trauma medicine

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Civilian Docs Look To Military For Advances In Trauma Care

In case you missed Carey’s excellent story about the latest medical advances in treating patients with massive blood loss, including lessons learned from the battlefield, here’s another chance.

On Radio Boston today she talked about what “losing all your blood” really means, the resurgence of the tourniquet and how shifts in blood banking have improved care for patients with such significant blood loss.

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And Joseph Blansfield, trauma program manager at Boston Medical Center and former chief nurse at a combat hospital in Iraq from 2006-2007, spoke about how civilian doctors are looking to the military — particularly to the wars in Iraq and Afghanistan — to advance trauma care, which helped immensely in treating victims of the Marathon bombing.

“We’re getting smart and we’re smart on the fly, collecting real-time data on the experiences” of war, Blansfield said. Though some of the battlefield “laboratories” are truly awful, he added, they are something to “exploit for the greater good.”

Medical Yarn: How Did Boston Injured Survive Massive Blood Loss?

Transit police officer Richard Donohue, in an undated photo (MBTA/AP)

Transit police officer Richard Donohue, in an undated photo (MBTA/AP)

How could this be? A transit police officer lost “nearly all his blood” after a bullet cut through three major arteries in his thigh during last week’s firefight with the Boston Marathon bombing suspects — but now he’s “doing excellent” and expected to make a full recovery.

And the officer, Richard Donohue, was not alone in either his heavy blood loss or his positive prognosis.

The Boston Marathon bombs left the finish-line area splattered and pooled with blood, yet, says James Hooley, chief of Boston Emergency Medical Services, “Anybody who arrived alive in a Boston hospital is alive today.”

Bombing suspect Dzhokhar Tsarnaev had reportedly been bleeding for many hours when he was finally found in a backyard boat, yet he recovered so fast that he has already been transferred from the hospital to prison.

This is not what happens in the movies. People who “bleed out” fade quickly, gasp a few last words, and then a sideward flop of the head signals that they have expired.

But in real life, trauma specialists say that among many other contributing factors to the success of Boston’s medical response to the bombings, the field has made important advances recently in treating patients with massive blood loss.

In fact, some of that progress makes quite a medical yarn, of how medicine can correct itself in the face of important new evidence.

‘We collected several units of this fresh whole blood, gave it to our wounded, and it was like magic.’

Dr. Daniel Dante Yeh, a trauma surgeon at Massachusetts General Hospital who helped treat the bombing victims, said that all his patients had lost a lot of blood.

“I remember, at the early stage of my training, how they would have gotten flooded with salt water and subsequently stayed in the ICU for weeks,” he said. “Although salt solutions can be lifesaving when there’s nothing else available, we’ve come to appreciate the harm they can cause when given in excess. The pendulum has swung back towards moderation and, in turn, our critically injured patients are doing better than ever.”

Salt water? Harm? Dr. Yeh explains the back-story of what he calls a sort of “re-revolution” in blood transfusions: Continue reading

Doctors Recall Station Fire Victims, Envision Future Of Burn Care

Jason Zubee and his wife, Robin Zubee, stand together near makeshift memorials on the site of The Station nightclub fire on Sunday. Zubee lost her cousin William Christopher Bonardi III in the 2003 blaze at the nightclub that killed 100 people. (Steven Senne/AP)

Jason Zubee and his wife, Robin Zubee, stand together near makeshift memorials on the site of The Station nightclub fire on Sunday. Zubee lost her cousin William Christopher Bonardi III in the 2003 blaze at the nightclub that killed 100 people. (Steven Senne/AP)

By Jeffrey C. Schneider, MD and Colleen M. Ryan, MD FACS
Guest Contributors

The Cocoanut Grove Nightclub Fire shook Boston and the medical community in 1942. Four hundred and ninety-two merrymakers perished in the fire and hundreds more were injured. The fire safety and treatment advances born in that fire a generation ago have had wide-reaching impact on building codes, triage, disaster management, burn resuscitation and the treatment of wounds, smoke inhalation and infections. The tragedy of those days was an engine for research and innovation that has since saved many more lives than lost, and is, in part, a fitting memorial to those whose lives were lost or heavily impacted by this devastating event.

We, as a burn surgeon and a rehabilitation physician who cared for some of the patients and families of the Rhode Island Station Nightclub Fire during the dark days after the fire and the ten years since deeply hope that our continued work studying this disaster and its impact will serve as a living memorial to those who lost their lives that day. This event has provided important lessons in burn disaster management, fluid resuscitation, and pain management of the critically ill patient. Innovative surgical techniques have been advanced because of this disaster. One of the important advances, driven by the grace and determination of survivors, is the development of resources and research into long-termrecovery. As doctors, we listened to their stories and we are now growing old with our patients, and still listening. There are little data on the long-term outcome from burn injury, not surprising since survival from massive burn injury was not commonplace until the mid-1980’s. We are trying to make headway in this area.

PLoS

PLOS One

We recently published a study, “The Long-Term Impact of Physical and Emotional Trauma: The Station Nightclub Fire” in the journal PLOS One. The study involved over 100 survivors of the Station Fire and looked at the multi-dimensional long-term effects of this catastrophic event. We assessed the differences in outcomes between survivors with and without physical injury. This was the first study to investigate the long-term effects of a large fire on its survivor population that included survivors with and without burn injuries. Among the main findings of the paper were that survivors experienced significant life disruption, including occupational, psychological and quality of life sequelae.

Furthermore, quality of life, depression and post-traumatic stress outcomes were related to emotional trauma, not just physical injury.
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