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Dr. Glenn M. LaMuraglia

Dr. Glenn M. LaMuraglia: Lessons from the Boston Marathon Bombing

December 16, 2013

Glenn M. LaMuraglia, M.D., is a vascular surgeon in Boston, MA with over 31 years of experience. He works for Massachusetts General Hospital and Mass General West. He received his medical degree from Harvard Medical School in 1979 and completed his residency and fellowship at Massachusetts General Hospital. He’s a leading expert in vascular surgery with dozens of publications. Castle Connolly has recognized him as one of America’s top doctors four years running.  

Why don’t you tell us a little bit about yourself?

I’m a vascular surgeon in Boston. I’ve been working at Mass General Hospital for a number of years. One of the great things about my specific practice is I operate on all kinds of problems. I do small bypasses. I do large surgery on the aorta, even the chest. I also do things that are minimalistic, or with balloons, and stents, and percutaneous work. So it’s a great practice in that I’m able to help a lot of people as they get older to enjoy their golden years free of vascular disease. I also treat a lot of patients who have strokes, who have aneurisms, diabetics with bad circulation in their legs or problems with circulation in their kidneys or their intestines. It’s a great practice really. There’s a lot of satisfaction taking care of these patients.

What made you decide to become a doctor?

I did that when I was pretty young. I had an uncle who was a physician and he was fortunate to work with Albert Schweitzer. I also had a great family doctor who I aspired to be like and who got me interested in science and the medical field.

What’s your connection to the Boston Marathon Bombing?

First, I live about four blocks away. The day before the marathon I enjoyed walking around seeing everybody get their numbers at the Convention Center in their wind jackets that had the emblem of the Boston Marathon. It was a really nice day. The next day I was working--operating--and one of the nurses came into the room and asked a scrub nurse not to go home at the shift change because of an incident. When we found out that a few bombs had gone off at the Boston Marathon, we went down to the Emergency Room and I ended up taking one of the victims to the operating room and trying to save their leg.

Did you manage to save their leg?

We did a bypass because they had an injury in the leg that prevented the blood supply from getting there, and we were able to make the bypass work, but the problem was that the foot was neurologically dead. It was decided three days later that despite the fact that the circulation was okay, the injury was so great that the person would be better off without their leg. So they ended up with an amputation for that reason.

What can physicians learn from the Boston Marathon Bombing?

One, that we are finally well organized, similiar to in England when they had the IRA bombings and in Israel with the suicide bombers. We learned at 9/11, when we were supposed to receive a number of victims from the New York area, that our preparedness was woefully inadequate. So, we’ve been doing drills and organizing between the hospitals, the police departments, the firefighters, the Boston emergency medical services, and developing the infrastructure so when this happened everything really worked very smoothly and it was tremendous to see.

Also, one of the things we learned from this was that most of the people who died, died of hemorrhage at the scene. What was truly amazing is that nobody who made it to the hospital died. At any hospital. And that really is quite remarkable. Unfortunately, the tourniquets that people used were not very good. People used belts, shirts, jackets, pants, and bag strings. What you really need to do is get enough pressure on the limb to be able to stop blood flow. When people are in shock their blood pressure drops so you’re more successful, but the only handmade or homemade device that would really work would actually be a necktie. You can put it around the limb and then use three pens to rotate it around to be able to get enough pressure to stop the bleeding. If you get a belt, you can pull all you want on it but you’ll never stop the bleeding. In the military, they use tourniquets which are very small carried by every soldier. They can apply them to an arm or a leg if they get shot and actually stop the bleeding. But most people won’t have that. If they think of using pens on a makeshift tourniquet to tighten it, that’s something that can actually save lives.

What can patients take away from this?

Patients can take away that everybody steps up to the occasion, like a lot of the spectators at the Boston Marathon did. There were also a lot of very fortunate things that happened. The bombing occurred at the change of shifts and all of the hospitals had twice as many people available. The infrastructure worked. The triage, sending people to all the different hospitals so no one hospital was overwhelmed, worked. And fortunately, although a lot of people lost their legs, had the spectators been 10 or 20 feet further forward, a lot of the projectiles and shrapnel would have hit them in their back and they would have lost more than their legs—they would have lost their lives, because then the shrapnel would have gone into the body and the back and people would have been paralyzed. Also what they used were very low explosives. They used gunpowder from fireworks. Had they used C4 or other types of military explosives, the damage would have been much, much greater. So although it was a terrible tragedy, in some ways it worked out better than it could have.

How do you think things are going to continue improving going forward?

Well, I think that people now have a good sense of what we are able to do with the infrastructure that we have. Systems have been set in place that actually work very nicely. I think the one thing that they’ve also learned, probably from the Aurora, Colorado shooting and from other shootings, is that they need to get to the victims quickly. Often a lot of the emergency personnel are not allowed on the scene, and people exsanguinate (lose all of their blood) because nobody can get in and stop the bleeding. They have to try to figure out ways of being able to get the tourniquets over and get people to stop from exsanguinating at the scene. But that’s a situational thing that has to be looked at on an individual basis. Here, there were two bombs and then everybody went in to help, which was fortunate for the victims.

Is there anything else you want to share?

One other thing that is really not talked about very much is the psychological effects, the post traumatic stress disorder. It’s very interesting that in the emergency room, a number of the nurses and doctors didn’t want to come to work one or two weeks later. It was a very difficult time for the city also. There was a lockdown two days later after the MIT policeman was killed and they were trying to find the perpetrators.

I think that the memorial at the scene was very touching, and I actually went a number of times myself. They had a lot of shoes; a lot of people who were in the marathon took their shoes off and left them for the memorial. And hats. There were also a tremendous number of things from kindergartens and schools around the country and internationally: teddy bears and little rings with people’s names on them. It was really touching. 

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