Station Nightclub Fire and Disaster Preparedness in Rhode Island, The

Medicine and Health Rhode Island,  Nov 2003  by Gutman, Deborah,  Biffl, Walter L,  Suner, Selim,  Cioffi, William G

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The Station nightclub fire in Warwick, Rhode Island occurred at 11:12 pm on February 20, 2003. It ranks as the fourth deadliest nightclub fire and the ninth deadliest public assembly fire in the United States. The fire consumed the entire building within 3 minutes. Ninety-six people were killed immediately and hundreds were sent to area hospitals. Four subsequent hospital deaths occurred over the next few weeks. In 1992 we marked the 50th anniversary of the Cocoanut Grove nightclub fire in Boston. Four hundred ninety-two people died that day, making it the second deadliest public assembly fire in United States history. That fire spurred the first comprehensive descriptions of inhalation injury, and many other improvements in all aspects of bum treatment.1 The Station fire, like the Cocoanut Grove fire, can improve our medical care and planning by focusing attention on the disaster response needs of severely burned patients.

A fire and mass casualty incident is an uncommon event, but in this era of disaster planning for terrorist events, mass casualty burn events are expected. In 2001 there were 6,196 civilian fire deaths, 2,451 of which were due to the events of September 11.2 Other terror-related events generating multiple burn victims include the Oklahoma City bombing (1995) and the Bali nightclub bombings (2002). Eight percent of patients admitted to the hospital after the Oklahoma City bombing sustained burns.3 The Bali nightclub bombing killed at least 190 people and seriously injured more than 500: the majority of injuries were severe burns.4

Even in natural disasters like earthquakes, burns may be a problem. In the earthquake in Duzce, Turkey, in November 1999 there were a significant number of burn patients secondary to scald injuries caused by hot water spill during the earthquake, because it occurred in the evening while families were preparing dinner.5 Mass casualty burn injuries may occur secondary to vehicular accidents, industrial or domestic events as well as terrorist activities. While each event causing mass burn casualties will be unique, common features allow for advance planning. The need to distribute limited burn resources emphasizes the need for specialized planning in the areas of command and control, coordination and communications, triage, initial resuscitation and patient transfers.

Many of the Rhode Island hospitals were involved in the Station Fire response and most received some type of pre-notification from Emergency Medical Services, although several hospitals noted that they were not given any notification at all, or limited/incorrect information about numbers of patients to expect and severity of injury. Communication between hospitals was also limited. There was no clear indication of the total number of victims expected, or to which hospital(s) they were being transported. Improved communication from the scene to a central command center could help determine the number of hospital personnel and extent of resources needed to cope with the disaster. A central command center could also assist with the assessment of available beds and resources ("surge capacity") at each of the area hospitals and match the distribution of patient types/ severity to each hospital. This would decrease the need for multiple patient transfers between hospitals. It would also help coordinate patient transfers out of state.

The time elapsed between notification and arrival of patients was brief for most hospitals. This occurrence is anticipated in the Centers for Disease Control Mass Trauma Preparedness and Response documents, which predict that in a mass disaster 50% to 80% of all casualties will arrive within 90 minutes of the first arrival to the closest medical facilities. As predicted, less-injured patients left the scene and presented independently to the nearest hospital. The prediction average of 3 to 6 hours for casualties to be treated in the ED6 was realized during the Station fire.

Mackie and Koning reviewed 11 mass casualty burn disasters: in all cases patients arrived within 1-2 hours of the fire. In descriptions of the Bradford [England] football stadium fire in May of 1985, where a football stand caught fire and was engulfed within four minutes, patients began to arrive at the nearest hospital within minutes of the fire by taxi, private car, on foot and by ambulance.7 Within 3 hours all of the patients had been admitted or treated and released. Similar numbers are described for the Cocoanut Grove fire in Boston in 1942. The first casualties arrived 15 minutes after the fire started. It is estimated that one casualty arrived at Boston City Hospital every 11 seconds for a total of more than 300 patients in two hours. More recently, in February 1999 an industrial explosion resulted in the transfer of 11 patients to Baystate Medical Center (BMC) in Massachusetts. Seven of the most severely burned arrived at BMC 5 to 18 minutes after the initial 911 call. Eleven patients arrived in the ED 25 minutes after EMS initiated transfers from the site and were dispositioned within 3 hours after arrival.8 The hospitals who received the majority of patients after the Station fire had similar experiences.