The Feb. 20 fire at the Station nightclub in West Warwick, R.I., has already achieved grim distinction as one of the nation's worst fire disasters. The fire killed 98 people and injured 186; about 60 people remain hospitalized, 29 in critical condition.
The latest victim died on Saturday, but burn experts say the toll could have been much worse if emergency workers had not been trained to deal with mass casualties under a statewide disaster response plan adopted after the Sept. 11, 2001, attacks.
The training included procedures to quickly assess the medical needs of large numbers of burned or poisoned people, to clear routes to hospitals and to activate a communication system linking government, medical and rescue agencies.
The training paid off in the Station fire. Burn experts credit the speed and precision with which rescue workers got the injured to appropriate hospitals with saving many lives, especially those of the more than 50 people with inhalation burns.
"Successful burn treatment requires a team approach," said Dr. Robert J. Spence, of the Burn Injury Rehabilitation Model System at Johns Hopkins University in Baltimore, one of four centers developing national burn care protocols.
Rhode Island's disaster plan before Sept. 11 emphasized more routine events, like hurricanes and bus crashes. After Sept. 11, state officials added terrorist attacks with hundreds of dead, maimed and burned victims, using a Justice Department grant for drills at the state airport. Hundreds of actors were hired to play screaming victims, panic-stricken relatives and terrorists bent on escape. State officials borrowed the war games theater at the Naval War College in Newport to practice with computer simulated disasters, said Lt. Gov. Charles J. Fogarty, chairman of the state's Emergency Management Advisory Council.
"We never expected this kind of test," Mr. Fogarty said. "But there is no question that all the training and focus on terrorism helped our readiness and capacity to respond."
Patients with severe burns are one of the greatest challenges in trauma care, particularly those burned over more than 20 percent of their skin surface. Virtually every organ system is taxed as the body goes into overdrive to try to heal huge areas of destroyed tissue.
Beyond damage to a patient's skin are potentially life-threatening injuries to kidneys, lungs, heart and brain as blood volume drops precipitously and metabolism goes haywire. In a frantic effort to close the wound, the body will cannibalize healthy tissue, including muscle, to obtain protein to fuel this exaggerated healing response. The lungs may be seared, interfering with breathing. Because burns are almost always contaminated by soot, debris and dead tissue, infection is often a complication.