Reflections from the Medical Tent of the Boston Marathon

| Posted On May 12, 2014 | By:

TFor the past 8 years, I’ve had the honor and privilege to lend my medical skills to support so many athletes with a dream: to run and finish the Boston Marathon. I’ve seen a lot during those years from my vantage point in Medical Tent A, the main one at the finish line on Boylston Street.

Through the years, I’ve been asked lots of questions about my experiences in the tent, but it wasn’t until the horrific events of last year and the renewed spirit from this year that I thought to paint a picture for others as to what we do and how it all works behind the scenes.

What It’s Like in Medical Tent A

The medical tent is run like an efficient MASH unit. The tent is long and open on both “short” ends.  Runners enter from one end and then, once treated, walk out the other end, a smooth flow in and out.  At the exit, there are also 4-5 ambulances staged should those be needed.

We have 160 cots lined up on both sides, supported by about 200 medical staff, a variety of specialists and sub-specialists – physical therapists, nurses, cardiologists, IV nurses, internists, ER physicians, podiatrists, etc. We also have a support team of over 100 volunteers, many of them nursing and physical therapy (PT) students, that are called “sweepers.”  The sweepers are the ones with the wheelchairs at the finish line and are quite good at identifying runners who might be in need of help – “Oh!  I think he looks shaky, he’s going down!” – and scoop them up and bring them to the tent for evaluation.

In the tent, we all have our own jobs to do. We have leaders for each station (which equals 8 cots) who supervise the activities of the other medical staff.  For example, I typically supervise a 10-person team of nurses, registered physical therapists, PT students, nursing students, and residents.  When someone is brought into the tent, we can evaluate and treat them very effectively given the resources at hand, from cardiac critical care to musculoskeletal concerns to rehydration needs.

If appropriate, we can order lab work on the spot to check sodium levels and blood sugar. If a runner is hyponatremic (low sodium), for example, and if it’s needed, we have the ability to start a saline IV.  We provide heated blankets on the cold days to combat hypothermia in the runners, but we also need to treat hyperthermia on the hot days, when we’ve measured runners’ core body temperatures as high as 104 degrees.  To combat that, we have ice bath stations in the tent, and we will fully submerge runners to bring down temperatures fast.  We also treat a variety of medical conditions from scrapes and blisters to muscle spasms, torn ligaments and tendons.

What’s always amazing to me – a primary care doctor who sees a number of elderly patients dealing with chronic conditions – is seeing these runners come in looking like they’re on death’s doorstep and have them turn around in 20-30 minutes, getting up under their own power and leaving the tent.

At 8am on race day, all of the volunteers – this year we had 1,900 medical volunteers and 10,000 total volunteers – come together to get briefed on the information we need: the all-important weather forecast, things to look for, and an overview of the schedule.  The Medical Director for Emergency Preparedness for the city of Boston also speaks and said: “What we have here is an organized disaster.  Every year we train for this, we prepare for this, we have the plans in place, but those plans reflect a disaster scenario.”

And if you think about it, she’s right: there are usually 27,000 or so runners, and on average 5-10% will get injured, so we need to be prepared to quickly and effectively treat 1,500-3,000 injured people in a compressed amount of time. This year lived up to the averages: with over 36,000 runners, we treated 1,187 runners in Medical Tent A alone, and a total of 3,762 medical encounters were recorded from every medical tent along the course and at the finish line.  Only 192 runners needed to go to the hospital; the vast majority we were able to help without further, immediate medical treatment.

The Boston Marathon Bombing

It’s impossible to write this blog and not reflect on the events of last year and being at the finish line as a doctor. As devastating as the bombing was, a (thin) silver lining is that there could be almost no better support for the victims – the sheer concentration of us, all 200+ strong, many seasoned emergency medical respondents, mobilized in one place with the infrastructure to help – probably made the difference for many.

When the first bomb went off, we were inside the tent (we never really leave it once we enter until the marathon is done). It was totally unexpected and at the busiest time of the race for runners and for the spectators who came to see them.  There was a big thump and the tent shook.  I was tending a female runner who sat up and asked, “What was that?” and I replied, “I don’t know, it sounded like a bomb.”

There’s a coordinator who’s in the tent all day with a microphone, updating the staff and directing resources to the various cots – “we need an IV nurse at station 5, we need an EKG at station 12, elite runners are now coming across” and so on. After the first explosion, the coordinator came on to say “Continue to do what you’re doing, stay in the tent, take care of the runners,” and then we heard the second blast but it was much fainter than the first.  At that point, the coordinator came back on to say, “Any personnel who has their runner stabilized, you need to go to the finish line immediately.”  My runner was taking soup and feeling better, so I ran out.

By the time I got out there – and again, a testament to the number of medical personnel concentrated at the finish line – many people were already being treated by EMTs and loaded into ambulances.  There was glass everywhere – my path crossed with a police officer who was looking up, and when I glanced up, I saw that a big bay window was partially blown out, but huge shards of glass still remained, so he started directing people away from that area.

I was helping get supplies like bandages and tourniquets to EMTs who were shouting for them when I reached a young woman, a spectator, whose legs were in pretty bad shape. Dazed, she looked up at me and asked, “What happened?”  I said, “You don’t know?  A bomb went off.”  She didn’t even know at that time what had caused it all.  She was crying and repeating “I won’t be able to walk again, I won’t be able to walk again.”  I looked at her and said, “Yes, you will be able to walk again.  I know that.”  You see, my son was born without a leg, and I have a lot of experience with organizations like The Challenged Athletes Foundation.  I know what people are capable of.  I didn’t know how, I didn’t know under what circumstances, but I knew she would walk again.

Then the police came up and said, “You have to clear the area, there’s another bomb.” It turned out just to be a stray backpack abandoned in the panic, but we cleared out and got everyone into the medical tent.

I am still both awed and proud of what happened over the course of the next 90 minutes. We triaged and cared for hundreds and were able to get 120 people to local hospitals in that time.  When all of the victims were gone, however, it was eerily quiet – normally at that time we’d still be very busy.  As we finished, the police entered the tent with bomb-sniffing dogs and said, “Okay, everyone, don’t touch anything, leave everything the way it is, pick up your belongings and leave…this is a crime scene.”  Usually, we put our supplies away, fold up the cots, and pat each other on the back for a job well done.  This year, we just walked away.  And the scene outside the tent was surreal, too – no one was around, no one but police among the debris.

A New Year, A New Place

This year, I had a decided change of pace and was out on the course in medical station #7, which was located at mile 13.2 in Wellesley. This was actually the first year any doctors were on the course.  Previously, the medical tents along the course were staffed by nurse practitioners and EMTs, but for a variety of reasons – the biggest one being that there were 10,000 more runners this year than an average year – doctors were asked to man these on-route medical tents.

I expected this experience wouldn’t be as intense as my experience in previous years at the finish line, but I was wrong. It was a smaller tent – only 10 cots – but we basically had occupied beds the entire time.  One of the biggest challenges of being on the course was when I had to tell runners that their marathon was over…at mile 13.  If someone came in with a torn ACL or a ruptured Achilles tendon, I had to tell them, “I’m sorry, but this is serious, and you’re pretty much done for the day.”  Many runners’ eyes would tear up and they’d say,” Oh, please don’t’ tell me that.  What can I do?  Can I walk the rest the way?”  In many cases, I had to explain that, unless this was the last marathon he or she ever wanted to run again, it wasn’t a good idea.  It was very hard to see the complete disappointment – at least in the finish tent, I watched them enter and can watch them leave with that finisher’s medal around their necks.

But I loved to be where I was for this race. It was the first time I could be part of the race – to step out of the tent and be in the middle of so many people: runners and spectators and the energy that comes from the Boston Marathon, especially THIS Boston Marathon.  I don’t know where I’ll be posted next year at the Marathon, but I know one thing for sure, I don’t want to miss it.

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About Dr. David Driscoll

Dr. David Driscoll practices internal medicine at our Beverly practice. He received his medical degree from Chicago College of Osteopathic Medicine and also completed a fellowship there in osteopathic manipulation. He completed his internship and residency at the Lahey Clinic in 1997. Dr. Driscoll joined The Medical Group in 2006, which in turn joined Harvard Vanguard in 2013. He became interested in sports medicine and the Boston Marathon while working with a nurse at the Lahey Clinic who had been volunteering her time and medical skills at the Marathon for several years. His son is a member of the US junior paralympics team (the official name is the International Wheelchair and Ambulatory Sports Association), and he has been the team doctor for the last two years.

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