Major burns such as those suffered by Martinez are considered "catastrophic" injuries, in that they can affect most of the body organs. While physicians must battle the constant threat of infection, they must also battle the clock to graft as much skin as possible to cover the wounds. The larger the burn, the less skin there is to graft. If infection sets in, the problems are further compounded. Since lungs are often damaged in fires due to smoke or chemical fumes, they can lose their ability to oxygenate blood. When the pulmonary system shuts down, it can lead to renal or liver damage.
In essence, at numerous critical junctures, the internal systems of a badly burned human collapse like dominoes. "So much energy is expended by the body to fight the trauma that the person just runs out of gas," said Dr. Neal Koss, medical director of the Torrance burn center. "All the other systems suffer."
For the past 16 years, Pam Hunt has seen every type of burn imaginable at the Torrance ward--from infants to octogenarians, from those who had no chance to survive and did, to those who somehow slipped away despite a favorable prognosis. Hunt is an emergency care nurse who runs the ward.
"What's amazing to me is that each year we seem to operate it at a thinner and thinner margin," she said. "But if we get five big burns, it may take up all of our staffing. I shudder to think what will happen if there were a big airplane crash or another major disaster.
"Last year, like the year before that, we took in more patients than we could reasonably handle," she said. "What you find out quickly about burns is that the peaks are very high and the valleys are seldom seen."
Dr. Bruce Zawocki, medical director of the burn unit at County-USC Medical Center, the county's largest, said that in the event of a major disaster, the capacity of the units can all be expanded, but only for a limited time.
"We can handle a pretty large number of burns maybe twice a year," he said. "But we can't do it for prolonged period of time. If that's required we'd have to begin transferring them."
Ironically, advances in burn treatment have led to longer hospital stays, which have resulted in increased costs. Most severely burned patients would not have survived long enough to require extensive medical care 30 years ago.
According to Dr. Arthur Mason, chief of the laboratory division at the prestigious Brooke Army Medical Center in San Antonio, Tex., a 21-year-old male admitted with burns over 50% of his body stood about a 50% chance of surviving then. Now, a person with the same injury has an 85% chance of surviving, and a young adult with an 85% burn probably has a 50% survival rate.
In the past, doctors waited weeks before entirely removing burned tissue and artificial dressing, a process that involved pain, demanded immobility and often led to infection.
But breakthroughs in the "harvesting" of skin taken from the victim's own body have helped enormously. Rather than waiting for long periods at great risk of infection, surgeons now perform skin grafts to cover the burned areas within three weeks after the patient is admitted. The grafts prevent fluid loss and bacterial infections, which are leading causes of death in burn patients.
To treat burn victims, doctors remove all the dead tissue destroyed by the burn and then cover the wounds with newly harvested skin. Although cadaver skin has been readily available for years, surgeons preferred not to use it because it is rejected as a foreign tissue by the body's immune system.
Rosario Chavez is living proof of the advances in burn treatment. The 33-year-old Santa Maria woman was critically injured in a house fire last Christmas Eve and had to be airlifted along with three of her children to burn centers in Los Angeles after the conflagration. She suffered burns over 80% of her body. Chavez and one of her sons ended up at Torrance, while her two other children were flown to Sherman Oaks.
Chavez defied the odds, moving from the critical-injury list to a rehabilitation hospital after nearly three months of intensive care and multiple surgeries at the burn center. As severe as her injuries were--most of the burn center's staff gave her little chance of survival--the toughest part came weeks after the fire, when she learned that two of her children subsequently died.
When Chavez left the hospital last month to go to a special rehabilitation center, she left the hospital with a $500,000 medical bill. Like many burn patients, she was uninsured.
"In that kind of catastrophic case, the (health-care) system doesn't operate very well," said Rahn, Torrance's chief operating officer. "If you end up with too many cases like that, then you have to decide whether you can continue to operate. The sad thing is, in burns, you're dealing with an extremely skilled and compassionate group of people. And it would be a real tragedy to lose any part of that."