Peter Burke had just finished the morning session of a medical conference at the Four Seasons Hotel Las Vegas when the news flashed on a lobby TV: two bombs had exploded near the Boston Marathon finish line, turning an annual celebration into a war zone.

Minutes later he received an emergency text message from Boston Medical Center (BMC), where he is chief trauma surgeon. The unit was inundated with the grievously injured from an attack that killed 3, among them BU graduate student Lu Lingzi (GRS’13), and wounded at least 260. Many of those rushed to BMC were battling for life, with mangled legs, collapsed lungs, and profound blood loss. Burke called his chief nurse to find out if there was any way he could help from a distance of nearly 3,000 miles. The answer was no.

When he arrived in Boston around midnight, Burke rushed from Logan Airport to BMC, one of the city’s five adult Level 1 trauma centers, all of which were scrambling to stabilize the injured. BMC received 28 bomb victims; 19 were admitted, 11 with critical injuries.

In his 14 years at BMC, Burke had dealt with hundreds of multiple admissions from car crashes or shootings. But Marathon day presented a scene more familiar to trauma program manager Joseph Blansfield, a nurse practitioner who has been at BMC since 1992. An active colonel in the US Army Reserve, Blansfield (SON’78) had run combat support hospitals in Mosul and Tikrit, Iraq. As BMC trauma surgeons, anesthesiologists, and nurses mobilized, Blansfield was doing what had become second nature in those war-torn places: identifying the most critically injured and getting them to the trauma bays.

The Marathon bombs, which killed 3 people and injured at least 260, were fashioned from explosives, nails, and ball bearings stuffed into pressure cookers. They released projectiles at speeds up to 2,700 feet per second. Sidebar Lessons from the Marathon Bombings AARON TANG/BOSTON GLOBE, GETTY IMAGES

Many of the wounded had limbs riddled with shards of concrete, wood, and plastic. Unlike the chest-level explosives typically used by suicide bombers, the Marathon bombs were left on the ground, so most injuries were to the lower body. In the sobering odds of trauma surgery this was lucky, says Burke, who is also a School of Medicine professor of surgery. Because the victims had been swiftly transported from a scene where emergency medical services personnel were already on hand, even those with legs completely severed arrived at the ER conscious and aware. The three most critically injured were a man in his 60s, who retained his legs but nearly died from blood loss, a 5-year-old boy with severely damaged lungs, and a man in his 20s who had traumatic double leg amputations. By the time Burke joined his team, they had performed amputations on five patients. Burke set to work on a patient whose legs were shredded, but, he determined, salvageable. He used forceps, probe, and scalpel to slice off dead tissue, a grueling process called debriding.

Fashioned from explosives, nails, and ball bearings stuffed into ordinary pressure cookers, the Marathon bombs released projectiles at speeds up to 2,700 feet a second. Such fragments can often do more damage than bullets, perforating vital organs and driving dirt deep into soft tissue. Dire wounds are inflicted by fragments of bomb, clothing, environmental debris, even “pieces of other people,” says Burke.

“When you remove fragments, a lot of it is done by feel, and you have to be really careful,” he says. “The reality is we leave a lot of bullets in people, because to dig them out would cause more damage.”

In the first 10 hours after the blasts, BMC surgeons would operate on 16 patients—a total of 7 limbs were lost from 5 people—and there were 52 more procedures in the next days and weeks.

Overseeing it all, Burke had many concerns, but the need to pull rank wasn’t one of them; his team, which routinely reviews and often second-guesses its handling of surgical cases, operates more like a repertory company than a rigid hierarchy. From paramedics to surgical colleagues, Burke wants his people to think for themselves and speak up about what can be done better.

“He’s definitely different from other surgeons I’ve worked with; instead of the typical surgical personality of my way or the highway, he’s a consensus builder,” says Blansfield, who occasionally wishes Burke were more of an autocrat. “He has a lot of humanistic qualities about him—he tries to approach people as peers.”

Tall and pale, the 58-year-old Burke has a close-mouthed grin, an easy laugh, and a renegade lock of otherwise kempt brown hair. He is one of four children of pioneering surgeon and Renaissance man Jack Burke, who left some outsized shoes to fill. Like his son, the elder Burke devoted time to the research laboratory as well as to the operating room.

“He was a big-time Harvard surgeon and a science guy,” says Burke, gesturing toward a shelf of textbooks written by his father, who died in 2011 at age 89. A former Army Air Corps pilot and research scientist, Jack Burke was a pioneer in the use of prophylactic antibiotics, tissue engineering, and the surgical treatment of deep burns. “He ran the Boston Shriners hospital for years, was internationally known, and did a lot of really important things. He was quite the man, and I had this wonderful relationship with him,” Burke says. “I’ll never be as famous as him, but that’s OK.”

Burke lives in Belmont, Mass., in the house he grew up in, with his wife, Rosie, a former social worker, and two cats. His son is working toward a doctorate in plasma physics, his older daughter does lighting design for a children’s theater, and his younger daughter just graduated from college. Burke unwinds by working in his vegetable garden and cooking the harvest. “I like to chop,” he says. As an undergraduate at Vassar, Burke majored in economics, but pursuing medicine had a certain inevitability, he says, because “I always wanted to take care of humans.” At Tufts Medical School, he chose trauma surgery for its deliberate, urgent nature; when it goes well, he says, what’s broken is fixed.

Busiest and Most Diverse Medical Center

Well known and respected in the city’s tight-knit, if competitive, circle of trauma physicians, Burke came to Boston Medical Center after 10 years at Beth Israel Deaconess Medical Center. “There are a lot of personalities in trauma care, and he manages them very well,” says Jonathan Gates, medical director of trauma services at Brigham and Women’s Hospital. “Their skill certainly was quite apparent after the Marathon bombs.”

Of the city’s urban medical centers, BMC is the busiest and most diverse. Its lobby is a place where one routinely hears Spanish, Creole, Arabic, Somali, Bengali, and Urdu, and sees traditional dress, ranging from djellabas to saris to boubous to hijab. The BMC Trauma Center admits more than 2,000 patients a year and receives the majority of Boston EMS ambulance transports, including trauma victims. BMC takes in the highest percentage of stabbings and gunshot wounds in the state. Falls constitute about 30 percent of BMC’s trauma admissions during the last few years, and an equal percentage of injuries results from violence. And some—too many in Burke’s mind—of the people he and his team put back together turn up again. “We see a lot of recidivism,” he says. “People do stupid things.”

Topping that list, for Burke, is gun violence. He is unnerved by its near-daily ravages: the 20-year-old multiple gunshot victim whose mother doesn’t recognize his destroyed face, the teenagers paralyzed from the waist down. In an open letter posted on his department’s blog in the wake of the fatal shooting of 20 children and 6 adults at Sandy Hook Elementary School in Newtown, Conn., in December 2012, Burke wrote that easy access to assault-type weapons and high-capacity ammunition clips are “an unnecessary and unacceptable threat to our society.”

“He was quite the man,” Burke says of his father. “I’ll never be as famous as he was, but that’s OK.”

“The young people get to him—the senseless violence, the alcohol-related stuff, lifelong injuries and death from things that are clearly preventable,” says Lisa Allee, coordinator of BMC’s Injury Prevention & Outreach Program, who calls her boss a surgeon with a social worker’s heart. With Burke’s help, one multiple gunshot victim in his 20s, after treatment at BMC, went back to school to become an EMT. “Now he works for anesthesia in the OR,” says Burke. “That’s an example of our team approach: we took an interest in this guy, he responded, and we helped him get his life back in order.”

Mandated by the American College of Surgeons for all accredited Level 1 trauma centers, the grant-funded Injury Prevention & Outreach Program is little more than window dressing at some hospitals, Burke says. At BMC it provides crisis intervention at patients’ bedsides, mental health care to victims of violence and their families, a “matter of balance” program to help the elderly prevent falls, and a training program to help people learn how to install infant and child car seats, which have an 85 percent misuse rate. The vigor of such programs at BMC is largely because of Burke’s commitment to broadening the scope of prevention services and research. Under his watch, the department instituted a Facebook page and a blog with posts offering advice on a range of concerns, including infant safety, extreme weather precautions, and ways to keep furniture and TVs from toppling, which in 2011 injured more than 12,000 children in the United States. “If we want to try to change people’s behavior, we have to focus on where they are,” Burke says, and in ever-increasing numbers, they are online.

He “is in tune with substance abuse and mental health issues like no other surgeon I know,” says Allee. He takes a particular interest in a one-on-one behavioral approach to prevent drunk driving, which is a factor in nearly a third of all car crashes and ranks on a par with violence as the most preventable cause of traumatic injury. “There’s a lot of good data that says that if you have what we call a brief negotiated interview with patients, you can alter their behavior,” says Burke. “So we launched this as part of a program to get people to stop drinking and driving.” His zeal for such efforts is by all accounts unusual in a chief surgeon. As his colleagues like to say, Burke seems intent on putting himself out of business.

Elaborate Choreography, Concise Dialogue

In a way, Burke’s trauma team had been preparing for an attack like the Marathon bombings for a very long time. The unit’s nine operating rooms are outfitted with high-tech monitoring and life-support equipment. But they also have wall-mounted digital stop clocks, so the teams can devise ways to shave off minutes, even seconds, when lives hang in the balance. “With head injuries or internal bleeding, the faster you treat them, the better the outcome,” says Burke. “Minutes count.” He runs the unit as a work in progress, engaging residents, nurses, and technicians to perpetually refine the elaborate choreography and concise dialogue of the OR.

Burke has been at the forefront of a surgical approach called damage control. “In the old days we tried to do everything at once—we’ve got a problem, go into the OR and deal with the problem, finish the surgery, and never have to come back,” says Burke. Then a 2006 study in the journal Trauma concluded that nearly 90 percent of patients with the most severe injuries were dying of lung or heart failure after surgery, or would succumb to unstopped bleeding. Consequently, he says, surgeons have “changed the way we think about time. Instead of doing the whole operation from beginning to end, we pay attention to stopping the bleeding and bringing them to the ICU, where we can restore their normal physiology.”

In the case of the Marathon bombing victims, patients were sent to the ICU with their wounds cleaned but left open. “The concept of damage control was critical to our successful outcomes,” says Burke. Damage control surgery treats the physiology rather than the anatomy of the patient, and the operations are often abbreviated and done in stages. A person’s physiological state signals whether it’s time “to truncate what I’m doing,” Burke says. Is the patient’s body temperature falling? Is his heart showing signs of distress? “Let him go to the ICU and warm him. Resuscitation is better done in the ICU than the OR. Doing this increases the likelihood of survival.”

Faced with BMC’s first multiple IED (improvised explosive device) injuries, Burke decided to check in with a surgeon who’d operated on such casualties routinely. He texted his friend Alan Murdock, a US Air Force lieutenant colonel based in Pittsburgh, who honed his combat surgical skills in Afghanistan. Over the next few hours, Burke typed a series of questions, among them: When do you go looking for nerves if there’s a nerve injury? How long do you keep these people on antibiotics?