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Since 9/11, hospitals around the country have prepared themselves for worst case scenarios to come rushing through their ER doors. But for Dr. Ron Walls, chair of the department of emergency medicine at Brigham and Women's University in Boston, the lessons that prepared him for the Boston bombing were much more recent.
"Ideally we work where we have one patient come in, as a trauma patient, we have a really highly-trained team around them that works beautifully together and takes care of that one patient," said Walls. "But what happens when you multiply that by 20? And one of the clarion calls for us was the Aurora shootings," said Walls.
In Aurora, one hospital received nearly two dozen patients in one hour. That's a very unusual circumstance, said Walls.
"It made us wonder, could we do that? So we started looking more specifically at how do we handle an unexpectedly large number of patients in a short amount of time," said Walls. "We always had that, and we'd tested it. But what Aurora did for us was crystallized a specific question, and that question was, 'Could we take 23 critical patients in one hour?' And we had never answered that."
Until last Monday, when they answered almost to the letter.
"I heard the sirens and it was almost like every siren in the city started up at once," Walls said of that dreadful day. "It's fortunate we had thought about this the way we had thought of the Aurora arrivals because in fact we did get 23 patients in a little over an hour."
The hospital still has 9 patients from the Boston bombing attack.
"They're actually doing amazingly well. I mean these are really serious injuries. These are life-changing injuries," said Walls. The remaining patients are undergoing limb-saving procedures. "Now they're into the phase where it's more about the healing and the reconstruction to restore their limbs to a functional activity."
Even for professionals like Walls, the scenes of that day take a toll.
"I've seen injuries like that individually but I have never seen them collectively, to get that many patients with those injuries. They were really dramatic injuries," said Walls.
"Seeing that many at once was a totally unique experience that I hope I never have again," said Walls.
Walls reached out to a colleague at an Aurora hospital that treated victims of the mass theater shootings, and asked for advice. That colleague said his hospital spent a lot of time worrying about the mental health of the doctors, nurses, and hospital workers who treated the shooting victims. Brigham and Women's Hospital said they are supporting staff, and helping them recover from the trauma of last Monday.
The remarkable thing about being an expert caregiver, said Walls, "is that when you see these people they're on the brink, they're right at the edge, maybe the edge between life and death, or the edge between a good life or a bad life, and pulling them back is very powerful experience," said Walls.
"We don't feel helpless in here, we feel like it's our mission to get them back."