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

For each of the aforementioned disasters and the Station fire there were only a few minutes between the incident and the first patients' arrival in the emergency departments. This is a very small time window for establishing effective communication between the scene and all the area hospitals. This emphasizes the need for improved information systems/networks as part of our disaster planning. For example, in New York State after September 11th the State Department of Health implemented an enhanced statewide system known as the Hospital Emergency Response Data system that allows hospitals to communicate over a Web-based secure system during a crisis.9 This type of system, if it were in routine use, would augment communication during a disaster.

In their review, Mackie and Koning observed a difference between outdoor and indoor fire disasters. Outdoor disasters result in a greater percentage of hospital admissions with larger surface area burns and a higher hospital mortality rate; however, indoor disasters (such as the Station nightclub) had a higher cumulative death rate with a greater proportion of immediate deaths at the scene (attributed to inability to escape and rapid hypoxia from inhalation injury) and a lower hospital mortality rate.10 This is important to disaster planning because victims presenting after indoor fires have consistently lower burn surface areas and more inhalation injury and may not necessarily require immediate evacuation to a burn specialty center, but they may require higher levels of immediate airway management and ventilatory support. The nature of burn injuries from an indoor fire disaster may allow for a greater time window to triage patients to specialized burn centers because those with the worst injuries tend to die immediately. The nature of indoor fires also complicates initial hospital triage secondary to the large number of dead or nearly dead at the scene. One of the major obstacles during the Cocoanut Grove fire was the large number of dead or near-dead transported to Boston City Hospital that prevented efficient care of those with survivable injuries.

Perhaps the largest obstacle to appropriate burn management in disasters is the need for referral to specialized burn centers. Triage becomes essential to the distribution and use of limited resources such as air evacuation, burn beds, and operating rooms. Where should the assessment and triage of burn casualties occur and who should do it? As evidenced by the Station nightclub fire, even a moderate disaster is capable of filling all local burn beds and requires evacuation to regional burn centers. The timing and coordination of the transport of burn patients requires effective and efficient communications between hospitals and burn centers.

During the initial response to the Station nightclub fire there was limited triage at the scene until several ambulances had arrived. Initial patients were transported to the nearest hospital. The patients were rapidly distributed to multiple area hospitals, primarily Kent County Hospital and Rhode Island Hospital, but there was no means for hospital coordination and prioritization of helicopter transfers of critical burn patients to burn centers. Ten medical transfers by helicopter occurred from 4 different hospitals in the first few hours after the fire. This utilized all of the air medical resources available in New England for that time period.