Rx for Boston: Interdisciplinary Rehabilitation

The images from this year’s Boston Marathon were numerous and horrific. The bombs killed three and injured over 260 people. If it not for the heroics of the many first responders, emergent resuscitation on scene and rapid transport to the city’s waiting trauma teams, many more would have died. Many of the survivors required surgery, many multiple times. Once the survivors began to improve, clinicians at Boston’s top medical centers began to reach out to SRH to pave the way for the next stage in their recovery. Orthopedic trauma teams called ahead to coordinate treatment with the Comprehensive Rehabilitation Program as the “baton” was passed to SRH to lead the rehabilitation effort.

 

Thirty-three patients in all were admitted with polytraumatic injuries involving bone, nerve, brain, vasculature, and soft tissue.  Several had burns and all had complex leg injuries. 13 adults and one pediatric patient had major lower limb amputations including 11 unilateral lower limb amputations and two patients with bilateral lower limb amputations. Many had hearing loss due to tympanic ruptures along with blast-related cognitive impairments. Multiple skin grafts, free flap procedures with no weight bearing, development of myositis ossificans complicated patients’ rehabilitation efforts. One patient remained at SRH for only 24 hours before it was clear that her leg wounds were worsening resulting in her eleventh surgery back at the acute care hospital. Two amputees required extended courses of antibiotics due to localized infection. Several patients required further removal of foreign bodies, with one patient removing a superficial ball-bearing from her leg during her pre-therapy hygiene. With Physiatry at the lead, the patients were cared for by an interdisciplinary team consisting of rehabilitation nursing, OT, PT and SLP therapists, Recreation Therapists, Case Managers, Dieticians, Chaplains and Mental Health clinicians.

 

Because the bombing was such a public and local event, our staff throughout the hospital required extra support. Many are runners or know runners, have run in the Marathon or have friends or family who ran in the Marathon. The parallels between them and the survivors and their families made caring for this group emotionally challenging. An additional stress came in the form of our move to a new hospital which came during our first week of caring for the survivors. The Mental Health team spent time with individuals and the care teams giving them a chance to process their own experiences and feelings related to the bombing and the care of the survivors. We heard repeatedly how much caring for the survivors helped caregivers heal from the trauma of the bombing.

 

The survivors and their families have been doing well. They have been progressing in their therapies and, as we say here, finding their strength through the support from their caregivers, their families and the community. All but a few have returned home. We are seeing many in our clinic as they continue to recuperate or work to master their new legs. Most have recovered from their initial traumatic reactions. Some are still adjusting emotionally to what has happened. They still have a long road ahead as they come to terms with their new realities and the challenges they face. We will continue to follow many of them through the course of their rehabilitation. Overall success will be measured less than a year from now on April 21, 2014, when many of these survivors and their families will return to Boston to finish the race.  We will be at their side.

 

David Crandell, MD  
Medical Director, Amputee Program
Spaulding Rehabilitation Hospital Boston
Runner in the 99th Boston Marathon

 

Christopher Carter, Psy.D.
Clinical Behavioral Psychologist and Director of Behavioral Medicine
Spaulding Rehabilitation Network
Runner in the 111th and 113th Boston Marathons

 

 

With the many different conditions I have, I feel they did everything humanly possible and I have come away from the pain program with some excellent tools.

A Painless Patient

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