Doctors treating victims of the Boston Marathon bombings have seen everything from mangled limbs to head trauma in their round-the-clock efforts to care for the more than 170 people injured in the terror attack.
Many physicians who came to the aid of children injured in the Monday blast likened the wounds they saw to those treated in war zones because of the blasts' potent percussive forces.
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"We've removed BBs and we've removed nails from kids. One of the sickest things for me was just to see nails sticking out of a little girl's body," said Dr. David Mooney, director of the trauma center at Boston Children's Hospital.
The many injuries to the lower legs of blast victims is a sign the bomb distributed its lethal jolt at street level, said Dr. Matthew Bank, director of trauma surgery at North Shore University Hospital in Manhasset. "Every bomb or mass casualty event has its own signature," he said.
The energy from the blasts "was created at a very low level, so there were a lot of injuries that occurred in people's lower extremities," he said.
Although many of the injuries can be successfully treated, there will be months of therapy for patients -- regardless of age -- as they recuperate. For those who lost limbs in the explosion, they face the added challenge of learning to navigate on artificial limbs.
Two children remain in critical condition at the hospital with serious leg injuries, Mooney said, adding that tourniquets applied by emergency responders saved the children's lives.
Among adults, injuries have been equally devastating because, investigators have said, the bombs were loaded with the type of shrapnel often associated with land mines.
The explosives carried "metal, nails and ball bearings . . . designed to shoot metal at high speeds to injure a lot of people," said Dr. Anders Cohen, chief of neurosurgery at Brooklyn Hospital Center. Those kinds of projectiles, he said, can cause severe brain injuries.
Dr. Stephen Epstein, of the emergency medicine department at Beth Israel Deaconess Medical Center in Boston, said he saw an X-ray of one victim's leg that had "what appears to be small, uniform, round objects throughout it -- similar in the appearance to BBs."
Amputations have occurred, Boston doctors said, because shrapnel damage irrevocably destroyed patients' limbs.
Doctors always attempt to save limbs whenever possible, said Dr. James Vosswinkel, chief of Stony Brook University Hospital's division of trauma and emergency surgery -- but tough choices have to be made quickly. "It's better to lose a limb than to lose a life," Vosswinkel said Tuesday.
But in instances when limbs must be amputated, Vosswinkel said, trauma surgeons often turn to a widely used assessment known as the Mangled Extremity Severity Score, which helps them determine whether a limb is salvageable.
When the bone, blood vessels, nerves and soft tissues, including the skin, are damaged beyond repair, Vosswinkel said, amputation is likely inevitable.
Equally serious, Vosswinkel said, is the invisible damage -- post-traumatic stress disorder -- which may not manifest immediately, but can remain with witnesses to the tragedy for the rest of their lives.
With The Associated Press