Four of five remaining Hawaii patients with severe injuries from the Aliamanu fireworks explosion are now awake, according to the Arizona Burn Center.

Dr. Kevin Foster, director of the Arizona Burn Center — Valleywise Health, in an update this morning confirmed that one patient succumbed to severe injuries “that were not really survivable.”

The four patients now awake are basically done with the operating room after their burn wounds have been excised, grafted and largely healed. Foster said the first patient was awakened about two weeks ago.

One patient with a severe lung injury remains on a ventilator but is making progress.

“Over the next several weeks we’ll probably be discharging just about everybody,” said Foster during a media conference. “We’re still working on what the acute rehabilitation plans will look like, whether that will happen here in Arizona or whether that will happen in Hawaii.”

A total of six were transported by military jet on Jan. 4 to receive care at the center after Hawaii hospitals were overwhelmed by severely burned patients from the New Year’s explosion.

The patient who died was 29-year-old Kevin Vallesteros, the Star-Advertiser previously reported. He died Jan. 28 in Arizona, where he was in an induced medical coma. He had suffered burns to over 82% of his body.

Vallesteros’s family has launched a GoFundMe to bring him home. The campaign says he is now “resting with Heavenly Father” after 28 days of relentless fighting against infections.

The death toll from the fireworks explosion has since climbed to six.

The four patients who are now awakened from drug-induced comas were informed of what had happened, where they are, and the extent of their injuries.

“They’re just starting to mobilize out of bed and look at themselves in the mirror and you know, we’re used to that process,” he said, “and it can be a bit startling and even disturbing at first, but all of them seem to be handling that very well.”

There was surprise, he said, but they have a lot of support from family and friends, as well as the center’s staff of nurses, therapists, psychologists and psychiatrists.

Still, all five patients face a long recovery ahead.

“Almost all of them will require pretty extensive reconstructive surgeries, prolonged rehabilitation with occupational therapy and physical therapy,” he said. “And we’re anticipating there’ll probably be some psychological and psychiatric problems. In general, burn injuries of this magnitude are a lifelong injury and it affects not only the patient but also family members and friends and an entire community.”

Additionally, there is pain associated with the wounds, and with rehabilitation and therapy. There will also be pain as scars are treated, which can cause discomfort for months or even years.

The first step of getting through acute care, however, is just about finished, he said.

At the Straub Benioff Medical Center Burn Care Unit in Honolulu, meanwhile, five patients from the Aliamanu explosion have been discharged, and three remain.

“We are now entering our sixth week after the burns,” said Dr. Robert Schulz, Burn Care Unit co-founder and medical director, in a statement. “The length of stay in the hospital and the severity of the burn in terms of the total body surface area burned and the depth of that burn, will dictate how long they’re with us.”

Usually, he said, 50% to 70% burn patients will stay at the unit for six to seven months.

“Following that, and even when they’re here and recovering, there is a huge process of physical therapy,” he said. “They may lose joint motion. If their faces are burned, there is a huge psychological impact that they must deal with. That’s all part of what we do in the Burn Care Unit.”

The burn care team is very unique, he added, with years of experience doing this type of work.

“When they are ready to be discharged from the hospital in Arizona, we’ll be completely ready to take care of them as outpatients at the Straub Benioff Burn Care Unit,” he said. “That’s just part of what we do with all our burn patients. They’re with us for years after they leave the Burn Care Unit, and that will be true of the patients who went to Arizona. We’ll take care of them in their secondary care here.”