PROVIDENCE - The ambulances kept coming, one after another, a caravan of nightmares lining up at Rhode Island Hospital.

Again and again, nurse Laurie Boisclair swung the doors open, wheeled out the stretcher, and faced a patient blackened beyond recognition, eyes singed shut.

She worked swiftly - too busy, too focused to feel the horror. At curbside triage, her job was to check the airways. For each, Boisclair decided whether to send the patient immediately to a trauma bed to get help breathing, or to the team of doctors inside for a second level of triage.

Inside, the busiest emergency room in New England was cleared out, staffed up and equipped - ready for the dozens

of injured people from the West Warwick nightclub fire.

Hundreds of health-care workers were summoned by a simultaneous page: nurses, doctors, doctors-in-training, respiratory therapists, social workers, pharmacists, administrators, registrars, housekeeping workers. Housekeeping tripled. Disasters are very, very messy.

What these people did that night has never been done before, not by anyone, anywhere. Even after the World Trade Center attack, there were not as many severe burn victims at New York Hospital as confronted Rhode Island Hospital on the night of Feb. 20.

Dr. William G. Cioffi, the hospital's surgeon-in-chief, had treated hundreds of fire victims in eight years as an Army burn specialist. But he had never seen anything of this magnitude: 65 people, more than half of them in critical condition, some near death, many unconscious, lungs seared on the inside, skin charred and blistered.

Before dawn the emergency room would be virtually empty. Every severely injured person would have a bed and a medical team.

Every last one would still be alive. What's more, by yesterday afternoon, every one still was.

WHEN THE call came in, Terri M. Maine, a clinical nurse manager at the Rhode Island Hospital emergency department, was just finishing her shift. It was 11:10 p.m. on an unusually busy night. But the word "busy" would prove inadequate to describe what came next.

When his beeper went off, Cioffi was at home in bed watching a Celtics game. One hundred burn victims on the way, he was told. Doctors hear things all the time, and it's almost never true, but you can't take any chances. Cioffi got out of bed. He wouldn't see that bed again for days.

Traveling along Route 117 from his home in the Cowesett section of Warwick, Cioffi could see the ambulances flashing. Then he knew it was for real. His military training in mass casualties would be put to good use.

Jane Metzger, the chief nursing officer and senior vice president, arrived at the hospital within minutes of being paged. She ordered the hospital's disaster plan activated. A "blast page" went out. Some people's beepers displayed "911." Some said, "Disaster - This is not a drill." The overhead pager instructed staff on the 3-to-11 shift to stay; those on the 11-to-7 shift had already arrived.

Terri Maine set to work clearing out the emergency department. The emergency patients from earlier in the evening, who had been waiting for beds, got them right away. Those undergoing treatment were moved to the walk-in area.

The trauma rooms were superheated because burn patients lose body heat quickly. Ventilators and other necessary equipment were assembled.

And the patients rolled in. Each trauma room had a team of doctors and nurses, who had to make sure the patients were breathing, insert breathing tubes if necessary, provide adequate fluids, cover their wounds and medicate their pain. Each had different needs, but all the needs were great.

"It was amazingly calm," recalls Boisclair, the nurse who greeted the ambulances. "People were not screaming. Everybody was being taken care of."

Dr. Anne Truitt, 31, amid her first year in Brown University's surgery training program, treated the very first patient to arrive, a woman with widespread burns. Truitt did not get emotional; as a doctor she has learned to detach from her feelings so she can do what needs to be done. But for days, her blond wavy hair would carry the scent of charred flesh.

Dr. Eric G. Halvorson, the chief trauma resident, a 32-year-old in his fifth year of postgraduate training, arrived just as the first few ambulances began to line up. "I was in awe. It was an unbelievable process. It was amazing to watch Dr. Cioffi in action. ...

He described Cioffi with another chief resident: "They'd walk in, glance over the patient, and say, 'Do this, do that and then this patient is going to this unit with this resident.' Although there was a flurry of activity, it was very controlled and well-executed."

METZGER, THE chief nursing officer, raced to find beds for the fire victims. She opened a vacant unit on the eighth floor, and transferred patients off the fifth floor, leaving only those in the trauma intensive care unit. The hospital has several ICUs, 135 intensive-care beds in all, and any intensive-care patient ready for a less-intensive bed was moved immediately. Every available ICU bed around the hospital received a fire victim. By the morning after the fire, all the fire victims were moved to the fifth floor, transformed - literally overnight - into a burn unit.

Later, when Metzger had a moment to rest, her mind would continue to spin with lists, running through them over and over - numbers, names, beds, Jane Doe, where did she go? Which bed for him?

A woman named Ava approached Maine, wearing scrubs, saying she was a nurse from Beth Israel Hospital in Boston who lived nearby and wanted to help. Not knowing who she was, Maine couldn't use her as a nurse, but put her to work on transport and other tasks, and she proved priceless.

"The staff just lined up there just waiting to run for something," Metzger says. "You never had to follow up. No one asked twice for something."

The hospital's security guards, described as ever polite and calm, directed families of the patients away from the emergency department to a separate area, where a team of six social workers spent the night matching relatives with patients.

"I worked with one family where it was clear the person they were looking for was not in any of the hospitals," recalls Mitchell Robbins, manager of adult social work services. "I called the hospitals, followed every lead, until they could reach the conclusion themselves."

WHEN CIOFFI first saw the severity of the injuries, expecting 100 patients, he decided to start sending some to Boston hospitals. No single hospital could handle that many severe burns.

Of the first 12 critical patients he saw, he sent three to Boston. He kept the most severe inhalation injuries because they were too fragile to move. When he realized Rhode Island Hospital would receive 65, not 100, Cioffi kept all the remaining critical patients. Rhode Island Hospital knows how to treat severe burns, he said; there was just a limit to how many it could take.

Later that night, 17 less severely injured patients were discharged, but more than half of those remaining were in intensive care.

"The first 24 hours is a really critical stage of resuscitation," says Halvorson, expressing amazement. "We didn't lose anyone."

Asked about it a few days later, Cioffi seems to choke up. It's hard to tell for sure - he is unflappable, a man of legendary equilibrium. But now he pauses, apparently unable to speak. "Teamwork," is all he can get out. "The staff here, you've got to give them credit."

Metzger, a woman of 47 whose face is rugged with both toughness and compassion, does not hide her tears: "I've never in my whole career seen people who performed so well."

Maine puts it another way. "We kicked butt," she says.

BUT THE first 24 hours is only the beginning. Of all the possible insults to a human body, there is nothing quite like a burn. Burns attack the organs that interact in vital ways with the outside world: the lungs that draw in lifegiving oxygen, the skin that shields. The injury to each compounds the other. If you have an inhalation injury, the chances of dying from your burns increase by 40 percent, according to Cioffi. Infections of skin and lungs are always a risk. Several patients now are struggling with pneumonia.

So it's always touch-and-go, requiring prolonged and labor-intensive care. Each burn patient needs two nurses; the typical intensive-care patient needs one. Changing the dressing on burn wounds requires three or four nurses and takes about two hours. Skin grafts heal slowly and painfully.

All this happens in superheated rooms, done by workers who are covered head-to-toe in protective garments to avoid spreading germs.

"There's a lot of physical work," says Halvorson, the chief trauma resident, "changing central lines, changing dressings, doing bronchoscopies. You're on your feet all the time. ... The rooms are 85 degrees, and you're wearing nylon gowns and gloves, doing some of the most gruesome surgery."

"It's really amazing," says hospital president Joseph F. Amaral, a surgeon, "to look at how these people continue to do what they're doing despite the fact that there's tremendous physical, emotional and professional demands on them."

Amaral said that care in the rest of the hospital was not disrupted. Not one elective surgery was postponed, even on the day after the disaster. Until Friday, when federal relief nurses came in, the hospital was relying exclusively on its own staff.

How is this possible at a time of labor shortages in health care? Amaral said that about 70 percent of nurses in the state work part-time. To meet the emergency need, nurses and others are putting in many more hours than they normally would.

"Obviously," Amaral said, "they're disrupting their own lives at home and making arrangements to be able to work more, voluntarily."

Metzger, for example, lives with her 35-year-old brother with Down syndrome, her mother disabled by multiple sclerosis, and her elderly father, along with her husband, Steven.

Steven Metzger, like so many spouses of the caregivers, is picking up the slack on the home front.

Nurses have come in on their days off, without anyone asking. Many simply worked through the weekend, never thinking to go home. A couple of them, Metzger says, came in at 3 one morning, sleepless, needing to work.

"The staff is having nightmares," Metzger says. "They don't want to go home. They say they're not sleeping anyway."

Social workers and psychiatric staff at the hospital have also been available to help them.

When asked how they cope with the work and its aftermath, doctors and nurses use the identical phrases: "We look out for each other." "We take care of each other." "We talk about it among ourselves."

And sometimes they cry. Nurses say they put their emotions "someplace else" when they're working hard. But those feelings can't always stay put forever.

The crying started in different units at different times, Metzger says. The emergency room people broke down on the Saturday and Sunday after the fire, when they went to visit the burn unit. Metzger herself was "a faucet" when she addressed the staff that Saturday.

When a burn victim from an unrelated incident came into the emergency department last Wednesday, Maine wouldn't let anyone who had worked the disaster go near that patient. "My staff is so fragile," she said.

JOE PANKOWICZ, a nurse in the surgical stepdown unit, typically cares for elderly patients recovering from routine surgery. Now, he says, he is suddenly learning to cope with ventilators and burn dressings - a demanding crash course.

But there are other new experiences for the nurses as they deal with suffering on a new order of magnitude - dozens of patients who have lost loved ones even as they face months of healing and a lifetime of disfigurement or disability.

"You look at the faces of these people and you wonder how they're going to put their lives together," Metzger says.

"One gentleman, 34 years old, they identified his wife [among the dead]," Metzger says. "He doesn't know. His kids got told yesterday. The nurse was a basket case."

The hospital's social workers have mobilized to offer the families everything from food to phone cards to advice on talking to children. They help the relatives "gown up" - don the protective garb - and accompany them when they first go in to see their injured loved one. Some have fainted; some became so distraught they were taken to the emergency department.

Katherine Richard, a licensed clinical social worker, helped a little girl put on her hat, gloves, and gown to visit her mother. They agreed to first stop at doorway, take a quick peek, and then decide whether to go on. The little girl made it to the doorway, and chose to go in. "It turned out to be a very positive thing," Richard says.

Deborah Turner, a nurse in the trauma ICU, has seen serious burns and other horrendous injuries. But this is different, because there are so many. "It's so massive and it affects everyone, everywhere," she says.

One of Turner's patients has a 12-year-old daughter. As she works, Turner is always aware of the child in the waiting room. She hasn't seen her mother yet; it's too soon for such a difficult encounter.

"You don't know what to say," Turner says. "I say, 'We're taking good care of your mom.' They kind of hang onto every word from you. It's just such a long road for burns.

"While you're working, you don't really think about it. Then, when you get a minute alone, it kind of hits you," says Turner, her tears welling up.

Paula Zompa, a nurse in the surgical intensive care unit, happened to pick up the phone when a woman was calling to check on her fiancé. The woman had escaped the fire by jumping out a window, and she was stricken with guilt. As the anguished woman spoke, Zompa's nursing skills were called upon in an entirely new way.

"I had to tell her, 'It's OK that you're not hurt,'" she recalls tearfully. "She said, 'I can't talk to him.' I said, 'Give yourself a day.' I told her, 'Go for a walk.' I didn't know what to say to her. That was a new experience for me."

Nurse Judy Elwell works in the surgical trauma unit with patients who are off the ventilator and starting to gain consciousness. "They're finding out about their lost family, friends," says Elwell, who is 32 and lives in Warwick. "Some are still having nightmares, waking up. I try to talk to them, make them more comfortable. A lot of times you just talk to them."

Then a smile comes over her face. "This is what nursing is," Elwell says. "I've seen the worst and I've made people better.

"No matter how bad it is, I know I've helped somebody. I come in and I look forward to it. My patients look forward to seeing me. I've done what I wanted to do.

"This is what nursing is. This is what I love."