By Jeffrey C. Schneider, MD and Colleen M. Ryan, MD FACS
The Cocoanut Grove Nightclub Fire shook Boston and the medical community in 1942. Four hundred and ninety-two merrymakers perished in the fire and hundreds more were injured. The fire safety and treatment advances born in that fire a generation ago have had wide-reaching impact on building codes, triage, disaster management, burn resuscitation and the treatment of wounds, smoke inhalation and infections. The tragedy of those days was an engine for research and innovation that has since saved many more lives than lost, and is, in part, a fitting memorial to those whose lives were lost or heavily impacted by this devastating event.
We, as a burn surgeon and a rehabilitation physician who cared for some of the patients and families of the Rhode Island Station Nightclub Fire during the dark days after the fire and the ten years since deeply hope that our continued work studying this disaster and its impact will serve as a living memorial to those who lost their lives that day. This event has provided important lessons in burn disaster management, fluid resuscitation, and pain management of the critically ill patient. Innovative surgical techniques have been advanced because of this disaster. One of the important advances, driven by the grace and determination of survivors, is the development of resources and research into long-termrecovery. As doctors, we listened to their stories and we are now growing old with our patients, and still listening. There are little data on the long-term outcome from burn injury, not surprising since survival from massive burn injury was not commonplace until the mid-1980’s. We are trying to make headway in this area.
We recently published a study, “The Long-Term Impact of Physical and Emotional Trauma: The Station Nightclub Fire” in the journal PLOS One. The study involved over 100 survivors of the Station Fire and looked at the multi-dimensional long-term effects of this catastrophic event. We assessed the differences in outcomes between survivors with and without physical injury. This was the first study to investigate the long-term effects of a large fire on its survivor population that included survivors with and without burn injuries. Among the main findings of the paper were that survivors experienced significant life disruption, including occupational, psychological and quality of life sequelae.
Furthermore, quality of life, depression and post-traumatic stress outcomes were related to emotional trauma, not just physical injury.
For the vast majority access to the support services needed to heal the physical and emotional scars is not adequate. The Shriners Hospitals for Children has been a leader in this effort with programs such as school re-entry for burned children, yet more work is needed. Similar resources for adults are extremely limited, and programs offering psychological support, peer support, coping techniques, studies of work accommodations and work and societal reintegration are scarce for adults and children. In order to address this problem, three institutions, the Sumner Redstone Burn Center and Fraser Outpatient Burn Center at Massachusetts General Hospital, Shriners Hospitals for Children-Boston, and Spaulding Rehabilitation Hospital have combined their efforts and expertise in burn care and rehabilitation to form a program for burn recovery, the Boston-Harvard Burn Model System. This collaboration was recently awarded funding from the National Institute on Disability and Rehabilitation Research as a Model System of care.
As directors of this center, our charge is to advance burn awareness and education, support best care practices and advance the field of burn research. Each of us sees patients and families eachday who learn to adjust to and overcome their injuries. For many this means excruciating hours of wound care, surgeryand intensive therapies. While our care teams work to heal the injuries we see, we need to continue to improve our abilities to understand and support our patients to overcome those injuries that are not visible to the eye. This is a work that we hope will honor those lost, and those surviving, the Station Fire – as well as all of our patients and families.
In addition to this somber anniversary, February also marks Burn Injury Awareness Month. While significant events such as the Station Fire tragedy bring much needed attention to fire safety and burn injuries, the fact is the vast majority of burn injuries happen on a small scale in our own communities. Over two million burn injuries occur each year, with almost 15% being children under 14. There is still work to be done in burn prevention. We applaud the Massachusetts State Fire Marshal office for their work on fireworks safety, home oxygen safety, cigarette safety and building code improvements. In the meantime, we strive to develop better treatments for burn survivors. We are thankful for our generous philanthropic supporters and grateful patients at our institutions; however, there is a lot of work to do and more funding is needed for this important work.
Jeffrey C. Schneider, MD is an assistant professor of Physical Medicine and Rehabilitation at Harvard Medical School, Medical Director of Burn and Trauma Rehabilitation at Spaulding Rehabilitation Hospital and Project Director of the Boston-Harvard Burn Injury Model System.
Colleen M. Ryan, MD FACS is a staff surgeon at the Massachusetts General Hospital and the Shriners Hospitals for Children®-Boston, and an Associate Professor of Surgery at Harvard Medical School. She is former Co-Director of the Sumner Redstone Burn Center and Director of the Fraser Outpatient Burn Service. She currently serves as Director of Burn Outcome Research at Massachusetts General Hospital and Clinical Director of the Boston-Harvard Burn Injury Model System._