It was about 5:30 p.m. Monday. Rush hour had crested, and all over the city hospital emergency room crews were settling into the routine of a typical weekday night. Then the red phones started ringing.
The Washington Hospital Center, D.C. General Hospital, George Washington University Medical Center Capital Hill Hospital. All were alerted via their direct lines to the Fire Department ambulance dispatcher that fire victims were on the way.
The first calls were inaccurate, as they sometimes are. "From what I understand, we got a call saying there had been a major fire in the city and 14 people were coming to the Hospital Center because the other hospitals were full." Dr. Bernard Wagman recalled yesterday.
By about 6:50 p.m., 59 physicians, medical students, nurses, emergency room technicians and respiratory therapists were at work in the four hospitals, [WORD ILLEGIBLE] to save those 11 victims of the fire who did not arrive in the emergency rooms already dead.
The ambulance drivers take emergency cases to the nearest hospital, unless that hospital's emergency room is full. If the hospital is full the ambulance dispatcher notifies the drivers that the hospital is on "re-route," said patients are taken to the next nearest hospital. In a case like Monday's fire, with numerous victims, the drivers themselves will take the victims to several hospitals, rather than overloading one.
The scene is the emergency treatment area of the Hospital Center was one of carefully choreographed chaos.
"I was eating dinner and I heard a call over the PA system that they had a cardiac arrest in the emergency room," said Wagman, the medical resident in charge in the emergency room Monday night. "We ran down there and that's when it started. Within 3 minutes we had four admissions.
"The first patient was the cardiac arrest. One person hooked him up to the monitor to follow the heart. The medical resident evaluated the patient. Someone was hooking him up to an electrocardiagram (to chart the heart action) someone else was trying to get an intravenous line into the patient . . . it took 15 or 20 minutes to get the heart back to normal rhythm in the patient." said Wagman.
At Capital Hill Hospital, "the emergency room was notified they were doing CPR cardiopulmonary resuscitation on one of the victims of the fire," said Dr. Maximo Perez, director of the emergency room. "The people in the emergency room were told he was coming in.
"They prepare the room" for heart failure victim," he continued. Fluids and drugs are readied. IVs are started, nurses, respiratory technicians and electrocardiagrams technicians are notified.
"He came in at 5:46." said Perez. They gave IV fluids, they inserted a tube in his throat to aid in breathing, they were pumping oxygen, they gave adrenalin (to get his heart going) and sodium bicarboante to neutralize and excess of acids in the system). But when he came in he was almost dead." At 6:45, 59 minutes later, the team gave up and the man was pronounced dead.
"We had two who came in in cardiac arrest," said Graig DeAtley, assistant to the director of emergency services at George Washington.
"Our emergency room more or less handles cardiac resuscitations utilizing the staff that's present," said DeAtley. "We don't have a 'code team' that swoops down into the emergency room. We called for the cardiac care unit resident to come down and for the anesthesiologist."
Both the patients came into the emergency room "lifeless," continued DeAtley. At the end of an hour, one was revived and one was pronounced dead. Of the effort expended on the one who died, DeAtley said, "it sounds like too little or too much. I'm not sure which."
D. C. General faced much the same problem, with two patients coming in from the fire, one semiconscious and one alert. The hospital also had two patients arrive dead.
At each institution physicians worked to overcome the damage caused by smoke inhalation and carbon monoxide poisoning.
Smoke inhalation causes edema, swelling of the lining of the trachea and bronchial tubes and inflammation of the area, said Dr. Jairaj Prashad, a pulmonary fellow and the physician incharge of the D. C. General emergency room Monday night.
Eventually, said Prashad, there is a sloughing off of the dead lining "leading to plugging up of the bronchial system and decreased oxygenation of the blood."
Another major problem is that the carbon monoxide inhaled in the smoke interferes with the blood's ability to carry oxygen to the tissues of the body, said Prashad.
"The danger of Pneumonia usually occurs a few days after" the injury, he said. The damage to the lining of the system interferes with the lungs' ability to clear fluids. This leads to a fluid buildup associated with pneumonia. "Most (smoke inhalation victims who die) die of pneumonia," said Prashad.