I Am a Boston Marathon Nurse

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May 2, 2013

Editor’s note: UMMC critical-care nurse Alexander E. Halstead, 24, was among the trained volunteer staff in the medical tent near the finish line of the Boston Marathon April 15, 2013, when two bombs exploded, killing three people and injuring more than 260.  In addition to his detailed account below, you can view his interview on WBAL-TV

By Alexander E. Halstead, BSN, RN, CCRN

Clinical Nurse II, Surgical Intensive Care Unit

University of Maryland Medical Center

On April 14, 2013, I hopped onto a northbound plane to return home to Boston to see family and again volunteer my services for one of the biggest events of the year.  I am a marathon nurse.  That doesn’t mean I run the marathon;  I volunteer to provide medical care to runners after they finish the race. This was my fourth consecutive year with the Boston Marathon. I also volunteered for the last two Marine Corps Marathons in Washington, DC.

I grew up in Framingham, Mass., so the Boston Marathon has always been part of my life. I started volunteering while still in nursing school at the University of Massachusetts in Amherst. I also worked as an EMT on campus, and in the ER at Baystate Medical Center in Springfield. Soon after graduating, I moved to Baltimore to embrace an opportunity to work in the Surgical ICU at the University of Maryland Medical Center.  But I always go back to volunteer for the Boston Marathon.

On Sunday, April 14, the day before this year’s marathon, I went out to breakfast with my family, caught up with old friends, and rested up for the exhausting day that was to follow.

Marathon Monday!  I arrived in downtown Boston to prepare for my day.  As in previous years, I spent the morning with my fellow volunteers and some of Boston’s leading sports medicine physicians, who gave us valuable information for treating runners. They explained the treatment protocols and some of the ailments we might come across.

We picked up our marathon jackets and we were dismissed to get lunch.  Boston does marathon medicine right!   The medical tents are massive air-conditioned structures with televisions, hundreds of cots, a laboratory section and multiple other resources.

We prepared our respective sections of the tent to receive runners.   Each section was made up of a physician, a few nurses, a physical therapist, and a few podiatrists –  a truly well-rounded medical team.

The cheering began as the wheelchair winners are the first to cross the finish line, and some of them pass through our tent on their way to the Copley Square Hotel.  Soon after, the men and women elite runners walk through the tent after their amazing feat – usually needing minimal care because they train so well.

At 12:30 p.m., the runners started trickling in as patients.  The high predicted temperature was 54 degrees, so we expected a slow day in the tent.  In my section, we saw runners for a wide range of issues.  Exercise-associated collapse, hypothermia, and dilutional hyponatremia are among the ailments that we frequently see.

At 2:50 p.m., I heard a blast not unlike the mock cannons that are fired every Sunday from Fort McHenry.  Whispers float through the staff in the tent.  Could the sound that we heard be celebratory cannons?  It was Patriots Day, after all. Shortly after, I heard another blast.  I walked over to one of the physicians, who voiced the thought in the back of my head — that it could have been a bomb.

Boston EMS personnel had been stationed in the respiratory care section of the tent, and all of their radios went off simultaneously. Some of them sprinted out of the tent while others stayed and frantically prepared their equipment.  I knew something had to be seriously wrong.   I looked over to the television and saw the blast being covered live.  I immediately took out my phone to call my mom.  When she picked up, I quickly told her, “I am safe. There are bombs in Boston, but I am safe.”  I sent a text to my girlfriend saying, “I am safe.”  After that moment, the phone traffic went dead.  No one in the tent could get calls out.

I discharged as many runners as I could from the tent. I told them that if they could walk, they should get out.

The first victim to come into the tent was an image I would never forget: a young man was wheeled in with both of his legs amputated by the blast. He was awake, and had mere strands of flesh hanging down from both of his legs.   It was surreal. The patients started rushing in, filling every corner of the tent.   All ages were present among the victims. It was mass pandemonium. Triage sections were set up in the tent so that the victims with more severe injuries would be transported first.   A subsection of the tent was assigned as the morgue.

I snapped into gear.  I had the training, and now I just had to use it.  I walked up to one of the victims awaiting transport.  He already had tourniquets on both of his leg amputations, and the bleeding was controlled.  I started an IV and hung fluids.   But what else could I do for this man?  He needed surgery and we could not do that in the tent.  There were four other doctors and nurses around his stretcher, so I stepped back for a moment to collect my thoughts.  Could this all be real? Or was this just a horrible nightmare that I would surface from soon?

A physical therapist in tears approached me. She was extremely upset that none of the runners were being treated for their injuries.  I quickly eyeballed the remaining runners in the tent to make sure they had no life-threatening injuries.

I then moved over to the Level 3 section of the tent.  I found an adolescent girl and her mother who each sustained injuries to both legs.  The girl was panicking that she would lose her legs.  I reassured her.  I started caring for the girl and her mother.  I put in IVs, reviewed their injuries, and splinted their legs for transport.  I even started taking a blood pressure on the mother, when I soon realized that the number is meaningless in the chaos of a mass-casualty incident.

About 25 minutes after the blast, we had all 97 of the blast victims who came through our tent transported to hospitals.  We transferred the remaining runners to Medical Tent B.  Shortly after, the police moved us out of the tent and sectioned the road off as a crime scene.   I heard another bomb go off, but was reassured by another volunteer that it was a controlled detonation by Boston police.

This tragedy, for me, was a major reality check.  It emphasized for me the importance of family, friends, and — most importantly — LIFE.   My heart goes out to the families and the victims of the Boston Marathon bombing.  That said, without such a well-trained, organized and dedicated group of first responders that day, there would have been more casualties.   The medical professionals in Medical Tent A, Boston EMS, Boston Police, and a countless number of bystanders saved many lives that day. I am proud to have worked among such a great group of people.  I am proud to be a Boston Marathon Nurse.

To view Alex’s interview on WBAL-TV, follow this link to the WBAL site.

UMMC critical-care nurse and Massachusetts native Alex Halstead has volunteered for the past four years in the medical tent of the Boston Marathon. UMMC critical-care nurse and Massachusetts native Alex Halstead has volunteered for the past four years in the medical tent of the Boston Marathon.

{ 1 comment… read it below or add one }

1 Elaine Swartz May 14, 2013 at 1:36 pm

As I have mentioned several times in the past few weeks, we are all so very proud of you, what you have accomplished and the many very special steps you have taken to reach this point. Those who come under your care – under any circumstances – are so very lucky. May you continue to be a blessing to all who are touched by you. Much love, Cousins Elaine and Charlie.

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