Planning for burn Planning for burn disasters:disasters: what can we learn from what can we learn from

one hundred years of history ?one hundred years of history ?

David J. Barillo, MD, FACSDavid J. Barillo, MD, FACS

COL MC USARCOL MC USAR

Commander, FEMA Burn Specialty Team 2Commander, FEMA Burn Specialty Team 2

http://www.answers.com/main/ntquery?method=4&dsname=Wikipedia+Images&dekey=Nagasakibomb.jpg

What kind of disaster should we be planning for?

Question

• What is the historical experience with burn disasters in the USA?

Methods

• Review of the pertinent medical, fire service and popular literature pertaining to civilian fire or burn disasters occurring within the United States between the years 1900 to 2000

Civilian burn MASCAL

• 1902 Birmingham, AL church fire 115 dead • 1903 Chicago Iroquois Theater fire 602 dead• 1904 General Slocum ship fire New York >1000 dead• 1906 SF Earthquake and fire ~500 dead (crush)• 1908 Lakeview Elementary School, OH 176 dead• 1908 Rhoades Theater Fire, Boyertown PA 170 dead• 1911 NYC Triangle Shirtwaist Factory 146 dead• 1917 Eddystone PA munition plant fire 133 dead• 1918 Minnesota forest fires 599 killed• 1919 Mayaguez Theater, San Juan PR 150 dead• 1920 Wall Street explosion 40 killed• 1923 School fire, Camden SC 76 dead • 1929 Cleveland Clinic Fire 125 dead

Civilian burn MASCAL

• 1930 Columbus OH penitentiary fire 320 dead• 1934 SS Moro Castle 134 dead• 1937 New London, TX school fire 294 dead• 1940 Natchez, MS Dance Hall fire 198 dead• 1942 Cocoanut Grove 492 dead• 1944 Hartford, CT circus fire 168 dead• 1946 LaSalle Hotel fire, Chicago 61 dead• 1946 Winecoff Hotel, Atlanta 119 dead• 1947 Texas City, TX 516 dead• 1949 St Anthony Hospital fire, Effingham IL 77 dead• 1958 Our Lady of Angels, Chicago 95 dead• 1977 Beverly Hills Supper Club 167 dead• 1980 MGM Grand, Las Vegas 84 dead• 1986 Dupont Plaza Hotel fire 97 dead• 1990 Happy Land Social Club 87 dead

US Burn Disasters 1900-2000

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1902

1904

1908

1917

1919

1923

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1946

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1977

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First 50 years

Cocoanut Grove

• 1000 + patrons in a club licensed for 460

• First alarm 10:15 pm• 2nd alarm 10:20• 3rd alarm 10:23• 4th alarm 10:24• Under control 10:45• 5th alarm 11:05

• 492 fatalities

Cocoanut Grove

• > 300 went to Boston City Hospital, arriving 1 patient every 11 seconds

• 114 went to to MGH with last patient 2.5 hr after the fire started

Coconut Grove

• All but 181 DOA or expired within minutes

• The dead got in the way of treating the living

• BCH sent a triage doctor to scene 11:30 pm

• MGH: 4 medical house officers in teams of 2 at the door “ it is important that two men should collaborate”

• Living patients: BCH 131 MGH 39 Other 11

Coconut Grove

• MGH admitted 39 patients

• By day 15: 7 deaths, 1 transfer, 16 DISCHARGES

• Days 16-32: 4 pulmonary patients DC (no or healed burns)

• One anoxia patient, burns healed day 10, DC day 67

• TEN PATIENTS with third degree burns required grafting

Our Lady of the Angels School FireDecember, 1958

FATALITIES: 92 Children & 3 Nuns

Our Lady of Angels

1468 students (Grades 2-8) + faculty

170 injuries

@14 hr: 88 dead St Annes (est) 45@ 1 month 3 dead Walther Memorial 14 late: 4 dead Garfield Park 12 Norwegian 4 -------- --------- 95 fatalities 75 survivors

St Annes Hospital• 322 beds, 647 employees, 104 physicians

• First hour: 80 children & 3 nuns arrive 10 DOA and 2 deaths before admission

37 children & 3 nuns admitted 6 students > 60% BSA 13 students > 40% BSA 12 students with 36 fractures 1 bystander CVA & 4 firefighter injuries

• 20 burn patients survived to require management

• At end of week one, 11 patients still critical

Beverly Hills Supper Club Southgate, KY 1977

• 2300 people in building

• 165 deaths, all but 3 on-scene

• 5 survivors

SUMMARY

• There were fewer than 40 large scale civilian burn disasters occurring in the last century

• The number of incidents is trending down

• The number of casualties per incident is trending down

• In burn disasters, most of the victims are DOA or expire quickly

Your next disaster will probably involve 10-15 burn patients from something ordinary burning in your community.

This is where disaster planning should start

UNLIKELY LIKELY

“keep working on the basics. Most of us are not smart enough

to make advanced mistakes”

Alan Brunicini

Fire Command

www.burndisaster.comwww.burndisaster.comwww.bst2.orgwww.bst2.org

dave@bst2.orgdave@bst2.org