Amount of lower-body injuries ‘not unusual’ given nature of device

The Boston Marathon bombs had been packed with metal fragments and placed close to the ground, causing amputations and other severe lower-body injuries, doctors treating survivors said yesterday.

In a statement delivered outside Massachusetts General Hospital – where many of the injured had been taken in the aftermath of the double explosion – George Velmahos, the hospital's chief trauma surgeon, said nails and pellets had been removed from the bodies of the injured.

The make-up of the bombs, as well as their positioning in a crowded area and low to the floor, may account for the high number of patients suffering severe lower-body injuries. Some of the injured victims were considered to be “automatic amputees”, Velmahos said. “We just completed what the bomb had done.”

Velmahos said surgeons had performed four amputations, and said two more legs were “at risk”.

In all, 176 people were treated by emergency staff at the scene and in hospital. Injuries ranged from relatively minor wounds to severed limbs. An initial death count of two was later updated to three, an indication that at least one of the deaths may not have been recorded at the scene. A number of patients remained in critical condition.

Velmahos said: “Probably, this bomb had multiple metal fragments in it. We removed pellets and nails,” he said. It was “not unusual” to see so many lower-body injuries given the nature and low placement of the device, he said.

He confirmed that some of those treated at the hospital had suffered primary blast wounds. According to the American College of Emergency Physicians, such injuries are “often considered a marker for lethal injury”.

Hospital staff noted the resilience and stoicism of patients. But many of those who lost limbs will need counselling. Dr Stephen Wegener, a psychologist and limb loss expert at Johns Hopkins school of medicine, said the victims may go through a lengthy process of physical, psychological and social rehabilitation.

“Over the long term, about 30 per cent of people who have an amputation will experience depression. If the amputation is associated with trauma – as in the case in Boston – those people have a risk of post-traumatic stress disorder – around a third of people suffer PTSD. But the majority of amputees do not suffer PTSD. People are remarkably resilient.”

Among those suffering loss of limbs were two brothers who had gone to cheer on the runners. Their mother, Liz Norden, told the Boston Globe that her sons, aged 33 and 31, had both lost the lower half of one leg in the blast.
– ( Guardian service)