The Marathon was ready for an emergency, staffing with physicians and other professionals. They were ready for a different type of challenge, but having such a concentration of resources saved lives.

As an emergency physician, I was uniquely able to assist, to see patients, and to make quick decisions. To stratify a number of patients who were triaged 1’s and 2’s, into subsets of injury severity. The other emergency physicians knew the system; they knew ICS and understood triage. A Trauma primary and secondary survey was indoctrinated into us and was ultimately valuable. I greatly appreciate having my family practice, internal medicine, surgical, cardiology, and other specialists there, but a subset of skills was critical at those moments.

Tourniquets saved lives. Ingenuity in bleeding control and homeostasis allowed the victims to survive to the hospital. I know I have had academic discussions about their clinical and prehospital use prior to this event. They turned out to be, in reality, much more elegant.

The Boston hospitals were ready and willing that day. To have such a concentration of high quality institutions in one area made a difference. All patients got the care they needed and in very timely fashion.

The setup of the tent allowed a natural exit with ambulances standing by. There was a direct line from the entrance to EMS at the back. The ambulances then had access to a number of major Boston thoroughfares. The importance of the ability to move patients rapidly to definitive care cannot be overstated. Although the footprint of the tent may not have been intentional, it made a tremendous difference.

In a time of such tragedy, I had the chance to witness terrible effects of human malice. At the same time, hundreds of volunteers stood up and took it upon themselves to rush to the aid of patients.

People rallied and delivered excellent trauma care even when it was well out of their scope of practice. In less than an hour, all of the wounded were gone. It was miraculous, and that positive is what keeps me going day in and day out.

Dr. Darnobid is an EMS Fellow and emergency physician at the University of Massachusetts Memorial Hospital in Worcester..