On a busy Saturday morning in your fully occupied 14 bed lntensive Care Unit a fire 
suddenly develops in the electrical switching box beside a central bed. What are the 
principles of handling this emergency?

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College Answer

This question  was aimed at testing fire drill awareness. a universal n:quirement.
A suggested response is:

(a) Rapidly remove all patients and staff from the immediate danget area. This means safely disconnecting Lines, monitors and ventilators. Move me patients towards the exits and bag
the ventilated patients.
(b) Notify switchboard. Activate fire alarm, state location and nature of fire.
(c) Shut aU doors and windows. Turn off oxygen outlets.
(d) Attempt to control and extinguish the fire with appropriate extinguishers and fire blankets, provided it is safe to do so.                                   .
(e) lffire is uncontrolled, commence evacuation of the patients via the fire exits.

Discussion

This question is almost identical to Question 8 from the second paper of 2011, though this later version does not specify that it is a busy Saturday morning.

In brief, the major objectives are:

  • Protect the patients in immediate danger (be evacuating them, as well as your staff)
  • Protect the rest of the hospital (basically, allow them to evacuate by telling them that your ICU is on fire)
  • Prevent the spread of fire (by decreasing its supply of substrate, be it oxygen or fuel)
  • Limit the damage to property. If it is not completely stupid to do so, make an effort to actually extinguish the fire.

Evacuate:

  • Follow orders from the fire warden
  • Evacuate to designated assembly points
    • On the same floor, away from the burning room; or:
    • Down the stairs, away from the burning floor; or:
    • Out of the building, away from the burning building
  • Check all ICU rooms and areas (unless it is unsafe)
  • Evacuation resembles inter-hospital transport:
    • Life-sustaining therapies are to be continued
    • Essential treatment is an ongoing part of ICU stay and continues while the patient is in transit or being evacuated. For instance, this means the bedside nurse can continue giving antibiotics to the septic patient while they are parked in the evacuation zone.
  • Transfer to safety
    • Usually designated evacuation areas are not suited to sustaining critically ill patients in the medium-to-long term
    • For this reason, the ICU team leader needs to liase with the emergency department, high dependency units, operating theatre and recovery rooms to accept some of the patients, eg. those who need to be ventilated

Reverse triage evacuation priorities:

  • Visitors first
  • Stable patients next
  • Unstable patients last

Fire containment

  • Turn off the wall oxygen supply
  • Close the doors and windows
  • Extinguish the fire:
    • Only if it doe snot place yourself at risk
    • Only if you are trained to do so
    • Only if the fire is of a manageable size (LITFL suggests a waste paper basket)
    • Using appropriate extinguishers (eg. CO2 instead of foam  or water for electrical fires)

Preventative measures

  • Response to damage:  life and property
    • Open disclosure to affected staff, patients and their families
    • Appropriate use of medicolegal representation, particularly if patients or staff were harmed
    • Contact with hospital executive unit to manage the media response and to control the public perception of the situation. At Chase Farm Hospital fire, TV crews gained access to the site and pestered rescuers with demands for individual statements.
  • Analysis of causes
    • Launch of root cause analysis 
    • Fire investigation may take a forensic or structural engineering pathway
    • Formation of a working party to create preventative policies and to steer the future fire safety approach
  • Preventative policies
    • Make basic fire safety training mandatory for staff
    • Ensure fire extinguishers are present and staff are trained in their use
    • Ensure fire department is rapidly contractible
    • Oxygen / medical air supply shut-off valves to be obvious and easily available in a central location of the ICU
    • Easy access to emergency assembly areas; rapidly obvious emergency egress paths (eg. flashing light directing the staff which way to evacuate)
  • Quality assurance program
    • Routine fire extinguisher checks
    • Fire safety committee (to ensure the policies are championed and audited)
    • Program of annual re-credentialing of fire safety for the staff
  • Assessment of adherence
    • Random audits to ensure passive fire safety standards are being followed (eg. no hospital beds parked in positions where they obstruct fire exits; no wardies smoking joints in the stairwells)
    • Log of staff members who have/haven't completed their mandatory fire training
    • Random fire drills and simulation exercises