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Trauma in the E.R.

No doctor can truly prepare for a tragedy like this. Kent Sepkowitz, a former ER physician, on the prognosis for victims with missing limbs and how medical workers cope amid crisis.

As yesterday’s statistics in Boston—three dead, more than 100 seriously injured—turn into specific, heartbreaking human stories, the role of the emergency rooms scattered throughout Boston will fade quickly into the background. This is as it should be; emergency health care is the job of the emergency room, after all. But the roles of hundreds of doctors, nurses, and other staff will be forever traumatized by what they witnessed, as described so vividly in December after the Newtown shootings. 

Aid Workers Help Injured

Medical workers aid an injured woman at the scene of the explosion near the finish line of the 2013 Boston Marathon. (Charles Krupa/AP)

I worked as an attending doctor in New York City ERs for four years, but I never had to deal with anything like what Boston's ERs handled yesterday. You just don’t see these types of injuries in an urban American hospital. In fact, ERs are usually boring places to work. Yes, there are moments of TV-worthy drama and tension, but in general, serviceable health care is delivered as quickly as possible with a forced smile.

But then comes the momentous tragedy of April 15, and everyone’s frame of reference is changed. I cannot imagine the sort of mayhem and fear, as well as nausea and tears, the ER staffs across Boston must have experienced. No one is ready for anything like this—the missing limbs, the bleeding, the shrapnel, the smell of burnt flesh, which once experienced remains forever present. Plus, there was an apparent concern that hospitals themselves might be targets of additional bombs, given the reports of SWAT teams in and around hospitals in the early aftermath.

Rhetoric Change

‘An Act of Terrorism’

The president used the T word to describe the Boston Marathon attacks a day after declining to do so. Howard Kurtz on the White House response.

President Obama reversed himself on Tuesday and declared the Boston Marathon bombings to be “an act of terrorism.”

Having drawn some political flak for omitting that word in his initial reaction to the attacks on Monday, the president offered a definition that raised questions about why he had been so cautious.

Obama said the FBI was investigating the twin bombings as a terrorist act. But a moment later, he said: “Any time bombs are used to target innocent civilians, it is an act of terrorism.” By that standard, the attack that has killed three people and wounded more than 100 should have immediately be seen as terrorism.

Speaking to reporters at the White House, the president echoed what investigators have been saying, that no one yet knows whether foreign or domestic plotters are behind the crude bombs: “We don’t have a sense of motive yet.”

It’s interesting to me that some conservatives take umbrage at any speculation that the bombings might have been the work of right-wing fringe groups. Why? What affinity does a rank-and-file conservative feel with a militia type?

I feel no affinity whatsoever with far-left violent radicals who might try to kill innocent people. I make no excuses for them, whether they’re American or Palestinian or whatever they are. I see that I got a little bit flamed on the Twitters last night for saying that we haven’t heard from left-wing fringe groups “in many a year,” but that was just a statement of fact, depending I guess on your definition of many a year. The Weather Underground Brinks Robbery, the last big fringe-violent left-wing attack that I remember, happened 32 years ago. I think it’s fair to call that “many a year.” Others may not, I suppose, but to most of us it's a long time ago.

I see that I was also supposed to know about every plot that didn’t reach fruition, like last year’s attempted bombing of a bridge in Cleveland by anarchists. I actually hadn’t even heard of that. Maybe I should have heard of it, so fine, that’s my lapse. But evidently some people assumed I was covering up for the far left by not mentioning it—the plotters apparently had ties to the Occupy movement and decided it wasn’t getting anything done. So here I am mentioning it. To jail and to hell with those guys. I have no use for them at all and certainly no interest in hiding their crime.

There are some people who think anything remotely resembling speculation is totally irresponsible. I can understand that point of view. But as I watched CNN and MSNBC last night, all the way to Brian Williams going live after midnight, they were constantly asking their terrorism experts about clues and meanings that might suggest this group or that, which is all I tried to do.

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A Time for Resilience

The worst domestic attack since 9/11 shook us out of complacency. Now we can’t let terrorists change our actions as Americans, even for one day, writes John Avlon.

There, with the end in sight, two bombs exploded on Boylston Street.

The shrapnel tore through the cheering crowd, knocking marathon runners down with the force of the blast, turning their moment of triumph into tragedy.

Even hours later, still surrounded by the fog of war, we are not sure of who set off the bombs or why. But whether this terror attack is the work of a lone wolf or al Qaeda or something else entirely, what’s clear is the cruelty of this twisted excuse for a human being.

Scene Near Boston Marathon Bombing

A woman who apparently sustained an injury to her hand is comforted by another after explosions interrupted the running of the 117th Boston Marathon in Boston on April 15, 2013. (Dominick Reuter/Reuters, via Landov)

Boston Nightmare

Shrapnel and Amputations

Massachusetts General had never seen so many patients on stretchers lining the hallways of the hospital. It’s not every day doctors operate on severed limbs. Lizzie Crocker reports from Boston.

Doctors and nurses were quiet as they left Massachusetts General Hospital Monday night, roughly five hours after two bombs exploded during the Boston Marathon. 

“I just want to go home,” said one young female nurse when asked about the 29 patients who are currently being treated at Mass General from the dual blasts that detonated in Boston’s Copley Square, just two miles down the road.

Victim Carried Away from Scene of Explosion

Ambulances lined up along Huntington Avenue following two explosions on Boylston Street in Boston near the finish line of the Boston Marathon. (David L. Ryan/The Boston Globe, via Getty)

There was a chilling calm in the darkness, a stark contrast for those who had tended to severed limbs in the bright lights of operating rooms or witnessed the bloody mayhem on Boylston Street in daylight.

Marathon’s Bravest

The Heroes of Boston

The marathoners who kept running to Mass General to donate blood. The first responders who ran straight into the bomb site. The Bostonians who offered food and shelter. Nina Strochlic on the bravery amid the carnage.

On Monday afternoon at 2:50 p.m., after 26.2 sweaty miles, triumphant runners crossed the finish line of the 117th annual Boston Marathon, just as two blasts ripped apart the sidelines of the race. With at least three dead and more than a hundred injured, the city saw the pleasant afternoon turn into a nightmare of severed limbs and blood-splattered sidewalks.

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Emergency personnel aid the injured on the sidewalk at the scene of the first explosion near the finish line of the Boston Marathon. (John Tlumacki/The Boston Globe via Getty)

As always, where there’s tragedy, heroes emerge. As the dust from the explosion cleared, runners and observers from all walks of life mobilized. Both trained and untrained, hundreds rushed toward the scene of the explosion site to tend to the injured. Marathoners tore off their shirts to use as tourniquets on victims. A first responder pushed a wheelchair-bound woman to safety and then returned to the carnage. The U.S. Army retweeted a picture captured from television of two fatigue-clad soldiers who had just finished the race and appeared to be running straight into the explosion site. Legendary Patriots guard Joe Andruzzi was spotted carrying a woman to safety after the blast. Peace activist Carlos Arredondo was identified as the cowboy hat-clad volunteer pinching the artery of a legless man in a wheelchair, thought to be a Newtown commemorative runner, in a widely spread photo. In five hospitals across Boston, medical staff braced for an onslaught and emergency staff worked tirelessly amputating limbs and giving blood transfusions. Online, pictures of these heroes in action were hailed and shared as the world reacted to the graphic scenes.

Monday’s marathoners continued to help after completing the exhausting race, proving months of training in the endurance sport was more than personal fitness. Around 4 p.m., NBC Sports tweeted reports that many marathon runners crossed 26 miles to the finish line and continued running to Massachusetts General Hospital, where they donated blood to victims. So many people rushed to follow in the runners’ footsteps that within hours of the blasts, Mass General and the Red Cross had stopped accepting blood donations.

Bravery Amid Evil

The Boston Cowboy

He had gone to the marathon to honor his dead sons. By the end of the day, Carlos Arredondo was a hero. He tells Michael Daly about saving a man with his legs blown off by the explosion.

Carlos Arredondo was in the bleachers by the finish line of the Boston Marathon when the first bomb went off directly across the street.

“Loud,” he says. “The fireball that came out. Also the smoke.”

APTOPIX Boston Marathon Explosion

Arredondo assists medical responders as they help an injured man following an explosion in Boston on April 15, 2013. (Charles Krupa/AP)

In the next moment, the 53-year-old from Boston was vaulting a barricade and racing straight into the acrid cloud, wearing a cowboy hat like some Western hero.

Boston Bombing

‘A Madrid-Style Event’

The number of devices, the apparent fireball—former FBI counterterrorism investigator Mark Rossini tells Lloyd Grove how the Boston Marathon explosions resemble the 2004 Madrid attacks, which killed 191.

Watching the images of Monday’s Boston Marathon bombing on CNN International and the BBC, former FBI counterterrorism investigator Mark Rossini thought he noticed a disquieting connection.

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Bystanders help an injured woman at the scene of the first explosion on Boylston Street near the finish line of the 117th Boston Marathon. (John Tlumacki/The Boston Globe,via Getty)

“This has the hallmarks of a Madrid-style event in many respects,” Rossini told The Daily Beast from Paris, where he was visiting on business for his private security consulting firm. “We don’t know who the bombers are, but I assume it was more than one. It’s just my gut that there might have been two people involved. And allegedly, a third device has been found.”

The Madrid commuter train bombings, a coordinated attack using multiple explosive devices that killed 191 people and wounded 1,800 on March 11, 2004, were attributed to an al Qaeda-inspired terrorist cell. Rossini at one point had been the FBI’s liaison to the Spanish police. And as one of the FBI’s team leaders on the scene in Nairobi, Kenya, investigating the 1998 al Qaeda bombing of the U.S. Embassy there, Rossini brings special insight to the Boston attack. He was also the FBI’s representative at “Alec Station,” the CIA’s out-of-the-way, tiny operation to track a little-known Saudi fanatic named Osama bin Laden years before 9/11.

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‘You Can’t Go Anywhere’

Horrified parents from Newtown were present during the bombings at the Boston Marathon—a race that was dedicated to the 26 victims of Sandy Hook elementary school. Eliza Shapiro reports.

Tragedy at the Boston Marathon on Monday was made crueler by the fact that the race was intended to be a symbol of hope, resilience, and strength for the victims and families of Sandy Hook Elementary School.

Boston Marathon

A motorcycle camera crew photographs the lead men's finishers as they pass the 26th mile marker, which was dedicated to the victims of the Sandy Hook Elementary School shooting in Newtown, Conn., during the 2013 running of the Boston Marathon in Boston, Monday, April 15, 2013. (Charles Krupa/AP)

The final mile of the marathon, cut short by twin bombings at the finish line that killed two and injured scores more, was dedicated to the victims of Newtown.

Nine Newtown residents participated in the marathon as part of Team Newtown Strong. They were running in honor of the victims at Sandy Hook Elementary School, according to the Connecticut Post. All members of the team apparently finished the race before the explosions and were unharmed.

Boston Blasts

Death on the Airwaves

Monday’s bombings at the Boston Marathon finish line brought out the media’s strengths and only a few excesses. Howard Kurtz on the saturation coverage—and television’s unifying role.

The pictures were horrifying, the experts measured, the anchors somber.

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NBC's Brian Williams reports on the bombing at the Boston Marathon. (NBC News)

The bombings at the Boston Marathon on Monday afternoon sent the television networks scrambling to cover a stunning act of terrorism that seemed almost a throwback to an era when such attacks were common.

As in the dark days after 9/11, those on the airwaves were serious, substantive, and restrained, resisting the urge for melodrama or reckless speculation. When there is a story of sufficient magnitude, as happened at the twin towers and again near the finish line of the Boston race, news outlets don’t need to resort to hype and hysteria. They simply sort through the painful facts that slowly emerge.

There are few solid clues so far in the bombing that killed two and injured more than 100.

Law-enforcement officials say they have no doubt that the explosions near the finish line of the Boston Marathon on Monday afternoon were bombs, possibly placed in mailboxes, garbage cans, backpacks or hidden in some other fashion. Officials at the scene say two people are dead and some 100 injured, including an 8-year old.

Boston Marathon Explosions

One of the blast sites on Boylston Street near the finish line of the 2013 Boston Marathon is investigated and guarded by police in the wake of two blasts in Boston Monday, April 15, 2013. (Elise Amendola/AP)

As rescue workers, bystanders, and runners rushed to try to help the wounded in the immediate aftermath, Boston limited airport traffic and subway service, fearing further attacks. Several cities, including New York and Washington D.C. put their own police forces on high alert.

But officials seemed to have few clues about who was behind the attack. “We still do not know who did this, or why, and people shouldn't jump to conclusions before we have all the facts," President Obama said from the White House. "But make no mistake, we will get to the bottom of this."

Tragedy

Runners React in Shock

Across the country, organizers of other major marathons expressed horror and empathy for participants in the Boston race.

Organizers of the nation’s other major races reacted with horror to the bombings that killed at least two and injured dozens more at Monday’s Boston Marathon. 

Boston Marathon Explosion

Medical workers aid injured people on April 15 at the finish line of the 2013 Boston Marathon following an explosion. (Charles Krupa/AP)

The Boston Marathon is one of the nation’s largest and most prestigious running events, with 27,000 participants in the 2013 race and more than half a million spectators. Runners from every state in the nation and over 90 countries participated before the race was halted immediately after the explosions.

Mary Wittenberg, the president and CEO of New York Road Runners, which puts on the ING New York Marathon each November, released the following statement on Monday evening, indicating that safety at future marathons is an immediate concern.

Boston Blasts

Third Explosion Possibly Unrelated

Third Explosion Possibly Unrelated JOHN MOTTERN / AFP

Commissioner: This is an “ongoing event.”

A third explosion in Boston was confirmed Monday by Boston Police Commissioner Edward Davis at a press conference briefing reporters on the tragedy at the Boston Marathon. Davis said the third explosion occurred at the JFK Library at roughly 4:30 p.m., and as such the situation is being treated as “an ongoing event.” But a spokeswoman from the police department and library officials later said over Twitter that, as was first reported, the fire began in the library's mechanical room and was probably not related to the bombings. Investigators are seeking further information.

Read it at The Daily Beast

Uncle: 'Turn Yourself In'

Adrenalized, impassioned, and unforgiving, an uncle of the Boston Marathon bombing suspects, Ruslan Tsarni, appealed to his fugitive nephew Dzhokhar Tsarnaev to surrender to authorities. 'He put a shame on our family' and 'the entire Chechen ethnicity,' said Tsarni.

FBI: Two Suspects In Boston Bombing

In a press briefing Thursday afternoon, the FBI announced two unidentified suspects in the Boston Marathon bombing, revealing pictures and video of the men and asking the public for help. "Identifying and locating those responsible is now our highest priority,' said DesLauriers.

Boston's Everyday Heroes

From the man in the cowboy hat to a baseball player who wrote 'Pray for Boston' on his glove, heroes big and small emerged in the wake of the Boston marathon bombing.

Obama: Everything Is Speculation

Speaking from the White House Tuesday, President Obama said the Boston bombing was being investigated by the FBI as an act of terrorism, but clarified that little else is known about who carried out the attack, or why.

Boston Marathon Explosion

Watch video of one of the explosions that rocked the Boston Marathon and the country.