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DAVID GREENE, HOST:

Now, we should say that whenever the Boston Marathon is run - as it was yesterday - hospitals in the city always staff up their emergency rooms. But they are expecting runners with cramps or dehydration, maybe the occasional heart attack. What they actually received yesterday was far worse. They admitted more than 100 victims, and NPR's Richard Knox reports on how they're handling it.

RICHARD KNOX, BYLINE: Like most big-city hospitals these days, Tufts Medical Center runs regular disaster drills, featuring simulated patients smeared with fake blood. So when word came yesterday afternoon that there'd been an explosion at the Boston Marathon finish line, staffers weren't sure what was happening. Robert Osgood, the hospital's emergency management chief, recalls those first moments.

ROBERT OSGOOD: There was sort of this beat where everybody in the emergency department sort of stopped for a second. And it was almost like you could hear each other breathing. And everybody looked at me and said, is this another one of your crazy drills? And the first thing I said was no, this is not a drill. This is for real. We need to huddle up.

KNOX: At first, they thought it was something accidental, like a manhole cover explosion.

OSGOOD: But once we actually found out that this was a manmade event, there's a certain mental toll that sort of hits a switch in some of the staff. And they say, why would somebody do this?

KNOX: But soon, there was no time for such thoughts. Terribly injured patients began coming through the emergency room doors of every big hospital in the city. Across town at the Beth-Israel Deaconess Medical Center, emergency room specialist Stephen Epstein describes the carnage.

DR. STEPHEN EPSTEIN: Limbs that were severed; limbs that, you know, we hope we can save, and some that we might not be able to save. A lot of very horrific injuries that we saw here today.

KNOX: He says some patients near the blasts had soot around their mouths and noses. That's a sign they'd breathed in scorching air. They needed to be put on ventilators right away because that kind of burn causes rapid swelling that can shut down people's airways and suffocate them. Many had pieces of glass and metal embedded in their chests and necks. Ruptured eardrums from the blast were common.

EPSTEIN: The device that went off today, for lack of a better term, was an improvised explosive device; and that's exactly what a number of our troops in Iraq and Afghanistan have had to deal with.

KNOX: And like those wounded troops, doctors say, many of those injured in the marathon blast will require a lot of rehabilitation - both physical and mental. Dr. William Mackey is chief of surgery at Tufts Medical Center.

DR. WILLIAM MACKEY: These were very disabling injuries, in that the blast caused a lot of soft-tissue injury but also, the shrapnel just rips through the tissues.

KNOX: Mackey says his hospital quickly canceled all elective surgery as his colleagues tried to repair the damage as well as they could. Patients needed hours of surgery, but Mackey says it was just the beginning for many victims.

MACKEY: They will definitely need repeated operations.

KNOX: It wasn't until 9 p.m. that Mackey could sit down in his office and try to absorb the events. He says it had been a very discouraging day.

MACKEY: Because you don't associate the Boston Marathon with anything but a great sense of pride in the city; pride in the athletes that train so hard to, you know, run the marathon. And to have this happen, you know, it's very disorienting. It's been a very upsetting day in many, many ways.

KNOX: But jittery as this city is today, Mackey doesn't think the marathon bombings are going to intimidate Boston in the long haul.

MACKEY: I don't think Bostonians are going to be terrorized by this. I think they're going to be motivated by this. I sure hope more people than ever turn out for next year's marathon.

KNOX: If they do, it's a safe bet all of them will be thinking about what happened at the finish line of the 2013 Boston Marathon.

Richard Knox, NPR News, Boston.

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