As first responders and hospitals handled nearly 200 casualties of the marathon bombings, one factor that helped them save lives was the military's experienced with improvised explosive devices in Iraq and Afghanistan. Those wars in effect served as field trials for doctors developing a new set of best practices for dealing with traumatic lower-body wounds, helping to dramatically lower mortality rates for injuries that were once virtual death sentences.
More MoJo coverage of the 2013 Boston Marathon bombings
Military hospitals "can't do prospective research, but they can record a tremendous amount of experience and give that back to civilian research," said Dr. Carl Hauser, a trauma surgeon at Boston’s Beth Israel Deaconess Medical Center. "This particular incident here was very much one where they had helped us."
Area hospitals treated 187 people for injuries related to the blast, including more than a dozen in critical conduction. Because the blast originated from a device placed on the ground, most of the injuries were to the lower body, rather than the head or abdomen. Some of the wounded, like Jeff Bauman, the man carried to safety by Iraq War activist Carlos Arredondo, lost limbs in the explosion; at least 10 people had amputations.
Chief among the lessons of roadside bombs was the resurgence of the tourniquet. A staple of pre-World War II trauma care, it had fallen out of favor in recent decades because of misuse. Going into the invasion of Afghanistan, "This was still being taught in EMS courses and in trauma literature as a bad thing," says Donald Jenkins, director of the trauma center at the Mayo Clinic in Rochester, Minn., and a 24-year Air Force veteran.
But military doctors soon found that when applied correctly and in the right situation, tourniquets pay enormous dividends—dropping the mortality rate in such instances from 90 percent to 10 percent. Now they're standard procedure among first responders. (The bleeding in Bauman's legs, for instance, was kept in check by a hand-made tourniquet made from a shirt.)
"How to care for these wounds—that's almost impossible to recreate in a civilian training environment."
Likewise, doctors in Iraq soon discovered that the conventional wisdom on how to stop blood loss in a trauma victim was basically backwards. For about half a century, doctors had relied mostly on red blood cells and crystalloid fluids. But when Jenkins was deployed to Oman in 2002, he and his colleagues began using a different formula, in which there was a much higher rate of plasma. "If you gave blood transfusions the old way, the mortality rate approached 70 percent," he said. "But if you did it in that 1 to 1 approach, the mortality approached 20 percent." Their policies were soon adopted by trauma centers back in the States.
"It wasn't really until the armed services started doing that as a concerted effort in the Middle East that we realized how much the early use of blood...changes things in a number of ways," Hauser says.
On a more logistical level, as the New York Times reported on Tuesday, hospitals in Boston adopted a basic tactic from Iraq to eliminate any unnecessary confusion as to which patients needed which kind of care. As the Times explained, surgeons "used felt markers to write patients' vital signs and injuries on their chests—safely away from the leg wounds—so that if a patient’s chart was misplaced during a transfer to surgery or intensive care, for example, there would be no question about what was found in the emergency room." But the largest benefit of the war experience may have been training.
"Learning how to care for these wounds, how much work has to be done, how much tissue you need to remove, how much to leave behind—that’s something that is almost impossible to recreate in a civilian training environment," Jenkins says. "We all learned to do this when we went to the war. And those of us who learned early passed it on, literally, surgeon to surgeon, as they exchanged positions in the war. A new surgeon replacement would arrive and you’d have three days to go over with them and you’d practice side-by-side and show them, this is how you do this.
"Now we have scores, hundreds of surgeons who have been through that and know how to do this."
Shortly before 8 p.m. CDT on Wednesday, a massive explosion rocked the central Texas town of West following a fire at a fertilizer plant. Early reports are conflicting, but it appears that over a hundred of people have been injured, and dozens of homes and businesses have been damaged or destroyed, including a high school and a nursing home.
Authorities are concerned that winds could carry the toxic fumes into residential areas. At a press conference on Wednesday night, Mayor Tommy Muska (who is also a volunteer firefighter) said, "A lot of people won't be here tomorrow…it's a cut across our hearts." Complicating matters is the location: A volunteer fire department serves the town of 2,700, and casualties are being transported to the nearest hospital in Waco—20 miles away.
The fire escalated so fast because of its fuel:
To put #West, TX in perspective, 4,800 lbs of fertilizer were used in OKC bombing. That fit in a Ryder truck. This was an ENTIRE PLANT.
The clearest footage we have of the blast itself comes from a man who appears to have been watching the fire from his car with his young daughter. The explosion comes about 30 seconds in (warning: not for the faint of heart):
The Dallas Morning-News captured the audio of the emergency dispatcher responding to the fire. At the 7:41 mark, the dispatcher advises that all units "need to load up and get out of there right now":
While the explosion registered on a seismograph over 400 miles away in Amarillo, Texas:
Wednesday's fire came one day after the 66th anniversary of the worst industrial accident in American history—the Texas City disaster, another fertilizer explosion that left 581 people dead when a French vessel hauling ammonium nitrate caught fire.
In February, a nearby school was evacuated due to a "concerning fire" from a fertilizer plant in the area:
By midnight on Thursday, more than 100 people had offered their homes to people displaced by the West, Texas explosion using a shared Google Doc. Over on Reddit, people are attempting to assemble a crowdsourced map of the blast site and emergency services that you can see here.
For on-the-ground coverage, check out the local station NBCDFW's livestream. On Twitter, follow the Waco Tribune (@wacotrib) and @DallasNews, as well as local reporters Lowell Brown (@LowellMBrown), Stewart McKenzie (@CBS11ProdStew), and Mireya Villarreal (@cbsmireya).
UPDATE 1, Thursday, April 18, 1:03 p.m. EDT: Video of the devastation:
UPDATE 2, Thursday, April 18, 1:05 p.m. EDT: Texas Governor Rick Perry held a press conference Thursday on the explosion. Perry reiterated that the search for survivors continues.
ALERT: AUSTIN, Texas (AP) - Texas Gov. Perry: Fertilizer plant explosion was "truly a nightmare scenario" for community.
UPDATE 3, Thursday, April 18, 2:34 p.m. EDT: Estimates have put the number of dead and missing at 15, but those figures are expected to rise. According to a 2011 safety plan filed with the EPA, the plant did not have firewalls or an automatic shutdown system, reported the Wall Street Journal.
UPDATE 4, Thursday, April 18, 3:11 p.m. EDT:
TCEQ official says #West fertilizer plant hasn't had a complaint since 2006 — meaning it hasn't been inspected since.
"We haven't had a complaint from that facility since 2006," Zak Covar, director of the Texas Commission on Environmental Quality, told the Texas Tribune. Covar added that the facility had been "grandfathered" from some environmental regulations until 2004.
UPDATE 5, Thursday, April 18, 3:56 p.m. EDT:
The Bureau of Alcohol, Firearms, and Tobacco will be spearheading the inquiry into what caused the explosion, the Waco Tribune reports. Officials told the paper the investigation could take up to six months.
UPDATE 6, Thursday, April 18, 8:30 p.m. EDT:
As many feared and expected, the number of those killed by the blast has risen. Tommy Muska, the mayor of West Texas, confirmed to USA Today and the LA Times that as many as 35 are dead, including 10 first responders. Waco Tribune reporter Lowell M. Brown captured the impact of this felt by one resident, who, after listing the names of volunteer firefighters still missing, told the paper the town would never be the same again. Meanwhile, survivors of the blast are taking comfort in the famed kolaches and coffee at Czech Stop—a nearby, 24-hour institution that kept its doors open through the tragedy.
There's still a lot we don't know about Monday's bombing near the finish line of the Boston Marathon. We don't know if the bombs were set off by one person or multiple people; we don't know if it was an act of foreign or domestic terrorism; we don't know what the perpetrators(s) look like; we don't know what the motive was. One thing we do know: Many of the initial reports on media outlets on Monday and early Tuesday have proven to be false.
That's inevitable during a breaking news event—and in this case, even some law enforcement officials did more to confuse than to clarify. But one day later, here's a look at some early storylines that have fizzled upon further scrutiny:
1. Cellphone service shut down in Boston. Reported by: the Associated Press, which credited the information to an unidentified "law enforcement official." But cellphone service continued uninterrupted in the city. Verizon spokesman Torod Neptune told Mother Jones the reports were "incorrect," and that service providers were not asked to shut down.
2. Explosions kill 12 people. Reported by: the New York Post. As of 6:58 p.m. on Monday, the tabloid's website was still touting the 12 dead figure on a splash on its website. (It has since been updated.) The Boston Police Department has only confirmed three dead, along with 176 injuries (including 17 people in critical condition).
3. Bombing at JFK library. Reported by: multiple sources, thanks to a series of ambiguous statements from the Boston Police Department. Boston police commissioner Edward Davis said at a press conference Monday that police were investigating a link between an incident at the JFK library and the marathon bombing. Time's Andrew Katz reported on a "possible" device, citing police scanners. By Tuesday morning, the JFK library incident had been officially classified as a "mechanical fire"—as library officials had maintained all along.
4. Saudi national in custody. Reported by: the New York Post, which stated on Monday that a Saudi national had been taken into custody as a "suspect." Although investigators said they were speaking with a Saudi man who was in the United States on a student visa and was being treated for injuries at a nearby hospital, no one has been taken into custody, and at the moment there are no suspects.
5. Five additional incendiary devices found. Reported by: the Wall Street Journal, which initially said that counterterrorism officials had found five unexploded devices around the Boston area—separate from the two detonated bombs. The New York Timesreported three unexploded devices, including one at the corner of St. James and Trinity Streets, and another outside the city in Newton. But the Journal walked back its report quickly and Newton police rebutted the bomb report. On Tuesday, Massachusetts Gov. Deval Patrick confirmed that "two and only two explosive devices were found yesterday," although many packages were investigated. "There were no unexploded explosive devices found." Both articles have since been updated.
6. Police have security footage of a "possible suspect." Reported by: CBS News, citing "one law enforcement official." According to a Monday afternoon CBS News report, authorities had found a video of an individual carrying backpacks on Boylston Street minutes before the first explosion. This would be news to the Boston Police Department and the FBI, both of whom say they are still looking for a suspect and have no description of what he or she might look like.
7. Sunil Tripathi did it. Reported by: Dozens of sources, most notably BuzzFeed's Andrew Kaczynski, and Reddit—which had zeroed in on the missing Brown University student over the previous 24 hours. But Tripathi's name had never been mentioned on the Boston police scanner prior to the initial reports on Twitter. And just a few hours later, NBC's Pete Williams officially corrected the record, breaking the news that authorities had identified Tamerlan and Dzhokhar Tsarnaev as the primary suspects in the bombings. (Tripathi is still missing.)
On Thursday, 16 Republican senators voted to move forward with debate on gun control legislation. Texas Railroad Commissioner Barry Smitherman's response: hang them.
Smitherman, a Republican who oversees the state's oil and gas industry (the name is a bit of an anachronism) retweeted an image listing all 16 GOP senators, along with an image of a noose with "treason" on top of it:
Smitherman still has a long way to go if he wants to claim the biggest overreaction to gun control legislation. Rep. Jeff Duncan (R-S.C.) alleged that national firearms databases could lead to "evil consequences"—such as genocide.
Update: The image has been taken down, but here it is:
If Scott Brown really is thinking of running for Senate in New Hampshire next year, he has an odd way of showing it. In May, the former Massachusetts Republican senator will travel to Las Vegas to give a topic at the SALT Conference, an annual confab put on by the hedge-fund giant Skybridge Capital. His topic: The consequences of over-regulating hedge funds.
Although Brown touted his crucial vote for the Dodd–Frank Wall Street reform law during his re-election campaign against Sen. Elizabeth Warren, he was widely credited with watering the financial-reform legislation at the behest of Wall Street interests. Among other things, Brown used his position as a tie-breaker to loosen the regulations on how much control banks could have over hedge funds, and to make it easier for them to use federal bailout funds to bail out failing hedge funds. (He brought in more than $3 million in campaign donations from the financial sector during his two campaigns.) Sure enough, in March Brown took a new gig at Nixon Peabody LLC, a law firm that services large Wall Street shops. As a release from the company explained at the time, "Brown will focus his practice on business and governmental affairs as they relate to the financial services industry."
The trip to Vegas looks like a sign he's focusing on the job he has now, not the job he might want later.