A History of Healing: How Firefighters have Revolutionized Burn Care

Throughout history, burn injuries have been one of the most prevalent and devastating
types of trauma faced in human societies. Although advances in burn care have produced
massive improvements in patient outcomes, reducing the mortality of severe burns to less than
five percent, their treatment still poses a significant challenge for medical practitioners
worldwide.1 Modern burn care involves a multidisciplinary approach aimed at stabilizing
patients, managing wounds, preventing infection, and promoting the patient’s long-term physical
and mental recovery. Progress in these areas has accelerated over the past fifty years, largely
driven by focused studies on the long-term effects of burns on firefighters. Since this group is
subjected to high burn risks and also required to undergo regular medical monitoring, firefighters
are a valuable population transforming burn care for both first responder and civilian survivors.
Indeed, major breakthroughs in medicine and burn care are demonstrated in the contrast between
the post-burn experiences of Sindy Lutz, an artist, former nanny, and hostess burned in 1969, and
Lauren Manning, a famous survivor of the 9/11 terrorist attacks in 2001. With the role of
firefighter-centered research and programs as a foundation, examining the dissimilar experiences
of these two brave women reveals how advances in burn care have considerably enhanced the
physical and psychological treatment of burn survivors.
The experience of Sindy Lutz, who was burned as a child in January of 1969, exemplifies
the limited medical knowledge and inadequate care that characterized burn treatment before
modern developments influenced by research on firefighter injuries.2 The accident occurred
when Sindy was three years old in her childhood home on Long Beach Island, New Jersey. In the early morning, while her parents were still asleep, Sindy and her five-year-old brother had been
playing with matches and candles when her pajamas caught on fire. At the time, there was no
hospital on the mainland in Manahawkin, so an ambulance first drove her north to Toms River
Hospital, which turned her away due to her young age and the severity of her injuries. The
ambulance then went east for another two hours until arriving at Saint Christopher’s Hospital for
Children in Philadelphia, Pennsylvania. Around 40 percent of Sindy’s body was intensely
burned, including her left hand, neck, and chest, and she remained in the hospital for three
months.
There were no intensive care units specializing in burns, so Sindy was treated in the
general hospital ward. She received multiple surgical skin grafts taken from her legs, which were
unburned. However, since scars do not actively expand in size as an adolescent’s body grows,
Sindy had to keep receiving periodic skin grafts through her teenage years at Saint Barnabas
Hospital in North Jersey, which was roughly two hours away. While physical therapy existed, it
was insufficient and not tailored to the unique needs of burn patients. Additionally, because there
were no rehabilitation centers nearby, the hospital merely gave Sindy’s mom a list of exercises
for Sindy to perform at home to prevent scar contraction. Furthermore, doctors completely
overlooked the psychological impacts of Sindy’s burns and neglected to inform her of any
options for group, family, or individual therapy, counseling, or psychiatric care. Eventually,
Sindy’s parents forced her to visit her high school’s therapist due to major depressive and
post-traumatic symptoms related to the long-term effects of her burn injuries as well as
self-image issues stemming from the continuing surgeries. Unfortunately, the school therapist
had a poor understanding of mental illness and worsened the situation by telling fifteen-year-old
Sindy that she seemed “kind of b*tchy.” Sindy ended up leaving that school and was unable to find appropriate psychological care until her late twenties, which she credits to developments in
mental health resources as well as her purposeful attempts to seek support (albeit without
assistance from healthcare providers) while living in New York City. Although Sindy has been
able to recover exceedingly well, her story represents how, prior to the establishment of
specialized burn units and advancements in medical research, the treatment of burn injuries was
rudimentary and focused solely on immediate survival and short-term physical recovery.
By contrast, Lauren Manning’s experience over thirty years later highlights the
significant progress made in burn treatment, particularly in terms of sophisticated physical care
and incorporation of both occupational therapy and psychological support into burn recovery. On
the morning of September 11, 2001, Manning was entering the lobby of the North Tower of the
World Trade Center for work when a wall of flame exploded from the elevator shaft and burned
over 82.5 percent of her body.

Although Manning was burned in exceptional circumstances, her
experience is relevant because her journey from surviving over 6 months spent in mostly critical
condition in the hospital to thriving was made possible by the intervening decades of
improvements in burn medicine. Initially, Lauren’s treatment did not appear to depart drastically
from Sindy’s: Lauren needed specialized care but was placed in a shared room on the general
emergency floor at Saint Vincent’s Hospital in New York.4 Lauren’s first doctors were also
ill-equipped to deal with her grave state even as they underestimated the extent of her injuries,
concluding that she mainly suffered second-degree burns covering around 60 percent of her body
(an inaccurate assessment).5

However, Lauren’s situation shifted once her nurses contacted the New
York-Presbyterian/Weill Cornell Medical Center burn unit, asking for help. Recognizing the
severity of Manning’s condition, the Weill Cornell Hospital transferred her within the day to their
William Randolph Hearst Burn Center, which is regarded as one of the best in the world.6 Lauren
was assisted by a team led by Dr. Roger Yurt, the medical director of the Burn Center, who gave
her eleven surgeries that included using cadaver skin and skin grafts as she lay in an induced
coma for two months.7 Dr. Yurt also consulted with Dr. Weiland of the Hospital for Special
Surgery, one of the nation’s top hand surgeons, for some of Manning’s procedures like partial
finger amputations and joint fusions.8 Both during and after the coma, Manning had a fleet of
nurses who ensured that she received pulmonary support through ventilators, intravenous fluids
delivering over 6,000 calories per day and several medications (namely painkillers, antibiotics,
and sedatives), visits to the “tank” (the room where patients are given a water bath to remove
burned tissue), and at least one daily occupational and physical therapy session to restore her
range of motion.9
Once Manning was stabilized, she participated in hospital-led group psychotherapy
sessions with other burn survivors as her occupational and physical therapy program intensified
to the point of being a “full-time job” when she moved to the Burke Rehabilitation Hospital.10
The doctors also gave Lauren’s family and caregivers guidelines on how to best support her
emotional and mental healing by instructing them not to volunteer information on anything
related to her accident or the events of 9/11 until she explicitly asked for it and then to answerher questions without elaboration.11 Like Sindy, Lauren struggled with her altered appearance,
grappling with feelings of “ugliness and imperfection” and of being a living “reminder of times
people would rather forget.”12 However, unlike Sindy’s doctors, Burke Hospital was sensitive to
burn survivors’ body image issues and focused on reintegrating patients into ordinary life
through therapist-accompanied group public outings, such as going to the movies, enjoying
pizza, or buying makeup.13 Lauren eagerly anticipated these outings, which boosted her
confidence and ameliorated her low self-image while helping her re-assimilate into the world
outside the hospital. Even though it is undisputed that Lauren’s recovery would have been nearly
impossible in 1969 without modern burn centers and state-of-the-art physical treatment, the
contributions from her multidisciplinary teams, especially the psychological and occupational
support, cannot be overstated. In this way, Lauren’s story indicates how burn care has evolved
not only in terms of scientific knowledge and physical treatment, but also how it has grown to
holistically encompass all aspects of recovery, addressing the long-term healing of both mind and
body.
The current burn protocols that have saved the lives of countless individuals like
Manning are direct results of research conducted on firefighters. A prime example is a ten-year
longitudinal study on firefighter burn injuries performed by the same hospital that treated Lauren
Manning, the William Randolph Hearst Burn Center. This Burn Center is New York’s first, and it
embodies the longstanding connections between pioneering burn treatments and firefighters in
numerous ways, most notably including its founding in 1976 in collaboration with the New York
Firefighters Burn Center Foundation.14 Together, these New York-based Burn Center
organizations provide “programs in wound healing, research, prevention, education, and
reintegration of burn survivors into their community.”15 From July 1992 to June 2002, the
duration of the study, the burn unit at Weill Cornell cared for 987 firefighters (as well as
members of the general public like Manning) using a diverse team of burn specialists, plastic and
reconstructive surgeons, psychologists, critical care medicine specialists, nurses, physical
therapists, occupational therapists, and other specialty staff.16 This study drew from data
collected by the National Trauma Registry of the American College of Surgeons and the Medical
Records Department on every Weill Cornell firefighter patient who suffered burn-related injuries
during this period.17 Researchers reviewed their charts to “identify the etiology and risk factors
for firefighters who acquire burn injuries, describe patterns of injury, and evaluate safety
interventions” for burn prevention and management.18 Thus, by analyzing nearly a thousand
records that detailed the different treatments, recovery times, complications, and long-term
outcomes of burn injuries over ten years, the study helped to improve clinical practices related to
burn care, which informed the protocols that Weill Cornell used to treat Manning.
Other crucial impacts of this decade-long study are related to burn injury prevention. For
instance, as a result of this study, existing burn prevention programs that had been initiated in
1983 by the Fire Department of the City of New York, firefighter educators, and the Firefighter
Burn Centers were modified to address the risk of burns for both the general public and
firefighters.19 Due to a noticeable rise in the number of firefighters receiving burn injuries in
1998, where such wounds accounted for approximately 25% of all injuries, the study prompted a reassessment of training protocols, equipment, and safety standards.20 These efforts have been
quite successful, as the National Fire Protection Association attributed burns to a mere 7-9% of
all fireground injuries in 2022.21 While these program modifications primarily aimed to reduce
firefighter injuries, many new training techniques and safety tactics developed to protect
firefighters were later adapted or incorporated into public safety measures. For example, through
the Life Safety Code, which is revised every three to five years, the National Fire Protection
Association updated building codes and construction standards to set stricter minimum
requirements on fire alarms, means of egress, sprinkler systems, smoke detectors, and
fire-resistant building materials, changes that have prevented burns for first responders and
everyday persons alike.22
Similarly, after the Washington Hospital Burn Center in Washington, DC, reported
treating 108 firefighter burn injuries in 2008, they partnered with the District of Columbia Fire
Department (DCFD) and DC Firefighters Burn Foundation to develop a Firefighter Burn Injury
Awareness Course.23 This comprehensive program covered a wide range of topics, including a
“medical perspective” section led by a burn professional that detailed the seriousness of these
injuries and described the lengthy recovery process that involves surgery, treatment,
rehabilitation, and reconstruction.24 After all 2,400 members of the DCFD took this course over
one month, there was a 20% decrease in firefighter burn injuries, which underscored the
importance of education on burn prevention for both firefighters and the general population.25
Since then, more widespread fire safety education campaigns and public service announcements
have informed the general public on how to prevent burn injuries in households, workplaces, and
public spaces.
Several studies on firefighters have also improved medical approaches to burn treatment,
particularly in tackling psychological wounds. The Firefighter Behavioral Health Alliance asserts
that more firefighters died by suicide than in the line of duty from 2014 to 2020, with increased
rates for those with Post-Traumatic Stress Disorder or other emotional “wounds of the spirit” that
are often generated by burn injuries.26 Furthermore, an ongoing survey by the International
Association of Firefighters in partnership with the American Burn Association (ABA) tracking
fireground burn injuries among firefighters in North America has also found that firefighters are
at heightened risk of developing psychological trauma and suicidal ideation following a burn
injury.
27 Even though this may seem obvious, the mental and emotional consequences of burn
injuries have been historically neglected, especially among firefighters who are reluctant to
report mental health issues. Therefore, findings such as these — which were featured in the
ABA’s Journal of Burn Care & Research, the only publication in the United States devoted
exclusively to the treatment and research of burn injuries — hold extra importance because they
validate the experiences of many survivors and have helped spur more research into this field.28
Indeed, experts contend that proper diagnosis and treatment of mental health issues is paramount
to rehabilitation therapy, as over 60% of all severely burned patients develop post-traumatic
psychological problems.29 Accordingly, psychiatrists and psychotherapists are now permanent
team members in burn wards, which reveals a critical shift in how we approach the healing
process. In other words, patients with burn injuries are no longer considered recovered when
their physical wounds have healed; instead, in part due to research on firefighters, we now
understand that it is imperative to address the profound emotional scars that can cause long-term
alterations in one’s well-being and overall quality of life.
Research on firefighter burn injuries has thus significantly transformed the physical and
psychological recovery process of all burn survivors. The experiences of Sindy Lutz and Lauren
Manning underscore the evolution in burn treatment over the last few decades. Although both
women were able to recover despite their life-threatening burns and would eventually meet each
other in person, Sindy’s journey was hindered by the limited medical knowledge and lack of
psychological support at the time. Conversely, Lauren’s recovery was characterized by an
interdisciplinary care team that fully integrated advanced physical treatments, occupational
therapy, and mental health support. Lauren’s comprehensive treatment encapsulates current
practices that include all stages of the healing process: initial first aid, assessment of burn size
and depth, fluid resuscitation, excision and skin grafting, nutritional and pulmonary support, pain
management, wound care, infection control, and physical, occupational, and psychological
therapy. In this way, insights gleaned from studies on firefighter burns have increased survival
rates through pre-burn prevention programs and post-burn treatments while fostering a more
holistic approach to burn recovery that confronts the emotional impacts of these disfiguring
injuries. As research continues to advance, we can hope for even better solutions that will further
improve outcomes for all burn survivors.

1 Hartmann, Bernd, and Lars Kamolz. “A History of Burn Care.” Medicina, Multidisciplinary Digital Publishing
Institute, 2021, www.mdpi.com/books/reprint/4631, p. 3

2 The author would like to thank Lutz for sharing her story through a series of phone interviews in November 2024.

3 Manning, Greg. Love, Greg & Lauren: A Powerful True Story of Courage, Hope, and Survival. Random House
Publishing Group, 2002, p. 1

4 Manning, Lauren. Unmeasured Strength: A Story of Survival and Transformation. Henry Holt and Company, 2011,
p. 63

5 Manning, p. 69

6 Manning, p. 70

7 Flayton, Leigh. “Amazing Things: Lauren Manning.” NewYork-Presbyterian: Health Matters, 8 Sept. 2017,
healthmatters.nyp.org/amazing-things-lauren-manning/.

8 Manning, p. 112

9 Manning, p. 124

10 Manning, p. 146

11 Manning, p. 113

12 Manning, p. 199

13 Manning, p. 160

14 “William Randolph Hearst Burn Center.” NewYork-Presbyterian, William Randolph Hearst Burn Center at New
York-Presbyterian Hospital, www.nyp.org/burn-center.

15 “William Randolph Hearst Burn Center”

16 “William Randolph Hearst Burn Center”

17 Rabbitts, Angela, et al. “Firefighter burn injuries: A 10-year longitudinal study.” Journal of Burn Care &
Rehabilitation, vol. 25, no. 5, 1 Sept. 2004, https://doi.org/10.1097/01.bcr.0000138290.49063.95.

18 Rabbits, et al.

19 Rabbits, et al.

20 Rabbits, et al.

21 Campbell, Richard. “Statistical Report: Firefighter Injuries on the Fireground.” NFPA Research, National Fire

Protection Association, 31 July 2024, www.nfpa.org/education-and-research/research/nfpa-research/fire-statistical-
reports/patterns-of-firefighter-fireground-injuries.

22 “NFPA 101: Life Safety Code.” NFPA List of Codes & Standards, National Fire Protection Association,
www.nfpa.org/codes-and-standards/nfpa-101-standard-development/101.

23 Woods, J, et al. “The Effectiveness of a Firefighter Burn Injury Awareness Program.” Injury Prevention, vol. 16,
no. 1, Sept. 2010, https://doi.org/10.1136/ip.2010.029215.472.

24 Woods, J, et al.

25 Woods, J, et al.

26 Dill, Jeff. “Wounds of the Spirit: Moral Injury in Firefighters.” Firefighter Behavioral Health Alliance, Firefighter
Behavioral Health Alliance, www.ffbha.org/.

27 “Burn Injury Fire Fighter Tracking.” American Burn Association, American Burn Association,
ameriburn.org/quality-care/burn-injury-fire-fighter-tracking/.

28 “Journal of Burn Care and Research.” American Burn Association, American Burn Association,
ameriburn.org/research/journal-of-burn-care-and-research/.

29 Spanholtz, Timo A. et al. “Severe Burn Injuries: Acute and Long-Term Treatment.” Deutsches Arzteblatt
International, vol. 106, no. 38, 18 Sept. 2009, doi:10.3238/arztebl.2009.0607