When the fires erupted Jan. 7, burn centers across the Los Angeles region braced for an influx of patients, updating one another on the beds and staff available for critically injured people.
The Eaton and Palisades fires would ultimately claim at least 29 lives. Dozens of people would visit hospitals to seek care for minor burns or smoke inhalation.
But fortunately, the mass casualty situation burn specialists feared and prepared for didn’t materialize. The vast majority of injuries were minor enough that patients could be treated and quickly released.
“Our wildfire experience appears to have been somewhat binary,” said Dr. Vimal Murthy, a burn surgery specialist at Torrance Memorial Medical Center, one of the region’s three primary burn centers. “People [either] successfully evacuated with relatively few injuries, or they passed away remaining in their properties.”
Dozens of people visited area emergency rooms seeking care for minor burns and smoke-related injuries. Nearly all were treated and released.
Five people sustained burns serious enough to merit hospitalization. Four patients were treated for severe burns at Grossman Burn Center in West Hills, medical director Dr. Peter H. Grossman said. Another was placed in critical condition for severe burns at Los Angeles General Medical Center.
On Jan. 25, a victim of the Palisades fire died in a hospital, according to the county medical examiner’s office. The office has not yet disclosed the person’s identity or the hospital where they died.
Tragic as the region’s losses are, burn specialists feared an even graver outcome in the fires’ explosive first 24 hours.
“I was extremely concerned we’d see a lot more patients than we actually did,” said Dr. Justin Gillenwater, chief of burn surgery at the Southern California Regional Burn Center at L.A. General, citing the rapid wind-driven spread of the fires and the congested escape routes.
“It’s a double-edged sword,” Grossman said. “It’s tragic — the homes lost, the memories lost — but it’s also amazing how the human life and the human mortality and morbidity could have been so much worse.”
Doctors and disaster management experts attributed the low injury rate to people heeding early evacuation warnings — when they were received. All 17 deaths in the Eaton fire took place west of Altadena’s Lake Avenue, an area that didn’t receive emergency evacuation orders until the early morning hours of Jan. 8, when smoke and flames were already encroaching on the neighborhood.
In addition, the intense heat, rapid spread and unpredictable behavior of wildfires typically leaves “little opportunity for partial injuries,” said Annette Newman, the Western Region burn disaster coordinator for the American Burn Assn.
“Unlike house fires, where individuals might suffer severe burns but still be rescued, wildfire victims seem to experience either full escape or fatal outcomes due to the fire’s intensity and speed,” Newman said.
Though many elements of last month’s fires seem to have caught Los Angeles off guard, its burn care specialists were ready.
In November, L.A.’s burn centers joined 25 others across 13 western states for an exercise organized by the American Burn Assn.
In the simulated scenario, a fictional freight train carrying hazardous materials through a crowded area derails in a fiery explosion, burning or otherwise injuring 800 people.
The exercise tests hospitals’ readiness for mass-casualty events. Providers gamed out what to do in a situation where all local burn center beds were full, and patients needed to be transported to other trauma centers and non-specialty hospitals. They practiced using the Burn Watch Board, a dashboard created by the Nevada Hospital Assn. that provides live updates on hospital bed availability for burn patients.
This kind of advance planning is necessary, Newman said, because “burn injuries require highly specialized care and burn beds are limited.”
Pain management and infection control require constant vigilance. Patients swell as fluids leak from blood vessels and gather around damaged tissues; they lose the ability to keep warm and control their body temperature. They need specialized nutrition, physical therapy and psychological care, often for weeks or months after the initial injury.
The western region put its burn disaster plans into action on Dec. 31, when a massive explosion of illegal fireworks in Honolulu killed six people and injured more than 20.
That disaster highlighted the need for doctors to be able to upload data to the dashboard from their phones, Newman said. The feature was added just days before the Palisades fire erupted.
“There are very few types of injuries that are as painful as burn injuries,” Grossman said. “It really is pretty remarkable that in the face of all this … it could have been a heck of a lot worse.”
