In January, a banner hung above the front door of the Gartner home that read "Welcome Home Mom." Bev Gartner's three children wanted their mother and anybody who passed by, to know just how excited they were to finally have her living with them again.

After four and a half months of hospital stays that included eight operations and countless hours of grueling therapy for life-threatening burns, Gartner returned home Jan. 14, 2000. The homecoming never would have happened without the medical care that Gartner received.

"In the beginning, I don't think they knew if I was even going to survive," Gartner said.

Gartner, from Iowa City, was one of six survivors from a Labor Day explosion that killed seven people in Richland, Iowa. All survivors were transported immediately from the accident scene to UI Hospitals and Clinics where doctors and a multidisciplinary team treated them - and in the case of Gartner and her longtime friend, Barb Dyer, brought them from the brink of death.

Dyer was burned over 78 percent of her body, Gartner over 68 percent. Many people burned over that much of their bodies never survive. Gartner and Dyer are living proof that Iowa's system for trauma care works - from the planning efforts to the communication network to the teamwork approach to treatment.

"They did everything right," said Dyer, who returned to her Richland home permanently on Feb. 11.

The care began at the explosion scene. Thanks in part to University of Iowa Health Care burn specialists, first responders knew what to do and how to do it. For the last 16 years, UI Burn Treatment Center nurse Jackie Heinle has traveled around the state, teaching first responders, emergency service technicians and paramedics how to initially assess burn patients and then how to begin treatment at the scene.

"It is critical that these first responders know what to do," Heinle said. "It can mean the difference between life and death for many of the most severely burned patients. Before we started this outreach, many people didn't know how to respond. Now, we're seeing almost a flawless transfer of care."

The emergency crews at the scene and the assembling emergency team at UI Hospitals and Clinics communicated continually until the patients arrived at the hospital.

"The Richland explosion is a good example of a good response from the beginning to the end," said Gerald P. Kealey, MD, who heads the University of Iowa Health Care trauma team. "If we know what's coming, we can get ready. "

The team followed the UI Hospitals and Clinics' established protocol for multiple casualities. The Emergency Treatment Center was cleared of all patients who could be moved, back-up surgery crews were notified, and extra teams of residents and staff surgeons were called in.

The assembling team also included orthopaedic surgeons and neurosurgeons, additional radiology staff, people from the blood bank and laboratory, pharmacists, housekeeping staff, and additional runners. Kealey organized the medical staff into teams that would be assigned to patients as they arrived.

"We were very fortunate; we had about an hour," Kealey said. "In an hour, you can get a great deal done. As the patients arrived, with the organizational structure we created, we were able to receive them, evaluate them and staff them. That's what makes the difference." All patients received necessary evaluations and tests and were bedded down either in the intensive care unit or the Burn Treatment Center within two and a half hours of their arrival.

"Considering the complexity of some of their evaluations and the extent of their injuries, that's very fast," Kealey said.

Gartner and Dyer, the most severely burned, required longer hospital stays than the other patients. The women were placed in the Burn Treatment Center where they received extensive care before being transferred to an inpatient rehabilitation center for continued therapy.

"I was amazed at the resources they had," recalled Dyer's husband, Greg. "Barb had more complications that you can shake a stick at. As soon as they saw any problem, a barrage of people was in her room, giving her what she needed."

To keep on top of the situation, the multidisciplinary team in the Burn Treatment Center met weekly to discuss how Gartner and Dyer were doing and what they needed to recover as fully and as quickly as possible. This is standard practice for the Burn Treatment Center team.

"Everybody sits around the table and makes their comments," Kealey said. "I bet at least once a week I find something out that is very useful, that is very important, and I would have never witnessed it because of what I do. As a physician, my time with the patient is very intense, very focused, but I don't find out about what is really bugging them. The other staff members do, and they bring that back to the table. It is never really one's person's therapeutic triumph. It is not my doing. It is not their doing. It is our doing."

Although they still have a long way to go in their recoveries, Gartner and Dyer are over the worst part and trying to adjust back to life at home with their families.

"I can't thank the staff enough," Gartner said.

Dyer added, "If it hadn't been for all those people, we wouldn't be here today."

Patient inquiries about burn care services at UI Hospitals and Clinics may be addressed by calling UI Health Access at 1-800-777-8442 and asking for Jackie Heinle in the UI Burn Treatment Center. Physician calls about the UI burn treatment services may be directed to UI Consult, 1-800-322-8442. Information is also available through the University of Iowa Health Care web site, www.uihealthcare.com.

Barb Dyer, burned over 78 percent of her body, practices her fine motor skills under the supervision of occupational therpist Vicky Moore.

Not much remains of the Richland, Iowa, home where six people survived and seven died in an explosion last Labor Day. The home's foundation can be seen to the right of the car.

Bev Gartner sorts through her late sister's rubber stamp collection with friend Julie Davis. Gartner is home again after lengthy hospital stays involving eight operations and hours of therapy for treatment of life-threatening burns.