Trial by Fire

Mike MeyerSeptember 1, 2014
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The only other information they could give Tarrant was this: The woman had just lit a candle. Then the house blew up.

The house was still “having multiple explosions,” so Tarrant took the couple to the corner of 7900 Cholla. The Peoria Fire Department arrived minutes later, gave the couple first aid, and airlifted the pair to the Arizona Burn Center.

What followed for the fire victims – Tiara Del Rio, 21, a data-entry clerk and an aspiring model, and Beau Zimbro, 32, a construction worker and painter – is a remarkable, still-unfolding story. It’s about a medical advance in burn treatment that has helped patients throughout the world as it awaits federal approval for use in the United States. It’s also a story of love and courage. Mostly, though, it’s a story of survival, and a resilience that kicked in seconds after the explosion.

Among other things, Del Rio recalls, Zimbro saved her life.
The couple had been dating for about two weeks. They met when Del Rio’s father hired Zimbro to help remodel and repaint the house, which Del Rio inherited from an aunt. Del Rio would unwind from her day job with crafts, including candle-making, which Zimbro found interesting. Besides their house-remodeling dates, they’d gone stargazing in the desert. Zimbro, an astronomy buff, owns several telescopes.

Del Rio lit the candle for no special occasion, she says – just “so the house would smell good. It was one of my aunt’s favorite candles. Pomegranate, to be exact.”

After the first explosion, she says, she was in a panic, practically running in circles. Zimbro says the blast knocked him off his feet. “I remember a point where I was put down on my knees and thinking, this is the end, I’m done.” Something told him not to give up: “You get to the point where you can go two ways.”

He remembers a waft of fresh air, from a window the explosion blew out. “I realized I wouldn’t leave that house if I didn’t have her with me,” he says. “I looked for her and grabbed her and at that moment you’re not trying to be nice – I had to kind of throw her out of the house.” Both were on fire at the time. Their hair. Their clothes. Their skin.

“He picked me up and threw me,” Del Rio says. Almost immediately, a second explosion occurred. If not for Zimbro, she believes, she never would have made it to safety.

“You could say it was an adrenaline rush, maybe,” Zimbro says. “You could say angels had my back or something.”

The escape from the house didn’t end their suffering, though. The back of Del Rio’s jacket was on fire. Zimbro yelled at her to take it off. They did the “stop, drop and roll” thing every grade-schooler learns. Roused by the earthquake-like explosion, several neighbors appeared. Some doused the couple with water from buckets and hoses.

Responders included five local fire departments, plus the supervisor of Peoria’s Major Crimes Unit. Fortunately, the fire didn’t spread to adjacent homes. For safety, police evacuated residents, but let them return by morning. Southwest Gas cut service to four neighboring houses. Media turned out in droves.

Tiara Del Rio, Beau Zimbro
Del Rio’s home at 7916 W. Cholla Street in Peoria was razed after the October 16, 2013, gas explosion. The couple says they are not considering litigation.

Zimbro and Del Rio still remember the sound of their own flesh sizzling. “The skin was completely peeled off my hands,” Del Rio recalls. Her face felt strangely tight, but she couldn’t use her hands to touch or feel it, or anything else.

“I would say that each one of them probably had a 1 in 5 chance of dying from their injuries,” says Dr. Kevin Foster, medical director at the Arizona Burn Center at Maricopa Medical Center in Phoenix. Del Rio had burns on over 53 percent of her body. For Zimbro, it was 59 percent.

Their condition was dire, but not unprecedented. The center sees 20 or 30 patients a year with burns covering 30 percent or more of the body, Foster says. Most of the couple’s burns were second- and third-degree, but some were fourth-degree: the burning damages tissue, muscle and bone beneath the skin. “So it’s unusual to have burns that bad,” Foster says. As soon as the victims were wheeled off their separate medevac helicopters, Foster and team got to work. The first job was “aggressive resuscitation” – breathing tubes, ventilators, “lots of fluid, lots of pain control, and nutrition through a tube,” as Foster describes it.

“Just like when you twist your ankle and your ankle swells up and there’s pain and inflammation, with a burn it’s basically like an entire body twists,” he explains. “So your entire body swells up, you lose lots of fluid, and we have to aggressively resuscitate people and make sure that their heart and lungs and kidney and bowel and liver continue to work properly.”

The couple’s next stop: The operating room, where Foster’s team put them in medically induced comas. “Think about if you touch your finger on a hot stove or on a match, and think about how much that little tiny spot hurts,” Foster suggests. “Now magnify that by about a thousand times, and imagine what that must feel like.”

That’s why the couple spent about three weeks in comas induced by barbiturate drugs. The pain of surgery, dressing changes, stitching, stapling, skin-grafting and other procedures is unbearably intense. “People treated 20 or 30 years ago speak in horror of having to go to the tub or the shower and have their wounds debrided and scrubbed on,” Foster says. “And we still do that occasionally for relatively small burns. But for any larger burns, we take those patients to the OR and put them to sleep and clean their burns up while they’re asleep so they don’t have to go through that horrible procedure.”

Del Rio breathed through a ventilator for about a month; Zimbro for about six weeks. Fortunately, their hearts and lungs were in good shape. The couple did remain on feeding tubes, and needed multiple blood transfusions: dozens of units of “about a soda can and a half of blood,” or 500 cc’s, Foster says.

And during the grafting process, Foster and team used a new kind of spray-on skin. It would prove to be a life-altering act of innovation for Del Rio and Zimbro.

Beating the Odds
ReCell is not a drug, but a medical technique developed in Australia in the wake of the 2004 terrorist bombings on the island of Bali. Twenty-two severely burned blast victims treated with the technique that eventually became ReCell recovered in about a week, says Andrew Quick, medical vice president for research and technology for ReCell’s Los Angeles-based manufacturer, Avita Medical.

The product is now being used in Australia, Canada, Europe and China, and currently under review by the U.S. Food and Drug Administration. Clinical trials are underway at nine locations in the U.S., including the Arizona Burn Center. Quick can’t say when ReCell will be approved for use in the United States. He attributes the long approval process to the FDA’s customary balancing act between approving useful medicines quickly, but also making sure they’re safe before they’re released commercially.

Ironically, the couple was too badly burned to be subjects for the ongoing trials, which enlist patients whose burns constitute up to 20 percent of their bodies. But because Foster realized the couple would benefit from ReCell, he asked the FDA for permission to use it. The agency agreed the benefits outweighed the risks, so Foster got the OK in just a few days – warp speed for government work. About eight other patients in the U.S. are being treated with ReCell on what the FDA calls a “compassionate” basis. One is a pediatric patient at ABC, but the center is keeping the details confidential.

As Quick explains, the first line of attack for severe burn treatment is autografting: taking a healthy patch of the patient’s skin, removing it, and grafting it onto the burned area. With more severe injuries, doctors use a device called a mesher, which stretches the graft by three or four times, to fit over the burned area. In extreme cases, doctors take a sample of the patient’s cells, grow them in a laboratory, and produce a sheet of skin to place over the burned area. But that’s expensive, time-consuming and unreliable.

British-born plastic surgeon Fiona Wood and medical scientist Marie Stoner had been researching better ways to grow human skin cells by the time they found themselves treating Bali bomb victims at the Royal Perth Hospital in Australia. As Quick tells it, they had many patients with bad burns and no time or facilities to grow cells in a lab.

Their solution: Take a skin sample from a given patient, break it down into a cellular suspension, then – instead of sending it to the lab for culturing – apply the suspension directly to the patient’s wounds and let the patient be the lab, so to speak. “We’ll let the patients be the culture medium,” as Quick describes it.

Tiara Del Rio, Beau Zimbro
“Right now I’m just trying to figure out what I can do, step by step, to touch people and let them know that whatever you have to go through, I did it. I had to do it; you guys can do it, too.”

Thus, ReCell was conceived.

And it worked.

“There’s really no better culture medium than an open wound-bed, because it’s got the blood supply that it needs to nourish the cells,” Quick says. “And that was the genesis of the technology.” It made a big difference for the Peoria couple.

Thanks to ReCell, the couple needed fewer operations than they might have otherwise, Foster says. It sped up the cell-harvesting and healing processes, and produced better-looking skin grafts.

Del Rio had a total of 21 skin-graft operations, which dispersed tattoos on her back to elsewhere on her body: “I had a wing on my back that is now on my hip and both my feet,” she says. But without ReCell she might have needed as many as 15 conventional skin-grafting operations on her legs alone, Foster says.

The ReCell process starts with a healthy patch of a burn patient’s skin. The process separates the dermis from the epidermis, by both physical and chemical means, and floats the epidermal cells in liquid to make a spray.

Foster’s work on the ReCell approval studies compared the product with conventional skin-grafting. One thing he, and researchers on the East Coast, noticed: “Sometimes the ReCell skin looks better, sometimes the conventional skin looks better, but the part that always looks the best is where there’s a combination of the two… The spray always goes over into the conventional area at least somewhat. And it’s that transition area that always looks the best.”

Which gave Foster the idea of using conventional skin grafting for Del Rio and Zimbro, and then spraying ReCell on top of it. The FDA approved this unforeseen test-use of the product. “That’s not part of the study,” Foster says, “…but in our hands we found that that was a very effective and cosmetically better way of doing things, and in the end it turned out that was true for both of them.”

Still, it took several months to finish the skin-repair process, Foster says. Skin taken for grafting grows back in up to 10 days, and Foster’s team went back to the source for seconds and thirds. “For Tiara we used [her] entire back multiple times to graft her legs and her hands, and for Zimbro we used his back to graft his upper extremities and his hands,” Foster says.

Foster is confident enough to make a bold prediction: By the time a year has passed after the gas explosion, people looking at Zimbro’s and Del Rio’s faces won’t be able to tell they’ve been burned.

Endurance Tests
The couple says they don’t remember much about waking from their comas. They’re even hazy on their first face-to-face meeting, in November. Del Rio remembers waking while she still had a tube down her throat: “It was just fricking painful.” She was conscious for some of the later graft operations, when the doctors took skin from her back. That hurt, too. Her treatment also included medicinal-grade honey, applied when she was in the coma: “It did wonders for my face.”

Zimbro endured more than just skin-grafts. He had operations to remove his gall bladder, and four inches of damaged intestine. He’s had multiple surgeries on his arm and elbow, and is facing more. He “had a bigger burn and a tougher time of things,” Foster says, “but, man, he has really come on strong now. He is almost back to normal, I think.”

Despite the danger facing severe-burn patients, Foster says he was always optimistic about the couple’s chances. “There wasn’t really any point in time where I was worried they wouldn’t be OK. I don’t think I ever remember having that response of, ‘Oh boy, we’re out of the woods now.’” But, he admits, with every big step – “they’re starting to walk, they’re starting to eat… it brings on a little bit of a sigh of relief.”

Del Rio says it took her about a month to learn how to walk again. She and Zimbro relearned how to talk, too, after having tubes down their throats for weeks. They could not open bottles or hold spoons, Del Rio says, and relearned how to grasp and handle things. On different rehab and sleep schedules, the couple phoned and texted each other. Zimbro did some rehab at the Maricopa Integrated Health System. “I did stay with him at the hospital, and rehab a few times,” Del Rio says, “so that was the best thing I could have done. I gave his mom a reliever to go home and take a day to kind of gather her thoughts. I really missed him.”

“It’s a long road,” Zimbro says. “When I was in the fire, and during the hospital, waking up from the coma, we were basically like little children. We had to learn how to do everything over again. Our bodies are still trying to catch up. We don’t have the energy or endurance that we should have.”

By the time Zimbro and Del Rio were strong enough to go to heal at their respective mothers’ homes – eight months later – they’d come into contact with about 200 people at the Burn Center, including surgeons, nurses, psychologists and psychiatrists, hand surgeons, occupational and physical therapists, nutritionists, and pharmacists. Then it was time to begin what Foster calls the longest and most important part of treatment: recovery, or, as he puts it – “People learn how to be people again.”

“The first few weeks was really hard for me when I was in the hospital,” Del Rio says. She still needed help with simple things like dressing and showering. “But the more I did things on my own,” she says, “the more I physically felt accomplished by doing something, [and it] gave me a better outlook on life, and just made me a positive person.”

Both say some days are better than others. Both complain about itchy skin, and the need to stay out of the sun. Both grapple with depression. “I would say it’s more of a mental anguish, less physical now,” Del Rio says.

The curiosity of onlookers is a mixed blessing. “I’m trying to get used to the people staring and asking questions,” Del Rio says. Zimbro adds: “You get some people staring at you, and you get some people asking you what happened, and you can tell they’re sincere about it, and they really care. So you get your ups and downs, depending on the people.” Del Rio’s face and neck still bear mottled traces of burning. Zimbro’s face shows almost no signs of burn, but his arms do.

Del Rio recently made her first trip out of town, traveling to New York City to join her mother on a family visit. A neighbor “wanted to go and asked me if I wanted to go, and I thought it would be good for me to get out,” Del Rio says. By that time, Zimbro was well enough to drive to pick her up on her return to Sky Harbor.

Both are eager to get back to normal. “I get up early in the morning,” says Del Rio of a typical day. “I just start doing things, like clean, or watch TV, or make crafts. Right now I’m making candles.” Del Rio and Zimbro recorded a video for the Burn Center, and Del Rio recently spoke to students at her alma mater, Peoria High School. “Right now I’m just trying to figure out what I can do, step by step, to touch people and let them know that whatever you have to go through, I did it. I had to do it; you guys can do it, too. That’s my main focus right now.”

Says Del Rio’s mother Christina Del Rio: “That’s something that’s made me so very proud, that she’s taken such a negative thing and turned it into a positive thing and wants more help for other people. She wants to be able to help burn victims.”

The couple is currently shooting a documentary film. Foster and colleagues are making it to show what the life of a burn victim is like, and also highlight the experimental treatment. Zimbro sounds in awe of ReCell: “They put you back the way you were and you heal in half the time. It’s remarkable.”

Stress Factors
After the medevac helicopters took Zimbro and Del Rio to the burn center, Peoria officer Tarrant put up crime-scene tape. The Peoria police report says friends and family members of Del Rio and Zimbro later called to say they thought the gas line was cut on purpose. According to the report, police questioned them and an ex-boyfriend of Del Rio’s who allegedly threatened the couple. Lacking evidence to make an arrest, though, the police closed the case and stamped it non-criminal.

The Peoria Fire Department calls the explosion an accident, says public-information officer Amanda Jacinto. The couple remains suspicious, but Del Rio says, “We’re just going to let it be and move on with our life.”

What caused the gas leak that caused the explosion? Southwest Gas spokesperson Amy Washburn says the company won’t comment, because of possible legal action. Zimbro says the company told him and Del Rio that the leak was a matter for the homeowner – that is, Del Rio. She says she doesn’t blame the company and has no plans to sue.

Another issue nags: The bill. Zimbro says his treatment was covered by the states’s Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS). Del Rio, though, got a bill for $2.1 million. She thinks her insurer, Cigna, will pay about half of it. She and Zimbro continue to get follow-up treatment, and every six weeks or so the Burn Center asks Del Rio about the bill.

“There’s no way I could pay that,” she says, given that her last job was in data entry.

“She stresses over it,” Christina Del Rio says. Arizona Burn Center spokesman Michael Murphy wouldn’t comment on billing matters.

Still: They’re alive. “These type of injuries are probably one of the most horrifying, challenging things that any human being can undergo,” Foster says. “And most burn patients come out the other side of their injuries with a different perspective on life.”

The couple says as much. “People question me every single day,” Del Rio says. “How am I feeling, how am I doing?” Her answer: “Although I did go through something horrific, I survived. And I am very grateful for that.”

Adds Zimbro: “You kind of look at life, how precious a commodity that the time you’ve got here is, and you don’t take it for granted anymore. You enjoy every day you’ve got.”

Now, says Del Rio, “We actually have a bigger and better life despite the burns. We are growing together, because we can relate to each other, and the pain we are both going through.” The couple recently moved in together, into a rental house. They plan to rebuild the house that burned down, and live there. And Del Rio is still making candles

Site for donations to Tiara Del Rio:
As of mid-July, it raised $11,044.29 from 97 donors

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