An electrical fire breaks out in the equipment room of your fully occupied 15-bed ICU. Outline the principles of management of this emergency.
This weird question addresses the candidate's knowledge of fire safety in the ICU.
NSW health has a policy directive which describe this in some detail. However, it is not specific to the ICU. It revolves around the RACE acronym. The main difference is the concept of reverse triage (i.e. the sickest patients evacuate last) and the idea that you may need to get other departments to look after these ventilated patients while the ICU burns. An additional feature is the need to turn off all the oxygen (and nitrous oxide).
Remove the staff and patients from immediate danger.
Alert the switch board and fire department
Contain the fire by closing doors and windows
Extinguish the fire if it is practical and safe to do so.
And after that, you evacuate the remaining patients.Reverse triage is applied at this stage.
Guidelines were also written for the British NHS in 1998 and these are available online. Again, these reiterate the above approach. There a few case reports of fires in the ICU which may be informative. This one is from a 24-bed NICU. The patients were easily evacuated, as only five were ventilated (but one needed three people to transfer, being paralysed with pancuronium and with two chest tubes in).
Major objectives are:
Reverse triage evacuation priorities:
Guidelines for Fire Safety in the Intensive Care Unit; 1998, Ridley and Parry for the NHS. .
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