwald explains the “public safety” exemption:

(T)he Obama DOJ exploited and radically expanded the very narrow “public safety” exception to Miranda, which was first created in 1984 by the more conservative Supreme Court justices in New York v. Quarles, over the vehement dissent of its liberal members (Brennan, Marshall and Stevens, along with O’Connor). The Quarles court held that where police officers took a very brief period to ask focused questions necessary to stop an imminent threat to public safety without first Mirandizing the suspect, the answers under those circumstances would be admissible (in Quarles, the police apprehended a rape suspect and simply asked where his gun was before reading him his rights, and the court held that the defendant’s pre-Miranda answer – “over there” – was admissible).

The Court’s liberals, led by Justice Thurgood Marshall, warned that this exception would dilute Miranda and ensure abuse. This exception, wrote Marshall, “condemns the American judiciary to a new era of post hoc inquiry into the propriety of custodial interrogations” and “endorse[s] the introduction of coerced self-incriminating statements in criminal prosecutions”. Moreover, he wrote, the “public-safety exception destroys forever the clarity of Miranda for both law enforcement officers and members of the judiciary” and said the court’s decision “cannot mask what a serious loss the administration of justice has incurred”.

As Marshall noted, the police have always had the power to question a suspect about imminent threats without Mirandizing him; indeed, they are free to question suspects about anything without first reading them their Miranda rights. But pre-Miranda statements were not admissible, could not be used to prosecute the person. This new 1984 “public safety” exception to that long-standing rule, Marshall said, guts the Fifth Amendment’s guarantee that one will not be compelled to incriminate oneself. As he put it: “were constitutional adjudication always conducted in such an ad hoc manner, the Bill of Rights would be a most unreliable protector of individual liberties.”

As controversial as this exception was from the start (and as hated as it was among traditional, actual liberals), it was at least narrowly confined. But the Obama DOJ in 2011 wildly expanded this exception for terrorism suspects. The Obama DOJ’s Memorandum (issued in secret, of course, but then leaked) cited what it called “the magnitude and complexity of the threat often posed by terrorist organizations” in order to claim “a significantly more extensive public safety interrogation without Miranda warnings than would be permissible in an ordinary criminal case”. It expressly went beyond the “public safety” exception established by the Supreme Court to arrogate unto itself the power to question suspects about other matters without reading them their rights (emphasis added):

   “There may be exceptional cases in which, although all relevant public safety questions have been asked, agents nonetheless conclude that continued unwarned interrogation is necessary to collect valuable and timely intelligence not related to any immediate threat, and that the government’s interest in obtaining this intelligence outweighs the disadvantages of proceeding with unwarned interrogation.”

That is what Graham advocated regarding Miranda: that Tsarnaev be interrogated about intelligence matters without Mirandizing him, and that’s exactly what Obama DOJ policy – two years ago – already approved. Worse, as (Emily) Bazelon noted: “Who gets to make this determination? The FBI, in consultation with DoJ, if possible. In other words, the police and the prosecutors, with no one to check their power.” At the time, the ACLU made clear how menacing was the Obama DOJ’s attempted roll-back of Miranda rights for terror suspects.

Constitution? What Constitution? Good work, Barack.

Breaking News: Possible Arrests In Boston Marathon Bombings

Cross posted from The Stars Hollow Gazette

Up Date 08:00 EDT: The two suspects have been identified as brothers who have been living legally in the US:

The suspects are Chechen brothers with the last name Tsarnaev, law enforcement officials told NBC News. The suspect at large, Dzhokhar Tsarnaev, is 19, was born in Kyrgyzstan and has a Massachusetts driver’s license, they said. The dead suspect was identified as Tamerlan Tsarnaev, 26, born in Russia.

Tamerlan Tsarnaev was run over by a vehicle during the firefight, law enforcement officials told NBC News. Law enforcement officials also told NBC News that the brothers entered the United States in 2002 or 2003, and that Tamerlan Tsarnaev became a legal permanent resident in 2007. [..]

Law enforcement officials said the tumult began just before 11 p.m., when the suspects approached a police officer from the Massachusetts Institute of Technology and shot him in the head.

The two then stole the officer’s cruiser, robbed a nearby 7-Eleven, carjacked a Mercedes SUV and briefly kidnapped the driver, the sources said. The suspects threw explosives out the window during the chase that followed, they said. A Boston transit police officer was shot and wounded, authorities said.

Up Date 06:05 EDT: From The Guardian:

All public transport has been suspended including buses and subways in the Massachusetts Bay area – Boston and the surrounding areas – it was announced. People at stations were asked to “please go home” and not congregate waiting for the system to come back.

The authorities want the residents of Watertown, Newton, Waltham, Bellamont, Cambridge, and the Austin and Brighton neighbourhoods of Boston to stay indoors for the time being. They are also asking businesses there not to open.

The person who was identified as suspect #1 came into  the hospital in “traumatic arrest” and was pronounced dead at 01:35 EDT. He died of multiple gunshot wounds and blast injuries. Suspect #2 is still at large. He is considered armed and extremely dangerous.

Up Date 04:57 EDT: The Guardian is reporting that one of the suspects was shot and killed as per police at a news conference. The other is still at large.

A shooting late last night on the campus of MIT that left a campus police officer dead and a shoot out in Watertown, MA with explosions, may be related to the deadly bombing at the Boston Marathon. The FBI released photos of two suspects in that case.

There are a lot of conflicting reports that about these two incidents and whether or not they are related to each other or the marathon explosions. There is one person in custody but it is unknown if this person one of the suspects.

One suspect apprehended, another remains on the loose

By Wesley Lowery, Akilah Johnson, Eric Moskowitz and Lisa Wangsness, The Boston Globe

WATERTOWN, MA – One suspect in Monday’s Boston Marathon bombings has been captured, according to an official with knowledge of the investigation. Another remains on the loose in Watertown after a firefight with police. Authorities have established a 20-block perimeter as they search for him.

A scene of chaos descended on Cambridge and Watertown late Thursday night and early Friday morning, as police confirmed an MIT police officer was shot and killed, and an apparent carjacking led police on a wild chase into Watertown.

Witnesses in Watertown said they heard explosions. Police officers were screaming about improvised explosive devices.

Authorities would not comment on whether the events were connected to Monday’s Boston Marathon bombings. At least one of the suspects in Watertown appeared to be a man in his 20s.

Here is the live feed from MSNBC. The commentators are being very cautious in their reporting.

Here is the live feed from The Guardian.

Update from Think Progress

Law enforcement officials believe that one suspect in Monday’s bombing of the Boston Marathon was killed Friday morning after a shootout and car chase with police, while the other is still on the loose. NBC’s Pete Williams reports that the two are brothers, age 19 and 20, and are legal permanent residents of the United States, living in Cambridge. The first suspect was taken into custody by police and was pronounced dead at Beth Israel Hospital at 1:35 AM. As many as nine thousand police officers are now conducting a door-to-door search for the second individual, Dzhokhar Tsarnaev according to NBC, and are asking residents to stay in their homes.

The two robbed a 7/11, killed a Massachusetts Institute of Technology (MIT) campus police officer in his car after 10 PM on Thursday night and later carjacked a Mercedes SUV. Pete Williams of NBC News reports that the suspects told the man that they killed a police officer and were the marathon bombers. The owner of the car was held at gunpoint for 30 minutes and later released near a gas station in Cambridge.

The men then led police on a chase to Watertown, where they exchanged gunfire and threw bombs out of the vehicle window at law enforcement, including one made from a pressure cooker. They stopped the car in Watertown, where the first suspect got out, was shot and likely detonated an improvised explosive device (IED) strapped to his chest. The second suspect drives on and later abandons the car.

Tourniquet: How to Save a Life

Cross posted from The Stars Hollow Gazette

Within seconds of the two blasts that ended the Boston Marathon, doctors and emergency personnel were faced with decisions that are only usually made in combat, life or limb. Confronted with horrific lower extremity injuries the life saving device that was used over and over was the tourniquet. Around for millennia but fallen into disfavor years ago, tourniquets were only to be used as a last resort to stop life threatening bleeding from a limb when direct pressure, elevation and pressure above the wound did not work. The common belief was that the prolonged cutting off the blood to the limb would lead to amputation. The problem was that there were no good studies to prove it. So up until recently the tourniquet was a last resort.

Then along came the wars in the Middle East. Studies showed there that the timely use of a tourniquet resulted in survival rates as high as 90 percent. Contrary to past fears, the tourniquets themselves didn’t cause any limb loss, even in the rare cases when patients had to keep them on for two to three hours. Considering that blood loss is the leading cause of death in a trauma patient and a person can bleed to death in three minutes from a severed femoral artery, the large blood vessel in the upper leg, the choice is simple. Every paramedic is now trained to apply a tourniquet. Since 2006, a tourniquet is issued to every soldier.

Here are some simple guidelines to use if you are ever confronted with a major limb bleed:

First, apply direct pressure with your hand or a cloth. Don’t worry about clean, at this point it doesn’t matter. If you’re not alone have someone call 911. If you are alone do it first, you can always put the phone down and yell into it while you’re applying pressure.

Elevate the extremity if possible.

If you’re unable to control the bleeding quickly, or the injury is really big, or an partial or full amputation, then you need a tourniquet. Find something long, strong and pliable. Shirts, pants, something that can be torn onto a long strip; belts (Should be at least 1 1/2 inches wide).

Place the tourniquet around the arm or leg between the wound and the heart.

Tie a half-knot – the same as the first part of the knot when you tie a shoe, but have not finished the knot.

Place a strong stick on top of the half knot. Anything long and rigid will do, improvise. If at home, a large serving spoon or kitchen utensil; in the workshop a screw driver; a pen, pencil, you get the idea.

Tie a full knot over the stick.

Twist the stick until the material is tight around the limb and/or the bright red bleeding has stopped.

If you have enough length, loop the loose ends of the tourniquet over the ends of the stick. Bring the ends around the arm or leg and tie the ends together around the limb. This is so that the tourniquet cannot loosen. Or, tie other material around to hold the stick.

Belts of course can be pulled as tight as needed to stop the bleeding but you may be “married” to holding it tight until help arrives, if it can’t be secured so it won’t come loose.

Outside a controlled hospital setting, this is called damage control, or how to save a life.

Two Explosions at the Boston Marathon

There have been two explosion at the Boston Marathon this afternoon. There are reports of numerous injuries. It is unknown at this time if there are any fatalities or the cause of the two explosions. MSNBC is also reporting a fire at the JFK library that started shortly after the explosions.

The A.P. said that a loud explosion was heard on the north side of Boylston Street, near a photo bridge that marks the finish line. Another explosion was heard several seconds later. [..]

The headquarters for the organizers of the marathon, one of the world’s oldest, was reportedly locked down while authorities investigate. Reporters inside the Copley Plaza Hotel, where the media center is and where many elite athletes are staying, were unable to leave.

The explosions went off more than four hours after the start of the men’s race, which meant that there were still several thousand runners yet to finish the race.

Up Date 21:10 EDT: This is the final up date for the night.

From the Live Feed at The Guardian

9.01pm ET

‘No further devices’

Police commissioner Davis is asked if he is confident that officers have found all the explosives.

“We’ve pretty much cleared the area … there are no further devices that we’ve located. … I’m not prepared to say that we are at ease at this point in time.”

He says the focus of the investigation is in the area near the explosions.

Agent DesLauriers says investigative activity is ongoing. “It is a very active and fluid investigation.”

He declines to comment on evidence analysis, possible people of interest – pretty much everything.

Governor Patrick says the secure area “may get smaller… but that area is not going to be accessible for normal traffic.”

“It’s not going to be easy, simple or regular. I think in most cases people are not going to have access to that specific area.”

The briefing is closed.

8.56pm ET

Police: three dead, no suspect

Police commissioner Ed Davis speaks, offering his sympathies to the victims. “This cowardly act will not be taken in stride. We will turn every rock over to find the people who are responsible for this. It’s been a horrendous loss of life.”

Davis says that at least three people died, but stressed the casualty numbers are in flux.

“There is no suspect,” he says. “There are people that we are talking to, but there is no suspect at Brigham and Women’s Hospital as has been reported.”

He went on: “Tomorrow, as the governor said, will not be business as usual in Boston.” He says police will be working 12-hour shifts to investigate the case.