Boston Bombings: A Surgical View of Lessons Learned From Combat Casualty Care and the Applicability to Boston's Terrorist Attack

The Boston bombing incident was a recent civilian mass casualty terrorist event that demonstrated effective transfer of the lessons of combat casualty care to inform effective civilian medical care. Thirty-nine patients were seen at Brigham and Women's Hospital and thirteen patients received emergency surgery in the first few hours after the event. The subsequent management, total hospital days 181, total number of operative procedures 72, and discharging service listing of these thirteen patients illustrate the intensive surgical resources necessary after a civilian bomb attack. Plastic surgery played a role in the multidisciplinary collaboration of the limb salvage efforts and this role can inform the importance of other plastic surgery contributions within mass casualty surgical management. We believe that prepositioned collaborative relationships of plastic surgery, vascular surgery, trauma surgery and orthopedic surgery may offer a model of collaboration for limb salvage that can be applied in military and mass casualty medical care if resources permit. In this attack, effective use of tourniquets was implemented by prehospital medical providers that saved lives and limbs and these actions reaffirm the important lessons learned from combat casualty care. Unfortunately, it is likely that more centers will deal with similar events in the future and it is imperative that we as a community of providers take what lessons we can from battlefield medicine and that we collectively prepare for and engage this future.