April 2014

Out on a limb: Teachings from Boston

1Limb-JordanaBy Jordana Bieze Foster, Editor

As emotional as any tragic event is its first anniversary. New Yorkers know. Residents of New Orleans know. The families in Newtown, CT, know. Now it’s Boston’s turn.

April 15 marks the one-year anniversary of the Boston Marathon bombings that killed three people and injured 281, including 16 who lost limbs (see “Clinicians come to aid of marathon victims,” May 2013, page 23). On April 21 the marathon will be run once again, trium­phantly, this time with 9000 more runners than last year and multiple extra security measures in place.

An anniversary like this is a time for those affected to remember, to grieve, and hopefully to heal. It’s also a time to take stock of steps taken to prevent future tragedies, and of lessons learned.

A lot has been written and presented in the last year about the calm, efficiency, and intelligence with which responders triaged and treated the injured Boston victims, which ultimately prevented the consequences from being much worse.

Any healthcare practitioner can appreciate the level of coordination and quick thinking those efforts involved. But, if you’re a practitioner whose patients don’t typically come to you via the emergency department, you might not think the lessons learned from the Boston experience apply to you. Listening to Elof Eriksson, MD, PhD, might make you think again.

Eriksson is chief of the division of plastic surgery at Brigham & Women’s Hospital in Boston, a division that may be best known for performing five of the seven full facial transplants that have been done in the US. The Brigham, as Bostonians know it, was also one of six Level I trauma centers where responders took injured victims after the marathon bombings. Speaking at a conference last month, Eriksson detailed the efforts of plastic surgeons and numerous other specialists in treating those patients, as many practitioners who shared the experience have done at conferences throughout the past year.

What’s different about Eriksson was that his talk took place at the Diabetic Foot Global Conference, where the focus is on preventing amputations of a much different nature (see “In the Moment: Diabetes,” page 11). But the lessons learned from the Boston experience, Eriksson said, didn’t just apply to trauma.

He compared the extent to which the approach to caring for injured victims at each of the six responding major trauma centers in Boston was cooperative and collaborative, as opposed to piecemeal and proprietary. Then he compared outcomes at the same six hospitals, and found that amputation rates ranged from 20% to 33% at the more collaborative centers, compared to 40% to 45% at the less collaborative centers.

These data are preliminary, the sample sizes are small, the number of confounding variables is high, and the findings may not be statistically significant. But the take-home message is invaluable: When healthcare practitioners cooperate and collaborate, patients benefit.

That’s something worth remembering, whether your patient is the victim of a terrorist attack, Charcot neuroarthropathy, a neuromuscular condition, or a devastating hit from a linebacker. And it’s something worth remembering no matter what day it is.

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