Lessons learned from a nightclub fire: institutional disaster preparedness.
BACKGROUND
On February 20, 2003, a nightclub fire caused a multiple casualty disaster, with 215 victims requiring treatment at area hospitals. In this report, we describe the events, the surgical response at our trauma center, and the lessons learned in institutional disaster preparedness.


METHODS
Information regarding the fire was obtained from public access media and state governmental and hospital reports. Patient information was obtained through review of our trauma registry, patient records, and questionnaires sent to regional hospitals.


RESULTS
Four hundred thirty-nine patrons were in the building at the time of the fire, of whom 96 died at the scene. One hundred people ultimately died. Two hundred fifteen patients were evaluated at area hospitals: 64 at our trauma center and 151 at 15 other area facilities. Seventy-nine patients were admitted: 47 to our center and 32 to other hospitals. Eight patients were transferred from Rhode Island Hospital (RIH) to other Level I trauma centers. Twenty-eight (60%) of the patients admitted to RIH were intubated for inhalation injury. For patients admitted to RIH, the extent of the total body surface burn was less than 20% in 33 patients (70%), 21% to 40% in 12 patients (26%), and greater than 40% in 2 patients (4%). The average age was 31 years (range, 18-43 years). Previous disaster planning drills facilitated a quick institutional response directed by a surgeon. The trauma floor of the hospital, which normally consists of a 10-bed trauma intensive care unit (ICU), an 11-bed step-down unit, and a 22-bed medical-surgical floor, was cleared of patients and converted into a 21-bed burn ICU and a 34-bed acute burn ward. Surgical residents were mobilized into teams assigned to the emergency department, ICUs, and surgical floors. In addition to the in-house trauma attending already present, four additional surgical staff members were called in to help man the emergency department and burn wards. Two operating rooms became dedicated burn rooms where 23 cases were performed the first week. In total, 43 operative procedures and 9 bedside tracheostomies were performed over 8 weeks. Over the first 4 weeks, 132 bronchoscopies were performed for diagnostic purposes and pulmonary toilet. There were no deaths.


CONCLUSIONS
Disaster planning as well as personnel and institutional commitment resulted in an optimal response to a multiple casualty incident. Still, lessons were learned that will further improve readiness for future disasters.
Mahoney
Eric J
EJ
Department of Surgery, Division of Trauma and Surgical Critical Care, Rhode Island Hospital/Brown Medical School, Providence, Rhode Island 02903, USA.
Harrington
David T
DT
Biffl
Walter L
WL
Metzger
Jane
J
Oka
Tomomi
T
Cioffi
William G
WG
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002056:Burns / Q000453:epidemiology / Q000628:therapy*; D004189:Disaster Planning / Q000458:organization & administration*; D005260:Female; D005390:Fires / Q000706:statistics & numerical data; D006302:Health Services Research; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D015397:Program Evaluation; D012041:Regional Medical Programs; D012042:Registries; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D015208:Smoke Inhalation Injury / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014187:Transportation of Patients / Q000458:organization & administration; D014193:Trauma Centers / Q000458:organization & administration*; D014218:Triage / Q000458:organization & administration