As victims of the tragic fire in West Warwick were being assessed in the field by Rhode Island EMTs, it was business as usual on BWH’s burn unit on 7D. That changed when the hospital received news of the terrible fire at The Station nightclub.
Appropriate beds were cleared on 7D to make room for potential patients resulting from the February 20 fire. Communication began between BWH, Rhode Island Hospital, Kent County Hospital, and MGH to better determine when and which patients would be transferred to BWH’s Level 1 Trauma and Burn Center.
As it turned out, BWH received eight patients from the incident, all of which were transferred from Kent County Hospital in Warwick. The eight burn patients arrived gradually via ground ambulance throughout the day on Friday, February 21. In addition to these patients, BWH also received three patients from a fire in Charlestown and a head trauma patient who wastransferred from Jordan Hospital in Plymouth.
“Our hospital-wide performance in response to the Warwick victims and other simultaneous trauma cases during that time displays what BWH is capable of as both a Level I Trauma and Burn Center,” said Jonathan Gates, MD, director, Trauma Center.
Housing a Level I Trauma and Burn Center verified by the American College of Surgeons, BWH handles 1,200 trauma patients each year, each requiring one-on-one nursing care. More than one hundred of those cases involve burn patients, a patient population that BWH is well equipped and practiced to handle.
Responsible for overseeing the assessment and care of these complicated BWH patient cases were Gates and acting director of BWH’s Burn Center Dennis Orgill, MD. Gates, Orgill, trauma attending physician on-call Ed Kelley, MD, and other physicians first surveyed the patients’ life threatening conditions—intubating those patients who couldn’t breathe on their own; determining proper settings on the ventilators; making certain their circulatory systems were not compromised and blood flow was constant to their extremities; and verifying that none had dangerous carbon monoxide levels in their bloodstreams. Their attention then went to carefully calculating fluid loss in order to administer the right amount of replenishing intravenous fluid.
Next, the patients’ wounds were carefully evaluated and wound treatment plans were initiated by the 7D nursing staff. Extra staff were called in to handle the volume of new patients, two of which were treated on 7C and one was treated on 7AB. When necessary, escharatomies (an incision made through the burnt layer of skin on the chest or arms to aid in chest expansion or circulation to extremities) were performed. Pain management was an ongoing concern and most of the patients were initially treated with continuous infusions of narcotics.
“Because of the thick smoke at the fire scene, smoke inhalation injury was a common finding in most of these patients and perhaps posed the largest challenge to care for this particular group of patients,” said Orgill. In addition, the patients all had some degree of second or third degree burns that were treated with topical antibiotics, artificial skin or excision and skin grafts. The care for their external burns included at least two dressing changes per day, a minimum of four hours time. Multiple bronchoscopies were also performed to flush out inhaled materials and to monitor the status and fluid shifting associated with the patients’ internal burns.
According to Orgill, like others treated in BWH’s burn center, some patients will experience some sequellae for years to come. Some may also need secondary reconstructive surgery in the coming months.
“The Warwick fire victims presented with bad burns, but BWH has treated worse over the years,” said Orgill, who pointing out the teaching opportunity that arose from the group of patients. Surgical residents Richard Bafford, MD and Robert Golden, MD were also instrumental in the ongoing care of the burn victims. Intensive care residents from BWH’s Anesthesia and Emergency Medicine Departments, under the direction of BWH’s Surgical ICU Selwyn Rogers, MD, were also closely involved in the initial and subsequent care of the eight individuals during their stay at BWH.
BWH has served as a preferred referral point for many of the area disasters in years past. In the last decade, patients from the Malden Mills fire; firefighters from a fire at a manufacturing plant in Springfield; and firemen burnt in a large fire in a Newton chemical plant were all brought to BWH for their burn care.
As of March 14, all BWH Warwick fire victims were discharged. Some have returned to BWH’s burn clinic, where clinicians monitor their healing process on an outpatient basis.