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Rhode Island Hospital surgeon-in-chief William G. Cioffi was watching a Boston Celtics game on February 20, dozing off in his bed in Warwick, Rhode Island, when a page informed him that as many as 100 burn patients could be en route to the emergency room. Cioffi, a onetime U.S. Army burn specialist and the J. Murray Beardsley Professor and Chairman at the Brown Medical School, didnt think much of it. We get a lot of calls like that, he says, and theyre almost never true. Cioffi turned off the game and drove to the hospital. He knew something serious was up when he approached the highway and counted seven ambulances in his rearview mirror.

Cioffi got to the hospital just before the first patient arrived from the inferno at the Station nightclub in West Warwick. Fortunately the hospital had recently drafted a disaster plan to prepare itself for a terrorist attack. Soon the entire hospital staff had been mobilized, from doctors and nurses to housekeepers and office workers. I was extremely nervous, Cioffi says of his reaction to the dozens of victims that began arriving. Could we do this? Did we have the resources? The doctors caught a break. The patients were arriving at a change in shift, so twice as many staffers as usual were already at the hospital.

Cioffi and an emergency-room doctor assessed each patient at the door. About half needed ventilators to breathe. Some were burned almost from head to toe. All of them, however, were about to get the best care possible: as the former chief of the burn-study branch at the U.S. Army Institute of Surgical Research in Houston, Cioffi is one of the countrys leading burn specialists. Two other surgeons who would provide additional care in the coming days and weeks are also veterans of the Houston center: Brown Medical School assistant professors David Harrington and Theresa Graves (who is married to Cioffi). Theres no burn center in the United States, Cioffi says, that has that kind of experience.

An eighteen-year-old who has burns on 82 percent of his or her body has a fifty-fifty chance of surviving. But eighteen years old is the peak age of survivability. Most of the patients Cioffi was seeing were at least ten years older. Cioffi decided the hospital could handle fifty of the most seriously injured. Eight patients were sent to a Boston hospital; seventeen others were discharged with minor injuries. Forty-three burn victims, some close to death, were admitted to Rhode Island Hospital. The care they required was constant. For two weeks every surgeon in sight became a burn doctor, and Cioffi himself didnt leave the hospital for two days. The patients airways needed to be kept clear, and they required many times the normal amount of fluids to make sure their kidneys didnt fail. The trickiest task was closing the burn wounds. On the surface its just a skin injury, Cioffi says; in fact, every organ in the body suffers from the trauma until the wounds are closed.

Cioffi and his team performed five skin-graft operations a day during the first week, while another team did another five. Doctors and nurses watched for signs of pneumonia and malnutrition. Recovering from serious burn injuries, Cioffi says, is like running a marathon, and as soon as you stop you run another one.

All forty-three of the patients have survived and have been released. But recovery can take a year or more. This is a life-altering event, Cioffi says. The physical therapy is hard because it hurts. But I think the tough thing has got to be to move on with life.





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