The Boston Marathon bombers killed three spectators and left at least 282 wounded—many of them with severe, life-altering injuries. Although there were scores of racers on Boylston Street at the time of the blasts, marathon runners were largely unscathed, and those who were hurt sustained relatively minor injuries, mostly hearing loss. Dave Fortier, 48, of Newburyport, Massachusetts, who was a few yards away from the first explosion, seemed to get the worst of it—shrapnel cuts on his right foot, necessitating seven stitches, and deafening shock waves through his ears.
Why weren't more marathoners bloodied? At both explosion sites, spectators may have shielded runners from harm. "Spectators seemed to take the brunt of the blast," says Fred Burton, a former counterterrorism agent who was one of the investigators at the 1993 World Trade Center bombing. "Without spectators, you could've had a different outcome with more runners hurt." Also, the bombs' proximity to buildings—and the spectators' proximity to those buildings—was likely a factor. "Many injuries from bombs are the result of flying glass," Burton says. "It's not unusual to see severed limbs at blast sites from glass."
Another variable is the angle of the bombs. "A device in a backpack is not necessarily tilted straight up," Burton says. "Some bombs use a V-shape that fires like a cannon in a specific direction."
Or there may be no logic to it at all. "It's a bit of luck of the draw how these devices detonate," Burton says. "There is often no rhyme or reason. You could recreate the scene and have a different outcome. Bombs are very unpredictable."
Though few runners were struck by shrapnel, there was no escaping the sonic blast. "The shock wave is this pressure that's really focused," Burton says. "You feel the wave hit you, and it's not like wind. It's sudden and powerful. Ruptured eardrums are very common."
It's unclear exactly how many marathoners suffered hearing damage, since many may not have sought medical help right away. However, local doctors, including Alicia Quesnel, M.D., an otologist at the Massachusetts Eye and Ear Infirmary, saw an influx of patients in the following days. "The eardrum is very delicate, and if the ear is hit in the right way by a big pressure wave, the eardrum can tear," Dr. Quesnel says. "This would cause decreased hearing, pain, and maybe some bloody drainage." Small perforations can heal on their own, sometimes in a week. But larger tears may require reconstructive surgery.
Tinnitus is another injury that occurs when the sound-detecting hair cells in the inner ear are damaged. It can cause a constant high-pitched ringing or buzzing and may last weeks, months, or even years. There is no cure; patients often learn to live with it—and Fortier may be one of them. As of press time, his ears were still ringing.
Beyond physical injuries, the carnage runners saw can leave emotional scars. "I saw a guy lose his leg and a girl with her foot hanging off. I had such a normal, quiet life—now I have night terrors," says Christine Mider, 42, of Denver, who finished in 4:09:51, eight seconds after the first explosion. "I thought I was making a big deal out of something I should be able to move on from. Then, with a therapist, I realized I'm talking about bombs, terrorists, and limbs, and this is a really big deal."
Post-traumatic stress is common among people exposed to such tragic events, says Joseph Boscarino, Ph.D., a senior scientist who specializes in disaster psychiatry at the Geisinger Clinic in Danville, Pennsylvania. Symptoms can manifest in a number of ways, including flashbacks, nightmares, sleep problems, and anxiety, plus feeling disconnected or losing interest in activities. The social support of family, friends, and running partners is important and can help process feelings, but Boscarino says anyone struggling with these problems weeks afterward should talk with a counselor.
Boscarino, a Vietnam veteran who was in the World Trade Center complex on 9/11, remains optimistic about our ability to recover from traumatic events. "Humans are resilient," he says. "Actually, some people grow from the experience—people often become stronger from it."