The bombs that made Boston look like a combat zone have also brought battlefield medicine to their civilian victims. A decade of wars in Iraq and Afghanistan has sharpened skills and scalpels, leading to dramatic advances that are now being used to treat the 13 amputees and nearly a dozen other patients — still fighting to keep damaged limbs after Monday’s attack.
Nearly 2,000 U.S. troops have lost a leg, arm, foot or hand in Iraq or Afghanistan, and their sacrifices have led to advances in the immediate and long-term care of survivors, as well as in the quality of prosthetics that are now so good that surgeons often choose them over trying to save a badly mangled leg.
Tourniquets, shunned during the Vietnam War, made a comeback in Iraq as medical personnel learned to use them properly and studies proved that they saved lives. In Boston, as on the battlefield, they did just that by preventing people from bleeding to death.
Military doctors passed on to their civilian counterparts a surgical strategy of a minimal initial operation to stabilise the patient, followed by more definitive ones days later — an approach that offered the best chance to preserve tissue from large and complex leg wounds.
At the same time, wartime demand for prosthetics has led to new innovations such as sophisticated computerised knees that work better than a badly damaged leg ever would again.
The Beth Israel Deaconess Medical Centre has performed amputations on three blast victims so far. A few other patients there may yet need them. Many doctors treating the victims have had military training. The military partnered with the American Academy of Orthopaedic Surgeons to train doctors throughout the United States on advances learned from the wars, said Dr. Kevin Kirk, an Army Lieutenant-Colonel who is chief orthopaedic surgeon at San Antonio Military Medical Centre.
John Fergason, chief prosthetist at Centre for the Intrepid, the outpatient rehab centre at Brooke Army Medical Centre, said advances include computerised knees that allow amputees with above-the-knee amputations to walk down steep ramps, to walk up steps and go from a walk to a run.
After every war, “you see a tremendous spike in prosthetic innovation”, largely because of increased research money, said Hugh Herr, a prosthetic expert at MIT and a double-amputee himself. Federal funds let his MIT lab do basic research on a bionic foot-ankle-calf system, and he founded a company that has commercialised that device.
If Boston victims are generally healthy and motivated, and their legs are amputated below the knees, or perhaps even above the knees, “it’s possible they could run the marathon a year from now”, he said. “It would take a lot of effort, but it’s indeed possible with today’s technology.”
Back on his feet
One amputee’s story is encouraging.
Dan Berschinski (28) used to run marathons but now works with the Amputee Coalition, an advocacy and support organisation based in suburban Washington, D.C. He was an infantry officer in Afghanistan when he stepped on an IED in August 2009. The blast blew off his entire right leg and most of his left leg. After treatment in the field and in Germany, he was sent to Walter Reed.
Recovery and rehab took about three years, including 10 months of daily physical therapy to strengthen his arms and core muscle power he’d need to learn to walk on prosthetics. The bionic legs he uses cost $60,000 apiece, are hydraulically operated and equipped with microchips and a gyroscope that sense when to relax and stiffen to help him walk. Walter Reed was involved in developing the legs, said Zach Harvey, former prosthetics chief at Walter Reed.
Mr. Berschinski used to run marathons but now competes in triathlons, swimming, biking with his arms and racing in a wheelchair.
“I’m very happy with my progress,” he said. — AP
Tourniquets, which were shunned during the Vietnam War but made a comeback in Iraq as medical personnel learned to use them properly, prevented people from bleeding to death in Boston