Killer Show: The Station Nightclub Fire (21 page)

The major systemic result of serious burns is fluid imbalance. Our bodies regularly walk a hydration tightrope, achieving a precarious balance of fluid intake and output. Our digestive system, kidneys, and skin (through fluid retention and loss through sweating) play critical roles in keeping variances in hydration within tolerable limits. However, when large areas of flesh are burned, our capillaries leak copious amounts of fluid. When the body sends more fluid to replace it, it is immediately lost. Worse yet, lost fluid may not be replaceable by drinking, due to paralysis of the digestive system, which occurs when more than 20 percent of the total body area is burned. The heart races to make up for loss in blood volume. Without intravenous fluid resuscitation, burn victims risk death from hypovolemic shock, when the heart is unable to pump enough blood to make up for the loss of fluids.

Prior to Boston’s 1942 Cocoanut Grove nightclub fire (the worst nightclub fire in U.S. history), the standard of care for initial burn treatment emphasized removing contaminants and devitalized tissue from the burn wound (“debridement”); unfortunately, many patients succumbed to hypovolemic shock during this horrifically painful process. However, the physician in charge of burn treatment at Massachusetts General Hospital at that time, Dr. Oliver Cope, was convinced that greater attention had to be paid to systemic fluid balance. As a result of his new treatment protocol, Cocoanut Grove survivors treated at Massachusetts General enjoyed better outcomes than their counterparts at Boston City Hospital. From that point onward, the standard of initial care for large burns would emphasize fluid resuscitation and infection control.

Human skin is pretty tough stuff. It can tolerate temperatures up to 104°F for hours before irreversible injury occurs. But above that temperature, depth of injury depends upon length of exposure. For example, a patron of The Station who stood upright in the club’s atrium ninety seconds after ignition
of the polyurethane foam, exposing his head to scorching temperatures five feet above the floor, would have had less than two seconds before the skin on his face suffered irreversibly deep injury.

And depth of injury is critical to survival, residual function, and appearance. Depth of burns is categorized by degrees: First-degree burns are red, dry, moderately painful, and involve only minor damage to the epidermis; they may slough the next day, but heal quickly without scar. Anyone who has turned lobster-red after exposure to the summer sun has experienced a first-degree burn.

Second-degree burns are red, wet, and blistered; they are painful and vary both in their damage to the dermis and their ability to heal without thick scars. They can, however, heal in two to three weeks without skin grafting. Many a slipped pot-holder has resulted in a second-degree hand burn.

Third-degree burns are leathery, dry, lack sensation, and have a charred or waxy appearance. They involve complete destruction of the epidermis and dermis, along with the latter’s blood vessels, hair follicles, sweat glands, and nerves — a so-called “full thickness burn.” Unless a third-degree burn is small enough to heal by the skin’s contraction over the devitalized area (less than an inch in diameter), skin grafting is always necessary to resurface the wound. Fortunately, most of us will never experience a third-degree burn.

Fourth-degree burns involve not only full-thickness destruction of the skin and subcutaneous tissue, but also underlying structures like fascia, muscle, or bone. Difficult as it is to imagine burning bone, it can and does occur, particularly where bones are small and near the skin’s surface, as with fingers. Because devitalized bone (like devitalized soft tissue) must be surgically removed, fourth-degree hand burns may necessitate finger, or even entire hand, amputations. Several Station fire victims can attest to this.

Surprisingly, second-degree burns are far more painful in their initial presentation than are third-degree; this is because nerves remain intact in second-degree, but are completely destroyed in third-degree burns. For this reason, Station fire victims stumbling around the club’s parking lot with blistered faces and limbs were initially in greater pain than their more seriously burned counterparts. Third-degree burn victims would eventually, however, far surpass their less-seriously burned friends in lifetime scarring and disability.

Because different areas of the skin conduct heat differently, location of the body areas exposed to heat may determine whether full-thickness burns result. The outermost layer of epidermis is an excellent insulator from heat; therefore, where it is thickest, as on the soles and palms, full-thickness burns
are rare. Backs of hands, by contrast, are much more susceptible to irreversible burn injury requiring skin grafts. Shake hands with several of the more seriously burned Station fire victims: you’ll often find their palms to be original equipment, and the backs of their hands, retreads.

The majority of Station fire fatalities did not succumb to their burns, however, but rather to inhalation injury. Inhalation injury is the most common cause of death in building fires. It occurs not only because of
what
is inhaled, but because of the
temperature
of what is inhaled. Either factor can kill, even in the absence of skin burns.

Reports of fire injuries commonly speak of “smoke inhalation.” What we call smoke is actually a suspension of visible particles in air and toxic gases. The types of toxic gases produced depend upon the fuel being burned and the completeness of its combustion. For example, combustion of the egg-crate polyurethane foam on the west walls of The Station produced hydrogen cyanide (the same efficiently lethal gas used in execution chambers). Hydrogen cyanide interferes with the body’s cellular utilization of oxygen.

The Station’s burning polyurethane foam also produced carbon monoxide. Carbon monoxide kills by competing with oxygen for a ride aboard our bodies’ red blood cells. And since carbon monoxide has over two hundred times the binding power of oxygen, it’s no wonder that it so efficiently displaces oxygen for that hemoglobin transport. Invisible and odorless, carbon monoxide emitted by something as mundane as an improperly vented home furnace can kill a family in its sleep.

Hydrogen cyanide and carbon monoxide together interact in a synergistic manner to depress the body’s central nervous system, preventing fire victims from escaping. Thought is slowed; perception altered; judgment impaired. Victims feel sleepy, and unconsciousness soon follows. When Station patrons like Stephanie Simpson and Katherine Randall speak of a “knockdown” or “pass-out” effect from inhaling smoke that night, they are describing their own rapid central nervous system depression.

Polyurethane foam was not the only plastic that burned in quantity during the Station fire. In 1996, then club owner Howard Julian screwed two-inch-thick blocks of white, closed-cell
polyethylene
foam to the walls of the drummer’s alcove — about 192 square feet of the stuff. The Derderian brothers later glued their egg-crate
polyurethane
foam on top of it. As soon as fire reached the polyethylene layer of the alcove walls, that burning foam produced acrolein, a potent chemical irritant of the eyes, nose, and lungs. Even if fleeing patrons wanted to keep their eyes open to find an escape route, their eyelids would have reflexively clamped shut in the face of this chemical onslaught.

The consumption of ambient oxygen by fire, even in the absence of toxic gases, can also injure or kill. Motor coordination is impaired when the ambient air oxygen concentration is about 17 percent; faulty judgment and fatigue occur at 10 to 14 percent; unconsciousness and death, at 6 to 10 percent. According to the
NIST
computer simulations of conditions within The Station, O
₂
concentrations in the club’s atrium dropped from a normal concentration of 21 percent to only 2 percent within ninety seconds. It is unsurprising that so many Great White fans died where they first fell.

The temperature of inhaled gases alone may eventually kill, even if not immediately. High temperatures can burn the trachea, resulting in swelling that narrows that airway ten to fourteen hours after injury. Unless stented open by intubation, that critically important air tube can swell shut, asphyxiating the victim.

With serious burns comes the possibility of fatal insult to circulation and respiration both
from within and without
. In a full-thickness burn, the skin forms a leathery outer layer called “eschar” (think overcooked meat). This eschar contracts as a result of the shrinking and hardening of collagen fibers within the skin that occurs with excessive heat. (Overcooking a pork chop under the broiler produces an eschar on its upper surface, curling the chop’s edges upward; on a grill, its underside contracts, causing the opposite effect.)

If a burn victim’s eschar is circumferential — as around a finger, arm, or leg — it can choke off blood supply to the extremity by trapping swelling tissues within its leathery case. Unless the pressure is relieved, the limb may be lost.

The situation is even worse if the circumferential eschar is on the neck or the torso. As tissues burned from the outside and inside (through inhalation injury) swell within the neck, a constricting eschar can cause the airway to be compressed, strangling the burn patient long after his escape from the fire. Even if the patient is intubated, however, breathing may still be impossible if burn eschar encircles her torso. As the charred skin contracts, it can prevent her from expanding her chest to draw a breath.

For this reason surgeons perform “escharotomies” — lengthwise incisions, down to the fat — of fingers, arms, legs, neck, or torso. This release from its leathery straitjacket is done in order to keep the body from literally choking itself to death. Several of the more seriously burned Station fire survivors were able to salvage limbs through this procedure. Most of these burn victims were among the crowd that headed for the front door when fire broke out. Unfortunately for them, however, they were not at the front of the pack.

CHAPTER 16

DOMINO THEORY

SOME SAY A GIRL WAS THE FIRST TO FALL
.

With the flood of patrons streaming out the double front doors of The Station, there began an exodus that, allowed to continue, would have saved most in the club. Erin Pucino, the Derderians’ gas station clerk who had attended the concert on a free pass with her closest friend, Laurie Hussey, was part of this human tide. As long as people at the front of the pack exited the front doors as fast as those in the rear needed to move, the system remained in tenuous balance. But when burning plastic began to rain down, toxic smoke filled lungs, and screams of “We’re burning!” pierced the air, instinct drove the scrum forward against those in the entrance corridor — the narrow area with the downward-sloping tile floor.

It was inevitable that someone in front would fall. As others behind that person tripped, they became additional obstacles. When a buzz-cut line-backer-size male threw himself over the top of the pile to escape, the die was cast. The narrow twenty-foot corridor to the front doors immediately filled with fallen club patrons, wedged diagonally like tipped dominoes, stacked floor to ceiling — and this occurred a mere ninety seconds after Great White’s pyro first ignited the club’s walls.

The only members of that unfortunate human pyramid who stood a chance were those, like Erin Pucino, trapped just short of escape with their head or arms extending out the front door. She and others lay within the isosceles triangle of temperature and oxygen tenability identified by the
NIST
researchers immediately inside the front doors. But even that location was no guarantee of survival.

In the seventeenth century, courts in the Massachusetts Bay Colony, fifty miles to The Station’s north, sentenced convicted witches to “pressing” by stones until they could no longer expand their diaphragms to breathe. An equally cruel fate befell Station Fire victims at the bottom of the front-door pileup. One young woman within the stack, untouched by fire or smoke, was found on autopsy to have simply asphyxiated from the weight of those trapped above her.

From outside the front doors, the situation did not immediately look so bleak. Patrolman Mark Knott radioed in his “Stampede” call and picked himself up from the club’s frozen parking lot. He watched as perhaps one hundred patrons streamed out the same doors through which he had been propelled moments earlier. His colleague, Anthony Bettencourt, popped out with the surging crowd, his radio microphone still attached to his uniform shirt’s epaulet, but its cord ripped from the radio. For a few moments, Knott thought that evacuation of the club would be successful, if not particularly orderly. Then he heard screams, and desperate people kicking at the atrium windows from the inside. When the first victims fell in the front doorway, Knott knew things would not go well.

Skott Greene, the genial proprietor of the Doors of Perception tattoo studio, and his buddy, Richard Cabral, were enjoying their status as personal guests of Jack Russell when Great White began its set. They both headed for the front doors as soon as it became clear that their free concert was over. Greene and Cabral soon found themselves in the immoveable crowd between the performance space and the club’s front doors. There they would spend the very brief remainder of their lives.