Are there lessons for Baghdad in the Boston bombings?

Are there lessons for Baghdad in the Boston bombings?

Amid the bleak news of the Boston Marathon bombing and its dramatic aftermath, one silver lining has been the success of the first responders in preventing a far more horrific outcome after the explosions. And people are citing an unlikely reason why: the war in Iraq.

In recent days, several articles have pointed to just how instrumental the lessons learned on the battlefield in Iraq and Afghanistan were to mitigating the damage in Boston. Scientific American notes that experiences with IEDs taught medics the importance of responding quickly, since bleeding out was identified as the most common cause of death in these explosions. In an article in Mother Jones, Tim Murphy echoes this idea, explaining the importance in Boston of applying tourniquets — a lesson learned in Baghdad.

But the spate of deadly bombings from Somalia to Iraq in the days since the Boston bombings made us wonder if the reverse could be true: Could the lessons of Boston apply to bombings in Iraq?

In fact, this debate took place in the pages of the Lancet in 2011. After the medical journal published a statistical analysis of suicide bombings in Iraq that highlighted their disproportionate effect on civilians, Pierre Pasquier and two fellow French scientists wrote the authors a letter suggesting the application of basic care techniques could mitigate these effects, substantially decreasing fatalities.

They pointed to studies showing that in the early years of the war, "around 90% of military combat-related deaths occurred before the casualty reached a medical treatment facility," and went on to say that medics in the military subsequently focused on preventing exsanguination, or blood loss, through the applications of tourniquets in pre-surgical settings, which drastically reduced casualties — the very lesson that was applied in Boston. They conclude:

Hence, focusing on civilians after bombing, we wonder whether simple tools such as the tourniquet, applied by the man in the street, could be a more efficient approach to improving survival than the hypothetical deployment of "high-quality treatment" facilities.

The study’s authors, however, issued an obvious but important reply — one that offers insight into why the lessons of Boston unfortunately may not be entirely applicable to Iraq:

It is essential to point out that, to whatever degree civilian-administered tourniquets might improve immediate rates of survival from extremity wounds caused by suicide bombs, a tourniquet is a temporary measure that does not replace the adequate health care required by victims for their continued survival. If a civilian-applied tourniquet is required temporarily to stanch severe bleeding from an extremity, to survive in the long term, that civilian will require effective emergency and surgical treatment to the limb once arriving at hospital.

They went on to cite studies about Israeli bombings to explain the complexity of injuries sustained in suicide attacks, pointing out that research shows the "substantial proportions of victims arrive not only with extremity injuries (44%), but also with internal injuries (32%), head injuries (22%), chest injuries (21%), abdominal injuries (16%), and burns (17%). Survival of these wounds would not be affected by tourniquets." Many of these injuries would require surgical and intense post-operation therapy, for which the Iraqi healthcare system does not have adequate capacity.

It’s a frustrating reminder of the public health and infrastructural problems that need to be addressed if pre-surgical care in Iraq is to make a significant difference in saving civilian lives, as it did in Boston.