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(NECN: Ally Donnelly) - Eighteen minutes after the first bomb ripped through the crowd on Boylston Street, wounded and terrified patients arrived at Boston Medical Center.
"So much, so many casualties all at once," Boston Medical Center's Dr. Alik Farber recalled.
BMC took in 28 patients, ranging from a 5-year-old child to a 70-year-old man. People were bleeding, moaning with shrapnel the size of iPhones splitting their legs.
"I'm in surgeon mode. I'm not thinking about the emotions with it, we just work," Dr. Tracey Dechert said.
That work was helped by so many factors: The well-trained, well-equipped first responders at the finish line; the fact that there are six Level One trauma centers throughout the city; the timing of the bombing -- at shift change -- when hospitals had essentially double the staff.
"There is no better place that it could have happened. There is no better time that it could have happened," Dr. Jeff Kalish, a Boston Medical Center vascular surgeon, said.
That might be true. After all, though three people died when the bombs went off, no one died at the hospitals. But what if they hadn't been so lucky? Are there things they could have done better? Lessons learned from mistakes made? A year later, can they say they're better prepared to save our lives?
Staff at BMC say yes. And here's why: No one at BMC knew how many patients they were going to get, so trauma nurse Joe Blansfield says staff followed procedure and put the first wounded to arrive into ER trauma rooms. That was a mistake, because in those walled rooms, it's a handful of staffers to one patient, when doctors really needed to be jumping from bed to bed.
"If we knew what we were going to be confronted with that day, we wouldn't have done that. We would have declared the entire area of the Emergency Department one large open trauma bay," Joe Blansfield, Boston Medical Center's Trauma Coordinator, said.
Sharing data through a newly-formed Boston Trauma Center Collaborative, hospitals also realized they need to figure out better ways to identify patients. Many survivors came in without ID or worse, someone else's. Krystle Campbell's family was told their daughter was heading into surgery at Massachusetts General Hospital, when she had actually died. Her friend, Karen Rand had Krystle's purse and it was not until Campbell's family came in to see their daughter that they realized the horrific mistake.
"It was a little bit scattered at the beginning and we really didn't get better at it until later on in the day," Blansfield said.
Another challenge was different family members scattered throughout the city -- a father at Brigham and Women's, his child at Tufts. BMC's IT team helped calm nerves by quickly getting computers and iPads into patients' hands as quickly as possile.
"Doing facetime and doing Skyping from one institution to another, so people were able to get some sense of reflief - 'Yes. I'm here. I'm alive. I'm at hospital X,'" Blansfield said.
Dr. Jeff Kalish says hospitals have also learned to focus medical teams -- ortho, vascular, plastics, psych -- into one unified voice.
"Repetitive questioning and rounding is streamlined in a way that we don't retraumatize these patients five times a day," Dr. Kalish said.
They've boosted security plans, including searching ambulances for explosives further from the building and scanning for suicide bombers that could come into the ER.
"It wasn't clear that it was the end of it. There may have been, you know, somewhere in the subconscious, I was worried there was more to come," Dr. Farber said.
In light of the backpack bomb used, Dr. Dechert says they are consulting with their military colleagues more often to keep up on injuries they don't normally see.
"Trauma to the ear drums and infections from the shrapnel and pieces of metal and plastic and all kinds things that were just stuck in people," Dr. Dechert said.
But perhaps the biggest lesson learned, several doctors say, was the value of tourniquet use at the scene, something Blansfield -- an Army veteran -- had been heralding for years.
"If you have an exsanguinating hemmorage and you're going to be bleeding out in 10 to 15 minutes and I put a tourniquet on and I can mitigate that bleeding so you can live for 20 or 25 minutes and you're 15 minutes from a trauma center," Blansfield said.
After the Marathon, every paramedic and EMT in the city, as well as every Boston Police cruiser, was equipped with a military-style tourniquets -- a change tangible and controllable after an attack so far out of anyone's control.