Twenty years ago, a fire ripped through the Greenwood Nursing Home in Hartford, CT. It resulted in one of America’s deadliest nursing home fires in the past half-century.
A mentally disturbed nursing home resident started the fire when she set her bed sheets on fire while playing with a lighter. The fire quickly spread throughout the patient’s room and down an entire wing of the 100-occupancy nursing home. All of the rooms in the affected wing had multiple patients. The facility lacked a sprinkler system.
That night, 10 patients were pronounced dead on scene. Twenty-three patients were transported. Six patients died at the hospital.
For those who responded to the call that day, the scene is impossible to forget. I was the on-duty supervisor that night for one of the two ambulance systems that provided EMS to the city of Hartford. The following is my recollection of the events of that night and the various, still-pertinent lessons that I learned.
On arrival
I was an unseasoned field operations supervisor who was promoted after only two years as a paramedic—only because I was young, ambitious and willing to accept the relatively low pay for the nonunion, first-tier management position. My supervisor training was minimal and lacked any mass-casualty incident or incident command system instruction.
It was frigidly cold the morning of the fire. Snow remained on the ground from a recent snowfall. I had cleared a hospital in the city’s north end when the Hartford Fire Department (HFD) responded at 2:40 a.m. to a fire alarm in the southwest wing of the nursing home. I started in that direction. I called the ALS crew that was about to get off shift and asked them to hold tight. Something felt different.
The drive to the nursing home was quick. I parked several hundred yards from the facility to avoid blocking the narrow road.
I walked up the dark street. From my perspective, the only indication of a problem was a charged supply line and frantic chatter on the fire frequency. I didn’t see any smoke or fire.
As I neared the nursing home, a second alarm was struck for heavy smoke and numerous bed-confined patients.
I entered the lobby and noticed that it was warm, void of smoke, and eerily calm and quiet.
I spoke to the EMS supervisor from the other ambulance system and got a quick briefing. That supervisor already called Connecticut’s regional EMS communications center and requested a hospital bed count. He also created a basic triage system in the lobby.
The calmness that I was witnessing didn’t correspond with the fire department radio traffic.
Patients evacuated through windows
As a third alarm struck, I left the lobby and walked outside of the building. A relatively calm fire department captain approached me and reported numerous fatalities and dozens of critical patients.
When I got to the farthest wing of the nursing home, the extent of the incident became apparent: Broken out windows were visible, and the strong, acrid smell of structure fire was heavy in the air.
I walked up to the emergency exit door and saw an utterly burned out and charred wing. Smoke filled the hall from floor to ceiling.
Dozens of patients were lying in their bed, trapped in the corridor. Firefighters had moved patients from the fire rooms in the hopes of evacuating them through the hall, but because of the exit ramp’s metal railings and short, L-shaped design, the turn was too tight for the large beds to make the turn to exit.
The fire captain and I quickly made plans to cut the metal rails to make room for the stretchers.
Simultaneously, firefighters who were inside of the building began to evacuate patients by removing them through windows and placing them onto mattresses that were laid on the snowy ground.
At that point, all of my senses were overwhelmed: the sights, the smells, the sounds. I still remember everything today.
Because of radio incompatibility, I was unable to communicate with the EMS supervisor from the other ambulance system, who was now on the other side of the building. I was alone, surrounded by critical patients.
Using the Nextel, I had our dispatch center send every available ambulance in the city and surrounding areas. Within four minutes, ambulances began to arrive.
All of the patients were bed-confined, and most had an oxygen demand before the fire.
There was no triage. They all needed immediate care.
The city of Hartford had two Level 1 trauma centers that were at equal distances from the fire. Using a rudimentary system, I assigned an ambulance, a patient and a hospital, alternating between trauma centers. I instructed each ambulance crew to run emergent to the hospital, clear immediately and come right back to the scene. Within 75 minutes, all of the patients were accounted for and transported.
From frantic to normalcy
By 5:00 a.m., the scene had stabilized, and executive leaders were on scene. I was allowed to return to the station to facilitate shift change for the morning crews.
As I walked back to the street where my response vehicle was parked, I came across a line of ambulances in staging, with many of the EMTs and medics outside of their idling truck, drinking coffee and smoking cigarettes. The normalcy was jarring.
Mistakes, personal and otherwise
Three days later, the EMS regional governing body held an incident debrief. Although response times were excellent—four minutes—most of the debrief concentrated on errors, many of which were the result of my lack of experience and training.
Most public safety agencies have learned how to respond correctly to mass-care events because of their increasing frequency over the past decade.
As of Aug. 13, 2013, the Centers for Medicare & Medicaid Services requires automatic sprinklers in all nursing homes.
Some lessons from the Greenwood Nursing Home fire are still pertinent.
Distinct events
Nursing homes present a significant challenge.
All patients have limited mobility, and many are bed-confined.
Some patients have limited communication and cognition. Determining a baseline mental status, medical history and normal vital signs is impossible during a disaster.
Additionally, the basics of triage are changed, because many patients aren’t able to walk, and their mental status is normally altered.
Triage
During the Greenwood Nursing Home fire, I depleted the entire area of ambulances and had 9-1-1 calls holding. Triaging 9-1-1 responses is essential during a disaster response. Emergencies still occur during mass-care events.
Communications challenges
Even under the best of circumstances, communication and interagency cooperation are difficult. Multiple dispatch centers, numerous agencies on different frequencies and different terminology are problematic.
On a recent large-scale incident in South Carolina, radio traffic overwhelmed the county’s 800 MHz radio system, which made it difficult to communicate, even when the channel was open. Heavy police communication on multiple channels throttled down the ability to use the EMS frequency.
Train for disaster
Because significant events will occur—it isn’t if, but when—you must change your mindset and prepare for worst-case scenarios. (I still am surprised by the number of agencies that still need to prepare for or even consider that a mass event will occur in their area.)
Refrain from using the current workforce shortages as a reason not to train. (If the event happens tomorrow, you will be short-staffed.) You must figure out how to overcome those challenges.
Further, you never will rise to the occasion; you always will sink to your level of training. I frequently use the concept of mental simulation: Thinking through anticipated issues and simulating probable outcomes allow me to consider complex issues before they occur.
Mental health
Twenty years after the fire, I still have vivid memories. Yes, I go through extended periods without thinking of that night, but a specific smell or some other trigger quickly takes me back.
You must be aware of the psychological toll that significant calls have on members. Don’t forget, emotional reactions might not occur immediately after a call. They can happen much later and be triggered by a similar stimulus.
Twenty years later, this still is difficult for me to discuss.
The fundamentals
Under the worst of situations, resort to the basics.
Mike Tyson famously said, “Everybody has a plan until they get punched in the mouth.” Even the best laid plans can get derailed.
If it’s on fire, put it out. The most critical patients move first. Don’t relocate the disaster: Split patients between numerous hospitals. Delegate where possible. Stay calm.
Struggles & growth
I still carry the lessons learned from that day, and I never will forget the smells, sounds, sights, and heroic actions of our EMS teams and the HFD. Some of Connecticut’s most experienced and knowledgeable EMTs and paramedics worked nights in the city, and I forever will be thankful to those who served as my team members that night.
The lessons that I learned in Hartford were instrumental in my growth as a paramedic, leader and person.
Aaron Dix
Aaron Dix is the executive director of EMS and patient flow for Prisma Health. Prisma Health operates a large EMS department that provides 9-1-1, ALS, mobile integrated health, emergency medical dispatch and critical care services in north and central South Carolina. Dix also is a commissioner for Clear Spring Fire Rescue in Simpsonville, SC, and an executive board member of the South Carolina EMS Association. He can be reached at [email protected].
