Urgent phone calls early on a Sunday morning left Fiona Wood in little doubt about the unprecedented task ahead to save life and limb.
The first information relayed to Royal Perth Hospital's burns specialist, within hours of the bombings in Bali, would prove chillingly accurate.
It was not confused second-hand reports but graphic descriptions from a hospital registrar in Bali who had seen the carnage.
"He made it very clear there had been a significant event and we would need to get the whole of Royal Perth ready because the majority of the patients he had seen at that time had significant burns," Professor Wood recalled.
"Because we had someone on the ground who understood the extent of the injuries and could describe them accurately, we thought, 'Whoa, this is overwhelming' and much more serious than people realised.
"So for the next few hours I was making phone calls around to anyone who would listen, saying we really had a challenge on our hands in respect to evacuation and the support we needed."
It had been a busy previous week at Royal Perth, so staff had to re- organise the burns unit to make room for the incoming casualties.
But even Professor Wood, a seasoned operator dealing with burns, was unprepared for what she saw.
"The injuries from that event were shocking - there is no other way to describe them," she said.
"Burn injury in itself is a shocking injury … visually and the pain that is involved. That added with the blast injury and the secondary injuries escalated it out of all my experience at that time."
Professor Wood said it was a surreal experience and she sometimes felt as though she was hovering over the top, observing staff as they operated like a well-oiled machine. But it was a myth staff did not sleep and worked around the clock.
"Burn injury isn't about a day, or few days," she said. "It's about the long haul. It requires treatment over a long period and integral to our planning was sustainability so we all still slept because we had to make sure people were rested.
"We knew we would be needed not just the first few days, or even weeks, but longer term."
Not surprisingly, she was most affected by the deaths of three patients, even though their survival rate was forensically textbook.
"In our practice normally we would have those who didn't survive the first day or so, where the injury is so overwhelming, and there are people who we would try really hard and it becomes apparent after the first week we can go no further," Professor Wood said.
"And then we have people who die about the three-months mark.
"That's exactly what happened with the Bali cases. One person died in the first few days, one after about a week and Simone (Hanley) at 56 days.
"It's never easy, but the death at the third month or thereabouts, when you know the person and you know how much energy has gone in to ensure that survival, that's not easy. They are very difficult days."
Her coping strategy was to learn from their cases so other lives might be saved.
"I know there are deaths along the way that have influenced later treatment and that's what we did to honour that situation and we were tested in that we had to do that on three occasions among the 28 people who came to WA," she said.
Even now, Professor Wood becomes emotional talking about the long-term mental scars of burns patients who survive.
"Your life changes in an instant and you go through a period when your life is in the balance and when the waves of infection come over and we try to heal you, and then the pain has to be dealt with," she said."It's a life-changer and it's never the same again. We do our best to heal but then it's left to the individual. You can't underestimate the impact a severe burn has on them."
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