David Williams, above, was burned on his face, arms and knees in the Jan. 29, 2003 blast at Kinston's West Pharmaceutical plant. He was one of 10 patients airlifted to the NC Jaycee Burn Center after the explosion.
NC Jaycee Burn Center went on high alert four years ago
David Williams was operating a rubber-mixing machine when the explosion ripped through Kinston's West Pharmaceutical plant on Jan 29, 2003, almost exactly four years ago. His story highlights the role of Chapel Hill's NC Jaycee Burn Center in caring for the state's severely burned patients.
"I found myself getting up off the floor and the whole building was burning," he said a few months after the blast..
Despite severe burns to his face, arms and knees, Williams was one of the first to make it outside Jan. 29, 2003, up on the building's east side.
He was still alive. Three of his co-workers that day were not so lucky.
Williams tried to flag a helicopter, thinking it was a rescue chopper. More likely, it was a news helicopter.
When firefighters finally scurried up a ladder and reached him, they cut his clothes off and checked his vital signs. He was rushed to a hospital in Kinston, then almost immediately transferred 100 miles west to the Jaycee Burn Center at UNC Hospitals in Chapel Hill.
Nine other burn survivors went to the center.
One of them was James Edwards Jr., who suffered burns on 62 percent of his body. Edwards remained unconscious most of the time. Doctors said he had a 50-50 chance of surviving.
On Feb. 12 , James Edwards Sr. sat next to Gov. Mike Easley, facing a row of television cameras and answering the inevitable question about his son's condition.
Edwards tried to remain upbeat, but the facts were grim.
The day before, the doctors had told him his son's kidneys had failed. Now the gallbladder was infected.
"I have a very different view of rollercoasters now," Edwards said. "[The doctor] told me it would be a rollercoaster effect dealing with my son. One day everything would be looking good, and the next day it would be going down the hill, and certainly, that's been true."
Still, Edwards knows his son is receiving some of the best care in the state, if not the region. The N.C. Jaycee Burn Center has earned a lofty reputation in the past two decades.
The center is the only one in the state verified by the American College of Surgeons, through the American Burn Association.
At the end of the center's most recent review last summer, the team leader - the medical director of a hospital in Texas - told the staff that the Burn Center is among the best in the world.
No argument from James Edwards.
James Edwards, Sr., keeps vigil at his son's bed in 2003.
"I can't say enough about the goodness they've shown," he said. "They are like part of my family here. I don't know how to describe it. When you talk to a nurse and you see tears in her eyes, it makes a difference."
Such success may be surprising considering that, at first, no hospital in the state wanted a burn center.
"Burn units have not always been viewed by everyone as an attractive addition to a hospital," said former medical director Michael Peck.
They don't always make money, Peck said. Many patients don't have insurance through their employer and end up paying the bills themselves, he said.
"In many states, burn centers lose money. That's obviously not a big drawing card," Peck said.
Becoming a reality
The push for the Burn Center began in the 1960s, thanks to an electrical contractor in Goldsboro named John Stackhouse. Stackhouse worried that several of his workers who suffered high-voltage electrical injuries were not getting top-notch care.
The effort came to a head during an ice storm in 1967, when one of his workers was severely burned while working on a power line. The state's major medical centers balked at treating him, Stackhouse said.
The young man survived after being treated by a local surgeon, but the experience galvanized Stackhouse into action.
He pledged $40,000 of his own money. The N.C. Rural Electric Association and the state association of volunteer firefighters voted to match it. Soon, the grassroots effort was gaining even more momentum.
In 1973, the Goldsboro Jaycees came up with the idea of selling jelly to raise money. They persuaded the North Carolina Jaycee organization to take up the cause. Stackhouse bought the first jar for $10,000.
But it took more than $1 jars of grape jelly for the burn center to become a reality. The state got involved.
"What Stackhouse had to do was to use his political connections," Peck said. "He was able to get the governor and influential members of the House to get behind the idea of a burn center at the state hospital."
In 1977, ground was broken at UNC for the six-story Patient Support Tower, one floor of which would house the new burn center. A special state appropriation covered over half of the $2.3 million needed to build and equip the center. The rest came from hospital funds and private sources.
On Feb. 23, 1981, five patients from the hospital's five-bed burn unit were moved into the new N.C. Jaycee Burn Center.
By then, North Carolinians had contributed about $2 million for the center. Contributions continued to pour in.
Outreach expands
During the 1980s, the Jaycees' statewide jelly drive netted about $100,000 a year. Though they eventually ended the drive, they continue to raise money through other fund-raisers. Last year they contributed $57,000 to the center.
Other contributors include the state's firefighters, power companies, bank and manufacturing companies. Today, the center's endowment has grown to $12 million.
As the center's treatment and training efforts have grown, its outreach program has expanded too. About 95 percent of all fourth-grade students in the state learn basic burn prevention through the center's "Learn Not to Burn" program, which is presented to teachers through the burn center staff.
Ernest Grant, a registered nurse and member of the burn center staff for 19 years, has expanded the nationally acclaimed program to include senior citizens.
The center also does cutting-edge research, focused on developing new treatments.
One area of study takes small amounts of skin from donors and grows them into larger sheets of skin in the laboratory. The Burn Research Laboratory, directed by physician Anthony Meyer, is seeking ways to help the body use this cultured skin without causing adverse immune reactions.
There also are clinical studies, comparing the effectiveness of different ventilators for smoke-inhalation patients or the use of a new topical cream for bolstering the body's immune system.
Special challenges
Still, with all the outreach and research, a big challenge remains: getting good people who can handle the stress of treating burn patients.
"There's not universal appeal to taking care of burn patients," Peck said. "There are some groups of patients whose care is more straightforward, and who tend to recover more quickly, such as caring for patients recovering from heart attacks. Burn care, on the other hand, involves caring for wounds that are often contaminated with bacteria and funguses. These wounds are also very painful, and the pain is very challenging to treat."
Burn patients tend to be more difficult than other patients, Peck said.
"These are patients with pain issues, with emotional issues, patients that you can sometimes spend months on and then still watch them go on and die," he said.
Emotionally, the climate can be difficult.
"We recognize that and we take appropriate steps to make sure that emotionally people are OK, that they are given an appropriate time and place to vent their feelings when they need to," Peck said.
Polly Dickson, assistant nurse manager, agrees.
"Part of the reason we have such good success in getting nurses here that want to be here is that we're very honest with them from the moment they come in for the interview," Dickson said. "We tell them without a doubt this is the most physically, emotionally and spiritually exhausting place you could ever want to work. ... We really want them to think about it long and hard, because even though you think you may have an understanding, and even though maybe you came here when you spent a day here when you were in nursing school, it's not the same as being out there every single day. So we get the caliber people who really want to be here."
Nurses' special place
It is hard to imagine the intense pain and emotional anguish a severe burn injury causes.
Lou Protonentis knows.
In 1986, he was working at a textile mill in Greensboro when an industrial machine exploded. The blast sprayed him with boiling water and covered most of his body with second- and third-degree burns.
Protonentis was rushed to the Jaycee Burn Center, where he endured more than 2,000 square centimeters of skin grafts.
"Obviously, you're in a lot of pain," he recalls. "You think, 'What did I do to deserve this? Am I going to be disfigured?' "
He remembers that, with all the suffering and pain medication, he developed an almost childlike dependence on the nurse who treated him.
"Sometimes I needed to be pampered and sometimes I needed to be cajoled," he said. "It was very personalized for what I needed every day. The one thing you want is reassurance, and the nurse is the one who is there. When you see that person, you know that is the person who is going to take care of me. It is really your connection back to the your normal life."
His nurse was Ernest Grant, now nationally recognized for his acclaimed outreach program.
Rising to the occasion
On Jan. 29, 2003, the Burn Center staff rose to the test. The Kinston explosion 100 miles away put the center on high alert.
Nurse manager Fred Price was in a meeting when his digital pager went off. He saw the words and his adrenaline raced - possible plane crash, plant explosion.
"I turned on the television," he remembered. "I could see the billowing smoke, the size of the plant, and I knew we were in for it."
The Burn Center was full, so the staff immediately started moving patients from the 11 intensive care rooms to other units within the hospital.
The desk staff pitched in. Ten beds were cleared. Off-duty workers started to call in.
"They said, 'I don't know if you need me, but I'm coming in,' " Price said. "There was a tremendous mobilization. Those people had beds right away."
One patient came in, then three more 20 minutes later. By the time the night was through, 10 critically injured patients were in the intensive care rooms.
"All 10 patients suffered from severe smoke-inhalation injury," Peck said. "The smoke pouring out of the plant ... was poisonous to their lungs."
Some recovered better than others. Many developed pneumonia.
"That's one issue," Peck said. "The other issue is that there's a wide range in terms of the burn size, and depth. Some patients have burn sizes of nearly 70 percent of their body's surface. There is a huge difference in terms of how it affects the body."
When the burn size exceeds 20 percent of the body's surface, he said, the heart, lungs, kidneys and overall metabolism begin to malfunction.
"Immediately after the burn, you have a phenomenon where the capillaries throughout the body become leaky," Peck said. "They open up the gaps in between the cells and water, electrolytes and protein molecules pour out. The blood volume goes down, and the heart is not able to circulate blood to the organs. If this is untreated the patient will go into shock and die."
That was one of the things that had to be handled when the patients first arrived from Kinston.
"They required tremendous volumes of fluids to keep their blood volume up and keep them from going into shock," Peck said.
He said the problem normally clears up within 24 hours. Other, more long-term problems are a greater threat.
"What we're seeing now is the risk of infection," Peck said.
When the burn exceeds 15 to 20 percent of the body's surface area, the ability of the immune system to deal with infection goes down dramatically, he said.
"Our infection rates, unfortunately, here are the highest of any unit in the hospital, and it's because the immune system of our patients is so depressed by the burn injury," Peck said.
Specialized care
Burns that affect large areas of a patient's skin have another long-term impact.
The patient's metabolism soars when burns cover a large area, doubling when burns cover 50-60 percent.
"In other words, those patients are burning twice as many calories as they normally would, so if we don't do something about this, they eventually starve to death," Peck said. "So we have to feed them."