By Mary Ellen Godin
Record-Journal staff

For the emergency room team at MidState Medical Center in Meriden, it was the toughest shift in a long time. After last Tuesday’s house fire on Franklin Street, emergency medical workers at the scene made the determination to bring Trent D’ Aniello, 2, Tristyn-Myles D’ Aniello, 4, and Hunter Michael Jandreau, 2, to MidState. Emergency technicians radioed the emergency room, where personnel quickly learned the children’s vital signs and basic conditions.
Hunter was pronounced dead at the hospital, and the MidState staff went to work monitoring and treating Trent and Tristyn. After several hours, the boys were transferred to the Shriners Hospital for Children in Boston for treatment of burns and smoke inhalation.
Both boys remained in critical condition Monday, according to nurses caring for them on the acute care floor at Shriners. They were on ventilators and morphine. Tristyn suffered third-degree burns on his left leg and arm and second-degree burns on his face and chest. Trent has third-degree burns on his right shoulder and his right trunk extending to his back and right thigh, and second-degree burns on his right cheek and left arm.
The decision on where to take a patient from an accident or fire is made in the field and based on location and the stability of the patients, said Susan Mc Gaughan, nursing director of emergency services at MidState. Patients who show signs of trauma are taken to a trauma center at Hartford Hospital. Both St. Mary’s Hospital and Waterbury Hospital also have trauma units for serious cases.
MidState has three zones within its emergency room: a main care unit, a minor care unit and a psychiatric care unit. Once patients are assessed, the care and treatment is constantly monitored to ensure a patient doesn’t need services offered elsewhere. For instance, the hospital doesn’t have a catheterization laboratory, and some cardiac patients must be moved. In the case of fire injuries, medical staff must address both smoke inhalation and burns. Lab tests can detect carbon monoxide levels and measure the patient’s fluids.
“We also need to look at how the patient is presenting and what complications the patients are having,” Mc Gaughan said. “The breathing pieces are as important as the physical burns themselves.”
Where to send a burn patient depends on factors including the extent of the burns, the patient’s response to treatment and his respiratory status, she said.
“Somebody going to a burn center has a significant injury,” Mc Gaughan said.
In cases of smoke inhalation or carbon monoxide poisoning, doctors may agree the patient needs to be placed in a hyperbaric chamber. Several Connecticut burn centers — in Bridgeport, Hartford and Waterbury — have hyperbaric chambers, as does Shriners.
In a hyperbaric chamber the patient is exposed to pure oxygen under high pressure, which can aid in healing. However, for the therapy to be effective, the patient must be placed in a chamber within 24 hours of being burned.
Assessment and evaluation is an ongoing process in the emergency room, Mc Gaughan said.
Medical staff also have debriefing sessions throughout their shifts to discuss procedures, treatments, and emotional issues as they arise.
“Standard emergency rooms are set up to deal with the what-ifs,” Mc Gaughan said. “Because it’s not always an event, people don’t realize the system is built so it can manage ups and downs.”