AJN REPORTS

The Boston Marathon Bombings One Year Later

Boston’s ED nurses remember that day.

I
t was April 15, 2013, at the finish line of the ambulances speedy access to hospitals; and there were
Downloaded from https://journals.lww.com/ajnonline by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3OlGIyw74G18qA+6M35eg/CyHmFnUUEs869bUYGrvnwE= on 10/24/2019

117th running of the Boston Marathon. Runners
passed and spectators cheered, as they did ev-
ery spring. Then two explosions rocked the narrow
stretch of Boylston Street where the race ends, in-
flicting devastating injuries on those standing close
by. Three people died and 140 sustained injuries,
including many lower-limb amputations. On-scene
medical personnel (on hand, as always, to give aid
to runners), police, and spectators applied make-
shift tourniquets to what remained of severed limbs
and carried victims to medical tents, ambulances,
and police cars.
Whether it was serendipity or fate, however, the
city was ready: the weather was good; few operations
had been scheduled throughout Boston because it was
Patriots’ Day, a Massachusetts State holiday; EDs were
already well staffed because of the marathon; medi-
cal personnel, ambulances, and police were already
on hand at the finish line; the surrounding roads,
which had been shut down for the runners, allowed
six level 1 trauma centers in close proximity.
Ambulances left the scene with victims, fanning out
to the different EDs, and at each hospital, nurses were
there. And nurses who weren’t there supported those
who were: some even sent flowers or pizzas from across
the country. The support continued long after that day.
Out of that tragedy was born a kind of triumph,
and the huge network of nurses working throughout
the city played an integral part. Inpatient medical–
surgical nurses facilitated rapid admission of emer-
gency patients to make room for the incoming trauma
patients they would come to know over the next days
and weeks. Operating room nurses rapidly coordinated
emergency surgery for patients transferred from the
ED. And nurse managers coordinated patient care and
family communications at the 14 hospitals involved.
Below, we hear from four emergency nurses who were
on duty that day. You can hear their full stories at
http://links.lww.com/AJN/A57.—Gail Lenehan, EdD,
MSN, RN, and Maryfran Hughes, MSN, RN

Jay O’Reilly, BSN, RN, Brigham and Women’s Hospital

J ay O’Reilly was in charge of the trauma room when the

call came in:
“‘There’s been an explosion. Multiple explosions.’ Then
one of our doctors got a call from hospital personnel at
the finish line. She turned and said, ‘It’s real and it’s bad.’
That’s all we needed to know. Not five minutes after get-
ting the news, the patients started rolling in. Fourteen
trauma bays filled within minutes.
“After the first wave, we’d be ready for the next wave.
Some cases of water were brought from the cafeteria, but
not one person would take [any]. So we opened the bot-
tles and handed them to everyone, and only then did they
drink. You don’t think about yourself; I don’t know if
anyone took the time to go to the bathroom, [because we
were] worried that [we’d] be needed.
“What we didn’t think of, others did. I noticed that
someone with a Geiger counter was checking readings on
all the patients and the environment.”
O’Reilly described a particular area off the ED where
the staff brought clothing and other evidence for the po-
lice. “Sadly, we had to look into shoes for body parts.”

20 AJN ▼ April 2014 ▼ Vol. 114, No. 4 ajnonline.com

 Katie Marenghi, BSN, RN, Massachusetts General Hospital

K atie Marenghi was working in the ED’s acute area that day.
“We were incredibly busy already that morning when the
disaster phone came on. ‘We’re en route . . . patient with a right
leg partial amputation . . . not responding . . . blood pressure
dropping . . . not intubated yet. There may be more victims. ETA
five minutes.’
“I thought, ‘Oh God,’ and told the ED attending and our
resource nurse that it sounded like we needed to clear rooms
out now. The inpatient-unit resource nurses began to call the
ED to pull appropriate patients upstairs to help decompress the
ED.
“My first patient rolled in. She had lost a lot of blood and
was unresponsive. We applied tourniquets and pressure and
rapidly transfused blood. She began to regain consciousness,
barely arousable but tearful. I kept saying, ‘You’re okay, you’re safe. We’re going to take away the pain.
We’re going to put you to sleep and get you to the OR.’ And I said what I always say to badly injured
patients, my favorite thing: ‘We’re going to take really good care of you.’ We medicated, intubated,
and paralyzed her, readied her for travel, and the respiratory therapist and orthopedic surgeon quickly
wheeled her into a waiting elevator and to the OR. By this time, there were more patients rolling in.
“I’ll never forget that day and how everyone rose to the occasion. We were calling out, ‘Call the OR

Photo by Brian Wilson.

and tell them . . . ’ ‘Call the blood bank and tell them . . . ’ ‘Send a runner for . . . ’ ‘We need this, we need
that.’ All the support staff, from transporters to unit coordinators, were fabulous. Every single thing we
needed appeared.”

Gretta Morris, RN, Boston Medical Center

G retta Morris had run the Boston Marathon four

times herself and knew “metabolic madness”
well—dehydration, hyperthermia, “labs” way off. But
she would see no runners that day, only spectators.
“Someone said that there was a blast at the Copley
[Hotel]—maybe fireworks. Then we heard it was a
bomb; then the first victim rolled in—pale face, nothing
below her knees, great loss of blood.
“And so it began, the controlled chaos—I can hear
it in my head now. Very organized. ‘We have every-
thing. We do constant drills,’ I told myself, and I began
to triage the walking wounded, periodically going to
the back to help get fluids and blood ready.”
Morris describes the amazing way everyone worked
together. Physicians came running; nurses came in. Staff
working at the [on-site first aid] tent came in.
“It was a horrible thing, but it ended up with so many people showing kindness to patients and to
frantic families. So many positive things came out of it.
“We see a lot of trauma at Boston Medical Center. MedFlight comes in daily; we’re ready for any-
Photo by Erlyn Ordinario.

thing. But that day was different. There were just a couple hours of controlled chaos—treating patients,
keeping track of patients, uniting them with family . . . and then calm descended on the ED. It all ended
for us, but for those patients, their new [lives were] just beginning.”

ajn@wolterskluwer.com AJN ▼ April 2014 ▼ Vol. 114, No. 4 21

 AJN REPORTS

Jessica Sexton, BSN, RN, Boston Children’s Hospital

J essica Sexton was off on Marathon Day, watching the race

with friends. They heard the loud booms but thought it
was cannons going off for Patriots’ Day.
“We left, saw the news, and I called the ED coordinator. I
was there within 10 minutes. I wanted to be there; I needed
to be there. Everyone did. It felt better to be at work.
“I saw some of the newer staff looking for guidance, and I
encouraged them to focus on what they knew. We had a lot of
people from other places—transport teams, the ICU—come
down, and I helped orient them, and looked to see what could
Photo by KC Cohen / Boston Children’s Hospital.

be done, even small tasks. With some victims, I just listened.

As ED nurses, we want to fix problems, and there were
things there that we couldn’t fix. That was the challenge.
“During the day, I remember how calm it stayed and how fo-
cused [we were], even with all the chaos outside. [It wasn’t] just
patients from the bombing site; there were other patients as well.
We still maintained a sense of calm for everyone there that day.
“I was so impressed by my colleagues. It wasn’t one per-
son, it was everyone. Didn’t matter what their title or role was.” ▼