Karen is a Charge Nurse in the Intensive Care Unit at University Hospital Hairmyres. She has completed a BSc in Adult Nursing and an MSc in leadership. She has worked in Intensive Care since August 2000. Her main interest is Critical Care Nursing and as a Charge Nurse, she has the lead role in the fire safety committee ensuring fire education and awareness within the department.
Words we thought we would never hear. Terrifying screams drowned out by the fire alarms. Thick black smoke filled the ward, flames flowing up the wall and across the ceiling, and windows shattered with the heat.
Just after 9pm a fire broke out in the temporary covid intensive care unit when a faulty air conditioning unit burst into flames fuelled by highly flammable propane coolant. 13 critically unwell patients were being cared for in the unit. We managed to evacuate 12 before the fire crews arrived 7 minutes later.
Leaving the last remaining patient was the hardest thing I have ever had to do. We had no choice; we couldn’t see and our eyes stung due to the thick smoke. Wearing protective equipment, the firefighters were able to enter the smoke-filled room and cut the remaining patient’s lines and tubes to allow them to be safety evacuated to the adjacent theatre recovery. Leaving the patient to be rescued, on a ventilator, had been incredibly difficult but it was the right thing to do.
The staff worked quickly and effectively in an extremely challenging environment. Incredibly, managing to avoid any fatalities or serious physical injuries, but there are still lessons to be learned.
Fortunately, a detailed fire simulation was undertaken a few months prior to the actual fire. It involved clinical staff, porters, managers & even the hospital switchboard. This proved to be invaluable. All these people were involved in the speedy response on the night. The simulation emphasised the importance of rapidly getting ready and then leaving the bed space. It also identified barriers to quickly evacuating the ward, which were cleared.
However realistic it appeared at the time, the simulation was still nothing like the real thing. The noise, heat and smoke made it so difficult to see and the situation deteriorated much more rapidly than we had planned for. It proved to us that there are always challenges around fire safety and this in turn encouraged us to undertake more drills/simulations for staff.
Below is a list of the key elements in being prepared for a fire evacuation based on our experience;
- Fire drills and simulations are important to give staff the essential knowledge, information and training they require to evacuate safely and effectively. Staff must know how to evacuate and where to evacuate to, how to raise the alarm, where the break glass points are and where to locate the fire extinguishers
- We have calculated the amount of time we would have to clear our unit based on information from our fire officer. Our simulations are timed, and we shout out time elapsed and the amount of smoke in the environment. We work to get our simulated evacuation to be within the available time.
- All staff must ensure that they keep tidy bed spaces. All equipment not being used must be removed to avoid obstacles.
- All infusion pumps should be labelled, and inotropes and vasopressors placed at the top of your stack for ease of removal. Sedation pumps can be left but adrenergic drugs are essential for the patient's survival.
- Evacuation equipment (oxygen cylinder, ambu-bag, mask and tubing) must be present checked at the start of every shift.
- Patient notes were not picked up during the evacuation, therefore, next of kin details ideally should be put into a computer system on admission, so there are no difficulties contacting relatives during a major incident.
- Have discussions about the unthinkable – what happens if you can't evacuate a patient? Leaving it to firefighters with specialist rescue equipment may save patients and staff lives.
- Having the resources and knowledge of how to support your staff after a fire evacuation is essential. Staff who are directly involved as well as those who have come in to assist should be supported and given the adequate help they require. Remembering that all staff are affected differently.
Ensuring your staff are prepped with the relevant information for a safe and effective evacuation, will hopefully reduce the risk of panic, stress and casualties.
All team members have an important role in fire prevention and must carry out the necessary checks to ensure the area is always safe. Our team are all highly committed to regular high quality fire training programmes. Hopefully, our story will encourage your teams to do the same. We never thought it would happen to us...