Like so many on the finish line of the Boston Marathon, Lehigh University director of sports medicine Jack Foley could not initially process what he heard at 2:49 p.m. on April 15.
He thought a transformer had blown. He smelled smoke. He saw a runner in his 70s wobble and fall from the sonic shock that traveled through the pavement. Instinctively, Foley ran toward him, and as he did, he heard yelling off to his right that quickly became louder and more insistent.
And then Foley began hearing cries of pain.
Mere yards away, Ray Castle, the athletic training program director and an associate professor at Louisiana State University, also ran toward the chaos.
"All we know is what we're trained to do,'' Castle said. "We're always in a reactive mode. We move toward people who are injured. It could have been bleachers collapsing. This happened to be the godless act of a bomb.''
Castle reached for the shears in his fanny pack, cut through the wire of the fencing that separated him from the spectator area where the first bomb had exploded, and stepped into an urban war zone.
Certified athletic trainers such as Castle and Foley have long been a crucial part of the medical presence at mass amateur events like marathons and triathlons. Some 65 athletic trainers were at the Boston Marathon on the finish line and in the medical tent, many from colleges and universities, to work alongside doctors, nurses and paramedics under the supervisory umbrella of marathon medical coordinator Chris Troyanos. Between 70-80 students in academic training programs also were there to observe and learn and do basic tasks like walk dehydrated runners to a water station or wheel those with minor injuries into the medical tent.
Athletic trainers are first responders by vocation, although never before have they been part of a traumatic event on the scale of the Boston bombings, which killed three and wounded more than 200.
Over the course of a career, they deal with the mundane to the life-threatening: heart conditions, hypothermia, concussions and spinal injuries. However, they usually only have to handle one injury at a time. "Going into that situation was like stepping into another world,'' said Brian FitzGerald, the athletic trainer coordinator for the marathon who has been on the finish line in Boston for 35 years. "I've never felt so helpless.''
That passed almost instantaneously as FitzGerald, like his colleagues, reacted on reflex, compassion, professionalism and years of drills for mass casualty scenarios. "Our nature is to care for, comfort and treat individuals with acute injuries,'' said Fitzgerald, who works as a trainer and community outreach coordinator for Boston Children's Hospital. "Go there. Help. Mobilize. Transfer.''
Scott Anderson, the head trainer at the University of Oklahoma and president of the College Athletic Trainers' Society, said athletic trainers are emergency workers at heart, even though the average sports fan may not think of them that way.
"Knowing and understanding that you're the person who has to stay calm and in control when circumstances and people around you may not be, and having to think clearly about next steps -- those are attributes that would have served them very well,'' Anderson said of the athletic trainers who were on site in Boston.
Foley thought he had seen a worst-case marathon scenario when he worked Boston for the first time last year. Unseasonable heat pushed many runners' core temperatures dangerously high. There were no deaths, but the stress of that day was "daunting,'' he said. "[My colleagues] didn't think I'd be back.''
More moderate weather made for a more routine day this year. There were issues -- there always are when more than 20,000 people run 26.2 miles -- but for most of the first four hours, Foley watched happy people stream toward him, smiling, arms raised in jubilation.
Then two devices detonated 12 seconds apart on Boylston Street. In photos and video footage of the immediate aftermath, the athletic trainers, wearing white adidas windbreakers with blue striping on the sleeves and red baseball caps, can be seen triaging and tending to the wounded alongside doctors, nurses and EMTs amid the blood and debris.
Foley and others kicked through the fencing to get to the bomb zone. The first man he reached appeared to be in shock with a fractured ankle and soft tissue damage and was trying to lift his head and shoulders; Foley used a belt to serve as a tourniquet. Another athletic trainer arrived with supplies, and Foley recalls that a soldier helped get the man into a wheelchair.
He checked on a woman with lower leg trauma whose husband had already applied a tourniquet, and made sure she was evacuated. He squeezed the hand of another severely injured young woman and looked into her eyes, which had a "far-away, distant look,'' he said.
The overall medical and law enforcement response was so swift, Foley said, that when the last seriously wounded person had been transferred from the first bomb zone, he glanced at his watch and saw that it read 3:04 p.m. -- just 15 minutes after the initial explosion. FitzGerald said officials told him 97 victims were evacuated from the bombing scene and triaged at the medical tent within 22 minutes. (Athletic trainers were not close to the second bomb zone further up Boylston, where EMS and fire department personnel and civilians dealt with the wounded.)
Castle said he has significant memory gaps about what he saw -- a blur of head wounds, burns and fractured, bleeding limbs from widespread shrapnel. "The time going by felt like it was hyper-drive, light speed,'' he said. But there is one image he will never shake, and that is seeing the laypeople who had swung into action before he and his counterparts could get to the wounded. "Talk about heroes,'' he said.
A man was applying pressure to the thighs of one woman who was bleeding profusely, and Castle gave him further instructions. "Relax, be calm, we're here, someone is going to take care of you,'' he told them.
About 40 minutes after the scene was cleared, someone asked Castle why he was limping and he realized he had slipped and fallen at some point while administering to the wounded and had a contusion on his knee. That was minor, he said, compared to the emotional aftershocks. He said he has consulted a military chaplain and a sports psychologist to help process his experience.
Last weekend, Castle went to watch a 5K race in Baton Rouge, La., from a distance, simply soaking in the sight of people running freely. He said he will honor his commitment to work at an Ironman Triathlon event next month in Texas.
"I'm learning a lot about myself as a person and a health care professional,'' he said.
Foley had been drilled in procedures after a potential terrorist attack when he worked at the 1996 Summer Olympic Games, but he said nothing could have fully prepared him for what he witnessed. Much of it seems surreal to him now, but he retains one strong, positive impression out of the horror: "The synergy among caring professionals, the way people acted in a crisis. I was a small part of a great effort.
"People have said to me, 'I bet you wish you hadn't been there,''' Foley said. "But I'm glad I was there, I'm glad I engaged and I'm glad I did the right thing. I'm proud to be an athletic trainer.''
FitzGerald said the horror and shock is still "looping through our brains.'' However, he, like Foley, is intensely proud of the job the athletic trainers and their students did that day.
"Those kids were rock stars,'' FitzGerald said of the students. "They grew up very fast. They followed their leaders. They were like soldiers.''
As for the athletic trainers, like marathon runners, they intend to lace up again. "Every one of them told me, 'I'll be back,' '' FitzGerald said. " 'Check my name off. Make sure you include me.' ''