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Injury toll from Marathon bombings rises

People on Boylston Street paused for a moment of quiet tribute and reflection exactly one week after the Marathon bombings.

David L. Ryan/Globe Staff

People on Boylston Street paused for a moment of quiet tribute and reflection exactly one week after the Marathon bombings.

Only two patients wounded in the Boston Marathon bombings remained in critical condition Monday, but the count of injured people who were treated in area hospitals has risen sharply to 282, according to the Boston Public Health Commission. That is far higher than the initial estimate of 170.

The number rose because dozens of victims delayed seeking medical care for minor wounds or symptoms that they thought would go away on their own, said Nick Martin, a spokesman for the health commission. He said the latest data, compiled Saturday by state health officials, show patients were seen at 27 hospitals in Greater Boston.

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“One of the best examples is hearing issues,” Martin said. “People might have first thought their hearing problems would be temporary.” Instead, hearing loss or continuous ringing or buzzing in their ears remained. Others sought delayed care for minor shrapnel wounds.

Of the 48 patients who remained hospitalized Monday afternoon, the two in critical condition were a 7-year-old girl at Boston Children’s Hospital and a man in his 60s at Boston Medical Center.

The fact that a week after the explosions none of the hospitalized victims has died and just two are severely ill is a testament to the quality of the trauma care at the city’s hospitals, specialists said.

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Considering the number of injured and the severe nature of many of the injuries, “it really speaks well of the Boston emergency medical community that there were so few fatalities,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians and an osteopath who practices emergency medicine in Allentown, Pa.

Still, many of the patients — among them 14 who had limbs amputated — are facing daunting recoveries. The 7-year-old girl remains in intensive care and had surgery last week for extensive leg injuries.

The family of Marc Fucarile on Monday thanked the staff at Mass. General, race bystanders, and first responders.

Dina Rudick/Globe Staff

The family of Marc Fucarile on Monday thanked the staff at Mass. General, race bystanders, and first responders.

“She’ll recover, and I expect that within the next couple of days she’ll come off the critical list,” said Dr. David Mooney, director of the trauma program at Boston Children’s who has been involved in her treatment. “She’s much better than she was; her improvement has been slow and steady.”

Of the 19 patients admitted to Boston Medical Center on the day of the bombing, 16 had surgery, mostly to repair leg wounds and perform amputations, and 15 were initially deemed to be in critical condition. The older man who remains critical lost a lot of blood from his leg injuries and required several operations, with more to come, said Dr. Peter Burke, who is chief of trauma services and has been treating the patient. The man also has required blood transfusions, and at one point, his heart stopped.

Burke said he is hopeful the critical patient and the three patients who remain in serious condition will make significant recoveries and return home in good health.

Hospitals have somewhat different standards for “critical” patients, those with the most life-threatening set of medical circumstances. “Critical, for us, typically means a patient requires life support on a ventilator and remains in the intensive care unit,” Burke said.

At Massachusetts General Hospital, 34-year-old Marc Fucarile of Stoneham is listed in serious condition but remains in the intensive care unit with grievous injuries. He regained consciousness only recently, his family said at a press briefing Monday.

He opened his eyes — which last looked out on a bloody Boylston Street — to a right leg amputated above the knee, burns across half his body, a left leg with multiple fractures, and shrapnel lodged in his heart. The first thing he did, the family said, was tell his fiancee, Jen Regan, “I am sorry for being there. I love you and Gavin,” their 5-year-old son.

The family members added that they were extremely grateful to the first responders and bystanders who saved “Marc and all those injured on that tragic day,” as well as the staff of Mass. General for the “exceptional care they have provided.”

The number of injuries could continue to climb if more people seek treatment. And health officials are monitoring whether there was any significant increase in heart attacks or strokes that could have resulted from Marathon Monday. Studies suggest that stress-related heart emergencies increase in the first few weeks after a traumatic event such as an earthquake or terrorist attack.

There’s little doubt, however, that more injured victims would have died had they not received optimal treatment, on the scene and at hospitals, for wounds that led to the loss of copious amounts of blood.

Emergency medicine experts from around the country have praised Boston’s preparedness and the response of volunteers, race participants — some of whom were physicians and nurses — police, firefighters, and emergency medical technicians, as well as the quick thinking and pivoting of medical staff working in a triage tent that was equipped to treat dehydration and other marathon-related injuries. Many of the victims arrived at hospitals with belts and other improvised tourniquets to slow bleeding.

“Injured patients were logically distributed to the right hospitals at the right time,” Rosenau said. “I’m happy that this has a better ending than most of us thought it would have.”

Globe correspondent Todd Feathers contributed to this ­report. Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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