Boston Marathon Bombing

Yesterday’s awful tragedy in Boston was devastating, and really hit close to home for me, having lived there, and worked at MGH, and cheered the marathon in past years.

This event brings to mind the important concept of the second victim. In addition to the lives lost and the physical harm inflicted to primary victims, there are numerous second victims. Family members and friends of injured loved ones are second victims. The parents of Martin Richard are second victims. Emergency responders (whether professionals, or just good samaritans) who ran toward the horrific scene to help those who could not run away are second victims. The doctors and nurses who received these patients at the hospital may be second victims. Evidence is strong that physicians caring for patients under these circumstances may experience profound psychological stress responses, particularly if they felt fear, horror, or helplessness during the event. They may have trouble with sleep and concentration, and experience disturbing re-living of the images and sounds of trauma. Some develop symptoms consistent with clinical depression or post-traumatic stress disorder (PTSD), including intrusive recollection (“flashbacks”) and physiologic reactivity when exposed to cues that resemble or symbolize as aspect of the trauma. I hope that all who are affected by this tragedy have the support and resources to help them cope.

Having trained as an anesthesiologist at MGH, I immediately thought of my former colleagues. Although almost never in the media or public eye, anesthesiologists are responsible for stabilizing and maintaining patients – literally keeping them alive – so that definitive surgery can be performed to save life or limb. At MGH and other top centers, anesthesiologists are the physicians who lead the intensive care units, caring for those in critical condition. Although emergencies of this magnitude are fortunately rare, these patients undoubtedly receiving the very best care, not only because of the excellence of the Harvard hospitals, but also because of the simulation training those doctors undergo. Simulation training is the gold standard for disaster preparedness, and Harvard has been one of the pioneers of this training in medicine.

My thoughts are with the people of Boston, and all of those affected by this very sad day.

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