Military Trauma Care Skills Proved Beneficial to Boston Doctor
By Dialogo May 20, 2013
In the aftermath of the bombing attacks at the Boston Marathon on April 15, at least one of Boston’s civilian trauma surgeons who treated several of the victims also happens to be a Military reservist whose combat casualty care training proved to be extremely handy.
Dr. Michael Yaffe, a trauma surgeon and critical care intensivist at Beth Israel Deaconess Medical Center in Boston and a lieutenant colonel in the U.S. Army Reserves, said in a phone interview that his military training served him well as he received and treated a large group of severely injured victims shortly after the attacks. “I have been trained, and I have trained a lot of people in combat casualty care in the Military,” Dr. Yaffe said. “A number of surgeons in our hospital have had military experience, as well. One of the plastic surgery chiefs actually deployed to Afghanistan.”
Dr. Yaffe explained there were several factors at play in the medical response to the attacks in Boston that have roots in military medicine. In Beth Israel’s emergency room, for instance, he and the surgical team wrote in indelible marker on the chest of each patient what specific injuries they had and the treatment needed to reduce confusion. That is a battlefield medicine lesson learned from the Military Health System in triaging a large number of wounded casualties.
Providing care under fire and the widespread use of often makeshift tourniquets were other military lessons applied by those who assisted the wounded on the scene of the marathon attacks. Dr. Yaffe said there was at least one injured military member who helped other victims in self-applying tourniquets.
Many of the injured who arrived at the hospital with tourniquets also had a letter ‘T’ and a time marked on their foreheads indicating when the tourniquet was first applied, to show doctors when to loosen it. “I think those lessons have disseminated down into the civilian population because so many of our Soldiers are now civilians,” said Dr. Yaffe. “That’s a lesson from the Military and it is now embedded in civilian mass casualty care response.”
Many of the 25 bombing victims treated at Beth Israel had traumatic wounds. “Most of the injuries were lower extremity injuries, traumatic amputations, significant soft tissue injuries, vascular injuries of the lower extremity,” Dr. Yaffe advised. “There were a lot of percussive injuries where patients had some degree of hearing loss, but hopefully it will be transient. And a smaller number had burn injuries due to the blast and heat of the projectiles.”
There was a smaller amount of upper body injuries, facial cuts and bruises, but no major torso or abdominal wounds.
Dr. Yaffe said he worked as part of a multi-disciplinary trauma surgical team. “As a whole we took care of 25 patients acutely in the ER,” he advised. “It was a very close collaboration where our emergency department, orthopedics, vascular surgery, prosthetics and plastic surgeons worked all as a team. Most of [the patients] we were able to stabilize right away, within an hour. Some were moved to the ICU, but we were well-prepared for this.”.
The United States Department of Defense has invested heavily in prosthetics research and development over the last several years. Currently, it is spending $107 million on active projects for extremity regeneration research and another $167 million on active projects for the rehabilitation of neuromusculoskeletal injuries, which includes prosthetics. “We owe a debt of gratitude to Department of Defense funding for having a significant impact on victims of civilian trauma,” Dr. Yaffe said. “Prosthetics are so advanced today.”
Another Military Health System principle in conflict settings includes transporting casualties from the field to more definitive care within the “Golden Hour” after injury. With Boston’s trauma centers in close proximity to the attacks, Dr. Yaffe said the wounded were transported by ground ambulances to ERs quickly. “Absolutely, certainly, everyone made it within the golden hour,” he said. “I would say most made it within 30 minutes.”
Dr. Yaffe was impressed with Boston’s overall medical response to the marathon bombings. “It was remarkable,” he admitted. “Whoever was in charge of the emergency management systems control in the city was fantastic in delegating trauma patients to the five level-1 trauma centers, which are all within 10 miles of the blast site. The emergency management system was able to disperse patients in an equitable manner to not overwhelm each center. I think this [went] better than any of the disaster drills I’ve participated in. The entire city of Boston conducts mass casualty drills once a year and to the city’s credit, they had the ability to mount a very effective response.”
The spirit of Boston’s medical community was pivotal to the response, as well. “Many physicians spontaneously came to the hospital as soon as they found out,” Dr. Yaffe said. “The emergency docs, orthopedic and vascular surgeons just showed up at the hospital, the nurses, as well. Everybody chipped in. This is Boston. They just took it on as their personal responsibility. It was really amazing and very remarkable how well everything was handled.”
With the Army Reserves for two and a half years now, Dr. Yaffe has received military training through Massachusetts Institute of Technology’s ROTC program, the Army Medical Department and Fort Sam Houston – specifically in the latter’s burn unit. He received and taught Tactical Combat Casualty Care techniques at the 399th Combat Support Hospital in Fort Devens, which is located 40 miles west of Boston and provides training support to all military services, active and reserve.
Although he has not yet had the opportunity to deploy, Dr. Yaffe said he would like to apply his skills in a deployment to Afghanistan or the Army’s Regional Medical Center in Landstuhl, Germany, at some point. “I am very much hoping to deploy, wherever they need me,” he said.
Matt Pueschel is a journalist with the U.S. Department of Defense Office of Force Health Protection & Readiness.