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

In a review by Slater et. al of 437 acute burn patients transferred to a burn center in Pennsylvania over a 15-month period they noted that many of the burn patients transferred to their facility by air may have been safely transported by appropriately staffed ground transportation. They believed there was an over utilization of helicopter services for burn patients.11 In addition to the air medical transports there were approximately 23 ground transfers within the next 24 hours. No discussions took place between the Rhode Island hospitals to coordinate out-of-state transfers. Future planning will need to address procedures for prioritizing and coordinating both ground and air medical evacuation of patients to specialized burn centers. The majority of burn care can be initiated at non-burn center hospitals as long as there are adequate resources for airway management, fluid resuscitation, analgesia and wound dressing. Decisions to transfer to specialized burn centers can possibly be delayed for the initial 24-hour resuscitation period. This would allow time for centralized decision-making and triage by burn/ trauma specialists within the state regarding which patients should be transferred and by what means.

Sixteen hospitals in both Rhode Island and Massachusetts cared for 196 burn victims from this disaster, 35 (about 17%) of whom required intensive care and ventilatory support. (Table 1). Kent County Hospital, the closest facility to the disaster site, saw the largest number of patients (82). Approximately 50% of those were treated and released, 25% were admitted and 25% were transferred to other hospitals. For the second time in its 80-year history Shriners Hospitals for Children opened its doors to the adults. (The first time was directly following the World Trade Center tragedy on September 11, 2001, although no victims were admitted to the hospital at that time.) Shriners received 17 victims from Rhode Island area hospitals. Rhode Island Hospital received 68 patients; approximately 63% were admitted. Half of them required ventilatory support and intensive care. Only 4 of the 196 patients admitted to hospitals after the fire died, consistent with observations made about indoor fires and also attributable to the airway management skills of Rhode Island's emergency physicians and emergency medical technicians. Many advances have followed the lessons learned about burn management from the 1942 Cocoanut Grove fire.

The Station Fire demonstrated that the resources and expertise of prehospital providers, multiple Rhode Island hospitals of various sizes and with variable resources, emergency staff and surgeons can be used to stabilize and treat multiple burn casualties. It has brought highlighted the issue of mass casualty burn care in future disaster planning. Lessons learned from this event include the need for a clearly demarcated command and triage center, improved prehospital communication, as well as inter-hospital communication regarding available beds, services and supplies, and coordinated use of air and ground transfer of patients to specialized burn centers.