Digital Extra: The Station Fire

About 230 victims were treated at area hospitals, and only 4 died.

01:00 AM EDT on Wednesday, July 14, 2004

BY FELICE J. FREYER
Journal Medical Writer

The hospitals and medical professionals who responded to The Station fire performed "monumental," "commendable" and "valiant" work, saving all but four of the people who escaped the fire alive.

Despite its awed praise for the quality and compassion of the medical care, the Titan Corp.'s report documents inadequacies of planning and failures of communication that seem mind-boggling for a small state.

Each hospital coped with "a seemingly endless stream of ambulances transporting badly burned patients" with no clue how many more were coming nor when it would be over. And when it was over, no one informed the hospitals that all the injured had been evacuated.

"No one had told them stand down," Governor Carcieri said at a news conference on the report. "We should have had better plans in place for mass casualties."

Hospital officials said yesterday that disaster planning had started before the fire, and accelerated afterward, so that many of the problems raised in the report have already been corrected. They pointed out that it's impossible to plan for every contingency -- and The Station fire was an extraordinary event.

"You can do drills, you can simulate. But the reality of The Station fire is that it was one of the worst events in terms of the influx of patients," said Cathy E. Duquette, senior vice president of the Hospital Association of Rhode Island. "I don't think anyone in their worst nightmare would have planned for the extent of injuries The Station fire resulted in."

Dr. William G. Cioffi, surgeon-in-chief at Rhode Island Hospital, said that the "survivorship" from The Station fire was higher than any other major fire ever documented. "You have to look at it from that perspective," he said. "No matter what could have been done better, the health-care system worked."

All told, 186 patients went to hospitals in Massachusetts and Rhode Island the night of the fire, and an estimated 50 people -- some with serious injuries who didn't want to distract from the life-saving efforts -- went to a hospital over the next 48 to 72 hours. Kent Hospital received 55 patients in the first 45 minutes after the fire.

Although hospitals were equipped with a Nextel phone system intended to allow communication among them, when Kent Hospital put out a Nextel call to the other hospitals, no one answered. Either the phone was parked in an administrative area, or it was in the ER but inaudible amid the hubbub, or the nearest staff person didn't know how to use it. Two other hospitals also tried Nextel calls, to no avail.

THERE WAS NO SYSTEM to notify the hospitals of the disaster and its scope, nor to find out from the hospitals how many patients each could handle.

Hospitals didn't even have written plans for dealing with sudden surges of patients, although such surges occur on a smaller scale nearly every flu season. "All of the hospitals did an outstanding job of finding beds and providing care for the injured in the absence of formal plans calling for expanded emergency surge capacity," the report said.

By a stroke of luck, the fire occurred around the time of the 11 p.m. shift changes at the hospitals, so workers from both the evening and night shifts were already on hand. But if the hospitals had needed to summon them, outdated personnel records with incorrect contact information would have stymied that effort, the report said.

Without a written plan for using helicopters during a disaster, hospitals faced delays summoning and coordinating the four air-ambulance companies in the region, which were needed to take the most severely burned patients to out-of-state burn centers.

"Each hospital made its own arrangements, which sometimes proved inefficient and was potentially counterproductive. . .," the report said. "Individual hospitals attempted to coordinate burn-center beds and helicopter transport without fully understanding the gravity of the entire situation on the health-care system."

The hospitals lacked standard statewide triage criteria or procedures, resulting in difficulties in tracking and identifying patients. Some hospitals treated patients for two or three days before they identified them, leaving distraught relatives searching and wondering.

Hospitals had a hard time tracking patients as they moved from the emergency department to treatment areas, and need to improve their methods of collecting patient information, the report said.

Also, some hospitals were unprepared to provide mental-health services to victims and their families, as well as to their own staff.

Donations and volunteers poured in, adding to the commotion; the hospitals, the report advises, should have a designated area or plan for dealing with them.

DESPITE THE CHALLENGES, the report notes, of the approximately 230 people who went to area hospitals, only 4 died. "This, alone, is proof of the monumental achievement of the hundreds of medical professionals who provided timely, prehospital triage, transport, inpatient treatment, rehabilitation, and loving care to the victims of the fire and to their families."

Hospitals lost hundreds of thousands of dollars for their good works, the report points out. Many patients were uninsured. In many cases, hospitals couldn't collect full reimbursement because they failed to adequately document the care provided. Even when reimbursed, the payments didn't cover costs, and the more severely injured the patient, the greater the gap between cost of care and reimbursement.

Since the fire, every hospital has gained experience with the Nextel system and fully trained its staff in using it, said Duquette, of the hospital association.

Every hospital has also written a surge capacity plan, or is developing one, Duquette said. Hospitals have also since reviewed and updated their staff recall procedures.

Cioffi said disaster planning is much more complex than it appears at first. A 100-car pileup, a plane crash, a biological attack and a fire all require different responses and involve different agencies.

In speaking about The Station fire around the country, Cioffi said, he often hears from medical people, even at major medical centers, who say they doubt they have a system in place to respond to a similar incident.