News Release

By TOM HUGHES
UNC School of Medicine

CHAPEL HILL -- North Carolina and the United States as a whole still have a long way to go before they can claim to be prepared for a disaster in the post-9/11 world, a study by University of North Carolina at Chapel Hill researchers concludes.

The study examined the response of the N.C. Jaycee Burn Center at UNC Hospitals and other key members in North Carolina’s disaster response system to a devastating explosion at the West Pharmaceutical Services Inc. manufacturing plant in Kinston in January 2003.

The study, conducted by medical staff in the burn center, is published in the March/April issue of the Journal of Burn Care & Rehabilitation, the official journal of the American Burn Association.

The entire issue is devoted to articles about recent burn disasters and mass casualty incidents, including the 1994 Pope Air Force Base crash in North Carolina; the Sept. 11, 2001, terrorist attacks in New York City and the Washington, D.C., area; the October 2002 nightclub bombing in Bali, Indonesia; and the February 2003 fire at The Station nightclub in Rhode Island.

The lead author of the Kinston study is Dr. Bruce A. Cairns, associate director of the N.C. Jaycee Burn Center and an assistant professor in the UNC School of Medicine’s department of surgery.

"While we were pleased that there were a number of aspects about the response that worked well, we believed that it was necessary to review our experience with the Kinston disaster and decide not what we did well, but where we could make improvement," Cairns said.

Cairns said he hoped that the authors’ open, honest appraisal of the incident would help lead to a more effective response to similar disasters in the future.

The Kinston explosion, which the U.S. Chemical Safety Board concluded was an explosion of fine plastic powder used in the manufacturing of rubber products, presented many of the same problems that emergency responders would face in the aftermath of a terrorist bombing, Cairns added. In particular, the disaster presented difficult challenges in terms of quickly assessing the medical care needs of patients with both burn and trauma injuries such as broken bones, removing patients from the disaster scene and transporting them to an appropriate medical facility, and then providing optimal care to multiple severely injured patients at once.

Soon after the explosion, which occurred at 1:37 p.m. on Jan. 29, 2003, the response was plagued by communication problems and confusion, according to the UNC researchers. For example, cell phone networks used by emergency workers became overloaded and, thus, this means of communication was no longer available. Emergency radio operations varied from county to county, so 800-megahertz radios were dispersed to key individuals in an attempt to establish reliable communication.

"Overall, the communication among the scene, transport systems and UNC Hospitals has to be characterized as poor," the UNC researchers wrote.

The article also raised questions about the actions of the authors themselves and their institution in response to the Kinston disaster. For example, the researchers wrote that keeping all 10 of the critically injured patients meant that the 21-bed burn center had four more intensive care patients at one time than it was designed to handle. This placed enormous stress on the burn center, raising questions about whether or not its resources had been overwhelmed and whether or not some of the patients should have been transferred to another burn center.

UNC Hospitals’ burn center met this challenge by placing some patients in other units at UNC Hospitals and increasing the number of caregivers per shift from seven to eight to 13 or 14. But this resulted in significant costs in overtime pay and increased stress on burn center workers.

"Although the needs of these 10 critical patients were met, the resources at our institution were clearly and almost entirely maximized," the authors wrote. "Although the institution’s response to the increased workload was impressive, it also was unsustainable over a long period of time."

One lesson the UNC researchers drew from their analysis was that even though North Carolina has what they describe as one of the most advanced regional trauma systems in the country, "a lack of education, communication and coordination continue to hamper our ability to efficiently and optimally respond to mass casualty events." They also cited the report on Sept. 11 written by the National Commission on Terrorist Attacks to demonstrate that North Carolina is not alone in this regard, adding that "there is still no comprehensive state, regional or national disaster plan that incorporates the care of patients with both burns and other serious injuries."

In addition to Cairns, study authors were Arvilla Stiffler, a former director of UNC Health Care’s trauma outreach program; Fred Price, who was the N.C. Jaycee Burn Center’s nurse manager at the time of the Kinston explosion; Dr. Michael D. Peck, medical director of the burn center and a professor in the School of Medicine’s department of surgery; and Dr. Anthony A. Meyer, chairman of the department of surgery. (The burn center is part of the department of surgery.)

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Note: Contact Cairns at (919) 966-3693 or bruce_cairns@med.unc.edu.

School of Medicine contact: Stephanie Crayton, (919) 966-2860 or scrayton@unch.unc.edu