Lessons learned in Pitt residency aid doctor amid Boston Marathon carnage

BOSTON — When he dashed into a tangle of bloodied patients in the Boston Marathon bombing, Dr. David Hirsch relied on instinct and field training he honed during an emergency medicine residency at the University of Pittsburgh.

“It was terrible,” said Hirsch, an emergency room doctor at Concord Hospital in New Hampshire. “They were all critical. There were lots of lower-extremity injuries, open fractures and a lot of blood. Everyone was dazed.”

Hirsch, 35, of Lunenberg, Mass., was one of more than two dozen physicians working in the race's 100-bed medical tent and among the many doctors, police officers and firefighters that Hirsch, runners and spectators credit with limiting the fatalities to three and helping more than 170 injured people.

Hirsch had only a pair of examination gloves with him when he reached patients sprawled near the finish line on Boylston Street.

“It smelled like fire and exploded gunpowder,” Hirsch said. “A lot of people had singed hair in a lot of locations. One of the patients, when I was examining her leg, her jeans were still smoldering. I had to pat out the smoldering as I was assessing her.”

He said he helped volunteers apply crude tourniquets to the wounded, using torn strips of shirt cloth and the few belts available from bystanders.

“The EMS folks were on top of things. They did a tremendous job,” said marathon runner Glenn Kishi, 51, a network engineer from San Jose, Calif. “You had people packed 20 rows deep on this corridor, and they were still able to get to people and deal with the situation.”

Hirsch, who lived in Friendship on South Fairmont Street, attended Pitt's emergency medicine program from 2005 to 2008. He said the program is unique because it puts physicians in the field — at any hour of the day — with paramedics from Pittsburgh EMS, STAT MedEvac and other agencies that respond to emergencies.

He spoke with former colleagues in Pittsburgh on Tuesday, a day after the twin bombings, about preparations for the medical tent at the Pittsburgh Marathon on May 5.

Hirsch, a husband and father of two young children, said Pittsburgh has a special place in his heart.

He encouraged organizers to stock tourniquets — Hirsch normally has one or two handy — to prepare for a mass casualty incident, however unlikely. He told them to examine triage procedures for categorizing patients' injuries and determining whether to transport them to a hospital.

Though some doctors raise questions about the use of tourniquets, Hirsch thinks in this case they saved lives.

“Typically, why would you need a tourniquet at a race? Now we know why,” said Dr. Ron Roth, medical director of the Pittsburgh Marathon.

“He's a great guy,” Roth said of Hirsch. “I'm not surprised at all he was there to help.”

Dr. Donald Yealy, chair of the Department of Emergency Medicine at UPMC, said Hirsch is an “exceptional” doctor in an emerging sub-specialty of emergency medicine physicians.

“We invest a lot of time and training in how to care for people outside the hospital, and he had a lot of exposure to that here,” Yealy said. “He is not only a wonderful person and a caring guy, he was an exceptional resident.”

Hirsch's wife, Erin, a psychologist, texted him soon after the bombings. She told him to leave because there might be more bombs.

“I texted her back and told her that I had to stay,” he said.

Hirsch said he felt numb emotionally on Tuesday. That has started to pass.

“I'm happy I was able to be there to help, but I was very happy to get home to my family,” he said.

Asked whether he would staff the medical tent at next year's Boston Marathon, he said: “I haven't decided yet. I would like to. I don't know if my wife will let me.”

Jeremy Boren is a staff writer for Trib Total Media.