The injuries suffered by dozens of victims of the Boston Marathon bombings are being compared to those you might find on a battlefield. That's creating surgical challenges not lost on the doctors at Harborview Medical Center.
If a similar situation happened in Seattle, most of the victims would end up at Harborview.
It's a Level One Trauma Center, and the anchor of the trauma system set up in this state.
"So we do disaster drills on a regular basis, we practice routinely to receive large numbers of patients and how to triage them and how to manage them quickly and get them to the operating room quickly," said Dr. Eileen Bulger, who is the Chief of Trauma at Harborview.
She has family in Boston, and says her first reaction to Monday's bombings was to contact them, to make sure everyone was okay.
Next, she and her staff started paying close attention to the injuries being reported, and how the hospitals in Boston were handling them.
She says the bombs made from pressure cookers loaded with nails and ball bearings pose a number of risks.
"You get a primary injury just from the blast itself, just from the impact of the pressure wave that comes out of the device, and that can disrupt your organs and can be immediately fatal," she said.
Then, there are the victims dealing with limbs severed by shrapnel, much like you might see in a combat zone.
Bulger says there's been a lot of training in recent years on how to handle those type of injuries, as a result of ten years of war in Iraq and Afghanistan.
She believes lessons learned from those war injuries will no doubt save lives in Boston.
She says doctors there are probably dealing with bone fractures and breaks as well, among victims who were thrown by the blast. Burns from the explosions and ruptured eardrums are also possibilities.
While the doctors and nurses at Harborview are prepared to handle a situation like that, they all hope they never have to.
"Unfortunately, we do this every day, so we're used to seeing tragedy, kind of every day," she said. "It's just on a larger scale."
They also worry about their counterparts in Boston, who've been working around the clock to save lives and limbs.
During disasters like this, counseling is often available for doctors and nurses on the front lines.