On Feb. 20, 2003, the nation's fourth-deadliest nightclub fire occurred in the Town of West Warwick, RI, killing 100 people and injuring nearly 300. The emotional impact on the responding firefighters continues. Many will not discuss the incident; some still receive medical care. Legal...
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The DHS report stated the bulk of the fire was knocked down with the scene changing from a rescue to a recovery operation within 40 minutes. At 2337, command radioed triage that people were still being pulled out from side A. Although master streams are not normally used in occupied structures, firefighters credited their use on side A with saving lives where numerous occupants were trapped and simultaneous rescue-recovery operations were ongoing. Firefighters had to remove deceased victims to access survivors wedged in doors and hallways. A diagram released by the RISAG in 2004 with approximate locations of bodies showed 68 at or near side A. Thirty-one were inside the hallway and vestibule, nine at the dance-floor entrance to the vestibule, three in the main bar and 25 in the sunroom adjacent to the common vestibule and hallway wall and windows. Twenty-eight were dispersed in the B/C areas, which lacked exterior doors and windows.
Two distinct triage areas emerged, one with Hopkins Hill Rescue 6 at the A/D corner and one at the CIR opposite the A/B corner. Twelve minutes into the incident, at 2325, triage was consolidated when Engine 1 radioed command confirming triage was inside the CIR. Several times, command directed FA to notify responding units of triage, rescue staging locations and specific travel routes to take.
As resources arrived, an Engine 3 member with a Cranston EMS officer conducted primary triage outside the CIR — tagging "red" critically injured for transport on the next-available rescue — and moving less seriously injured people inside for further assessment. Inside, an Engine 2 member with a Warwick EMS officer coordinated triaging victims — separating and tagging them "green" and "yellow" for treatment. As operations slowed, a sweep ordered of the fireground and surrounding areas found additional injured victims. At 0037, incoming rescues were canceled; all living victims had been transported. The DHS report Annex B — Emergency Medical Services noted the effectiveness of the EMS operation and in particular how out-of-town EMS supervisory staff and command officers assisted the triage and transport process. Within 90 minutes, about 200 injured were triaged and transported, mostly by fire department rescues and commercial ambulances; the balance in commercial and fire department buses and private vehicles.
Survivors' injuries and autopsy results can reveal accurate scientific representations of conditions inside a burning structure. Hospitals reported 273 patients treated, most with inhalation burns and smoke; 40%-plus with third-degree burns of face, upper extremities and upper body. An October 2003 Health Care Industry publication noted that 17% of 196 burn victims were admitted into intensive care on ventilatory support. Another stated that only four hospitalized victims expired, which was attributable to the airway-management skills of the EMTs and emergency physicians. A 2005 seminar estimated 20 to 30 critical third-degree burn victims were saved by firefighters.
The medical examiner's 2003 grand jury testimony, released in 2007, revealed autopsy results for 98 victims. Each specified the main cause of death listing any significant factors the medical examiner felt were contributory, noting the victim possibly could have expired without suffering the contributing factor. Eighty-six causes of death were from the "inhalation of products of combustion and a super-heated oxygen-deficient atmosphere" (inhalation). All 86 listed significant thermal burns as a contributing factor. Three listed thermal burns and inhalation as the primary cause, three listed inhalation and compression injuries and two listed compression injuries only. Four listed thermal burns as the main cause. Only one deceased, with compression injuries only, did not suffer inhalation or burns. Survivors' injuries mirrored those of the deceased. Dental records were necessary in identifying 70% of the deceased. The medical examiner testified 20 deceased had significant levels of cyanide, indicative of inhaling an atmosphere containing hydrogen cyanide, a product of burning polyurethane. Most of those bodies were recovered near the stage and dance floor.
Recovery & Rehabilitation
The DHS report stated the medical examiner's office was overtaxed. Grand jury transcripts indicate the U.S. Public Health Service Disaster Mortuary Response Team (DMORT) was requested to assist. West Warwick firefighters not on the first-alarm assignment assisted with body recovery. An officer with three firefighters (or firefighters from surrounding departments who volunteered) worked in teams with the medical examiner, state fire marshal and law enforcement. After locating, tagging, photographing and removing a body, teams attended debriefing sessions. Due to the large number of deceased, teams made multiple recoveries. Fire department rescues assisted in transporting bodies. The Providence Fire Department detailed several companies to assist at the morgue in Providence.